Sex and Scoliosis: Embracing Intimacy and Confidence

When questioned using the Female Sexual Functional Index (FSFI), 34% of women with idiopathic scoliosis reported sexual dysfunction. The reported area of most dysfunction was the ability to achieve orgasm and pain during intercourse (Durmala et al, 2014). If it affects a third of women with scoliosis, who is talking about this pervasive problem? Ummm… Well… No one? Which is why we are taking the leap. To be fair, our clients bring it up, but that’s only after we know them quite well. Most likely because sexual intercourse isn’t simply a physical activity; it is also a highly emotional activity.

The emotional side of scoliosis and sex

Edie (not her real name) flew in from Europe to work with me. We had a great time working together for 5 days, 3 hours daily. She made beautiful changes; seeing her feel better and breathe better in our short time together was the most rewarding experience. Despite her severe scoliosis, she had a truly beautiful spine.

We hadn’t talked much about our personal lives in those 5 days, so I asked her on the last day, “Are you excited to go home? Is someone waiting for you? Friends? Family?”  Her eyes quickly teared up. She said, “I don’t have a boyfriend.” I shrugged as I bounced on the exercise ball I was sitting on, saying, “That’s okay! They can be a lot of work!”  She said, “No, I just can’t explain my back to one more person.” And the tears spilled and continued to flow.

She is not the only person to visit me who scoffed or gave me a side-eye when I said, “Look at that beautiful spine!” when they are standing tall and elongating through their corrections. These comments are often met with disbelief or a feeling that I am being overly kind – or that I say that to everyone – some sort of dismissiveness that the positive comment they received is not actually positive. They quickly turn it into a negative. I won’t dwell on why that happens in this article, but our emotional side is the first side to approach when it comes to sex and scoliosis. If you know your scoliosis is beautiful, then sex will be more natural. If you know your curves are poetic and graceful, you can enjoy someone else appreciating that poetry and grace. Here’s another blog about the beauty of scoliosis. But for the moment, we move on. Let’s focus on the physicality of sex and scoliosis.

The realities of living with scoliosis — and making love.

Let’s look at a few realities of living with scoliosis and how they may create challenges in the purview of sex and scoliosis.

  • Fused and unfused spines that don’t bend. If you are fused, you know your spine doesn’t bend at the fusion. However, if you are unfused, did you know your spine also has trouble bending at the curve? It’s not the same as being fused, but side-bending, rotation, and extension are all limited within the scoliosis curve. Forcing movement because we are in the midst of an activity – like sex — will most likely just make you move from the joints above and below the fusion—just like in a fusion.In both fused and unfused scoliosis, the joints above and below the fusion/curve get a LOT of use. They have no choice but to step up and take care of us. These joints keep us moving and doing what we love, like loving our partner. Awareness of this can help us appreciate that these joints may eventually cry out from being worn out – pain in the form of aching, pinching, crunching, and dropping. Until we can figure out how to elongate out of these areas so that more joints can be used to create movement. Regular Scolio-Pilates classes will help you understand how to move and strengthen with scoliosis.
  • Pelvic asymmetry. The pelvis, for someone with scoliosis, can have just as many changes as the spine. While spinal fusion increases pelvic symmetry in the scoliosis patient, the asymmetry is still significant when compared to those without scoliosis (Delpierre et al, 2023).

You can see your own pelvic asymmetry in the appearance of your hips. One hip may appear more forward than the other, and one side of the hips might jut out to the side – it’s easy to rest groceries or a child on this hip. 😊 If you can see asymmetry from the outside, there’s a chance there is an internal asymmetry as well.

The change in the shape of the pelvis may mean that if you are directly facing your partner while having sex, the position may leave you feeling like you are getting bombarded on one side of your pelvis. Our spines aren’t straight up and down, so don’t be surprised if the entry to your pelvis isn’t either. A little shift left or right or a pillow under one side of your pelvis to tip your pelvis center might be an easy solution. Scolio-Wedges anyone?

  • Shoulders that pinch. Just like when we reach for something on the top shelf and the shoulder pinches, the same can happen if you take your arms overhead while having sex. If the shoulders have challenges in everyday life, then the challenge will be the same in bedroom. A pillow behind the sand dune/convexity of the ribcage may help, but changing the rib position doesn’t always change the shoulder position. Whether sex or some other activity, the shoulders will benefit from length from one shoulder to other. Think wide at the front of the chest. This is not achieved by pinching the shoulder blades together but instead by reaching the shoulder points, or the fingertips wide to the side of the room. Look down at the shoulders and make sure they are open and free. See the video for this blog to help you with that.
  • Strength: You are going to need strength to have an enjoyable sex life. We’ve got a video here to help you strengthen the upper and lower body so you can think about the person you love, not your arms and legs giving out on you. I also talk about some scoliosis-specific solutions to keep your shoulders and hips happy. See the video!

The physical side of scoliosis and sex

What if your scoliosis physically makes sex difficult? Maybe you just hurt. Maybe all positions except the corner of the couch are simply uncomfortable. Let’s use the one position that feels good and comfortable to you in everyday life to find a position for sex that will be just as comfortable. After you read this, you can also see our video: for strength for scoliosis and sex.

Quick Quiz. Quick Solutions.

Circle the position that is easiest for you in everyday life. Then, use that position when making love. Ideas accompany each position.

Quick Quiz: What position do you find most comfortable in everyday life?

1. Sitting
2. Standing
3. Lying on your back
4. Lying on your side

Quiz Solutions

  1. Sitting: If you are comfortable sitting, both partners can take advantage of having more control over the shape of their spine. You can navigate your back into a position that allows for comfortable freedom of movement. A pillow between your partner’s thighs and your bottom can help to create support for your thigh muscles. If you are seated below, a pillow behind your back can also create support.
  1. Standing: An embrace while standing can work the same as sitting – it allows for adjustments to the spine’s shape in a dynamic position. Sometimes, the constant change of position that must happen in standing will keep the spine moving. This is a good thing. It is often static positions that begin to cause pain. This means that sex is automatically a good exercise form for scoliosis since it requires constant motion. Great news!

3. Missionary position. Whether lying on your back or above, both positions allow for control of how the spine moves. If you are lying on your back, you can easily use wedges and pillows to adjust your position. If you are above, then you can adjust the movement and the position of the pelvis to what you need. Try putting a pillow under your hips if you are above. You can rest your hips on this pillow to give your spine a break if needed. If you are below, then using wedges or pillows for adjustment will be easy.

  1. Lie on your side: Facing your partner side-to-side may allow for just the right control of the position that you need. Many with scoliosis find side-lying to be the most comfortable position to sleep in; just find the right side that feels best to you. If you use a pillow between the knees when sleeping, you can use your partner’s knee or leg between the knees. If you love side-lying to sleep but find that your pelvis isn’t super happy during intercourse, see Pelvic Asymmetry section below. For now, though, remember to be creative. This is your time together.

Speak UP

Talk. Your medical team is not your mind-reading team, nor is your partner. If you find yourself beginning to dread the idea of sex, you must share this with your partner and possibly your doctor. If you are having trouble discussing this, find a therapist to help you start the conversation. It’s important; this is your life.

Here are a few books that can help you begin the sex conversation with your partner.

  1. Come as you are: Revised and Updated: The Surprising New Science That Will Transform Your Sex Life by Emily Nagoski Ph.D.
  2. Sex Talks: The 5 Conversations That Will Transform Your Love Life by Vanessa Marin (Author, Narrator), Xander Marin 
  3. When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain by Andrew Goldstein MD (Author), Caroline Pukall Ph.D(Author), Irwin Goldstein MD

 

To finish, let’s visit Edie.  

Remember Edie?  I talked about her at the beginning of the article. She said, “I can’t explain my back to one more person.”  And how the thought of describing her scoliosis to someone new made her cry? You’ll be extremely happy to know that her opinion of her spine changed. She knows her spine is beautiful and she was willing to share that beauty. She is now married, and they have a gorgeous child. So, let’s celebrate our spines. Sure, they are different, but who wants to be normal?

 

Our purpose today was to talk about a fairly taboo topic and start normalizing the conversation. Do you have comments for us? Do you want to hear about something more? Different? Please share solutions so that the entire scoliosis community can benefit. We are listening!

 

Delpierre Y, Lemaire E. Hip loading asymmetry in Lenke type 1 idiopathic scoliosis: Effect of spinal fusion and sex. Clin Biomech (Bristol). 2023 Aug;108:106063. doi: 10.1016/j.clinbiomech.2023.106063. Epub 2023 Aug 9. PMID: 37579615.

Durmala, J., Blicharska, I., Drosdzol-Cop, A. et al. The assessment of the sexual functioning in women with idiopathic scoliosis- preliminary study. Scoliosis 9 (Suppl 1), O82 (2014). https://doi.org/10.1186/1748-7161-9-S1-O82

Sex and Scoliosis: Embracing Intimacy and Confidence