Back Pain and Sex

Low back pain is indeed one of the commonest musculoskeletal ailments that affects literally 80% of the general population at some point of their life (1). Clinical data indicates that chronic lower back pain (back discomfort lasting for more than 12 months) is prevalent in 22 to 65% of the general population (2).Besides compromising the quality of life and increasing the risk of disability, the chronic lower back pain is also classified as a leading cause of sexual dysfunction in a number of patients.

How Can Lower Back Pain Influence Your Sex Life?

Lower back pain can affect sexual activity by a number of ways; such as:

1. Limitation of Activity:

Pain and discomfort in the back is often associated with rigidity and stiffness of spinal muscles. Any sudden movement or activity of trunk can aggravate pain and may lead to lightening or bolt like sensations. Needless to say that such as arrangement makes it impossible for a male to perform comfortably in the bedroom.Most importantly, feeling of pain, agony and discomfort also negatively impacts the mood, stamina and energy levels that are required for maintaining sexual advances.

2. Spinal or Nervous Involvement:

Depending upon the primary cause or pathophysiology of back pain, there is a high propensity of spinal/ lumbar involvement. For example, spinal conditions like spinal stenosis, facet syndrome etc. are strongly associated with nerve impingement syndrome that affects the nervous communication and activity of nerves required for sexual activity.

3. Pelvic Trauma:

In some individuals, lower back pain is followed by a prior history of pelvic trauma, surgery or injury, which may also be responsible for the symptoms of sexual dysfunction or erectile difficulty.For example, according to a new study reported in the peer reviewed journal Spine (3), investigators suggested that lumbar surgery of anterior spine is often followed by anterograde ejaculation in males. Additionally (4), procedures like discectomy (that are usually performed for the surgical management of chronic lower back pain due to prolapsed intervertebral discs) is strongly linked to erectile dysfunction in males. When the procedure is performed in young healthy adults, the incidence of ED is 34.7%, which increases abruptly if the procedure is performed middle-aged to elderly males.

4. Common Pathological Factors:

In some cases, lower back pain and sexual difficulty shares the same pathophysiological phenomena. For example, morbid obesity leads to cartilage loss and aggravated wear and tear damage to the inter-vertebral joints. At the same time, obesity also leads to hormonal and metabolic disorders and may present as sexual dysfunction due to low testosterone levels (it has been observed that peripheral conversion of testosterone to estrogen is fairly high if BMI is more than 28 kg/m2). Other similar patho-physiological factors that may presents with lower back pain and sexual dysfunction are:

• Uncontrolled diabetes
• Physiological aging
• Prostate malignancy

How to Address Back Pain That is Interfering With Your Sex Life?

Despite remarkable advancements in the field of therapeutics, talking about sexual dysfunction is still considered a taboo and a lot of people tend to ignore the symptoms instead of seeking medical help. It is highly recommended to discuss with your primary care provider regarding sexual dysfunction in order to devise a functional treatment plan. Additionally, you can also follow these tips to optimize your spine health:

• Learn About Different Sex Positions: Trying out different sex positions is definitely helpful in establishing a strong romantic bond with your partner. Additionally, you can also work-out few favorable positions that would allow you to perform intercourse without exacerbating your back pain. Although spooning and modified doggy-style are associated with least movement of lumbar segments (and are usually preferred by individuals with back pain); yet results and outcomes vary from person to person.
• Massage: Massaging helps in alleviating pain, swelling and rigidity. Additionally, a sensual massage also helps in building the mood and energy levels for a great sex. It is highly recommended to seek the help of a professional therapist if you have back pain due to spinal ailments.
• Speak to Your Partner and a Therapist: Communication is the key. Healthcare providers recommend individuals to share with their partners all the factors that are influencing the sex life. It is also recommended to see a sex therapist to learn more about effective ways to address back pain without interfering with your sex life.

To conclude, if you are suffering from chronic lower back pain, it does not mean that you cannot perform sexual intercourse. Besides exceptionally effective treatment regimens, there are several other options that can be utilized to optimize sexual as well as spinal health.References:

1. Hoy, D., Bain, C., Williams, G., March, L., Brooks, P., Blyth, F., ... & Buchbinder, R. (2012). A systematic review of the global prevalence of low back pain. Arthritis & Rheumatism, 64(6), 2028-2037.
2. Walker, B. F. (2000). The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. Journal of Spinal Disorders & Techniques, 13(3), 205-217.
3. Lindley, E. M., McBeth, Z. L., Henry, S. E., Cooley, R., Burger, E. L., Cain, C. M., & Patel, V. V. (2012). Retrograde ejaculation after anterior lumbar spine surgery. Spine, 37(20), 1785-1789.
4. Siddiqui, M. A., Peng, B., Shanmugam, N., Yeo, W., Fook-Chong, S., Tat, J. C. L., ... & Yue, W. M. (2012). Erectile dysfunction in young surgically treated patients with lumbar spine disease: a prospective follow-up study. Spine, 37(9), 797-801.
5. Samartzis, D., Karppinen, J., Mok, F., Fong, D. Y., Luk, K. D., & Cheung, K. M. (2011). A population-based study of juvenile disc degeneration and its association with overweight and obesity, low back pain, and diminished functional status. The Journal of Bone & Joint Surgery, 93(7), 662-670.