Sexual health and chronic low back pain: A qualitative study

Background

Chronic low back pain presents a major challenge to society and healthcare systems, with significant financial and personal consequences. Beyond physical limitations, it affects relationships and sexual well-being—an often-overlooked aspect. Reduced sexual activity and satisfaction can strain intimacy, heighten psychological stress, and amplify pain perception. Despite its importance, sexual health remains underdiscussed in clinical care, and research on this topic is limited. A holistic approach addressing both physical and psychological aspects, including sexual well-being, is essential.

Methods

This qualitative study included 12 sexually active patients (aged 18–90) with CLBP but without sexual dysfunction. Semi-structured interviews were conducted in January 2023, developed from existing literature by a multidisciplinary team. A single researcher conducted interviews (in person, by phone, or via video), lasting up to 60 minutes. An inductive thematic analysis using NVivo® involved transcript familiarization, coding, and theme development. Findings were reviewed and validated by the research team.

Results

All 12 patients completed interviews, with data saturation reached after 10. While CLBP had minimal impact on overall relationships, nearly all participants reported reduced sexual desire. However, most adapted by adjusting intercourse techniques, experimenting with positions to minimize strain. A gender difference emerged: male participants emphasized partner satisfaction but did not express guilt when unable to engage, whereas female participants reported feelings of guilt.

Conclusion

Chronic low back pain led to reduced desire and the need to adapt sexual practices. Despite these challenges, many participants reported positive relationships, often thanks to empathetic partners and finding alternatives during intercourse. As a result, sexual activity and satisfaction were not affected contradicting existing literature that suggests lower desire typically leads to lower satisfaction. However, discussing sexual issues with healthcare providers was difficult, with participants preferring experienced specialists and face-to-face consultations, while finding peer support groups valuable for emotional support.