Sex is an important part of the intimacy between couples, and attitudes about sex, about rejection and about our self-image when we don’t feel up to a sexual encounter can haunt a couple for a long time.

Sex is supposed to be pleasurable for both of you and the fear of hurting yourself or your partner inhibits the spontaneous joy that you probably felt before your back pain developed. But what can you do about it? Most couples in which one or the other is restricted by back pain will eventually get around to realising that back pain does not automatically mean no more sex. What it does mean is that you will need to make some accommodations to the pain and or the fear of it. It also means you will need to talk about sex in a slightly different way than you are used to.

Let’s back up for a second and begin with a very strong suggestion. Because pain has both a psychological component and a physical component, getting a sound diagnosis is critical to putting your mind at rest about what is wrong and secondly having a sound diagnosis will also give you guidelines for your physical limitations.

Secondly, after you have the diagnosis, involve the doctor or physical therapist in a frank discussion about do’s and don’ts. Maybe that’s an uncomfortable subject for you, but these days we are talking more openly about sex and you should tap into the doctor’s experience here. In a perfect world the doctor would open the discussion for you, but if they don’t you may have to initiate it. Ideally your partner should be present because he or she will have his or her own questions and concerns. Sex Advice Starting off right To start sex off right, start off with a massage, or ice down the painful area. A warm shower together might help too. That way the muscles are relaxed. Positions Here are some sexual positions that can help you enjoy a pain-free experience. For males: 1. Lay on a firm surface and use pillows to support your knees and head. You might like to try placing a small rolled towel under your lower back. 2. Try a side-by-side position. 4. Place a pillow under your lower back while your partner straddles you on top. You can also sit in a sturdy chair instead of lying down. For females: Try missionary position with the legs bent toward the chest. 2. Sit on the edge of a chair and have your kneel between your legs for entry. 3. Rear entry may also be more comfortable for women with back pain. Try it kneeling on the bed or lying on your belly with a pillow under her chest. 4. Sit on your partner's lap as he sits in a chair.

Remember, the health of your back is dependent on many dynamic factors. Your symptoms may change over time so you may need to work with your health care provider from time to time as you go through the many stages of recovery. A word of caution is in order at this point. It is pretty common to begin feeling better and then overdo it and have your back pain symptoms flair up. I call this, the Eureka effect and it can happen to anyone. Just remember that as you improve gradually, so should your activity level also increase gradually.

As I mentioned earlier pain has two parts. There is the physical part. This is the actual stimulation of the nerve, like a painful tooth or a herniated disc pressing on the nerve. And then there is the subjective or the psychological part. This is how it feels to you and includes, among other things, such attitudes as fear that it will get worse or last forever, what will it means to be chronically disabled, and what you believe your partner thinks about it as well as how you are coping with your condition.

So, at the top of your agenda there needs to be a frank discussion of your pain limitations and expectations about sex. It is a mistake to believe that your partner understands what it feels like. It is your responsibility to communicate those limitations as clearly as possible; it is their responsibility to listen and try to understand. Pain, after all, is invisible and subjective. That means your pain is unique to you. We have heard people liken back pain to everything from a hot poker going down one or both legs to a chronic aching sensation localized to the lumbar area. It doesn’t matter what words you use, just try to explain the pain, what causes it (position, certain movements, or whatever), and what feels good or is what is comfortable for you.

Is it obvious that if it hurts, don’t do it is generally good advice but some positions and techniques hurt more than others? It may require some gentle experimentation to find out what works but as in most sex advice, “gentle” is the best place to start.

In terms of maximizing yours and your partner’s sexual pleasure, it is very important to stress that all you really need is your imagination and the willingness to experiment to open up new areas of intimacy. But it all begins with willingness to try. And given that, you just may find that the challenge of your back pain can be turned into the juice of new sources of mutual pleasure!