Sexuality with back pain – the best positions

Sexuality with back pain – not an easy act

The back can obviously provide a lot of sensual pleasure. During sexual intercourse, the mobility of the lower back as well as flexibility and flexibility are particularly important. However, in the case of chronic and, to an even greater extent, acute back problems, sexual activity can lead to considerable pain. On the other hand, loose movements can also lead to pain relief – sex as preventative exercise for back problems?

In addition, the spine is a place where numerous internal and external disruptive factors can manifest themselves as pain. As an expression of a person’s “inner situation”, the spine and the muscles surrounding it are the projection field of psychologically anchored, uncontrollable expressions of pain. An unfulfilled sex life plays a significant role here, especially in women, whereby it is not only the type, number and intensity of orgasms that are responsible, but the entire area of affection and recognition.

There is no question that organically caused back pain, e.g. due to a herniated disc that has not been operated on or immediately after disc surgery, as well as existing instability of spinal segments, can disrupt the pleasure of sexual intercourse and thus set off a cycle that can ultimately lead to psychogenically superimposed back pain. As an orthopaedic surgeon in Münster, Dr. Frohberger provides valuable tips.

In a publication (sexual difficulties of chronic pain patients: Clin.J.Pain 2001), AMBLER found that 73% of chronic pain patients had problems with sexual activity. The reasons given were difficulties with position, getting up, pain aversions, low confidence, difficulties in performing and partner problems. All of these led to a lower frequency of sexual activity with back pain. There were almost no differences between men and women. Furthermore, there was no correlation of sex life with mood or level of disability. A back school would be incomplete if these many eminently important problems were not also addressed when necessary, especially as we know that more than 70% of all people suffer from back pain at times or all the time.

According to BÜTTNER (“Peterstaler Rückenschule”), the first priority for sexuality with back pain is a trusting discussion with the partner, who must be aware of any existing back pain or back pain that occurs during intercourse so as not to misinterpret any listlessness that occurs. Together, the partners should look for ways in which they can both achieve satisfaction and in which the partner feels little or no pain. You should not be afraid to use manual or oral methods of satisfaction and try out sexual practices that may have been taboo until now – there are no sexual taboos!

According to LOWEN, aggressive energy is necessary to act out sexual desires and needs. However, aggressive here does not mean sadistic, crude or possessive, but is derived from the Latin verb “aggredere”, which means “to advance” or “to attack”. According to LOWEN, aggression arises from the flow of excitement into the muscular system, especially into the large muscles of the back, legs and arms. If this flow of energy is blocked, this leads to tension in the back muscles, among other things. Aggression is not least the ability to strive for what you want. It is the opposite of passivity. Aggression is a necessary part of the sexual act, not only for the man but also for the woman. If there is a lack of aggression in sexuality with back pain, sex is reduced to indefinite sensuality, to erotic stimulation without climaxes and orgasm.

However, the tensely held still pelvis is the guardian of the aggressive and sexual feelings that the patient is afraid of. It is therefore necessary to slowly awaken the suppressed feelings and work through the fears that arise. In Tai Chi (Chinese shadow boxing), the area around the fifth lumbar vertebra is also referred to as the “heavenly gate”, which needs to be opened through certain exercises. By gradually opening this gate, the energy in the back can flow freely again. In this way, many back patients have lost their pain …

Even in old age, there is a need to experience satisfying sexuality, even if intercourse no longer works as well as it did in younger years. The reduced mobility of the spine, the ability to spread the hip joints or even osteoporosis-related vertebral fractures in women have a restrictive effect here. The STARR-WEINER report from 1982 on over 1,000 test subjects over the age of 60 showed that older people are not only interested in sex in principle, but also often think about it and long for it.

Sexual behavior after spinal surgery

The preoperative diagnostic procedure such as myelography can already lead to a loss of libido, although it is unclear whether the damage to the intervertebral disc with its mechanical consequences or the associated pain leads to a restriction or cessation of sexual activity. Postoperatively – assuming the operation was technically successful and the structures operated on were also the cause of the complaints – the inhibition threshold is removed by the pain, so that the desire for sexual activity often arises early on as soon as the pain has subsided.

Sexuality with back pain – when is sexual activity safe from a medical point of view?

Surgery for herniated discs in particular often results in temporary instability of the affected segment due to the complete removal of the disc space. Consequently, the surgeon gives the patient suggestions for everyday behavior, such as a temporary ban on sitting for a certain period of time, a ban on driving, lifting and carrying or a ban on sport for a certain period of time. Even if the prolapse is removed by microsurgery, segmental instability remains for a few months, albeit to a lesser extent.

Unfortunately, it is usually “forgotten” to inform patients who have undergone surgery about when and, above all, in what position sexuality is possible again postoperatively if they have back pain. In a study carried out by BÜTTNER, not even 15% of 100 intervertebral disc surgery patients surveyed received such information. Whether the back pain relates to the cervical, thoracic or lumbar spine, the principles of precautionary measures are the same. Slow movements with simultaneous stabilization by tensing the paravertebral muscles are permitted. Fast, short and uncontrolled movements should be avoided. This can lead to painful rotation of injured spinal segments. Compression loads and rapid back and forth movements should also be avoided in the case of vertebral body instability. The surface should not be too soft or too hard.

The pelvic floor muscles can also be affected if the core muscles are weak overall or due to nerve damage. In order to strengthen these muscles, which are particularly important for a woman’s quality of experience, they can be specifically trained. The aim here is to repeatedly tense the muscles of the vagina and bladder outlet – repetition 50 to 100 times a day leads to a comprehensible strengthening of the trained muscles. A good performance test is to voluntarily stop the flow of urine.

With acute and chronic complaints, there is no need to give up a satisfying sex life. The prerequisite for sexuality with back pain is mutual empathy and the motto: “It’s love if your partner can do it…”

Sexuality with back pain – the following positions help you to enjoy being together:

Spoon position
An effortless and comfortable position, the spine, hip joints and knee joints can be moved easily and the back is only subjected to slight pressure.

In profile
This position is ideal if both partners have back pain. One partner lies on their back with their knees bent, the other lies on their side with their hips and knees bent as if sitting. The legs should then lie across the partner’s waist and between their thighs.

Face to face
She embraces his hips with her thighs as if she were sitting on his lap. He has his hips and knees slightly bent so that her bottom rests on his thigh. Both should be able to move easily and without back pain.

Prone position
This position is comfortable for women lying down in a neutral position. However, if the man also suffers from lumbar spine complaints, he will not prefer this position. The man’s elbows provide weight relief. A flat cushion under the abdomen also protects the woman’s lumbar spine.

Woman astride
The stable neutral position of the man with lumbar spine problems enables pain-free pleasure. The woman controls the angle and depth of penetration, leaning back and resting on his thighs reduces the pressure of the weight.

Inverted missionary position
This position is also easy on the man with lumbar spine problems and offers him the best way to hold back his orgasm. It is also suitable for couples where the woman is short and the man is tall.

Sitting position
Depending on the back condition, the sitting position may also be practical. The partner with back problems supports their back on the stable seat backrest, a small footrest prevents painful lumbar spine lordosis.

Kneeling position
This position should also be easy on the back if both partners have lumbar spine problems. Kneeling allows both partners to extend their lumbar spine, and the woman can also vary her position slightly. Cushions under the knees provide comfort.