Back Pain and Sex: Safe Sex Positions for Your Back Pain

For lots of people, "sex" is an uncomfortable subject. Add back pain into the mix and it can feel like a totally off-limits discussion to have with a partner or your care team. It's not uncommon for those with chronic pain to feel ashamed, have a lower sex drive, and fear making their pain worse or triggering a flare-up by engaging in sex.

However, it's important to know that with a little patience, education, and some minor adjusting, a healthy sex life with back pain is possible.

In this article, we want to help build a bridge between "sex" and "back pain". Read on as we share tips on how to have safer and better sex, and reveal the best sex positions for your back pain type.

During orgasm, your body releases oxytocin. Oxytocin is a hormone and neurotransmitter that is proven to alleviate pain, anxiety, depression and more. The best part: oxytocin is 100% natural and 100% free!

Back Pain and Sex: A Brief Q&A

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Ah, don't you just love the internet? With the anonymity of the interwebs, you can learn a little bit and hopefully regain enough confidence to engage in sex or at least talk to your physician. Before we breakdown specific back pain types and favourable sex positions, let's answer three common questions about 'back pain and sex'.

Q: Is having sex with back pain dangerous?

As you know, back pain is very complicated. Of course, like any activity that involves physical exertion, if you're not engaging in sex positions that are safe for your back pain type or injury, you can cause more pain. Causing more pain or adding strain can be dangerous.

Above following the "rules" for your back pain type and pre-sex tips for safer sex, it's really a matter of letting your pain levels be your guide. If certain positions hurt, don't do them. If you are experiencing pain during sex, stop while you're ahead. Overdoing it by pushing through pain will likely lead to a longer recovery, spasms, a flare-up etc.

Q: Are there sex positions that I should avoid?

Yes. Again, let pain and common sense be your guide. In saying this, we will detail positions that are generally safe for men and women with different pain types. For example, if you are a woman who is extension-intolerant, spooning or side sex may be unsafe. If you are a man who is extension-intolerant, doggy style may not be comfortable or safe for you.

Continue reading as we detail tips on making positions more comfortable and safe positions for you.

Q: Will my sex life improve if I have back surgery?

Great question! First off, there are pros and cons and varying degrees of effectiveness when it comes to spine surgery. Some spine surgery types, like a decompression surgery with a visible structural issue (like a herniated disc or scoliosis) are highly successful for treating chronic pain. Other back surgeries, where a structural issue is not visible may be less successful at treating pain.

Curious about back/ spine surgery? We asked a top orthopedic spine surgeon, who will back surgery help the most?

Some studies show a positive correlation between back surgery, like a spinal decompression or spinal fusion, and pain relief during sex. An study published in Spine, looked at patients undergoing surgery and non-operative treatments for spinal stenosis and degenerative spondylolisthesis. The study found that 71% of patients interviewed said that "sex life was relevant" to them. 39% of all patients interviewed reported having pain associated with their sex life. Four years after surgery, "the three operative groups had a lower percentage of patients reporting pain with their sex life compared to the non-operative group." In short, in this study, those that had surgery to help with back pain also had improved sex after surgery.

The study concluded that, "sexual function is generally improved postoperatively when compared to preoperative function".

Tips to Having Safer, Better, Less Painful Sex

Although it may seem less romantic and lack some spontaneity, the more you get ready for sex and follow these tips, the better.

Tips Before/ After Sex to Reduce Back Pain:
  1. Take a pain reliever: Take a non-narcotic pain reliever if you're feeling back pain prior to sex. Avoid narcotic painkillers like opioids. Take the recommended dose of NSAIDs like Aspirin, Aleve, Advil, Motrin, or your preferred over-the-counter nonsteroidal anti-inflammatory drugs.

  2. Take a warm bath/ shower: A hot water soak will loosen up muscles and actually reduce your likelihood for muscle spasm and tightness.

  3. Stretch: This might seem a little over-the-top, but just like you'd stretch before a game of tennis or a run, you want to loosen up your muscles and encourage flexibility before sex. Here are some exercises for back pain that you can run through at home to treat and prevent a flare-up.

  4. Ice, ice, baby! If you feel some tension in your back after sex, be sure to ice the affected area. Icing reduces inflammation (which is a leading cause of pain). Ice for just 15-20 minutes at a time and do not apply the ice directly (wrap in a tea towel, t-shirt etc.).

  5. Talk to your partner! There needn't be any shame in your game. By being open and honest about your back pain, you will both have a more fun and relaxing encounter.

  6. Avoid Morning Sex? If you have disc problems, your back will stretch out throughout the day and alleviate some of your disc compression. Having sex after you've moved around a bit may be less painful for those with some back conditions.

Tips During Sex to Support Your Back:
  • Let your partner do the work! If your partner does not have back pain, let them assume the "top" position. For men with pain, let your partner go into the reverse missionary position. For women with pain, standard missionary may be best. The more that you can lay with a neutral back, the better.

  • Small posture corrections for the win! By flexing your abs, neutralizing your spine, and making slight adjustments, you will notice that you're less susceptible to pain during "the act".

  • Keep your back locked/ neutral. Avoid flexing or extending your back too much. This is especially true if you are motion intolerant.

  • Use pillows for support. For certain positions, like laying down in missionary, towels or pillows under your lower back or under the knees will reduce pressure on your back.

  • Play it safe. Stick to positions that do not over-extend or over-flex you back. Relieve pressure from your back by using your hips and stop immediately if your pain increases.

Sex Positions for Your Back Pain Type

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For many obvious reasons, it's important to know what triggers your back pain or causes your flare-ups. Knowing your back pain type is also important for comfortable sex. In a nutshell, when it comes to sex, you'll want to know if you are flexion-intolerant or extension-intolerant.

  • Flexion Intolerant: This type of pain commonly affects those that lean forward too much (whether in front of computer for work or caused by jobs that require a lot of bending forward. This means that pain is worsened with forward bending (like picking something up, prolonged sitting etc.).

  • Extension Intolerant: This type of pain is brought on by too much arch in the back. As a result, pain is worsened with backward bending (like lying on stomach and pushing up).

  • Motion Intolerant: This type of pain is harder to pin down, but essentially, pain is triggered when the spine moves away from its neutral position. In this case, laying down can hurt, standing up straight etc.

Safe Sex Positions

Flexion Intolerant Extension Intolerant Motion Intolerant
Women Side/ SpooningKneeling/ Doggy Style Missionary Missionary
Men Doggy style (partner on knees) Side/ Spooning Squating
Missionary (with elbows for support) Reverse Missionary (partner on top) Reverse Missionary (partner on top)
Reverse Missionary (partner on top)

Unsafe Sex Positions

Flexion Intolerant Extension Intolerant Motion Intolerant
Women Missionary Doggy style Doggy style
Side/ Spooning Missionary (knees up)
Men Side/spooning Doggy

Our hope is that you're feeling more confident about regaining control over your sex life. There are many health benefits to having fulfilling sex and back pain shouldn't have to stop you!

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Hi, I'm Grace. I write and research about hip and knee replacements, PreHab before orthopedic surgery & ReHab. Content advised or co-authored with physicians (MD) and orthopedic surgeons (OS).

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