April is Sexual Assault Awareness Month. According to RAINN, sexual violence and assault impacts 1 in 6 women and 1 in 33 men in the US every year. The aftermath of sexual assault results in what therapists refer to as “Big T” trauma which frequently seriously impacts sexual and emotional intimacy in romantic relationships. Many survivors find themselves struggling to regulate and communicate contradictory emotions as well as somatic shutdowns internally, which prevent them from experiencing authentic pleasure in their sexual lives. These struggles are common among survivors of sexual trauma. It is important to know that healing and reclaiming sexual pleasure is possible.
Understanding Sexual Trauma:
When a sexual trauma survivor experiences Post-Traumatic Stress Disorder, seemingly normal stimuli can cause them to feel as though their life is in imminent danger. Research shows that trauma may change the way the brain functions. Bessel Van de Kolk, a ground breaking trauma specialist, writes in his book The Body Keeps the Score that the frontal lobes in PTSD patients often don’t work properly. The frontal lobe (responsible for planning, reasoning, and decision-making) often shuts down in survivors’ brains so that the medulla (responsible for regulating many bodily survival functions) can react quickly to escape the threat of violence. This is essential to survival when a person is indeed being threatened.
With sexual trauma, any erotic stimuli can cause survivors to push their partner away in anger, go numb and disassociate (feeling as though the body and mind are separated), avoid the situation entirely, or grin and bear it through intimacy. These survival instincts automatically become triggered and are expressed by one or more of what trauma therapists call the 4 F’s:
- Fight
- Flight
- Freeze
- Fawn
What sex therapists treating both the survivor and their partner in couples therapy must provide psychoeducation on these neurological processes, and tell them it’s not the partner’s fault if the sexual trauma occurred in a previous encounter or relationship. Sex therapists will need to support both the survivor AND their partner who may not know or realize the full extent of the sexual trauma.
Reactions to Sexual Trauma:
Many survivors will dissociate during intimacy after their assault. Dissociation is often linked as a precursor to other PTSD symptoms that can continue to grow in severity. Sex Therapists assess and name what they call “spectatoring”, where survivors feel their psyche is floating above their body and watching the motions of sex but not feeling integrated pleasure or connection. While the body may respond physically to the stimuli by getting aroused and may even orgasm, the psyche and soul are not registering this as a body/mind/spirit integrated enjoyable experience.
Most survivors report that something is inherently broken inside them due to these experiences with partnered sex. Wendy Maltz, renowned sex therapist, discusses that the first step for trauma and sexual therapists to do is to help clients make the connection between their past sexual trauma and their present-day somatic reactions to intimacy. This can be challenging, as some clients may have suppressed memories or might not even identify their experience as abuse, assault or trauma. Any instance where sex is used to harm or control, rather than for mutual pleasure, can be considered non-consensual and/or assault. Sexual trauma and boundary crossings do not solely include sexual assault and rape in its definition. Voyeurism, obscene phone calls, stalking, financial abuse and sexual harassment are included in the definition of sexual trauma.
In order to move forward, one must understand the long-term impact that sexual trauma has on sexuality. Maltz’s book, The Sexual Healing Journey, has included many of the most common symptoms that survivors, no matter their gender, can experience: penetrative pain, Erectile Dysfunctions, Anorgasmia, and Delayed Ejaculation. Trauma symptoms can emerge at any time, immediately after the assault or many years later. It’s critical that sexuality-educated and erotically-informed trauma therapists educate their clients on these symptoms as potential consequences of past abuse while offering hope that survivors (and their partners) can learn skills to heal and thrive in their sexual lives.
How to Help Clients Heal from Sexual Trauma:
Sexual healing is a process of first identifying one’s somatic symptoms, learning how to calm the body’s alarm system after it has been triggered and letting a partner know that one needs some time to get grounded again. Beginning somatic regulation exercises can include mindfulness and meditation exercises like: body scanning, deep belly breathing, visualization and grounding through tightening and releasing parts of the body, all proven exercises in treating trauma. The wheel of consent, created by chiropractor, author and teacher Dr. Betty Martin (as seen here) is often one of the more intermediate and advanced techniques I utilize after survivors have learned the regulating exercises named above. In working with the wheel, therapists can teach survivors and their partners to break down any action into answering two questions:
- Who is doing the action?
- Whose pleasure is it for?
The “giving” quadrant represents touching someone else for THEIR pleasure. The “receiving” quadrant means you are allowing someone to touch you for your OWN enjoyment. The “taking” quadrant represents touching a partner for one’s OWN pleasure. The “allowing” quadrant is letting someone touch you for THEIR pleasure . Couples are invited to go back to foundational basics to fully understand each boundary, who an action is for, and the permission to pause to check in before requesting action and responding to a partner’s request.
By clearly naming and teaching survivors and their partners what the meaning and depth of each quadrant is, survivors can gain back power and agency around where their particular boundaries lie, what actually feels enjoyable, and the wide array of choices open to them. Recovery is indeed possible. Working with a somatically-trained, sexual-trauma-informed therapist is usually a recommended first step to addressing symptoms of dissociation, numbness, avoidance, and sexless relationships. This model can lead survivors to communicate more clearly, improve their somatic awareness, and create those mind-body connections that are crucial to healing and sexual pleasure.
