Ptsd And Sex

Ptsd And Sex
Part of HuffPost Wellness. ©2022 BuzzFeed, Inc. All rights reserved.
Postcoital dysphoria, or post-sex blues, can have a huge impact on trauma survivors — even during pleasurable sex.
Anyone can experience postcoital dysphoria, but research suggests it’s strongly linked with a history of sexual assault.
For many sexual assault survivors with PTSD, simply being present during sex can be emotionally painful and triggering — even when they’re with a supportive and respectful partner.
Though stigma around mental illness and sexual health persists, there’s no shame in seeking help from a mental health professional for post-sex blues.
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Lela Vásquez, a 23-year-old childhood sexual abuse survivor, never understood why she cried after having sex with supportive partners or masturbating. It wasn’t until she was 18 and had been in multiple sexual relationships hat she realized the deep depression she felt after any sexual experience was linked to her post-traumatic stress disorder from her abuse.
Vásquez dealt with it privately until six months ago, when she learned that her experience was so pravelent among sexual assault survivors that there was even a term for it.
Postcoital dysphoria , also known as post-sex blues or postcoital tristesse, refers to intense feelings of sadness, agitation or anger after consensual ― even pleasurable and intimate — sex or masturbation. Symptoms of postcoital dysphoria include “anxiety, depression, feelings of emptiness, melancholy or crying,” according to Jill McDevitt , a sexuality educator and sexologist at CalExotics, an adult sex toy brand.
That’s precisely what Vásquez was experiencing. Though recovery from sexual trauma is rarely — if ever — a straightforward or predictable process, research shows that PTSD can largely affect both physical and mental health . That includes a person’s sex life.
Yet, the impact of PTSD on survivor’s sexual wellness is still largely considered a taboo topic, and oftentimes, health concerns related to sex and intimacy go unaddressed because of stigma.
Forty-six percent of women reported experiencing postcoital dysphoria at least once in their lifetime, according to a 2015 study by the journal Sexual Medicine, and a history of childhood sexual abuse was found to be the most important predictor. A history of physical abuse, emotional abuse and sexual assault in adulthood also appeared to be risk factors. Additionally, new research in the Journal of Sex and Marital Therapy shows that a history of childhood sexual abuse is associated with postcoital dysphoria in men .
Though postcoital dysphoria isn’t widely acknowledged, it’s a common and normative response to trauma, said Patti Feuereisen , the founder of GirlThrive and a psychologist who has worked with sex abuse survivors for more than 30 years.
Many survivors will dissociate, or essentially “tune out” at the time an assault is happening, Feuereisen said, and this feeling can linger long after the abuse is over. In fact, dissociation is one of the common symptoms of PTSD, which makes it more difficult for sexual assault survivors to feel connected to themselves, their bodies, their loved ones and the world around them.
Survivors may experience PTSD-related flashbacks during sex that can bring on post-sex blues.
“Postcoital dysphoria is more common among sexual assault survivors,” said Stefani Threadgill , a Texas-based sex therapist, “because memories of trauma are stored in the parts of the brain associated with survival — the amygdala and the hypothalamus — that can be triggered during a sexual experience.”
Experts agree that practicing self-care, both in and out of the bedroom, is a key component to overcoming the issue on a regular basis.
“You have to just stop at that moment ... do whatever sort of self-care that you do,” Feuereisen said. “Maybe your partner sits up and brings you a cup of tea. That begins to restructure and remap the experience .”
Remapping a traumatic experience — or reframing the negative situation into a positive one — can be empowering and healing.
One way to remap is by practicing intentional intimacy for 20 minutes or so with a partner or by yourself, Feuereisen said. Simply put, intentional intimacy is about setting aside time in a busy schedule to foster connection ― whether that’s sexual, emotional, physical or spiritual connection ― with one another or on your own.
“With intentional intimacy, it’s everything you want — you get to choose it. For survivors, it’s a wonderful thing,” Feuereisen said. “You have to relearn how to enjoy your sexuality. In order to be OK, you have to go through these feelings, [and] you can no longer dissociate from them.”
McDevitt takes a similar approach with clients experiencing postcoital dysphoria. “If the client wanted to feel joyful and relaxed after sex, we’d work to qualify what ‘joyful and relaxed’ means and looks like,” she said. “Then we’d backtrack, breaking down this goal into smaller and smaller steps.”
Summer,* a 41-year-old childhood sexual abuse survivor, lived with PTSD-related postcoital dysphoria for nearly 13 years. (She asked to remain anonymous so she can more freely discuss her mental health.) The condition left her feeling either “dead inside” or shaking and crying uncontrollably, she said. But much of her healing came through remapping her sexual experiences with a trusted loved one.
“Through time with a compassionate, loving and understanding partner, I learned to feel safe and valued,” Summer said, adding that it’s been around a decade since she last had a bout of postcoital dysphoria.
“I still struggle with postcoital dysphoria a great amount, and my intention is to accept the emotions, wait for the wave to pass and plan ahead,” Vásquez said. “Learning to cope with my postcoital dysphoria has definitely been a part of my trauma recovery.”
Dealing with post-sex blues doesn’t mean a survivor dealing with PTSD is broken or that they are “damaged goods.” It isn’t indicative of some moral failing. Experiencing postcoital dysphoria simply means they’re processing and healing, and that ― most importantly ― they’re human.
“The most important thing here is to remember that all of this is about you taking your power back if you’ve been sexually traumatized,” Feuereisen said. “When you work it through, you sometimes may have a moment where the postcoital dysphoria comes back, but they will just be moments.”
“Living With” is a guide to navigating conditions that affect your mind and body. Each month, HuffPost Life will tackle very real issues people live with by offering different stories, advice and ways to connect with others who understand what it’s like. In June, we’re covering trauma and PTSD. Got an experience you’d like to share? Email wellness@huffpost.com.

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Although it is not a requirement for diagnosing a woman with Post-Traumatic Stress Disorder (PTSD), about 90% of them report sexual dysfunction, according to Rachel Yehuda, Ph.D. at the conference for the International Society for the Study of Women’s Sexual Health (ISSWSH) I attended recently in San Diego. Many therapists who have clients with PTSD make the assumption that this shows up when women have “psychological” reasons to have low sexual desire and activity. They often think that if the traumatic event was sexual in nature (such as sexual exploitation or rape), of course there would be a sexual difficulty. But, it turns out that loss of libido is present regardless of the type of upsetting event that happened.
Yehuda went on to explain why. In the brain, the amygdala is involved in the emotion of perceiving an event. For example, one might think, “A tiger! I’m afraid!” But, also in the brain is the hippocampus which is involved in assessing the context of an experience. So, one would adjust one’s response but noting, “Oh, but this tiger is in a zoo. I’m safe.”
In the brain, substances called catecholamines affect what one thinks about a situation. Those thoughts can trigger distress. And, as it turns out, distress can trigger more catecholamines, which can trigger more thoughts and, in turn, more distress. Yehuda stated that if catecholamine levels are too high, this may result in what she called an “over consolidation” of memory and that leads to PTSD. This happens if the event is very distressing or if normal coping mechanisms are not engaged.
It’s difficult to engage “normal coping mechanisms” when an event happens that is highly unpredictable and cannot be controlled. These two factors contribute to the occurrence of PTSD. So, the overconsolidation occurs.
So, where does sex fit into all of this?
A woman who can think about a life event and say, “These things happen,” will not develop PTSD. But, a woman who after a life event says, “I’m not going to be the same,” will develop PTSD.
Women who have PTSD are in a state of being numb. They tend to avoid the feelings of general arousal (not sexual, but more what we think of as alertness and vigilance) because it takes them out of their numbness. That is stressful and exhausting.
Arousal (the sexual kind) is required for sexual interest and response, but it is very difficult for women to choose to be aroused since it requires that they not be numb. It can also bring them closer to the memory in the amygdala of feeling afraid. And, it turns out, they are lacking a safety context because during the stressful event, safety was very much in doubt for them. So, staying numb feels like a safer choice and that makes sex out of the question.
In addition to this dynamic, people with PTSD may also have sleep disturbance, medication side effects, chemical dependency and abuse, and other psychiatric conditions that do not easily predispose a person to choose to be sexual. All in all, sexual lack of interest caused by PTSD must be treated with an understanding of the brain structures and neurotransmaitters, the nature of sexual arousal’s similarities to general arousal, and other difficulties that can develop as a result of a traumatizing event.
I received an email inquiry about therapy yesterday from an Iraq War soldier and I have a hunch that I’ll be putting Dr. Yehuda’s ideas into practice.
I was raised in a very traditional Christian background where yoga was often considered to blend over into beliefs not aligned with my own ....
Stiffness. Pain. Swelling. Every day. The lab results bore out the symptoms I was facing, and I was not surprised in the slightest. My erythrocyte sedimentation ...
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Eur J Psychotraumatol

v.8(sup4); 2017

PMC5632782

Eur J Psychotraumatol. 2017; 8(sup4): 1351204.
Published online 2017 Sep 29. doi: 10.1080/20008198.2017.1351204

a
Department of Psychiatry, Academic Medical Center , University of Amsterdam and Arq Psychotrauma Expert Group , Diemen, The Netherlands

CONTACT Miranda Olff ln.avu.cma@fflo.m , Department of Psychiatry, Academic Medical Center , University of Amsterdam and Arq Psychotrauma Expert Group , Diemen , The Netherlands
Copyright © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Franci
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