A doctor explains how to overcome the intersection of intimacy and PTSD.
By Sharna Striar
For many of us, an intimate relationship can be challenging. But for those with PTSD, it can often feel impossible. If you have experienced difficulty in your intimate relationships, sexual expression, or self-esteem, you are not alone: People diagnosed with PTSD have a higher risk of problems with intimacy than the general population.
The National Center for PTSD states that sexual problems experienced by victims of sexual assault and those with PTSD can leave the individual afraid of and avoidant of sexual activity. Experiencing an overall decrease in sexual interest and desire results in diminished sexual intimacy with your partner; it can leave you feeling ashamed, frightened, alone, and tormented by the fear of losing love relationships.
In my role as a psychotherapist and certified sex therapist, I have treated many men and women with longstanding histories of traumatic events that lead to difficulty with sexual intimacy. These individuals have come into my office distressed. Their presentation can include hypersexuality with random partners devoid of intimacy, addiction to masturbating to Internet porn, reporting phobic avoidance of touch and sexual activity with their partner, and even an overall numbness of sexual feelings. The stories are varied but frequent in the trauma they induce. “My uncle touched my genitals”… “The foster boy in our home locked me in a closet and violated me; I was 7”… “I saw women and children maimed during my tour”… “My Mom pulled my pants down and whipped me repeatedly”… “I was date-raped at 15 and then ridiculed by my peers”… “My panic attacks from my near-death experience keep me in constant fear.”
What these stories share is the way that trauma shifts one’s view of intimacy. The traumatic experience acts as a veil that often produces intrusive negative thoughts and images, limiting an individual’s capacity to trust, connect, feel, and engage in a healthy sexual relationship. The good news is it’s possible to restore the emotional and sexual pleasure in your relationship even if you have PTSD or experienced trauma. The process requires time, patience, and expert guidance.
I often hear “How can I recover? I want to be normal.” First, seek counseling, with a psychotherapist credentialed in sex therapy to work through the trauma in a safe environment. It is common for survivors of sexual trauma to grapple with feelings of guilt and shame. Counseling gently guides survivors to accept that the trauma was not their fault.
Second, step back into your body through a sexual retraining process of gradually learning to give and receive pleasure to help gain the capacity and desire for intimacy. People can be hesitant to embark on this process, but it is done slowly and at a pace appropriate for the individual. If the thought of beginning “sensate focus exercise” is overwhelming to you, the touching assignment can be visualized at first, guided by the therapist, while managing any anxiety and negative thoughts that may arise.
When you are ready, the next step is often to progress to a touching exercise by yourself, focusing and exploring sensations and reclaiming your body. At this point, your partner is typically introduced as part of the therapy process to re-establish rapport and mutual understanding. After that, you and your partner engage in progressive sensate focus exercises, focusing on sensations, and the “now.” These assignments may be frightening at first as you reconnect with your body, with sensual feelings, and to each other, but they are a path to reconditioning your mind and body to touch and pleasure.
It is essential to keep in mind an array of factors that may play a part in the treatment process. Relationship tensions, anxiety about sexual performance, attachment issues, depression, medical problems, and prescription medications can all influence the clinical process.
Healing is always a gradual process full of starts and stops, particularly for people with PTSD. Stay patient, connected, and, most of all, stay positive and be kind to yourself, building self-esteem and empowerment as you go. In my practice, I have seen many patients who suffer from PTSD-related sexual concerns reconnect with their partners, and have a fulfilling sexually intimate life.