These stresses can affect your relationship with your spouse too. There may be a sudden lack of communication. Back pain does come between you and your partner due to the obvious physical stresses but, also to the emotional stresses that emerge. There is often a loss of desire and ability to have a satisfying sexual relationship. The negative effects of pain on your sexual relationship result in bad feelings and these make any other problems feel worse. By being able to restore your sexual relations you will immediately decrease your stresses which in turn may reduce the amount of pain you are feeling.

Besides limiting your physical abilities, back pain also limits your sexuality. However, your sensuality is not affected. By sensuality we mean your thoughts and attitude towards sex, romance and the creation of atmosphere. Create a gentle and romantic environment using music, candles, lighting, and privacy. A gentle approach to the moment in a non-threatening way will decrease the demand from your back and your fear of pain.

NURTURE CLOSENESS, COMMUNICATION AND SENSUALITY -NOT JUST SEX!!!!!

Advice for those with severe back pain

Severe back pain may limit the amount of penetration. In this case, partners must make use of other sexual techniques that can spare the back, like massage, touching, atmosphere creation and oral sex.

Begin with a romantic strategy and create an atmosphere that is not rushed and very relaxed. Take time to pleasure each other and be patient. Giving stimulation is as erotic as receiving it. The partner with the back pain may need to take a more passive role. Some patients find it more comfortable to lie on a firm surface with a pillow supporting under the knees. You may like to roll a small hand towel and place it in the small of your back to give it a slight arch.

If the man has the back pain, the woman may straddle him. Otherwise, the man can mount the woman using the so-called "missionary position" if it is the woman who has back pain. Oral sex can be performed by both parties with 1 person on top assuming a variety of positions and the back sufferer lying on his/her back.

Pain, or the fear of pain, can get in the way of a pleasant experience. Therefore, do not rush the moment, be relaxed and patient with each other.

Sexual positions with minimal back stress

This position can be used whether the woman or man has back pain. The woman lies on her back while the man lies beside her on his side, facing her. She bends her legs up enough to allow the man to move his legs forward underneath hers. She then rests her legs over his. The man can then enter her in this position. The woman can place a rolled up towel in the small of her back for comfort. This position is great for communication and the couple can touch each other easily.
The couple lies "spoony, spoony". The woman lies on her side with her back to the man. He lies on his side facing her back. The front of his body now rests against the back of her body. Here he can enter her from behind again and it allows for touching and communication.

The position of the lower back is normally in that of an inward curve or arch (lordosis). The various structures of the back are in their ideal resting positions when this arch is maintained. However, every back problem behaves differently. In some people, bending forward tends to make the pain worse due to pulling and stressing certain structures. These problems often feel better when the spine is straightened up or bent backwards a little to take the stress off those painful structures. Other back problems can feel worse when the spine is bent backwards and patients may feel relief when they bend forward. For example, a bulging disc often feels worse with the spine being bent such as sitting, driving, gardening. Arthritic joints feel worse with activities that require bending backwards or even just being upright, closing the joints down. Due to these differences, sexual positions need to be adapted for each and every individual. These are not hard and fast rules. There are times when people do not present like the textbook says.

Taking the above principles into mind, here are a few sexual positions that may favour your particular back condition.

PEOPLE WITH PAIN WHILE BENDING FORWARD OR SITTING

Women
The missionary position can be adopted by the woman if her lower back is supported with a rolled up towel. The women should not bend her legs up too far as this causes her arch to flatten out. Keep the legs low to maintain the arch.
The woman may lie on her tummy to give her some extension of her back. If more extension is needed, she can prop up on her elbows or can place a cushion under her tummy. The man can enter her from behind.
Using a firm chair with no arm rests, the woman can sit on her partner who is sitting on her chair. She can either straddle him while facing him, or she can sit on him with her back to him. The woman can control the position of her back during intercourse. Either she can rock her pelvis or she can move her entire body to produce stimulation without moving her spine.
Another position to adopt is with the woman on her hands and knees so that the man can penetrate her from behind. Either she can do this on the bed or on the floor at the edge of the bed with her upper body supported on the bed itself. A pillow under the knees would help a lot.

Man

The missionary position may or may not work for you. The man will have to support himself on his hands so that his back is arched inwards a little bit. This may get rather tiring. The woman can help by bending her legs up to her chest and placing a pillow under her pelvis to lift it up towards him.
With the man lying on his back, he can support his lower back with a rolled up towel. The woman can then straddle him. She can be in full control and the man can take a more passive role in lovemaking. This position also allows for greater communication.
The man can also sit on a firm chair with his back supported by a roll. The women can sit on him either facing towards or away from him.

PEOPLE WITH PAIN WHILE STANDING OR BENDING BACKWARDS

Women

The missionary position can again be used however, the women should lie with her legs bent up to get some flexion of the spine. The more she brings her knees to her chest, the more the spine will bend.
She can straddle the man as before but, should bend forward and place her chest on his to get the flexion of the spine.

Man
1. He may enter her from behind as they both kneel on the bed. He must remember to round his lower back.
2. The woman can lie on her back with a pillow under her pelvis to lift it up a bit. The man can then lift up her hips so that she is straddling him while he sits on his haunches and keeps his back bent.

Learn about your back pain! Know what aggravates it and what eases it. This will help you manage your pain and live as normal a life as possible!!!!!

Compiled by: Danielle Kloeck (BSc. BSc.Physio)