I know it’s a “taboo” kind of subject, but back pain and sex don't go together very well.   If you or your partner is among the 35 million people who have back pain, you know that back pain can disrupt your relationship in more ways than one.  

Sex is an important part of the intimacy between couples, and attitudes about sex, about rejection and about our self-image when we don't feel up to a sexual encounter can haunt a couple for a long time.

Sex is supposed to be pleasurable for both of you and the fear of hurting yourself or your partner inhibits the spontaneous joy that you probably felt before your back pain developed.  What can you do about it?  

Most couples in which one or the other is restricted by back pain will eventually get around to realizing that back pain does not automatically mean no more sex.  What it does mean is that you will need to make some accommodations to the pain and or the fear of it.  It also means you will need to talk about sex in a slightly different way than you are used to.  Communication is the key!

Back up for a moment and let me begin with a very strong suggestion.  Because pain has both a psychological component and a physical component, getting an accurate diagnosis is critical to putting your mind at rest about what is wrong.  It will also give you guidelines for your physical limitations.  It may also reveal what you probably already knew… that you needed to lose fat weight which is a strong contributor to back pain.

After you have the diagnosis, involve the health care provider in an open and honest discussion about the dos and don'ts.   That's probably an uncomfortable subject for you, but these days we are talking more openly about sex and its issues.  In a perfect world the doctor should open the discussion for you, but if they don't you may have to initiate it.  You’ll want your partner there, too as he or she will have his or her own questions and concerns.  Remember, communication is key!

Here are some valuable tips…

To start sex off right, start off with a gentle massage or to the level of tolerance.  You may want to ice down the painful area for about 12 minutes.  A warm shower together might help too. That way the muscles are relaxed.

Here are some sexual positions that can help you enjoy a pain-free experience.

For males:

• Lay on a firm surface and use pillows to support your knees and head. You might like to try placing a small rolled towel under your lower back.

• Try a side-by-side position.

• Place a pillow under your lower back while your partner straddles you on top. You can also sit in a sturdy chair instead of lying down.

For females:

• Try missionary position with the legs bent toward the chest.

• Sit on the edge of a chair and have your partner kneel between your legs for entry.

• Rear entry may also be more comfortable for women with back pain. Try it kneeling on the bed or lying on your belly with a pillow under her chest.

• Sit on your partner's lap as he sits in a chair.

Remember, the health of your back is dependent on many dynamic factors. Your symptoms may change over time so you may need to work with your health care provider from time to time as you go through the many stages of recovery.

A word of caution: It is pretty common to begin feeling better and then overdo it and have your back pain symptoms flair up.   Just remember that as you improve gradually, so should your activity level also increase gradually.

As I mentioned earlier pain has two parts.  There is the physical part.  This is the actual stimulation of the nerve, like a painful tooth or a herniated disc pressing on the nerve.  And then there is the very subjective or the psychological part.  This is how it feels to you and includes, among other things, such attitudes as fear that it will get worse or last forever, what will it mean to be chronically disabled, and what you believe your partner thinks about it as well as how you are coping with your condition.

Again, at the top of your agenda there needs to be communication of your pain limitations and expectations about sex.  It’s a mistake to believe that your partner understands what it feels like.  It is your responsibility to communicate those limitations as clearly as possible; it’s their responsibility to listen and try to understand.

Pain, after all, is invisible and highly subjective. That means your pain is totally unique to you.  I’ve have heard people compare back pain to everything from a hot poker going down one or both legs to a chronic aching sensation localized to the lumbar area.  It doesn't matter what words you use, just try to explain the pain the best you can, what causes it (position, certain movements, or whatever), and what feels good or is what is comfortable for you.

If it’s obvious that it hurts, don't do it.  It may require some gentle experimentation to find out what works but as in most sex advice, “slow and gentle” is the best place to start.

In terms of maximizing yours and your partner's sexual pleasure, it is very important to stress that all you really need is your imagination and the willingness to experiment to open up new areas of intimacy.  But it all begins with willingness to try.  And given that, you just may find that the lemon of back pain can be turned into the lemonade of new sources of mutual pleasure.