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How PTSD Can Affect Sex (And What to Do About It)

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Editor's Note

If you’ve experienced sexual abuse or assault, the following post could be potentially triggering. You can contact The National Sexual Assault Telephone Hotline at 1-800-656-4673.

The first time I remember my post-traumatic stress disorder (PTSD) affecting me during sex, my partner threw me onto the bed and then I started sobbing. This is when I had to come to terms with the fact that the sexual abuse I experienced as a child still affected me as an adult. After learning more about PTSD, I realized it had been affecting me in many more ways during sex. All of the major symptoms of PTSD were also interfering with my sex life: detachment, dissociation, flashbacks, intrusive memories and mood instability, among others, each became present during sex.

• What is PTSD?

I have many examples of what it’s like to have PTSD during sex, but I didn’t realize my PTSD was bothering me at the time. Looking back, it seems obvious. For example, I struggled with dissociation/depersonalization/derealization a lot. I often stared up at the ceiling or off into space with a blank mind, felt separate from my body while I waited for it to stop, or saw myself have sex while being behind or floating above my body like a fly on the wall.

These are just a few examples of dissociation during sex. The other symptoms of PTSD can affect sex as well. For example, flashbacks and intrusive thoughts can cause major problems. I can be having a grand ol’ time until, suddenly, the way my partner touches me zaps me back to remembering one of the most horrific traumas of my life. Then, I have to try to push that out of my head and try to resort back to what I was doing as if nothing happened. In the case of sobbing when I was thrown on the bed, clearly that wasn’t possible. My partner was frightened to see me crying and not know why. I had to lie there for a while to recover from what happened because the flashback was so powerful. It helped to then share my story and talk about what I was experiencing; it gave the memory less power.

1. Flashbacks.

Flashbacks and intrusive memories are a major part of PTSD. It’s what most people think of when they think of PTSD, even though there are many more symptoms. Flashbacks are some of the most powerful symptoms, which means they can be devastating when it comes to sex. If I’m having sex and even for one second have a flashback where it feels as if I’m back to being sexually assaulted by my abuser, then it’s near impossible to be able to continue having sex after that. It’s incredibly disturbing, confusing, distressing and frustrating.

2. Detachment.

Sometimes during sex, I can start to feel emotionally numb, detached from myself or have trouble feeling pleasure. This is most likely another form of dissociation where I don’t quite feel like myself and I don’t know why or how to fix it. In my case, I try to just keep going and focus, but that’s easier said than done. Having trouble feeling pleasure is one of the most emotionally destroying aspects of having sex when you have PTSD because, for me, I’m not sure how much of it is caused by my body shutting down from previous abuse. These forms of detachment can make even wanting to have sex challenging because I will think I won’t enjoy it or that I’m broken and other self-defeating thoughts. Of course, all of those types of thoughts only make it worse.

3. Negative thoughts and beliefs.

Another issue with having sex when you have PTSD is that you can view sex in similar ways as the abuse. It’s common to think things such as that you are only there for the other person’s pleasure, that you’re a vessel or that you don’t have your own agency to say no to sex or certain acts you may be uncomfortable with. These thoughts can be extremely damaging psychologically. Personally, I have been buried in them. I will have sex when I don’t really feel like it, then end up being detached or dissociating, so then the sex isn’t great and it doesn’t work out for anyone. I don’t recommend it. It takes a lot for me to be able to turn down sex or say no to doing certain things. When I found the power to say no, it was incredibly scary, but also completely worth it.

4. Mood instability.

Another common symptom of PTSD is mood instability. Sometimes life can feel like an emotional roller coaster and I don’t always know why. When it comes to sex, I might want sex one minute but then something will happen and I’ll change my mind. This can be incredibly frustrating for my partner. I will want to have sex, but then something subtle might trigger me or I might have an emotional flashback or feel some negative thoughts about myself, and then it’s as if I become a completely different person. My mood changes and even if I say that I still want to have sex, it’s clear that I shouldn’t or that I don’t really want to. This can also happen during sex. My partner might say something or do something, maybe I’ll see myself in the mirror, or something will trigger me to have some negative thoughts and all of a sudden my mood will go into a downward spiral that I’m frantically trying to get out of.

How to Have Better Sex When You Have PTSD:

1. Mindfulness.

For a long time, I struggled with thinking I was broken and could never have a good sex life because of my PTSD and childhood sexual abuse. It wasn’t until I discovered how mindfulness can improve anyone’s sex life that I realized I could apply that to me. It’s even more powerful for people with PTSD or who have trouble focusing. I read a book, “Good Sex: Getting Off Without Checking Out” by Jessica Graham, that showed me how to be mindful during sex. It provided mindfulness/meditation exercises to try during sex. This was mind-blowing for me. For example, one exercise focused on paying attention to different sensations. This was great for when I was dissociating because if I felt myself drifting off, I could have something to focus on that would pull me back in. This also made my sex life way better because I was way more present than ever before. It also made me closer to my partner; we were closer and more connected to each other.

2. Relaxation.

Another important aspect that improved my sex life is relaxation. This may seem obvious, but to me, it wasn’t. During sex, I had the tendency to tense up my entire body. This makes it difficult to receive pleasure when your body is preparing to receive pain. I did more meditations to learn how to relax in general because I realized I was always tense, and it was just worse during sex. I also read another book, “The Survivor’s Guide to Sex: How to Have an Empowered Sex Life After Child Sexual Abuse by Staci Haines, and it included a section on how to relax your body to enjoy sex and even make it easier to have an orgasm. It works! It involves pushing your muscles out instead of holding them in, if that makes sense. That’s what worked for me, at least.

3. Communication.

The last major thing that helps my sex life is communication with my partner. It’s common knowledge to have open communication in relationships, but this means different things to different people and not everyone really follows through with it. My partner and I are completely open with each other. Being the partner of someone with PTSD is not easy. It can be emotionally draining, challenging, frustrating and even scary to see your loved one go through something and not really be able to make it better. The partner of someone with PTSD wants to have a healthy sex life too, and this can be difficult to deal with PTSD when they don’t have it but are only seeing the effects of it. I often think about how my partner sees how PTSD is affecting me but only from the outside, not knowing what goes on inside of me. I try really hard to communicate it, but it’s never the same. My struggles with PTSD during sex affect both of us, so I communicate why I’m behaving the way I am or what’s going on with me so she understands. I think this has brought us closer and also helped her understand PTSD better. It has improved our relationship which, in turn, has led to more intimacy and better sex. 

Having PTSD during sex can be challenging, to say the least. Flashbacks, dissociation, detachment, mood swings — all of these symptoms (and more) are not something I want to bring into the bedroom with me. I don’t want my partner or myself to be thinking about my past abuse when we want to have sex. So, I’ve tried a lot of different things to find a way to make our sex life better. What has worked for me boils down to mindfulness, relaxation and communication. Each of these things helps someone with PTSD in general, but when brought into the context of sex, they can make your sex life incredible. Mindfulness taught me how to stop “checking out” during sex. Relaxation taught me how to make my body physically ready to receive pleasure. Communication taught me the importance of bringing my partner on my journey with me because my sex life includes both of us. I am still learning new strategies to improve my life with PTSD, but for now this has been the most effective approach at healing my sex life and healing me as well.

Image via Zackary Drucker/The Gender Spectrum Collection

Originally published: January 30, 2020
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