Surprise, Surprise, Sex and Back Pain don't go together very well do they?

And if you or your partner are among the 35 million people who have back pain, you know that back pain can disrupt your relationship.

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. But what can you

do about it? Most couples in which one or the other is restricted

by back pain will eventually get around to realising 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.

Let's back up for a second and begin with a very strong suggestion.

Because pain has both a psychological component and a physical

component, getting a sound diagnosis is critical to putting your

mind at rest about what is wrong and secondly having a sound

diagnosis will also give you guidelines for your physical

limitations.

Secondly, after you have the diagnosis, involve the doctor or

physical therapist in a frank discussion about do's and don'ts.

Maybe that's an uncomfortable subject for you, but these days we

are talking more openly about sex and you should tap into the

doctor's experience here. In a perfect world the doctor would open

the discussion for you, but if they don't you may have to initiate

it. Ideally your partner should be present because he or she will

have his or her own questions and concerns.

Sex Advice

Starting off right

To start sex off right, start off with a massage, or ice down the

painful area. A warm shower together might help too. That way the

muscles are relaxed.

Positions

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

experience.

For males:

1. 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.

2. Try a side-by-side position.

4. 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:

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

2. Sit on the edge of a chair and have your kneel between your legs

for entry.

3. 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.

4. 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 is in order at this point. It

is pretty common to begin feeling better and then overdo it and have

your back pain symptoms flair up. I call this, the Eureka effect

and it can happen to anyone. 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 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 means to be chronically disabled, and what

you believe your partner thinks about it as well as how you are coping

with your condition.

So, at the top of your agenda there needs to be a frank discussion of

your pain limitations and expectations about sex. It is 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 is their responsibility to listen and try to understand. Pain, after

all, is invisible and subjective. That means your pain is unique to you.

We have heard people liken 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, what causes it (position, certain movements, or

whatever), and what feels good or is what is comfortable for you.

Is it obvious that if it hurts, don't do it is generally good advice but

some positions and techniques hurt more than others? It may require some

gentle experimentation to find out what works but as in most sex advice,

"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 challenge of your back pain can be turned into the juice of new

sources of mutual pleasure!

Terry O'Brien

Back Doctor UK