Dr Sunil Rama
At my practice, I always advocate ergonomic and lifestyle changes to allow the patient quicker recovery and less pain by changing their habitual patterns that have initially caused the current dysfunction
However, patients do find that their sexual activity becomes compromised as a result of their painful condition and are often too embarrassed to ask, thus I posted this blog, for you get research based advice on which sex positions are less strenuous on the spinal joints and discs
In several research studies, it has been shown that approximately 34% of men and 55% of women reported decreased coital frequency owing to lower back pain (LBP) and these patients were not clustered at the older end of the age spectrum: The mean age of study participants was 43.6 years for women and 42.9 years for men.
A recent study discovered through biomechanical testing that the position that had been most often “authoritatively” recommended to patients with lower back pain, “side-lying” (popularly known as “spooning”—rear entry, in which the woman is lying on her left side and the man is lying on his left side behind her, both with their hips and knees flexed), was actually the most likely to provoke pain in men whom have difficulty bending forwards (flexion)
The sexual positions are divided into:
1) Males in Pain with bending forward
2) Males in Pain with bending backward
3) Females in Pain with bending forward
4) Females in Pain with bending backward
MALES THAT FIND IT DIFFICULT TO BEND FORWARD
For men that have difficulty bending forward, the quadruped position (doggystyle position) in which the woman supports herself on her elbows was the least likely to lead to pain.
The missionary position in which the man supports himself on his hands was the next least likely to be painful
This was followed by the quadruped position in which the woman supports herself on her hands and then the missionary position in which the man supports himself on his elbows
The side-lying position was most likely to produce pain for men with flexion-intolerant LBP.
If a man gets increased LBP when he flexes his spine (eg, bending down to touch his toes or sitting for long periods), then he should avoid positions where his spine tends to use more flexion (spooning) and try positions where his spine uses more extension (ie, doggy-style)
The recommendation is reversed for men whose back pain is triggered by bending backward
FEMALES THAT FIND IT DIFFICULT TO BEND FORWARD
The best-tolerated position for women with lower back pain upon bending forwards was the quadruped (doggystyle) position in which the woman supports herself on her hand
This was followed by the side-lying position
Then the quadruped position in which the woman supports herself on her elbows
And missionary position in which the man supports his upper body with his hands and the woman’s hips and knees are minimally flexed
For women whose back pain is worse on bending backwards the rankings would run in reverse, with the missionary positon in which the man is supporting his upper body with his elbows and the woman is flexed at the hips and knees least likely to provoke pain and the woman in the quadruped position supporting her upper body with her hands and the man kneeling behind her as most likely to cause pain
The study on women also investigated coital positions to avoid if LBP is exacerbated by movement. In that event, the most tolerated position is the missionary position with the man supporting his upper body with his elbows and the woman flexed at the hips and knees, followed by the missionary position in which the man is supporting his upper body with his hands and the woman is minimally flexed at the hips and knees
However, more research is warranted on this interesting topic and we rely on patients for feedback regarding their pain patterns on different coital positions.
Dr Sunil Rama
Laidman, J (2015), Is There Sex After Low Back Pain?, Medscape Orthopedics, August 26