The SMSNA periodically receives and publishes ‘guest editorials.’ The current article was submitted by Mia Barnes, a freelance writer and researcher who specializes in women’s health, wellness, and healthy living. She is the Founder and Editor-in-Chief of Body+Mind Magazine.

A sore lower back can make intimacy feel difficult. Back pain during sex is more common than many people expect and affects both men and women. Practical adjustments, core strength, and a doctor’s guidance can help you feel comfortable and connected again. 

How Common Is Back Pain During Sex?

Lower back pain ranks among the most widespread health complaints in the world. Researchers estimate it affected 619 million people in 2020, and cases are rising. For many people, back pain affects sexual comfort.  

A 2023 physical therapy paper found sexual disability — pain or limits that disrupt sex — affects 37% to 81% of people with lower back pain, depending on the group studied. The same paper noted that clinicians often skip the topic. Many patients welcome the conversation but wait for their provider to start it.

Why Sex Can Trigger a Flare-Up 

Sex asks your spine to bend, arch, twist, and hold positions. The movements that trigger pain depend on which part of your back is irritated. 

Bending vs. Arching

Some people have pain with forward bending. Their backs ache when they bend forward or sit for long stretches. Others have pain when they arch backward. A position that feels comfortable for one person may cause soreness for another. 

Discs, Joints and Stiffness 

The discs between your vertebrae act as cushions. When one bulges or herniates, it can press on nearby nerves. In a 2022 study, 77% of men with an acute herniated disc reported lower sexual desire and satisfaction. Their sexual function improved significantly within eight weeks of surgery. Hip and lower back stiffness can add strain, too. 

Positions and Tweaks That Ease the Strain

For example, a man who sits all day may notice more pain after long drives. That pattern suggests their back is sensitive to forward bending. Neutral or gently arched positions may feel better than curled-forward ones. 

A few practical strategies can help most couples:

• Add support: Place a pillow or rolled towel under your lower back to lighten the load on your spine. 
• Share the work: The partner with less pain can take the more active role.
• Pace yourself: Try a more demanding position briefly at the start, then switch to one that feels easier. 
• Agree on a signal: A word or tap that means “let’s switch” keeps things relaxed. 

Utilize Assistive Devices

While a pillow or rolled towel may do the trick for DIY support, investing in adaptive sex equipment and intimacy aids can be a viable long-term solution. Tools like ramps, wedges, rocking chairs, straps, and support pillows are helpful tools that can alleviate pain and provide stability for various different positions. 

Build a Stronger Back Outside the Bedroom

Your exercise, stretching, and sitting habits can affect how your back handles intimacy. Your core muscles work like a built-in brace. Core strength supports the lumbar spine, flexibility improves motion, and aerobic exercise boosts blood flow to back tissues.

Low-impact options like walking, swimming, and stationary cycling build support with less strain. Sit-ups and standing toe touches can stress the lower spine. Check with your doctor or a physical therapist before you start a new routine. 

Physical therapy plans for back-related sexual problems often pair aerobic activity with training in the positions people actually use during sex. 

When to Bring It Up with Your Doctor 

Bring it up plainly. Tell your provider that your back hurts during sex, and it’s affecting your relationship. Being forward gives your provider a clear starting point.

At the University of Bologna, a team of physical therapists built a four-pathway framework for this exact problem. It starts with questions about your sex life, including one from the Oswestry Disability Index, a common back pain questionnaire. From there, you move to standard therapy, psychological support, or a specialist referral. Occupational therapy can play a role as well. Occupational therapists provide aid in therapy plans and education on activity modifications and devices that can be helpful. Seek care right away if you notice new numbness in the groin, leg weakness, or changes in bladder or bowel control. 

Back in Business

Back pain during sex is common, and plenty of people find ways to keep intimacy comfortable. Knowing whether bending or arching sets off your pain helps you choose positions that work for your body. A stronger core, a supportive pillow, and honest talk with your partner can ease the strain. If the pain lingers or new symptoms appear, bring it up with your doctor. Relief often starts with that one conversation. 

Resources:

GBD 2021 Low Back Pain Collaborators. (2023). Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: A systematic analysis of the Global Burden of Disease Study 2021. The Lancet Rheumatology, 5(6), e316-e329. DOI: https://doi.org/10.1016/S2665-9913(23)00098-X

Panneerselvam, K., Kanna, R.M., Shetty, A.P., & Rajasekaran, S. (2022). Impact of acute lumbar disk herniation on sexual function in male patients. Asian Spine Journal, 16(4), 510-518. DOI: https://doi.org/10.31616/asj.2021.0083

Salari, N. [Desert Institute for Spine Care]. (2022, October 7). Best Exercises to Help With Back Pain. https://www.sciatica.com/blog/best-exercises-to-help-with-back-pain/

Vanti, C., Ferrari, S., Chiodini, M., Olivoni, C., Bortolami, A., & Pillastrini, P. (2023). Sexual disability in low back pain: Diagnostic and therapeutic framework for physical therapists. Healthcare, 12(1), 80. DOI: https://doi.org/10.3390/healthcare12010080