The Best Sex Positions for People With Bad Backs

Sex with a bad back is no laughing matter. Research suggests that no less than 37% of adults with low back pain experience some level of difficulty during sex. Moreover, up to 7% report that low back pain has significantly limited their sex lives.

If you're wondering how to have sex with a bad back, you'll first need to understand the various causes of back pain and how posture directly and indirectly influences pain. This is especially true with respect to people with disc problems, including herniated discs and slipped discs.

Assess When You Have Back Pain

Back pain caused by disc problems is typically increased whenever you bend forward (referred to as spinal flexion). Bending the spine in the opposite direction (spinal extension) can help alleviate this pain. Most of us refer to this as "arching the back."

It stands to reason, therefore, that sexual positions that either minimize flexion or increase extension can help reduce pain during sex. When formulating a plan, start by determining how much you can arch or flex your spine without pain. This can tell you one of several things:

  • If you have significant pain in either direction, you will need to focus on postures that stabilize the back.
  • If you can flex the spine a little without significant pain, you need to focus on moving your pelvis while keeping your back straight.
  • If you cannot flex at all, there are things your partner can do that allow you to remain still during oral, vaginal, or anal sex.

Whatever your spinal condition, staying relaxed is the key to avoiding pain. Stress and anxiety almost invariably cause muscle tightening and contractions that enhance, rather than minimize, pain.

Sex Positions to Help Minimize Back Pain

There are a number of positions and tricks that can effectively minimize back pain during sex. If you tend to use the same position with your partner, some of these may be a little awkward at first. By discussing them beforehand, you can feel more at ease during sex and reduce the risk of injury.

The recommended positions are especially valuable in older couples in whom low back pain can be progressive. This is especially true for postmenopausal women, who have a greater likelihood of low back pain compared with men of the same age.

The Missionary Position

When you are in the missionary position as the bottom (receptive) partner, you can support your lower back by placing a rolled towel under it. This will likely keep a slight arch in your ack.

Maintaining a slight arch is preferable to keeping your back flat. A flat back forces the pelvis slightly forward, causing more flexion than you might expect.

Partner on Top

The missionary position may be less comfortable for the top (insertive) partner since it forces you to flex and extend the spine. One way to stabilize the back is to have the receptive partner on top while you lie flat on your back.

However, you need to be careful that your partner doesn't bounce too vigorously. This can force your pelvis into the mattress, causing spinal flexion. One way to avoid this is by placing a solid board under your buttocks and lower back. This can help keep your back straight while the underlying mattress acts as a shock absorber.

Sitting and Kneeling

If you are the receptive partner, you can often avoid pain by sitting on your partner's lap. This will give you some control over your back's position. Another possibility is to kneel as you support your weight on your elbows. In this position, there is room for you to adjust your back as your partner enters you from behind.

Sitting in a chair can also benefit the top partner. It stabilizes the back and minimizes flexion even if the insertive partner is moving vigorously.

Kneeling can be more problematic for the top partner, especially if the mattress is soft. With that said, back pain can be avoided if the partner on all fours does all the movement, pushing back and forth into the insertive partner.

Facedown Position

Lying on your stomach will automatically put your back in an arch. You can control the amount of arch from this position in several ways. To add more arch, start by placing a pillow under your chest. If that does not provide enough spinal extension, prop yourself up on your elbows. To decrease the amount of arch in your back, place the pillow under your stomach.

If you are the top (insertive) partner and your partner is facedown on the mattress, you can minimize back movement by placing a pillow under your partner's pelvis. This better exposes the vagina or anus and doesn't force you to flex your back as much as you thrust forward.

Frequently Asked Questions

  • Can opioid pain relievers affect erections?

    Yes. Erectile dysfunction is one of the most common side effects of taking opioids such as Vicodin (hydrocodone), OxyContin (oxycodone), and codeine. 

  • Do opioids affect a woman’s libido?

    Yes. Research shows women who take opioids for chronic pain often experience a decreased libido. In addition, opioid medications can also alter hormone levels and interfere with menstrual cycles. 

  • Can over-the-counter pain relievers cause erectile dysfunction?

    Possibly. A study of more than 80,000 men found that those who regularly took non-steroidal anti-inflammatory drugs (NSAIDs) were 38% more likely to experience erectile dysfunction. However, investigators noted that it was unclear whether the medication causes ED.

    Erectile problems could also be related to a health condition that people take NSAIDs for.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Wáng YX, Wáng JQ, Káplár Z. Increased low back pain prevalence in females than in males after menopause age: evidences based on synthetic literature review. Quant Imaging Med Surg. 2016;6(2):199-206. doi:10.21037/qims.2016.04.06

  3. Ajo R, Segura A, Inda MD, et al. Erectile dysfunction in patients with chronic pain treated with opioids. Med Clin (Barc). 2017;149(2):49-54. English, Spanish. doi:10.1016/j.medcli.2016.12.038

  4. Wersocki E, Bedson J, Chen Y, LeResche L, Dunn KM. Comprehensive systematic review of long-term opioids in women with chronic noncancer pain and associated reproductive dysfunction (hypothalamic-pituitary-gonadal axis disruption). Pain. 2017;158(1):8-16. doi:10.1097/j.pain.0000000000000691

  5. Gleason JM, Slezak JM, Jung H, et al. Regular nonsteroidal anti-inflammatory drug use and erectile dysfunction. J Urol. 2011;185(4):1388-93. doi:10.1016/j.juro.2010.11.092

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.