Bad Backs, Good Sex
Few topics are taboo in chiropractor Donna Schoales's office. Even marital troubles come up for discussion. But when it comes to how back pain is affecting their sex life, most people clam up. "My patients get very open with me with a lot of other issues," Schoales says. "But I think I can count on both hands the number of times that a discussion about sex and back pain has come up over the past 17 years."
That's too bad, because statistics indicate eight in 10 people experience back pain at some point in their life. And when they do, sex is one of the first things that men and women avoid, even though it can be just as comfortable with a few modifications.
In fact, according to Maine physical therapist Lauren Hebert, author of Sex and Back Pain, people with back pain who aim to learn and practice pain-free techniques and positions with their partner often improve their sex life for good. "I have had people say that their sex life is better since they had a back problem and started using my book," he says. "It opens things up for them, forces them to talk about it and communicate."
Schoales, a Toronto-based chiropractor, agrees that communication is essential, because relationship problems often develop when people have long-term, chronic pain and don't explain what they're experiencing to friends and family. "Often, people will say 'my family doesn't understand the pain I'm going through,'" says Schoales. "That can occur when people have pain that's not related to something visible. With back pain, people can't see that you have a cast on your arm or a gash on your leg."
Communication is usually the biggest challenge, as most back pain doesn't involve actual sexual function. In fact, Hebert says that even in extreme cases of back pain he doesn't recommend people stop being sexual. "There can be very passive positions people can take," he says.
The key is to open up enough to discuss which positions are comfortable and which aren't. "Learn what you can and cannot do physically," he says. "If you really can't talk about it, then just use a book-marking technique, where you bookmark pages in my book that contain positions that are of concern to you, hand that to your partner and have him or her do the same."
It's also important that you don't worry excessively about your performance, and that you don't try too hard and get aggravated. To help, it's good to emphasize eroticism and use more foreplay. Romantic massages, hot baths and showers facilitate relaxation and loosen muscles. Massages are especially useful, as they can also help calm the nervous system. "That way you're not starting out with fear, tension, spasm and pain," says Hebert. "You're putting that off and replacing it with something a bit more comforting."
After selling over one million copies of his book and having thousands of clinics in North America and Europe use it to educate patients, Hebert can be confident that his advice will help people with back pain return to sexual activity. And even if the sales weren't enough, there's always the anecdotal evidence. "I frequently get notes from people who say 'I bought your book and it saved my marriage,'" he says.
Part of that success may be due to the book's easy-to-use categorization. Hebert realized that sex generally only involves two back movements: forward bending (flexion) and backward bending (extension). So he used those movements as a starting point. "I thought, well, when it comes to sex there are going to be positions that will bend the spine one way and positions that will bend the spine the other way," he says. "So, using a physical therapist model of categorizing back pain, I could easily fit the various sex positions in."
Patients who have back pain during even slight movements should see Hebert's section on brittle back, while those with more pain while bending backward should see the section on extension pain and those with more pain while bending forward should see the section on flexion pain. Then, they should discuss their concerns with their partner, plan an intimate evening that begins with a warm bath or massage and follow the instructions.
Brittle back
Brittle back refers to serious back conditions that make even slight movements uncomfortable. Patients with such a condition should try lying on their back on a firm surface and using pillows or rolled towels to provide support behind their knees, head and, if it helps, low back. They should also take a passive role while their partner does most movement slowly, and should communicate with their partner to tell him or her when anything is causing discomfort.
Extension pain
Patients who have pain during extension might find many traditional positions uncomfortable. In searching for a more comfortable position, the most important thing they should do is support their low back. A woman can try lying with a rolled towel under her low back and bending her legs as little as possible. A man can try using a rolled towel under his low back while his partner straddles him. Both men and women with extension pain should also consider seated sex. A chair will provide support for a man's low back, and by sitting on her partner's lap a woman can control the pace to minimize discomfort.
Flexion Pain
Patients who have flexion pain should carefully monitor their posture during sex to avoid forward-bending positions. Often, it's best for people with this type of pain to adopt a more passive role during sex. A woman should try lying on her back in the standard missionary position with her knees bent toward her chest, or using a chair and sitting on her partner's lap while controlling the pace. A man with flexion pain may want to sit in a chair as well, or can ask his partner to adopt the traditional missionary position and raise her bottom with pillows to ease the amount of forward bending he must do.
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