Sexual Positions That Cause Back Pain and What to Do About Them

For Arthritis Sufferers, Post Surgery Patients and Others

Back pain can be the unwanted third wheel in what otherwise could be a fulfilling sexual experience. Spinal conditions such as herniated disc, facet joint pain, spinal arthritis, sacroiliac joint dysfunction, and/or recovery from surgery each demand sexual position modification — especially if you'd like to keep things pleasant at bedtime.

Here are some basic positioning tips you might try after you turn off the lights.

Couples with sore backs in bed
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Missionary Position and Back Pain

The missionary position is a tough one for people with back pain, and especially for the partner on top.

It is fairly limiting in terms of movement, but with the help of a rolled towel placed in the small of your back, and claiming dibs on the bottom position, you might be able to support your spine enough to minimize your pain.

For more missionary position tips, learn about modifying the missionary position for back pain.

Sexual Positions for People With Disc Related Back Pain

Disc problems are often irritated by excessive spinal flexion movements; the pain or other symptoms may abate when you are able to arch your back.

To that end, lying on your stomach, which is called the prone position, may be your best bet. Lying prone automatically puts more arch in the back for most people. If you try it and find you still need more arch, consider placing a pillow under your abdominal area. And you can raise up even higher by doing a small press up action with your forearms providing the support for the arching movement.

The idea is to experiment for the right amount of arching. The rule of thumb when experimenting is to keep away from extreme positions, especially if they cause pain. Back down the position when pain occurs, and voila! You've identified a workable sexual position.

Sexual Positions for Spinal Arthritis Sufferers

Spinal arthritis tends to be a wear and tear affair. That is, it develops over time and is all but inevitable as we age. But certain things may hasten its onset; for example, if you sustain a back injury, your risk for spinal arthritis may be increased.

Because spinal arthritis does take a while before it's noticed, it's often preceded by conditions such as facet joint hypertrophy and/or bone spurs.

The symptoms associated with facet joint problems, bone spurs and/or degenerative spinal arthritis may be more pronounced when you arch your spine. This is because these conditions affect the back part of the spinal column; when you arch, you may be pinching or compressing the structures there, which can get uncomfortable.

Keeping this in mind, you may want to assume positions that allow you to favor a flexed position of the spine.

As with any sexual experience while you have back pain, staying relaxed is the key to success.

Sexual Positioning for Sacroiliac Joint Sufferers

If you don't know already, sacroiliac joint dysfunction is essentially a one-sided condition. In other words, either the right or the left sacroiliac joint is the primary site of the problem, and oftentimes the side with the most pronounced pain.

This is why Lauren Hebert, a physical therapist and author of the book Sex and Back Pain recommends bending the leg on the painful side during the act. Doing so, she says, will likely relieve the pain there, or at least reduce it. Hebert explains that a flexed hip eases that same-sided joint into a backwards direction, which is what it takes to calm irritation related to the dysfunction that may occur there.

In fact, Hebert says, eighty percent of people with sacroiliac joint instability find relief from their symptoms when the hip relaxes backward.

A number of possibilities for comfortable sex exist for sacroiliac joint dysfunction sufferers. You might lie on your side — with the painful side up — and wrap your leg around your partner, for example. For more ideas check out sex positions to accommodate pain on one side only and sacroiliac joint problems.

Sexual Activity Post Spine Surgery

And if you're recovering from back surgery, you may be facing an increased risk for pain or a possible decrease in satisfaction that is beyond your control. For example, a 2018 systematic review published in the Spine journal found surgery that comes in through the front, called the anterior approach, is associated with a higher incidence of retrograde ejaculation.

The good news, according to the study, is there's an overall trend toward improved sexual activity and function after a spine surgery.

If you have any questions or concerns about resuming sexual activity after spine surgery, ask your healthcare provider.

4 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.
  1. Yoon JY, Kim JW, Kang MH, An DH, Oh JS. The effects of an exercise with a stick on the lumbar spine and hip movement patterns during forward bending in patients with lumbar flexion syndrome. J Back Musculoskelet Rehabil. 2015;28(2):359-64. doi:10.3233/BMR-140528

  2. Goode AP, Carey TS, Jordan JM. Low back pain and lumbar spine osteoarthritis: how are they related?. Curr Rheumatol Rep. 2013;15(2):305. doi:10.1007/s11926-012-0305-z

  3. Jonely H, Brismée JM, Desai MJ, Reoli R. Chronic sacroiliac joint and pelvic girdle dysfunction in a 35-year-old nulliparous woman successfully managed with multimodal and multidisciplinary approach. J Man Manip Ther. 2015;23(1):20-6. doi:10.1179/2042618614Y.0000000086

  4. Malik, A., et. al. Sexual activity after spine surgery: a systematic reviewEur Spine J. May 2018. doi:10.1007/s00586-018-5636-7

Additional Reading
  • Herbert, L. Phone interview.

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