Back in the bedroom: Sex and back pain

The well-known sex expert, “Dr. Ruth” Westheimer, Ed.D., has said, “The most important sex organ lies between the ears”. This fact is so widely accepted that the quote appears on a Food and Drug Administration website! Since the mind and the body both influence how sexuality is felt and expressed, both need to be thought about when considering how chronic back pain affects sexuality.

Why is sex important?

For many people, sexuality is a pleasurable feeling, and sexual activity plays an important role in maintaining and deepening the intimate relationship with their “significant other”. In fact, few people with chronic back pain who worry about their sexual desire, or their ability to perform sexually, ever talk about these concerns with their health care provider. This may be because they feel embarrassed, that it’s not important, or that the other person will be uncomfortable having this discussion.

How thoughts can interfere with sexual pleasure

If the brain is the most important sexual organ in the human body, what can go wrong? Lots of thought can interfere with sexual pleasure, including feelings of poor self esteem, depression, anger and frustration.

When back pain interferes with your usual family role, or you cannot do everything that you used to do, you may not feel so good about yourself. When you don’t feel good about yourself, it is hard to feel attractive and desirable. If your mind is always on your pain, worries, and sadness, it can be hard to be relaxed or get “in the mood”, without feeling performance anxiety.

Get your body to cooperate

Sexual pleasure and orgasm can occur without intercourse, but this may be new for you. Recognizing that sexual intimacy includes massages, kissing, stroking, or taking a bath together, may help. You may need to tell your partner that you want to take a more passive role during sexual activity.

A good rule of thumb is “if it hurts, don’t do it.” Physicians or physical therapists, knowing your specific back injury, are good resources for suggestions about sexual positions that put less stress on the back. This may mean experimentation, and that you and your partner feel comfortable trying something new.

You can look for books and articles offering specific information about what sexual positions may be less stressful on your back. Here is the kind of information you may find:

  • Male on top
    • This can be most comfortable for a woman with back pain, who may be helped by placing a pillow under her lower back
    • For one-sided pain, one knee can be bend up while the other is flat

  • Female on top
    • This can be a good position for a man with back pain, who can bend his knees or keep them straight, depending on what is most comfortable
    • This position allows the woman with back pain to have more control over physical movements

  • Side by side
  • This postion can be very relaxed and comfortable for a woman
  • This postion can give a man more control over the position of his back

Communication with your partner

Sexual intimacy is more than just a physical act. Communicating about how you can improve your intimate time together can bring you closer and strengthen your emotional link. If you find this a difficult conversation to start, set aside a time to talk, rather than waiting until you are in the bedroom. Then say what you have on your mind. Are you afraid of hurting yourself physically? Do you feel the desire but have no energy? Tell your partner what your concerns are and discuss what you can do about them together.


Living with chronic back pain does not mean you have to give up intimacy and pleasure. It may mean talking about sex with your partner and asking your health care provider for help. There is information out there, and there are experts on the subject. Don’t feel that you are the only person who has faced this problem.


Sinel, M.S., & Deardorff, W.W. (1999). Back Pain Remedies for Dummies. New York: Wiley Publishing.

Moore, J, Lorig, K, et. al. (1999). The Back Pain Helpbook. New York: Perseus Books.

Herbert, L.A. (1997). Sex and Back Pain: Advice on Restoring Comfortable Sex Lost to Back Pain (Paperback). Impac USA.