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Back Pain Can Affect Relationships and Sexual Health

Some say the secret to great sex is “all in your head.” Sexual medicine and spine experts might disagree — some sexual problems originate in the lower spine.

Dr. Irwin Goldstein, medical director of Alvarado Hospital’s Sexual Medicine Program—the first hospital-based sexual medicine program in the U.S.—and editor-in-chief of The Journal of Sexual Medicine, recently treated a patient who experienced erectile dysfunction (ED) and numbness in his legs as the result of injuries suffered in a car accident.

“After completing the initial workup, we determined the problem was the patient’s pelvic floor muscles,” Dr. Goldstein said. “We referred him to one of the hospital’s physical therapist who had advanced training in pelvic floor rehabilitation.”

Dr. Goldstein explained that the muscles in the pelvic floor support the organs located inside the pelvis — bladder, urethra and rectum. These muscles also play an important role in sexual function. When they are contracted tightly causing pain, it is not possible for the smooth muscles in the penis to relax, requiring medication to achieve an erection. These muscles must relax to trap blood in the chamber of the penis, which is necessary for sustaining an erection.

The patient’s pelvic floor muscles had developed spasms and become weaker as a result of the spinal injury suffered from the car accident. This caused instability in the sacroiliac joint that connected his spine to the pelvis.

Physical therapist and pelvic floor specialist Kerri Krebs helped the patient with muscle energy, core and lumbar strengthening exercises to align the pelvis and relax the pelvic floor muscles. Upon return to Dr. Goldstein for reassessment, the patient was found to have improved erectile function and less numbness upon testing, and his erectile dysfunction medications were decreased. This patient had seen many doctors before finding multidisciplinary help at Alvarado Hospital.

Dr. Ramin Raiszadeh, an orthopedic spine surgeon at the Advanced Spine Institute and Minimally Invasive Spine Center at Alvarado Hospital, said patients experiencing chronic sexual problems and chronic back or pelvic pain, or incontinence, should consult with a specialist as quickly as possible.

“These problems are usually musculoskeletal in nature, but other medical conditions, including cardiovascular disease, diabetes, infection, inflammation and tumors, can cause these symptoms as well," Dr. Raiszadeh said. "The spinal disorders that may impair sexual dysfunction, including nerve compression by a disc herniation, muscle spasms from weakness and inactivity, long-standing spinal stenosis and even trauma from a fall or an accident."

Conservative measures, such as specialized physical therapy for core strengthening, are often quite effective. Other treatment options may include epidural steroid injections, massage, acupuncture, chiropractic adjustments, yoga, traction and for patients who have sustained a fracture, and/or brief immobilization with a brace.

Surgery is rarely indicated; however, if surgery needed, minimally invasive approaches may be implemented.

Dr. Raiszadeh added that most patients want to know how soon they can have sex after surgery. “The answer depends on the underlying problem, the type of surgery, and the patient’s level of pain."

"If the sexual problem persists, the patient should see a sexual medicine specialist,” said Dr. Goldstein.