Let’s talk about sex, baby. Let’s talk about you and your back…

Being in pain can reduce your excitement, enthusiasm, and options when it comes to many areas of your life. That includes your sex life.

With 90% of people experiencing low back pain at some point in their life, patients sometimes question me as a clinician about what to do when they are having pain with sex—and usually they do so with a certain amount of trepidation in their voice.

From a strictly biomechanical standpoint, there are some positions that are going to be less likely to aggravate pain. According to the research of Natalie Sidorkewicz at the University of Waterloo, the knees up missionary position is the most comfortable if someone is motion-intolerant or extension- intolerant (meaning if you have pain with most movements or with backward bending movements specifically). She cites doggy style as being the best for those who are flexion-intolerant (that is you have difficulty bending forward). But she also cautions that very small tweaks in a posture or position can make a big difference for the better or worse. Having this information beforehand can help to give you more agency over your pain in the moment. (There will be some videos that follow to better explain this…!)

The difficulty in writing this article is the wide variability of back pain, and also that we can’t predict the internal experience of sex as a human being.

The brain is the interface where we experience pain and behavior. Because your brain is a prediction machine, it has evolved to anticipate the future, so it only acts once it perceives a situation. If we have a perception that there will be pain with an experience, it will influence how or whether we engage with the activity. In this way, sex can also be useful in changing your perception about your back pain as you find positions in which you feel less fragile and less constricted. That being said, while you can feel proud and excited about having managed your pain in this beautiful experience, don’t feel like you can go and crush a marathon or deadlift a house.

With these things in mind, here are some useful tips to better manage your condition:

1. Try doing a solo run-through and rehearsing better positions. In trying to move effectively, powerfully, and in balance, the injury and pain fall by the wayside—with a perceived sense of humour.
2. Whether through Brainfullness, meditation, or whatever is your means, learn to manage your stress and anticipatory pain around perceived exertion.
3. Get your sleep. Sleep deprivation amplifies pain.
4. Self-medicating with booze or narcotics or whatever other forms is not a helpful tool—you might win the race, but not the war.
5. Communicate with your partner. Don’t try to be the hero—tell your partner if you are having pain. Honesty, trust, and communication in your relationship will help to enhance the intimacy —and can even be an endorphin release that helps modulate your pain.

With the complete acknowledgement of the fact that so many factors influence the comfort and pleasure experienced during sex, and assuming that all else is loving and copacetic in the relationship (you both are vegan, politically aligned, love Soul Cycle, and are socially woke), these relatively simple things can help you to, not only control your pain, but manage the threads of anxiety or thoughts that are running in the background.

As a cautionary tale, the brain is an adaptive, dopaminergic system, so be wary of trying to always exceed the experience, as it is our biological tendency to have ebbs and flows. We must also take into account that sex is a dynamic interaction between many complex systems–within the brain, the site of pain in the body, and the biological and identity experience of it.

While pain does reduce your options, and can feel like it decreases your capabilities, it can also help you broaden the spectrum of what is good and pleasurable. Sex creates a bilateral stimulation that affects both hemispheres of the brain, allowing for improved efficiency, and leading to a more robust insula which can improve athletic (or sexual) performance, emotional self-regulation, and a more expansive view of the future. Being willing to explore other options to expand your view of what that is can be neurologically resetting and healing, and you can still have an intimate, romantic experience irrespective of the anticipated outcome.

Because as challenging as back pain is, it could also be a creative process of learning something new. It allows us to be curious and expressive, in the context of humility. That being said, when experiencing low back pain, there is no shame in asking for help and, as someone who believes in post-injury or pain growth, I can help you get your game back on track. As they say, you better check yourself before you wreck yourself.

Dr. Tabrizi is a chiropractor, osteopath and a passionate member of both the local and scientific community, whose goal is to teach that the pursuit of optimal health and wellness is much more than being symptom-free. His practice is rooted in the philosophy of treating the person rather than just treating the illness or ailment. As a result of his interdisciplinary training, Dr. Tabrizi has developed a neuroscience-based therapeutic education approach to treating his patients, focusing on healing illness from a wider perspective, placing equal responsibility on patient as well as practitioner. Dr. Tabrizi aims to educate his patients and provide them with the tools and framework needed to integrate pain management and healthy living into the fabric of their everyday lives.