PTSD and Sexual Dysfunction: the Role of the Dual Control Model
A calming and supportive image symbolising connection and togetherness in the context of PTSD and relationships.
Sexual dysfunction is a significant yet often overlooked consequence of Posttraumatic Stress Disorder (PTSD). For many individuals with PTSD, trauma can profoundly affect sexual health, leading to issues with sexual desire, arousal, and satisfaction. Understanding the underlying mechanisms of these dysfunctions, particularly through the lens of the Dual Control Model, can provide valuable insights into both the causes of sexual dysfunction in PTSD and potential avenues for treatment.
The Connection Between PTSD and Sexual Dysfunction
PTSD is known to affect multiple aspects of a person’s life, including their sexual health. Sexual dysfunction in individuals with PTSD can manifest in various ways, including decreased sexual desire, difficulties with arousal, and reduced sexual satisfaction. These issues are often intertwined with the core symptoms of PTSD, such as emotional numbing, hyperarousal, and avoidance behaviours.
Emotional Numbing and Avoidance: PTSD often leads to emotional numbing, where individuals become detached from their feelings and struggle to experience pleasure, including sexual pleasure. This detachment can result in decreased sexual desire and a lack of interest in sexual activity (Yehuda, Lehrner, & Rosenbaum, 2015). Additionally, avoidance behaviors—efforts to avoid reminders of the trauma—can extend to sexual situations, further inhibiting sexual functioning.
Hyperarousal and Anxiety: The hyperarousal symptoms of PTSD, such as irritability, anxiety, and heightened vigilance, can also interfere with sexual activity. Individuals with PTSD may find it difficult to relax and engage in intimate experiences, leading to difficulties with arousal and maintaining sexual interest (Tran, Dunckel, & Teng, 2015).
Sexual Dysfunction as a Symptom of PTSD: Studies have consistently shown a high prevalence of sexual dysfunction among individuals with PTSD, particularly in populations such as military veterans. For example, research indicates that 60-85% of male veterans with PTSD report some form of sexual dysfunction (Badour, Gros, Szafranski, & Acierno, 2015).
The Dual Control Model and PTSD-Related Sexual Dysfunction
The Dual Control Model of sexual response, developed by Bancroft and Janssen (2000), provides a useful framework for understanding sexual dysfunction in PTSD. This model suggests that sexual response is regulated by two systems: the Sexual Excitation System (SES) and the Sexual Inhibition System (SIS). An imbalance between these systems, particularly with an overactive SIS, can lead to sexual dysfunction.
Sexual Excitation System (SES): The SES is responsible for promoting sexual arousal and interest. However, in individuals with PTSD, the functioning of the SES may be impaired due to emotional numbing and reduced positive affect. These symptoms can diminish sexual interest and excitement, making it difficult for individuals to experience sexual desire (Bird et al., 2021).
Sexual Inhibition System (SIS): The SIS, on the other hand, inhibits sexual arousal and activity in response to perceived threats or negative emotions. PTSD-related hyperarousal, anxiety, and avoidance behaviours can enhance the SIS, leading to increased sexual inhibition. For instance, intrusive thoughts or flashbacks during sexual encounters can trigger the SIS, causing the individual to disengage from the experience (Bancroft et al., 2009).
Imbalance Between SES and SIS: In individuals with PTSD, there is often an imbalance between the SES and SIS, with an overactive SIS and an underactive SES. This imbalance can explain many of the sexual difficulties observed in PTSD patients, such as decreased sexual desire, difficulties with arousal, and reduced sexual satisfaction (Yehuda et al., 2015).
Treatment Implications and the Role of Comprehensive Care
Addressing sexual dysfunction in individuals with PTSD requires a comprehensive approach that considers both the psychological and physiological aspects of the condition. Treatments that focus solely on reducing PTSD symptoms may not be sufficient to improve sexual functioning. Instead, a more holistic approach that also addresses sexual health is necessary.
Cognitive-Behavioural Therapy (CBT): CBT can be particularly effective in addressing the cognitive distortions and avoidance behaviours that contribute to sexual dysfunction. By challenging negative beliefs about sex and working through trauma-related triggers, CBT can help individuals regain a healthy sexual response (Monson et al., 2012).
Mindfulness-Based Approaches: Mindfulness techniques, which promote relaxation and present-moment awareness, can help individuals with PTSD reduce anxiety and hyperarousal, potentially improving sexual functioning. These approaches can help individuals reconnect with their bodies and reduce the impact of trauma-related intrusions during sexual activity (Yehuda et al., 2015).
Sex Therapy: For individuals whose sexual dysfunction is closely tied to their PTSD, working with a sex therapist can be beneficial. Sex therapy can provide a safe space to explore sexual concerns, address issues related to sexual inhibition, and develop strategies for enhancing sexual pleasure and satisfaction (Bird et al., 2021).
Conclusion
Sexual dysfunction is a common and distressing potential aspect of PTSD, affecting both the individual’s quality of life and their intimate relationships. The Dual Control Model offers a valuable perspective on how PTSD symptoms can disrupt sexual functioning, highlighting the importance of addressing both the SES and SIS in treatment. By integrating sexual health into PTSD treatment plans, healthcare providers can offer more comprehensive care that addresses the full spectrum of challenges faced by individuals with PTSD.
References
Bancroft, J., Graham, C. A., Janssen, E., & Sanders, S. A. (2009). The dual control model: Current status and future directions. Journal of Sex Research, 46(2-3), 121-142.
Badour, C. L., Gros, D. F., Szafranski, D. D., & Acierno, R. (2015). Problems in sexual functioning among male OEF/OIF veterans seeking treatment for posttraumatic stress. Comprehensive Psychiatry, 58, 74-81.
Bird, E. R., Seehuus, M., Clifton, J., & Rellini, A. H. (2021). Dissociation during sex and sexual arousal in women with and without a history of childhood sexual abuse. Archives of Sexual Behavior, 50(4), 1551-1563.
Monson, C. M., Fredman, S. J., Macdonald, A., Pukay-Martin, N. D., Resick, P. A., & Schnurr, P. P. (2012). Effect of cognitive-behavioral couple therapy for PTSD: A randomized controlled trial. JAMA, 308(7), 700-709.
Tran, J. K., Dunckel, G., & Teng, E. J. (2015). Sexual dysfunction in veterans with post-traumatic stress disorder. The Journal of Sexual Medicine, 12(4), 847-855.
Yehuda, R., Lehrner, A., & Rosenbaum, T. Y. (2015). PTSD and sexual dysfunction in men and women. The Journal of Sexual Medicine, 12(5), 1107-1119.