Extracted from www.spine-dr.com

If you or your significant other is suffering from back or neck pain, you know that sex is one of the first activities to be put at the bottom of the list of things to do. This is a very common problem and one that is infrequently discussed or written about for people with back or neck pain. The reasons for this closed mouth attitude are multiple. People who are suffering with it feel that they may be the only ones having the problem and therefore embarrassed to talk about it, even with the doctor. Some doctors do not feel comfortable with the subject, or may not even recognize it as a problem.

Sexuality is an integral part of normal and healthy relationships. It need not be the first thing abandoned when you are bothered by a flare-up of your neck or back pain. If you have chronic pain, it should not prevent you from enjoying this part of your relationship.

To over simplify the problem, there are basically 3 components of sexual functioning. All 3 must be in working order for things to function normally. First and foremost are the emotional and psychological aspects of sexuality. If you are depressed, angry, frustrated, preoccupied or uninterested, you are unlikely to enjoy a sexual experience. If you are preoccupied with your performance you may not be able to function as you would wish. This article is not meant to be an in-depth examination of the psychological aspects of sexuality. If you are experiencing any of the above and are not able to resolve them with your partner, discuss it with your primary care physician or seek help from a licensed psychiatrist, psychologist or mental health clinic. Most problems are successfully and rapidly resolved.

The second key components of sexuality are the physiological and anatomical ones. These refer to your equipment and wiring. If they are not working normally, you will not be unable to function normally. This is not to say that you will not be able to enjoy sex, but that it will be different. For example, men with spinal cord injuries are not able to obtain to maintain erections without assistance, yet they are able to have intercourse and achieve orgasm. The nerve connections, or wiring, must be intact from the brain to the sexual organs and they must get an adequate blood supply in order for things to proceed "normally". There are a very large number of medical conditions that can affect sexuality in this fashion. These include but are not limited to diabetes, heart disease, prostatism, vascular disease, and the pain from compression of a nerve. If you have the desire and are free of pain yet are not able to function, then you should be thoroughly examined by a physician to look for a medical source.

Thirdly, many people have the desire, and the equipment and wiring are fine, but are unable to enjoy sex because they are not able to get into a comfortable position due to neck or back pain. Many conditions of the spine can make certain positions uncomfortable. These are usually easily overcome with some thought and experimentation. The general rule is "If it hurts do not do it". Positions that are not comfortable in your day-to-day activities will not be comfortable during sex either. Do not be afraid to experiment, there is no right or wrong, normal or abnormal.

The following is a general outline of some of the more common back diagnoses and their symptoms. Along with the position diagrams, try to use these examples as a 'jumpimg off point' to guide you through an evaluation of what works and what does not.

• Your back or legs hurts when you sit, bend or stoop. You feel better standing, walking, sitting in a recliner or lying with your back supported. These symptoms are usually caused by disc disease such as internal disc disruption, annular tears, central disc herniations and or sprains and strains . Acute disc herniations and 'sciatica' will some times act similarly. Flexing the low back worsens symptoms. This means bending it forward. The symptoms may be relieved by straightening or by extending, bending the spine backwards. In these situations you will be more comfortable with your low back in a neutral, which is straight, or extended position. This can be accomplished in the following ways. Any of the following also apply to your neck and arm symptoms. Be very careful in positioning your neck in extension, this can increase pressure on your spinal cord. Just remember one simple rule. "If it hurts, do not do it."

• Your back or legs hurt when you stand, walk or reach over head. You feel better sitting, reclining and in certain positions lying down. Spinal stenosis, spinal arthritis, facet joint disease, sprains and strains, deconditioning and soft tissue diseases, may cause these symptoms. Acute disc herniations and 'sciatica' will some times act similarly. These conditions tend to be worsened by extension of the spine and relieved by flexion or the neutral position. This can be accomplished in the following ways. Any of the following also apply to your neck and arm symptoms. Just remember one simple rule: "If it hurts, do not do it."

As you and your partner embark on this adventure to make sex more enjoyable, remember that this can be emotionally charged and potentially frustrating. Take your time and start slowly. If your partner is the one in pain, offer to start with a hot bath or shower together. Most conditions respond favorably to gentle massage with some warm oil. The massage works to decrease pain, relax the muscles and mind, and can be stimulating. Share your feelings and enjoy.

What follows are some positions which may be more comfortable for certain conditions:

The female back patient with back problem lies supine and comfortably on the floor or bed with hips and knees bent. Pillows or towels may be used for support. Her partner without back pain is on top being more active, but cautious and gentle.

The woman with back problem lies supine in a comfortable position supported by pillows or towels. Her hips and knees are bent and relaxed over her partner. He enters her while facing her, with minimal stress to his or her back.

The patient with back pain can lie supine on the floor or bed with appropriate supports, pillows or towels for comfort. The patient should be relatively passive and reduce stress to his back. His partner without back problem is on top and is taking a more active role.

The patient with the back problem lies in the supine position on the floor or bed with appropriate supports, pillows or towels for comfort. His back is protected and immobile. His partner without back problem is on top and is taking a more active role.

With certain spine problems (ususally non-disc related), sitting may be more comfortable during sex. This sitting position may allow more sensuous caressing; however, careful coordination by the partners is important.

A woman with a back problem, especially disc related, may be more comfortable in the prone position. When she lies in the prone position, on her stomach, the lumbar spine is in extension, which puts less stress on her discs. The degree of back extension can be adjusted using pillows or cushions under the chest or abdomen.

Patients with back problems other than disc disease may be more comfortable when sitting. There may be less pain during sex by adjusting the posture and movements. Excessive spine movements can be avoided by careful coordination with your partner. This position often allows more intimate caressing and kissing.

A woman may rest on her arms and knees while her partner is positioned posteriorly. While kneeling, the partners' knees should be padded for appropriate height and comfort. A woman with back pain should assume a more passive but protective posture.

Please do not try these sexual position without your doctor present. Just kidding - but Watch Your Back!!