Back pain and sex don't go together very well and if you or your partner are among the 35 million people who have back pain, you know that back pain can disrupt your relationship. 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 realizing 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 dos 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.

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.
Try These Positions Tonight...

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.
3. 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:

1. Try missionary position with the legs bent toward the chest.
2. Sit on the edge of a chair and have your partner 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. We call this, the whoopee effect and it can happen to anyone. Just remember that as you improve gradually, so should your activity level also increase gradually.