Don’t Let Back Pain Ruin Your Sex Life

Even sex can be rough (and not in a good way) when you have back pain, but we'll show you how to reclaim your sex life.

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Back pain: Is there anything it can’t ruin? You may have to plan every motion you make, and do it so slowly and carefully. Car or plane rides could be agony after more than a few hours. It might keep you out of the gym or even bedridden.

Well, add sex to that list too.

Find out the best sex positions when you have back painFiguring out if you're flexion-intolerant or extension-intolerant is the first step in reclaiming your sex life from back pain.

Millions of Americans experience either recurring or chronic back pain, most commonly in the lower back, and a study even revealed “some reports showing global prevalence of almost 20% in people aged between 20 and 59 years” whose chronic pain was localized to the lower back. This same study tracked the worst daily life impairments of people with lower back pain, and sexual function was ranked highly for a large percentage of those who replied, especially men.

Most doctors, especially those who deal with back pain and conditions, have all had patients come to them complaining of regular issues with intense pain or flare-ups caused by sex. How can those who do have pre-existing back pain think ahead and choose sex positions and styles that will cause less harm and a lot more good?

Knowing Your Intolerance

It used to be that spooning positions were praised and recommended for essentially anyone and everyone suffering from back pain during sex. Now, according to the University of Waterloo it “is no longer recommended as the best position for every couple.” Instead, general consensus is that the best position for comfort and pain relief will actually vary from person to person, primarily depending on the type of pain they have (and at times the location).

Dr. Gbolahan Okubadejo, a New York based spinal and orthopedic surgeon, broke down the best and worst positions, noting the importance of knowing whether you’re flexion intolerant or extension intolerant to decide what’s best for you. Here’s the difference:

  • Flexion intolerance happens “when someone experiences pain in the lower back due to flexing the torso over the hips,” according to Dr. Okubadejo. Think: pain when you reach to your toes or sit for extended periods.
  • Extension intolerance, on the other hand, is “when someone experiences pain when arching the back.” In this case, laying on your stomach would likely cause pain.

Knowing which type of motion intolerance applies to you, you can then keep the following suggestions in mind when choosing sex positions for the most pleasurable experience.

For Flexion Intolerant Partners

Women who are flexion intolerant, experiencing the bulk of their pain when they flex forward, should avoid missionary position, or being the “bottom” partner. Although this may seem like a fairly straightforward, pain-free position to be in as a female partner, “missionary position can force the pelvis forward, causing more flexion than you might expect,” and resulting in back pain, according to Dr. Okubadejo. Instead, he recommends doggy style or spooning for women with flexion intolerance.

Somewhat the opposite, flexion intolerant men should stay away from spooning and side positions, and opt for doggy style positions when possible. “Spooning sex makes it harder to move the hips, which places stress on the spine. Doggy style position allows men to use more of their knees and hips rather than the spine and is the ideal spine-sparing position,” adds Dr. Okubadejo.

Anyone who is flexion intolerant should also consider positions that involve sitting in a partner’s lap, particularly with the use of a chair or support. This can particularly benefit the top partner, as it minimizes flexion while stabilizing the back, reducing the potential for pain later on.

For Extension Intolerant Partners

Here’s where the difference between these two pain forms becomes important. What works best for those with flexion intolerance is almost entirely different from what’s recommended for extension intolerant people, simply because their pain stems from and is exacerbated by such different movements.

Dr. Okubadejo recommends that extension intolerant women avoid doggy style or positions where the other partner is behind them. He adds, “missionary is a better option because the woman can have her knees and hips slightly flexed, which supports the lower back and keeps the spine in a more neutral position.”

Likewise, extension intolerant male partners should also stray away from doggy style, because it tends to involve a lot of extending and flexing of the spine, a surefire way for them to have a pain flare-up. Instead, spooning or missionary positions again offer a better option, allowing the back to stay relatively flat.

Anyone who is extension intolerant, regardless of gender or partner, should avoid positions where they’re laying flat and face-down, as this will put a natural arch in the spine that is exactly the problem with this root for back pain. Dr. Okubadejo notes, though, that “placing a pillow under your chest or propping yourself up onto your elbows can decrease the arch in your back and decrease back pain.”

Other Ways to Reduce Pain

For people who do experience regular and intense back pain, and have had particular problems during sex, choosing the right positions is undoubtedly the biggest key to enjoying any sexual experience and finishing it without worsening back pain. However, if you want to be sure to give yourself the best chance for pain-free and enjoyable sex, you can also follow a few of Dr. Okubadejo’s other suggestions for pre-encounter preparation.

  • Always try to move with the hips rather than the spine, no matter the position.
  • If you expect some pain, take a naproxen or ibuprofen before sex if possible (or after if not) to reduce pain and inflammation.
  • Try a topical ointment or pain cream on painful parts of the back before sex, just be sure to wash hands thoroughly before getting down to business (to avoid getting substances anywhere sensitive).
  • A hot shower or bath before sex can have a lot of benefits, soothing aching spots, relieving tense muscles, and improving blood circulation.
  • A massage before sex can also reduce muscle tightness and strain (plus get you in the mood)
  • Place a pillow below the hips, neck, back, or chest to support parts of the body and help stabilize the spine.

Ultimately, the best course of action is to get comfortable, know your body (or your partner’s body) and sources of pain, and then be attentive to how you feel. Sometimes simply tweaking yours or your partner’s positioning only slightly is enough to make a position go from painful to pleasant, but persevering through intense pain is never the way to go.  Listen to your bodies, react to pain right away so you don’t regret it afterwards, and then relax and lean into the moment. That’s what sex is all about anyways.

Updated on: 05/17/21
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Back Pain and Its Impact on Sexual Satisfaction
Gbolahan Okubadejo, MD
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Back Pain and Its Impact on Sexual Satisfaction conducted a national survey on how back pain affects sexual satisfaction. Hint: it doesn't make sex better. Another hint: back pain doesn't mean you can't have sex anymore. Read the full survey results here.
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