Even today, low back pain and sciatica (radiating pain down the buttock and leg due to a low back problem) can cast a pall over one’s love life. I’ve lived with chronic back and radiating leg pain for seventeen years now, through relationships with nine sexual partners.

Back troubles contributed to the break-up of my first marriage, and they continue to present challenges during the eight years of my current relationship. I’m an extreme case, but I’m not unique. About eighty percent of Americans suffer from back pain at some point in our lives, so even that lucky pain-free twenty percent are probably going to want to make love to somebody with back pain someday.

Here’s how:

Be creative.
Don’t limit your idea of lovemaking just to sexual intercourse. For someone with very brittle, acute back pain, intercourse may not always be possible. If you think only intercourse is real sex, you’re sunk. If you can enjoy touching and being touched, massage, mutual masturbation, oral sex, sex toys, role-playing, talking “dirty” and phone sex, you’re going to be a much happier camper whether or not you or your partner have degenerative disc disease.

Be patient.
It’s not always a good time for sex. If either partner is in too much pain, it’s better just to wait until another time. If you’re the one in pain, be clear about your needs and your limits. If your partner is in pain, try to be secure enough to wait until he or she says it’s a good time.

Know when to stop.
What has made sex the most fun for me is my husband’s security with his own sexuality. If I say I need to give it a rest, he stops, and he’s not threatened, crestfallen or sulky. That lets me know that if I start having sex, I don’t have to finish it in pain. It makes it easier for me to begin, and we have more good sex in the end.

Play with toys.
When intercourse is just too painful, don’t be afraid to whip out your vibrators and other sex toys, which you can find conveniently at www.goodvibes.com.

Do your homework.
Nobody wants to think of sex as work. But if you or your partner has a bad back, a little leisure reading about sexual positions is going to lead to a lot more fun in the sack. Besides which, you might even get off looking at drawings of couples in different sexual positions. There are plenty of books and articles out there on sex with back pain that read like a Kama Sutra for the creaky.

Here’s a partial list (click on link for more information):

• Sex and the Back: Taking the Pain Out of Sex
• Sex and Back Pain
• Sex and Low Back Pain

You can get physical therapist Lauren Andrew Hebert’s illustrated Sex and Back Pain as a pamphlet, an e-book, or a see a video.

You can let your fingers do the walking to Amazon.com and order the paperback book version, Sex and Back Pain: Advice on Restoring Comfortable Sex Lost to Back Pain (Impacc USA; 3rd edition, 1997) by the same gal. Or, you can read Loving With Back Pain: Good Sex With a Bad Back by Kathy Ulrich and Vicki Chandler (Wondersight Ltd Liability Co, June 1996).

Most of these books and articles will give you a few basic tips:

Make love on a firm surface. Try using pillows under the knees if you’re on your back or between your knees if you’re on your side. Some people might find a towel rolled up and placed for support in the small of the back helpful when lying on their back. Try positions that don’t put as much of a strain on the sore back, such as lying like spoons, and having one partner enter the other from behind. Alternatively, the partner with back pain can lie on her back while her partner lies on his or her side next to her. She can lift her legs and then drape them over the pain-free partner’s legs as the pain-free partner enters her. There’s even a physical support designed specifically for people with back pain called (perhaps wishfully) the Harmony System. It looks like it would allow you to try a few more positions with less strain on the lower back. While I haven’t tried it myself and can’t specifically recommend it, I found looking at all the pictures of couples using it in different positions a mild turn-on. (Okay, I tend to find almost anything a mild turn-on.) Check it out for yourself and see if you’re as pervy as I am.

During my recent evaluation at the UCSF Pain Management Center, a psychologist gave me a copy of Hebert’s Sex and Back Pain. She earnestly cautioned me not to try the positions exactly like they were portrayed in the pictures—because all the couples were drawn wearing bathing suits! I left the booklet out on the kitchen table, where my husband and I like to read over meals.

Just having the book out there got us thinking more about sex, and looking at the pictures got us in the mood. Trying the different positions has been a huge amount of fun, reminding me of when I was in my early twenties and first experimenting with somebody who had read a lot about Tantric sex.

I developed back pain when I was twenty-seven. Most people don’t really start to be bothered by it until their mid-thirties. Somewhere around thirty-five or forty, you discover sitting around at a party of your age-peers that everybody is complaining about some joint or other that hurts. So if you’re poised on the threshold of that host of orthopedic problems, don’t despair! Know that there is a literature of illustrated sex books out there just for you. Find one, crack it open, and let the games begin.

Unfortunately, most of the written guides assume that sex is between a man and a woman. Perhaps it’s not as exciting a prospect as marriage equality or getting all our civil rights, but it will be a great day when sex manuals for people with back pain include drawings of men making love to men and women making love to women. Will you be the one to write one? If you know of one, please tell me about it. The closest I’ve seen is the following sentence from the booklet Relationships, Intimacy and Arthritis put out by Arthritis Care, a British national charity:

“The illustrations and descriptions are of heterosexual couples, but gay couples should find it easy to adapt and use these positions.”

Kudos to Arthritis Care, but a picture would be worth a thousand carefully chosen politically correct words. How about tasteful line drawings of a woman with a big black dildo in her thigh harness doing a nipple-ringed butch who’s hanging blissfully in a suspension system? Personally, I’m holding out for the watercolor/gouaches of the intersex person wielding a ribbed, rotating vibrator gleefully sodomizing the non-op tranny boy shown yowling in unrestrained ecstasy. Or perhaps in four-point restrained ecstasy.

I think I’m getting mildly turned on now. Gotta go.