If you’ve ever wondered how to have sex with back pain, luckily for you, some researchers have been working hard recently to figure it out.

Research suggests that around 50% of people with chronic low back pain experience significant sexual difficulties. In one study, low back pain led to a decrease in sexual activity for 34% of women and 55% of men, with most of the participants in this study around 43 years old (Maigne & Chatellier, 2001). In another study, a staggering 84% of women and 55% of men (average age 41) with lumbar disc herniation reported sexual problems due to low back pain (Akbas et al., 2010).

It’s pretty common then, to experience problems when trying to have sex with back pain. So, what can be done to make things easier and help everyone enjoy sex again?

The typical recommendation for men and women, or men and men having sex with back pain (or, presumably, anyone using a strap-on), is to adopt a spooning position and for one partner to enter the other from behind.

Two researchers at the University of Waterloo in Ontario, Canada, have turned this conventional wisdom on its head recently, however.


In two studies, these researchers used sensors attached to the bodies of couples to monitor spinal motion while they had sex in a variety of positions (Sidorkewicz & McGill, 2014; 2015). All the couples in these studies were healthy cisgender men and women without low back pain. The researchers also used electrodes attached to the skin on the hips and abdomen to monitor core and hip muscle activity.

What the Canadian researchers found was that this spooning-rear-entry position was the most likely position to actually trigger pain in men with flexion-intolerant pain. Pain with flexion is pain that arises when you bend forward or are sitting. Pain with extension is pain upon leaning backwards.

Perhaps unsurprisingly, the researchers found that the best position for having sex with back pain depends on if a person’s pain is flexion-intolerant or extension-intolerant.


The volunteers had readings taken for five sex positions in total, including spooning, two quadruped (doggy style) positions, and two ‘missionary’ style positions. For one quadruped position, the woman supported her upper body using her elbows; for the other, she used her hands.

In the first missionary position, the man supported his upper body using his hands. In the second, he supported his upper body using his elbows. The woman kept her feet on the mattress in both positions with little flexion of her knees and hips in the first missionary position. In the second position, the woman flexed her hips and knees more.

So, which position or positions did the researchers find worked best for people having sex with back pain?


The positions ranked in order of least to most likely to cause low back pain for men with flexion-intolerant back pain were:

  1. The quadruped position, with the woman supporting herself on her elbows
  2. The missionary position, with the man supporting himself on his hands
  3. The quadruped position, with the woman supporting herself on her hands
  4. The missionary position, with the man supporting himself on his elbows
  5. The spooning-rear-entry position.

For men with extension-intolerant back pain, i.e. pain when lying on their stomach or when bending backward, the list goes in reverse order. Spooning is best, in other words.


For the women in the study, missionary positions involved more spine flexion, while quadruped positions involved more spine extension. So, for women with low back pain on flexion (i.e. when bending forward), the following ranking applies:

  1. The quadruped position, with the woman supporting herself on her hands
  2. The spooning-rear-entry position
  3. The quadruped position, with the woman supporting herself on her elbows
  4. The missionary position, with the man supporting his upper body with his hands (with the woman’s hips and knees minimally flexed.

For women with extension-intolerant back pain, the order goes in reverse, with missionary position best, and the quadruped position worst.

Some general advice for anyone having sex with back pain is to try to minimize spinal movement and instead move from the hips and knees where possible. It is also a good idea to adopt positions where the person without back pain does most of the moving while their partner keeps their spine in a neutral position. Putting a towel underneath the lower back to help maintain the natural curve of the spine can be helpful here.

Missionary positions seem to be better for women with back pain made worse by movement, followed by spooning. Quadruped positions are the most likely to trigger pain in women with low back pain worsened by movement.


Why was the spooning position first recommended to people having sex with back pain? Well, the rationale was that by flexing the hips and knees, this relaxes the psoas muscle and sciatic nerve. This helps to straighten the spine and can reduce bulging in the intervertebral discs.

Physicians used their knowledge of anatomy and physiology to come up with this advice a couple of decades ago. Newer research makes use of new technology however, offering greater insight into intervertebral disc mechanics and nerve function.


If sex with back pain continues to be difficult, it might be a good idea to check out the wide variety of available sex aids for people with mobility issues. These can be found at specialist stores online and in some cities. And, of course, couples would be wise to ensure that their mattress is comfortable for all partners.

RBP Bed Wedge Pillow, Support for Back Pain


Akbas NB, Dalbayrak S, Kulcu DG, et al. (2010). Assessment of sexual dysfunction before and after surgery fur lumbar disc herniation. J Neurosurg Spine, 13:581-586.

Maigne JY, & Chatellier G. (2001). Assessment of sexual activity in patients with back pain compared with patients with neck pain. Clin Orthop Relat Res, 385:82-87.

Sidorkewicz N, & McGill SM. (2014). Male spine motion during coitus. Spine (Phila Pa 1976), 39:1633-1639.

Sidorkewicz N, & McGill SM. (2015). Documenting female spine motion during coitus with a commentary on the implications for the low back pain patient. Eur Spine J, 24:513-520.