When you or your significant other is suffering from back or neck pain, sex is one of the first activities to be put at the bottom of the list, but it need not be that way.

To oversimplify the problem, there are basically three components of sexual functioning. All three must be in working order for things to function normally. First and foremost are the emotional and psychological aspects of sexuality. If you are depressed, angry, frustrated, preoccupied or uninterested, you are unlikely to enjoy a sexual experience. The second key components of sexuality are the physiological and anatomical ones. These refer to your equipment and wiring, and if they are not working normally, you will not be unable to function normally. Thirdly, many people have the desire, and the equipment and wiring are fine, but are unable to enjoy sex because they are not able to get into a comfortable position due to neck or back pain. This is usually easily overcome with some thought and experimentation. The general rule is If it hurts do not do it. Positions that are not comfortable in your day-to-day activities will not be comfortable during sex either. Do not be afraid to experiment, there is no right or wrong, normal or abnormal.

The following is a general outline of some of the more common back diagnoses and their symptoms. Along with the position diagrams, try to use these examples as a 'starting point' to guide you through an evaluation of what works and what does not.

Your back or legs hurts when you sit, bend or stoop and you feel better standing, walking, sitting in a recliner or lying with your back supported. These symptoms are usually caused by disc disease such as internal disc disruption, annular tears, central disc herniations or sprains and strains. Acute disc herniations and 'sciatica' will sometimes act similarly. When the symptoms are relieved by straightening or by arching the spine backwards use this as a basis of your positioning.

Alternatively, your back or legs hurt when you stand, walk or reach over head and you feel better sitting, reclining and in certain positions lying down. Spinal stenosis, spinal arthritis, facet joint disease, sprains and strains, deconditioning and soft tissue diseases, may cause these symptoms. These conditions tend to be worsened by an arched back position and relieved by bending forward or sitting.

As you and your partner embark on this adventure to make sex more enjoyable, remember that this can be emotionally charged and potentially frustrating. Take your time and start slowly. If your partner is the one in pain, offer to start with a hot bath or shower together. Most conditions respond favourably to gentle massage with some warm oil. The massage works to decrease pain, relax the muscles and mind, and can be stimulating. Share your feelings and enjoy.