Is There Sex After Low Back Pain?

A Major Cause of Sexual Dysfunction

Although quality of life in patients with low back pain (LBP) has increasingly been a focus of medical research, relatively few studies have investigated the effects of LBP on sexual function.

"Sexuality is an important aspect of quality of life," note Jean-Yves Maigne and Gilles Chatellier in "Assessment of Sexual Activity in Patients With Back Pain Compared With Patients With Neck Pain."^[1] They add, "Recent research has shown significant adverse effects of chronic low back pain on sexual activities in 46% of patients."

Several studies have demonstrated that LBP leads both men and women to reduce the frequency of intercourse. In 2001, for instance, Maigne and Chatellier recruited patients from a vertebral pain clinic and prospectively entered them into a study after clinical and radiologic examinations. All patients were ambulatory, had pain of moderate intensity, were 25-60 years of age, and had to have been experiencing chronic low back or neck pain for more than 2 months.

The investigators found that approximately 34% of men and 55% of women reported decreased coital frequency owing to LBP.^[1] And these patients were not clustered at the older end of the age spectrum: The mean age of study participants was 43.6 years for women and 42.9 years for men.

A 2010 study by Naz B. Akbas and colleagues^[2] found similar results.It evaluated sexual problems and sexual behavior patterns of 43 men and women with lumber disc herniation (mean age, 41.4 years). A visual analog scale, the Oswestry Disability Index, the Hospital Anxiety and Depression Scale, and a sexuality assessment questionnaire were administered to the patients to evaluate pain and sexual dysfunction. Eighty-four percent of the women and 55% of the men reported sexual problems related to LBP.

In the 2014 study "Male Spine Motion During Coitus, Implications for the Low Back Pain Patient"^[3] and the 2015 study "Documenting Female Spine Motion During Coitus With Commentary on the Implications for the Low Back Pain Patient,"^[4] Natalie Sidorkewicz, MSc, and Stuart M. McGill, PhD, were apparently the first to investigate which coital positions would cause the least pain in patients with LBP on the basis of biomechanical testing.

So-Called 'Best' Coital Position Is Inaccurate

Sidorkewicz, a PhD candidate on the faculty of Applied Health Sciences at the University of Waterloo in Waterloo, Ontario, Canada, told Medscape that before their study, the only advice on coital positions available to patients with LBP had been anecdotal, based on physician experience "and popular media resources rather than empirical data."

She and Dr McGill, who is a university professor and director of the Spine Biomechanics Laboratory at the University of Waterloo, discovered through biomechanical testing that the position that had been most often "authoritatively" recommended to patients with LBP, "side-lying" (popularly known as "spooning"—rear entry, in which the woman is lying on her left side and the man is lying on his left side behind her, both with their hips and knees flexed), was actually the most likely to provoke pain in men with flexion-intolerant pain.^[3]

Sidorkewicz and McGill conducted biomechanical analyses on 10 healthy couples during intercourse.^[3,4] To analyze the couples' movements, they used a system that is common in the development of computer graphics and video game character animation. With the aid of infrared cameras, they tracked participants' movement in three-dimensional (3D) space via reflective markers affixed to the participants' bodies. The 3D positions were then translated into spine angles. The researchers also measured activity in core and hip muscles by attaching electrodes to the skin over these muscles, Sidorkewicz told Medscape.

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Cite this: Is There Sex After Low Back Pain? - Medscape - Aug 26, 2015.