Why trauma survivors avoid sex

The following case illustrates how couples intimate lives may be affected by trauma. 

Baruch,  a 23 year old combat soldier recently married to Shira, served in the Israeli army. In the course of a mission, enemy fire injured three men in his battalion and two were killed. Baruch, who was inside his tank,  was physically unharmed, but the impact of the terrifying incident affected him intensely and he suffered from severe anxiety, flashbacks, nightmares, and difficulty sleeping. After six months, Baruch was diagnosed with PTSD. He underwent a year of intense therapy that helped him learn to recognize his triggers, self-soothe, and learn to keep calm in stressful situations. He was taking medication to help with depression and anxiety and was also exercising regularly. His wife, Shira, came with him to couples therapy, stating that while Baruch was doing much better, he was difficult to live with. He often became aggressive with her and avoided emotional or physical intimacy. When they did have sex, he would either not be able to get an erection, or become very quickly aroused and ejaculate prematurely, even before intercourse. 

Therapy for Baruch and Shira included psychoeducation based on explaining to them exactly how his trauma affects sex. Sexual desire involves parts of the brain and release of brain chemicals that are similar to those involved in the stress response. Our excitatory mechanisms cause the heart rate to increase and the blood to flow but our inhibitory centers let us know that even though our body is in a state similar to the flight or fight response, we have nothing to fear. People with PTSD lack that regulation. Once they experience sensations and a physiological reality that mirrors stress, they may experience a heightened fear response. Because Baruch experienced these responses, he was holding back on allowing himself to become aroused, which accounted for his erectile dysfunction. On other occasions when he would become aroused quickly and ejaculate just as quickly, he reported that he didn’t even feel anything. We understood that Baruch was simply disassociating from the act, though physiologically, his body was responding.

In the course of therapy, it also became apparent that Shira was anxious to become pregnant, and this was an additional source of stress for Baruch. Treatment for Baruch and Shira allowed each of them to communicate better about their feelings in the marriage, to understand one another better, and to create opportunities to improve emotional intimacy with compassion and empathy.  The sex therapy component was focused on restoring awareness of sensations and the experience of pleasure without demands on performance. After several months of therapy, while Baruch still suffered from the after-effects of his experiences in combat, he and Shira were able to recreate the intimacy that had been lost and enjoy making love, and not war. 

Join me in a two-part online course taking place this January. This course will highlight the mechanisms by which emotional and sexual intimacy may be incompatible with PTSD. To illustrate this, studies linking PTSD to sexual dysfunction will be reviewed, aspects of the neurobiologies of PTSD and the sexual response will be elucidated, and treatment suggestions will be offered for promoting healthy intimacy in couples where one partner is challenged with PTSD. 

For more information and to register, click here.

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