Did you know that 89% of veterans experiencing PTSD report one or more kinds of sexual dysfunction? And that survivors of childhood sexual abuse have a very common set of negative feelings and beliefs about sex? That’s the bad news.
The good news: your marriage can become a place to help heal trauma — even through what happens in your most intimate moments.
In our previous post we asked whether trauma might be having an unseen impact on your marriage, and how you can identify and begin to heal this issue. Previous trauma can have a major impact on a marriage by damaging your ability to trust and open up to your spouse. It can also have a major impact on marital sexuality.
Like last week, we’re not trying to encourage anyone to make up something that isn’t actually there. But I believe that trauma is impacting more of our marriages than many of us realize. And one area the symptoms are particularly evident in is the area of sexuality.
We’re going to start by looking at how trauma impacts female and male sexuality individually. And then we’re going to show you how to improve your sexual relationship directly.
If trauma is affecting your situation or even if you don’t have any trauma that you’re aware of, the last half of today’s post is going to have some very useful teaching on becoming more conversant about your sexual relationship.
How Trauma Impacts a Wife’s Sexuality
Unfortunately, a common cause of trauma in women is childhood sexual abuse. And although this also happens to men, we do have a very useful study from 2012[i] that specifically looks at the impact of childhood sexual abuse on women’s sexuality.
Based on their review of the research, this study found that trauma impacts women’s sexuality in the following ways:
“Women with a history of CSA report more negative feelings about sex and experience less sexual satisfaction than do non-abused women[ii]”. I want to be clear: this is normal. I know when statements like this are made it’s easy to put yourself in the “damaged goods” category. But that’s not what this is about. It’s really helpful when we’ve been through something profoundly difficult like trauma to know that we’re not alone in our struggles. Finding out that this is a normal experience should normalize it. So you’re not crazy, you’re not the only person like this. The good news is that there is hope and recovery. So just stay with me here. The first take-home point is that it’s not uncommon to report more of these negative feelings.
Next, “Forming intimate adult relationships is often difficult” for survivors, and “when relationships are formed, sexual and emotional fulfillment is often lacking[iii]”. So if you’re listening today you may be listening because you want more from marriage — more from your relationship with your husband. That’s great!
Research has found that the most common sexual difficulties in survivors are “disorders of desire, arousal, orgasm, and less often dysarenuia (painful sex) and vaginismus[iv]”. Vaginismus is the term given to recurring, involuntary tightening of the muscles around the vagina whenever penetration is attempted, making sex difficult or impossible. So these are common issues that female trauma survivors face in the context of married sexuality.
What causes these sexual difficulties?
That’s a good question to ask. One common underlying factor is often that survivors of sexual abuse have been found to have “more negative self-schemas [ways of thinking about self] than non-abused women[v]”. When psychologists talk about schemas they are referring to our core beliefs- the things about ourselves and the world which we hold as irrefutably true. You can imagine that in intimacy when these deeply held negative ways of thinking about yourself are the dominant stories, it’s going to have an effect. It doesn’t matter how beautiful your husband thinks you are — you just can’t see yourself any other way. These messages are the main headlines running through your head and your husband’s opinion isn’t able to make the front page.
Here’s another quote from this research: “Meston and Heiman (2000) found that sexually abused women were more likely to use negative terms to describe themselves and less likely to attribute positive meaning to sexual behavior[vi]”. So you can see how this perception impacts sexuality. And how it would easily impact desire, arousal, orgasm and so on.
Listen to this even more specific observation: “Wenninger and Heiman (1998) found that women with a history of CSA perceived their bodies as less sexually attractive than did nonabused women and reported feeling angry at, and distant from, their own bodies during sexual activity[vii]”. So there I would see old protective mechanisms — ways of coping with abuse that are no longer needed — still kicking in and operating even though the new context of what is happening with your husband is actually safe and blessed by God and respectful.
So it really becomes about these beliefs that inform how you see yourself and how you see sex as you explore and engage in physical intimacy in your marriage. Abuse has created this view of yourself that you are unattractive and that sex is something dangerous rather than enjoyable, and shifting that mindset becomes really difficult.
How Trauma Impacts a Husband’s Sexuality
This study is a little different. No longer are we looking at childhood sexual abuse but now at PTSD in war veterans. So a very different kind of trauma.
Each veteran completed a marital satisfaction scale and a sexual dysfunction checklist. They found this:
“89% of PTSD veterans reported one or several kinds of sexual dysfunction[viii]”. That number shocked me.
“Among all the sexual dysfunctions, decreased libido and decreased sexual arousal, which is a result of decreased libido to some extent, were the most common problems (68.2 and 61.8%, respectively). Also, 41.8% of our subjects experienced premature ejaculation”[ix]. I don’t know why this is particularly an issue.
“22.7% of them are averse to sexual relations[x]”. This really shocked me. I typically think of veterans as almost defining manhood. A veteran is a man’s man and I know we all respect our service members and the sacrifices they make for the benefit of our freedom and our countries. We appreciate that so much.
But until I came across this study I was not expecting to see this significant of an impact in marriage. It just goes to show how serious trauma really is. That you can have something happen in a battlefield 5000 miles away and you come home and in bed things are not functioning as expected because of those traumatic experiences.
Overcoming Trauma’s Effect on Sexuality
Taken together, these two studies of husbands and wives show us that it is extremely common for different types of trauma to impact both men and women’s experience of sexuality.
Of course, sexual dysfunction can be embarrassing and often brings about feelings of deep shame. It is difficult to talk about and can leave people wondering, “What is wrong with me?” It’s hard to walk into a doctor’s office and say “I can’t get an erection” or “My husband can’t get his penis inside me.” That’s really personal territory.
But the good news is that if you are experiencing these issues, you are not alone. I hope there’s comfort there.
It is extremely common for trauma to impact an individual’s sexuality. And if you are experiencing any of these issues you are joined by many other people who have been impacted in the same way. Sexual difficulty is a common response to traumatic experiences. But hear this especially: there are ways to move forward.
Start By Working On Your Marriage Generally
So in moving forward: if you think about trauma, it takes a couple forms. In the context of CSA it’s a violation of human connection. As we saw last week, healthy marriage provides a beautiful corrective experience for this where connection and vulnerability are re-learned in a safe and loving context. In the context of PTSD in veterans, you’re looking at trauma that comes as a result of feeling profound overwhelm and distress with no real safe haven to retreat to. Again: healthy marriage provides a wonderful corrective experience for this.
These researchers came to the conclusion that individuals should engage in marriage counseling with the goal to reduce marital dissatisfaction. Their belief was that if the quality of the marriage improves, there will be a corresponding recovery from sexual problems and disorders [xi]. We’ve seen in previous episodes how the best sex happens in a healthy, loving marriage, so working on your marriage will naturally lead to better sex (among many other benefits!).
In particular, when it comes to males with PTSD, Ahmadi et al.[xii] note a “significant relation between sexual dysfunction and violence and anger. Violence and anger reduce relations between husband and wife and hence reduce libido.” So: if we can work on the violence and anger then we’re already moving towards improving the sexual relationship. What this means is that everything in the previous episode on how trauma impacts a marriage relationship applies here. All of the tools that were discussed to improve a relationship in the midst of trauma can be applied for the ultimate good of the sexual relationship.
So the first step is to address the overall quality of your marriage. Now let’s talk about the sexual part of the relationship directly. Here we’ve created a bonus worksheet that you can print and complete. It’s available exclusively to our much appreciated supporters. This worksheet helps you layout step-by-step safe touch exercises, which we’ll be looking at next. It’s something you complete together and then go through together to help you restore and renew this part of your marriage.
Restoring Sexual Intimacy
This worksheet helps you lay out step-by-step safe touch exercises, which we’ll be looking at next. It’s something you complete together and then go through together to help you restore and renew this part of your marriage.
Addressing Your Sexual Relationship Directly
So general marriage counseling can get you going in the right direction. If you’re new to the website, by the way, I am a marriage counselor and would be glad to help you. Of course, if you’re from a state that doesn’t allow qualified therapists from outside the state to practice with residents of your state, then I would only be able to offer you marriage coaching.
In any case, I want to follow the literature review study that we’ve been referring to[xiii], to look at what the research has to say about treatment for survivors of sexual abuse.
Based on their literature review, here are five ways you can improve your sexual relationship when one or both of you has experienced sexual dysfunction due to past trauma.
Understand what your partner is going through when you are having sex: as the non-traumatized partner, it is important for you to understand what is going through your spouse’s mind when you are sexually intimate. What is he or she experiencing?
For example, one study found that sexually abused women report “abuse flashbacks during sex; dissociative experiences during sex; distress, shame, and guilty about responding sexually; and aversion to specific sexual activities[xiv]”.
These kinds of very intense feelings and experiences are obviously going to impact sex in a big way, so you need to understand what connotations sex has for your spouse and what it means for them. Become aware of what your spouse is experiencing through good communication about what triggers them and what is OK.
Become equal partners in finding solutions: Colangelo and Keefe-Cooperman[xv] state that “it is not uncommon for the abused partner to accept blame for any sexual problems in the relationship.” So this means both of you have to look at becoming willing co-participants. This is an issue for both of you.
Neither one of you asked to be a trauma survivor. So the fact that just one of you has trauma does not need to mean that this same person is responsible to do all the fixing. Remember: marriage is a healing environment. That means this is a marriage issue, not just your problem.
This means that you both can move forward in finding solutions. In fact you’re going to have much more success in finding solutions if you are both engaged in the process, not just the trauma victim.
Engage in non-sexual safe touch exercises: Before engaging in sexual intimacy, it can be important to engage in non-sexual touching to develop and reinforce the marriage as a place of safety.
The worksheet available to our patrons will help you with this part. Engel[xvi] recommends engages in “safe touch” exercises “that help [partners] learn touch, communication, and boundaries by caressing hands”. This can be extended to other forms of caring safe non-sexual touch.
Engage in mutually agreed upon intimate touching: Once you’ve established the safe non-sexual touch, you can continue to move forward. So you as a couple can slowly move into more intimate touching at a speed that feels safe and comfortable to the survivor.
The goal of moving slowly is that it begins to “build positive associations to sex and sexual feelings. Proceeding slowly, never pushing, ensures that [partners] will have the time and opportunity to experience sexual desire, sexual curiosity, and sexual pleasure” in a manner that feels safe and does not trigger a traumatic response[xvii]. This is about gradually stripping away that belief that sexual intimacy is dangerous and frightening, layer by layer.
Develop a unique sexual style that works for your relationship: One way to consider the overarching goal in addressing your sexual relationship is that you are seeking to “develop a unique sexual style…that is both comfortable and functional[xviii]”.
This requires a great deal of communication and the willingness to engage in sexuality in new ways that work for your relationship. If you stop and think about this, you’re now doing what we encourage all couples to do: to find ways to creatively grow and explore your sex life.
Before we finish I just want to emphasize again: this is a progressive thing. Take your time. Go slow. Be patient with yourselves and with each other. What you’re doing here is you’re engaging in a process that takes this theoretical idea that marriage can be a healing place and you’re figuring out how to make it actually function as that on a day to day basis in the bedroom and in the rest of your time together too.
References[i] James J. Colangelo and Kathleen Keefe-Cooperman, ‘Understanding the Impact of Childhood Sexual Abuse on Women’s Sexuality’, Journal of Mental Health Counseling, 34.1 (2012), 14–37. [ii] Colangelo and Keefe-Cooperman. [iii] Colangelo and Keefe-Cooperman. [iv] Colangelo and Keefe-Cooperman. [v] Colangelo and Keefe-Cooperman. [vi] Colangelo and Keefe-Cooperman. [vii] Colangelo and Keefe-Cooperman. [viii] Khodabakhsh Ahmadi and others, ‘Sexual Dysfunctions and Marital Adjustment in Veterans with PTSD’, Archives of Medical Science, 2.4 (2006), 280. [ix] Ahmadi and others. [x] Ahmadi and others. [xi] Ahmadi and others. [xii] Ahmadi and others. [xiii] Colangelo and Keefe-Cooperman. [xiv] Colangelo and Keefe-Cooperman. [xv] Colangelo and Keefe-Cooperman. [xvi] Colangelo and Keefe-Cooperman. [xvii] Colangelo and Keefe-Cooperman. [xviii] Colangelo and Keefe-Cooperman.