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Tuesday, April 27, 2010

PTSD and Sexuality

this article is from The Post-Traumatic Gazette #29, copyright Patience H. C. Mason, 2000.
What did you learn about sex and where did you learn it? Did you learn it through words, actions, or unspoken messages? Did you learn sex was dirty? That only “sluts” liked sex and nice women didn’t? (Words define the speaker, in my opinion). Did you learn sex was necessary for proper physical functioning and “shouldn’t” have emotional content? Or that only love justified sex? Did you learn sex is fun? Or duty? Or that you should do it every chance you get with anything that moves of the opposite sex? Did you learn that sex was a power game, that seducing or even forcing others is a sign of strength? Did you learn that men forced sex on women because they have “needs” and women don’t? Perhaps you learned a good wife always has to give her husband sex? Or that sex is only for marriage, so if you are married you must have sex? These are common misconceptions and stereotypes.
Some effects of trauma:
Child sexual abuse, no matter how gentle, has an impact on children which most grownups cannot comprehend. Children are not interested in having sex. Children want to play and explore and grow, not do the same not-very-interesting thing over and over and over. They are young, immature, with short attention spans, and even if they want to please and aren’t being hurt, it is still the same kind of torture as sitting still in church or being lectured by your mom. Children endure it. Child sexual abuse is often physically painful. When the grownup is also violent and physically abusive, the traumatic effects are even more intense.
Children are interested in love, affection, and attention. Wanting closeness, attention and interest from a grownup are not the same as wanting sex. The betrayal of child sexual abuse is a high price to pay for getting natural needs met. Betrayal intensifies the traumatic effect of the experience.
A woman who was sexually abused as a child or raped as an adult may not enjoy sex, or even be able to take part in it. Women who survive other traumas like war also have problems: Sharon Grant, a Vietnam nurse wrote “By the time I bedded a man/who didn’t smell like mud and burned flesh/ He made love and I made jokes.”
Male survivors of childhood sexual abuse or adult rape may be burdened by shame. It says on the National Organization on Male Sexual Victimization site “To be used as a sexual object by a more powerful person, male or female, is always abusive and often damaging.” see Only recently has it become possible to talk about it. The rape of men by men in prisons caused Stephen Donaldson to found Stop Prison Rape, Inc. He was gang raped in jail after a Quaker “pray in” at the White House in the 70’s. He wrote, “The catastrophic experience of sexual violence usually extends beyond a single incident, often becoming a daily assault...[some] become rapists, seeking to `regain their manhood’ through the same violent means by which they believe it was lost.” ( Men who were sexually abused may not be interested in sex or may use it addictively or abusively.
Although there can be other reasons including high blood pressure medications, diabetes, and alcohol abuse—which all may be related to PTSD—PTSD can cause a loss of interest in sex in men who are not survivors of sexual abuse. Perhaps it is an unacknowledged anniversary. Perhaps something triggered a reaction, but men tell themselves “It shouldn’t bother me” (a numbing ritual), and the numbness extends into sexuality. A man who lost control in combat (or in the streets) and hurt people may lose interest in sex because orgasm is like losing control and unconsciously, he’s afraid he’ll hurt someone. Feeling guilt over not saving someone, or over things done in the war zone, may cause him to deny himself the pleasures of sex and love.
People who put their life on the line can feel so alienated from even their nearest and dearest that connecting sexually is almost impossible. After moving a rotted corpse or seeing a decapitated car accident victim, love and sex are from another planet. In CopShock: Surviving Posttraumatic Stress Disorder by Allen R. Kates, one cop mentions “the sexual, sleep and other dysfunctions,” that keep cops from going home, and another talks about occasional bouts of impotence from being on steroids. (Neither appears in the index however.) The book is a terrific resource, however partly because it lists about a million PTSD and law-enforcement/stress sites and all kinds of other resources.
For survivors of other trauma, especially what is called “duty related” trauma, veterans, cops, peacekeepers, EMT’s, firefighters, sexual dysfunction is not discussed except in jokes. At a workshop on Critical Incident Stress Debriefing, one EMT told a joke about condoms. The six pack for Protestants (Monday, Tuesday, etc, but not Sunday), the eight-pack for Catholics, (Monday, Tuesday, etc,. and twice on Sunday) and then the new 12 pack condoms just for EMT’s: (January, February, March...) The audience (EMT’s) howled with laughter.
During the interviews for my book, Recovering From the War, quite a few of the combat veterans I interviewed said that after a year of combat, sex was “inconceivable” or “impossible” for a period after they came back.
The myth that a real man always wants sex can tear up a survivor and partner when he doesn’t. How does that affect the partner? She may feel unloved, undesirable and full of shame. Learning that this is a common reaction to trauma takes the pain of personal rejection out of it. Unfortunately if a survivor doesn’t know this is a common reaction, he may think or tell his partner she’s no longer sexy because he’s no longer reacting the way he once did and doesn’t know why. This can be an extremely painful and scary experience for a man. He may find himself turning to prostitutes, pornography, or a new sex partner who makes him feel like a “real” man again.
If a partner is perceived as demanding sex, people with PTSD may resist the demands because they need to regain a sense of control over their lives.
On the other hand, a person who is dealing with traumatic experiences may use frequent sex as a way of numbing or avoiding pain. The intense adrenaline rush of sex with a new partner, of cheating on someone, or being newly in love can also serve this function. Men and women can become sex and love addicts, looking for the perfect mate who will fix them, or simply drowning their sorrows in sexual activity.
Traumatic experiences may also affect attitudes towards others. Hating the opposite sex, feeling that all men or women are abusive, homophobia based on child sexual abuse (which is pedophilia not homosexuality) can affect sexuality. Who wants to fool around with the enemy?
People who were sexually abused may feel sex is all they have to offer. It can become the focus of a people-pleasing lifestyle that has nothing to do with the person’s real feelings about sex. When the survivor begins to deal with sexual abuse, he or she may need to set limits on sexuality. This is very hard on the spouse. If you are with a person with PTSD it is important to distinguish between sex and love. Sex can be an expression of love, but it isn’t the only one. Taking a vacation together from sex can be a very loving act by the partner of a survivor.
Survivors of any kind of trauma may have to be in control to the extent that they can’t relax enough to enjoy sex or have an orgasm. Many survivors can’t feel loving or sexual feelings. Some, especially survivors of sexual abuse, can’t feel parts of their bodies during sex. They may be triggered by sexual activity, or triggered by specific words or actions during sex. This may lead them to avoid sex, or have scary reactions, flashbacks, crying and screaming, or trying to fight off their partner during sex. They may dissociate during sex, spacing out and not really being there.
Some people are aroused by acts or attitudes which turn out to be reenactments of childhood sexual abuse. Sex may be associated with power and control or pain. Love is pain.
A survivor’s life may be ruled by body image: The only thing I am is sexy, or I will hide my sexuality under layers of fat or huge clothes. Growing a layer of fat may signal to others, “I don’t have boundaries,” as can the big clothes. Skin tight clothes send the same message. Abusers pick up on it.
A survivor may also feel “I am not worthy so I’ll take anyone, no matter how badly they treat me. I deserve it.” If that is the message you are telling yourself, man or woman, I want you to know that you deserve to be treated by your nearest and dearest like a valued friend, with respect and consideration, in every area, but especially in lovemaking.
Solutions: I think it is impossible to find solutions to sexual problems until they are acknowledged and accepted as one of the common normal responses to trauma. The old idea of “shouldn’t be affected” tends to rear it’s ugly head here and combine with societal attitudes about sex as a contact sport so that it is difficult to see when fun becomes addiction. Sexual selectivity can veer into sexual anorexia, the person with no sexual interest at all. That is another signal that PTSD may be involved.
Sexual difficulties brought on by trauma can be a tremendous blow to a person, magnifying the trauma.
Sexual healing is difficult for those who have been sexually abused or violated. An experience which is by nature sensuous, sweet, and spontaneous has been affected by the perpetrator’s criminal behavior. God or evolution gave us sexual pleasure, so we were meant to be able to enjoy it. I consider sexuality a sacred part of being human. Sex can be a spiritual and emotional as well as a physical union. Enjoying all three aspects is the goal of sexual healing.
Many resources exist for survivors of sexual abuse and much of the information in them can be adapted for other trauma survivors. One excellent book is Wendy Maltz’ Healing Your Sexual Self which I just finished reading. Maltz has a web site at The book has inventories you can take and exercises to try which focus on being both safe and sensual. Taking your time and staying safe are emphasized.
Reading about sexual healing can be upsetting. If you become triggered, distraught, or have the urge to hurt yourself or others when you read about sexual healing, finding professional help is really important.
If you are triggered by sexual activity and want to heal, you can start by making a chart of safe, possibly safe, and unsafe sexual activities (see VOICES in Action Conference Report in Issue #25). One survivor whose safe list consisted of being touched on the right knee when she started therapy regained the capacity to feel safe and sexual one inch at a time, and you can, too.
Even if you were not sexually abused, making a chart of what is safe and not safe can help. If you use sex compulsively, and do things that endanger your life (unprotected sex), your freedom (illegal sex or having sex with drunken/drug-using partners, or pressuring people for sex), or a relationship you value (unfaithful sex) then they are not safe behaviors for you. What do these behaviors do for you? What are they doing to you? Are you becoming someone you dislike? If so where can you find help?
Perhaps you are not doing unsafe sex, but aren’t enjoying the sex you have. Another helpful idea is to listen to your body, which means being in your body, not off in your head or someone else’s head, worrying about what they might be thinking. This is called embodiment. In some senses it is like meditation. It takes practice and concentration to be fully present in your own body, focusing on what you physically feel. When you are embodied, you may also find yourself fully aware of what is pleasing to your partner, too. Awareness of these reactions may increase your pleasure.
Listen to your body. If you want to have sex but your sexual parts are not responding, what are they telling you? What are you trying to prove? Who are you trying to please? It is certainly not kindness or self care to force yourself to perform. On the other hand, as we age, sexual responses are slower. It takes more time and stimulation for older people of both sexes to get physically ready for sex, so more foreplay is helpful. The new anti-depressants can have sexual side effects as can blood pressure medications.
I suspect that as other PTSD issues resolve in therapy, some sexual problems may, too. Emotions that were unavailable to you when numbness prevented pain, like joy and closeness, return, improving sex. Talking and listening to your partner are important skills in any part of a relationship and even more important in this area where so much of our self-worth may be affected. As usual, I think using the word “I” is important. “I feel worthless when I don’t want to make love to you, and then I get angry,” is a lot harder to say than yelling “You don’t turn me on!” but it will probably have a more positive effect. “I feel sick when I smell liquor. It is like my step-father is crawling into bed with me all over again,” is better than “You pig!”
Al-Anon’s booklet Sexual Intimacy and the Alcoholic Relationship could be helpful couples dealing with PTSD. The New Male Sexuality by Bernie Zibergeld suggests ways of reconnecting both with your body and your partner. New books on sex come out all the time. Find one that helps you feel okay about yourself and leads you in the direction you want to go.
Acceptance (yes, trauma affected my sexuality, and that is normal for me) and time, combined with finding effective help, (therapy, books, groups) can heal this area of your life, too.
the end of the article.

To this I would add these resources: is a woman founded foundation which keeps a list of therapists for trauma survivors and publishes books and pamphlets.
In Gainesville Florida they have groups for sexual assault survivors at the local crisis center/victim services which are open to people no matter how long ago it happened.
If you want counseling, I recommend interviewing several counselors (free 15 minute interview, not a paid 55 minutes) and asking what experience they have had with sexual trauma survivors and how they proceed in therapy. When you find someone you fit with, then you proceed. It will hurt, but you survived the traumatic events and you can survive therapy.
Two relatively quick and non-intrusive therapies are EMDR and TIR (traumatic incident reduction) which you can google to find practitioners.
Please also go to and read the free handouts and check out the links.


  1. Hello, veteran of Vietnam and the 48th Assault Helicopter Company. Robert served with us or we with him. Loved the book. Used the GI bill for an education, now a retired college professor. The best thing I ever did in my life was teach a Vietnam War class. I'll never forget Vietnam but I have had a good life. Peace and welcome home

  2. Howdy! This post couldn't be written any better! Reading this post reminds me
    of my good old room mate! He always kept talking about this.
    I will forward this post to him. Fairly certain he will have a good read.

    Thank you for sharing!