Patients often ask when they can safely have sex after back surgery. This is a common concern for the patient and for their significant other.
Often their sex life has already been affected. Back pain may interfere with intimacy, decrease sex drive (libido) and interfere with sexual enjoyment. Patients with pelvic numbness or nerve dysfunction may feel less stimulation and pleasure or have difficulties developing or sustaining an erection or orgasm. Even worse, sex might aggravate the back injury, causing a great deal of pain and ultimately making sex unpleasant and unwanted. Back pain can also lead to depression or be associated with depression, another factor that can affect your sex life.
No wonder people are concerned!
I am happy to tell you that sex is safe after back surgery. For patients undergoing traditional back surgery, doctors commonly recommended waiting 6 to 12 weeks before resuming sexual activity. These operations involved a large midline incision, muscle retraction and bone resection, and patients suffered intense pain from muscle damage. These surgeries are very different from today’s advanced endoscopic spinal surgery. Endoscopic surgery is done through a tiny incision the size of your finger nail, using a little high definition video camera the size of a pen! There is minimal skin, muscle and bone damage. Most people recover in a few weeks and the incision is small and less likely to be torn open.
The great advancements that have been made in minimally invasive back surgery means that patients treated endoscopically can start having sex again after only 2 weeks if their incision is healing well, their pain has resolved or significantly improved, and their sex drive has returned. The healing time will increase for other more invasive surgeries or surgeries involving spinal instrumentation. As with all activity, the patient should approach sex in a safe, gentle manner and take on a passive role. The patient should avoid heavy lifting, bending and twisting. They should stop if pain develops. As an old colleague of mine told his patients, “No shaking the trailer!”
They may benefit from small pillow under their low back, stacked pillows under their knees to bend the hips and support the legs, and taking a well-supported position. They may also benefit from taking pain medication prior to sex. Their partner should avoid putting their full weight on them. The patient may have less pain starting with missionary position, lying down on their side or standing and bending over a chair.
Since all patients and surgeries are different, you should discuss your return to sexual activity with your doctor. Though you might feel awkward bringing it up, don’t worry. It’s a very normal, healthy concern.