PTSD, Emotions, and Sexual Dysfunction
Trigger warning: this article deals with some complex issues and may be emotionally activating and distressing. These issues would likely take a significant amount of time to address in therapy. Please consider your current mental state before you read this article. Practice self-compassion if you proceed and if you can relate to these issues, please hold hope that you can move forward and build a life through post-traumatic growth.
Note: ‘Sexual dysfunction’ is often a loaded term. There are numerous issues associated with sexual dysfunction, and it does not mean a person is broken. Not wanting to have sexual contact or behave sexually is not necessarily sexual dysfunction. Distress in relationships, in combination with experiences of personal distress and problems with physical sexual wellbeing are usually involved. All factors should be clinically considered if therapy or treatment are being pursued.
This image features a serene and calming abstract design with soft, muted tones and gentle light rays. The abstract forms represent emotions, symbolising the journey of healing and recovery. The image is intended to complement a blog post that explores the complex relationship between PTSD, emotions like shame and disgust, and their impact on sexual dysfunction, offering a sense of hope and compassion.
Introduction
Living with post-traumatic stress disorder (PTSD) is an experience that goes far beyond the immediate aftermath of trauma. For many, the ripple effects touch various aspects of life, including intimate relationships and sexual well-being. This article delves into the intricate relationships between PTSD, emotions such as shame and disgust, and their influence on sexual dysfunction. While the topic may feel challenging, it's important to approach it with compassion and understanding, offering insights and hope for those navigating these difficult intersections.
PTSD and Its Influence on Emotions
PTSD is a condition that often manifests after experiencing or witnessing a traumatic event. It’s not just about reliving the traumatic moment—PTSD can evoke profound emotional responses, including intense feelings of shame and disgust. These emotions are particularly prevalent in people who have experienced sexual trauma, but they can also arise in other forms of trauma, deeply affecting one’s sense of self and relationships.
Shame in the context of PTSD often involves a deep-seated feeling of worthlessness or inadequacy. It’s not uncommon for survivors of trauma to internalise the belief that they are somehow to blame or responsible for their experiences, leading to overwhelming shame (Yehuda, Lehrner, & Rosenbaum, 2015). Disgust, on the other hand, may manifest as a visceral reaction to reminders of the trauma, such as feeling dirty or contaminated. This emotion can be particularly challenging as it can trigger avoidance behaviours, further complicating the healing process.
The Dual Control Model and Sexual Dysfunction
To understand how these emotions affect sexual function, it’s essential to explore the Dual Control Model of sexual response. This model posits that sexual arousal and response are governed by two opposing systems: sexual excitation (the “accelerator”) and sexual inhibition (the “brakes”) (Janssen & Bancroft, 2007). For sexual function to proceed smoothly, there needs to be a balance between these two systems. For a more detailed exploration, read this article about the Dual Control Model.
However, for individuals with PTSD, particularly those experiencing intense shame and disgust, the sexual inhibition system often dominates. When the “brakes” are constantly engaged, it becomes difficult, if not impossible, for sexual arousal to occur. This can lead to various forms of sexual dysfunction, including decreased desire, arousal difficulties, and even sexual pain disorders (Bancroft et al., 2009).
Emotions, Sexual Inhibition, and Dysfunction
Shame and disgust are powerful activators of the sexual inhibition system. When someone feels ashamed, they may become highly self-conscious, which in turn makes it difficult to experience sexual pleasure. Shame can cause individuals to avoid sexual situations altogether, leading to a cycle of avoidance and sexual dysfunction (Byers, 2020).
Disgust, particularly in those with a history of trauma, can be even more debilitating. Disgust responses are often automatic and can be difficult to control. In sexual contexts, this might mean that even the thought of sexual activity triggers a disgust response, effectively shutting down any possibility of arousal (Borg & de Jong, 2012). For women, in particular, disgust sensitivity has been linked to higher levels of sexual inhibition and lower sexual satisfaction (Fleischman et al., 2015).
Trauma, Emotions, and Sexual Self-Esteem
Sexual self-esteem—how one feels about themselves as a sexual being—is often deeply impacted by trauma, shame, and disgust. For many individuals with PTSD, these emotions erode their sexual self-esteem, making it difficult to engage in or enjoy sexual activity. This can create a vicious cycle where low sexual self-esteem leads to further sexual difficulties, which in turn reinforces negative self-perceptions (de Jong, van Overveld, & Borg, 2013).
Women are particularly vulnerable to this cycle. Societal and cultural expectations around sexuality can exacerbate feelings of shame and disgust, leading to a pervasive sense of inadequacy or worthlessness (Peixoto & Nobre, 2016). Men, while also affected, may experience these issues differently, often related to performance-based anxieties rather than self-worth (Bancroft et al., 2009).
Addressing Sexual Dysfunction in PTSD: A Path Towards Healing
Understanding the interconnections between PTSD, emotions, and sexual dysfunction is crucial, but what can be done to help? The good news is that there are several therapeutic approaches that can offer hope and healing.
Trauma-Focused Therapy
One of the most effective treatments for PTSD is trauma-focused therapy, such as Prolonged Exposure (PE) or Eye Movement Desensitisation and Reprocessing (EMDR). These therapies help individuals process their trauma in a safe environment, reducing the intensity of negative emotions like shame and disgust (van Minnen et al., 2023). In theory, as these emotions become less overwhelming, sexual function could improve as well.
Emotion-Focused Therapy
Given the strong link between emotions and sexual dysfunction, therapies that specifically target emotion regulation can be incredibly beneficial. Emotion-Focused Therapy (EFT) helps individuals identify, understand, and manage their emotions, reducing the impact of shame and disgust on sexual inhibition (Fischer et al., 2022). By learning to regulate these emotions, individuals can break the cycle of avoidance and begin to reclaim their sexual selves.
Integrative Approaches
For many, a combination of therapies may be the most effective approach. Integrating trauma-focused therapy with sex therapy techniques, for example, can address both the emotional and physiological aspects of sexual dysfunction. Mindfulness and body-based interventions, such as yoga or somatic experiencing, can also be valuable in helping individuals reconnect with their bodies in a safe and positive way (Brotto et al., 2016).
Hope for the Future
While the journey to healing from PTSD and its associated sexual difficulties can be challenging, it is important to remember that recovery is possible. With the right support, individuals can learn to manage their emotions, rebuild their sexual self-esteem, and regain a sense of control over their sexual health. Therapy can help disentangle the web of shame, disgust, and inhibition, allowing individuals to move forward with greater confidence and peace.
Conclusion
The relationships between PTSD, emotions like shame and disgust, and sexual dysfunction are complex and deeply intertwined. However, understanding these connections can pave the way for more effective treatments and, ultimately, healing. By addressing both the emotional and physiological components of sexual dysfunction, individuals can work towards a future where intimacy and connection are not overshadowed by the past but are instead sources of joy and fulfillment.
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.
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.
Borg, C., & de Jong, P. J. (2012). Feelings of disgust and disgust-induced avoidance weaken following induced sexual arousal in women. PloS One, 7(9), e44111.
Bornefeld-Ettmann, P., Steil, R., Lieberz, K. A., Bohus, M., Rausch, S., Herzog, J., ... & Müller-Engelmann, M. (2018). Sexual functioning after childhood abuse: The influence of post-traumatic stress disorder and trauma exposure. Journal of Sexual Medicine, 15(4), 529-538.
Brotto, L., Atallah, S., Johnson-Agbakwu, C., Rosenbaum, T., Abdo, C., Byers, E. S., ... & Wylie, K. (2016). Psychological and interpersonal dimensions of sexual function and dysfunction. Journal of Sexual Medicine, 13(4), 538-571.
Byers, E. S. (2020). Relationship satisfaction and sexual satisfaction: A longitudinal study of individuals in long-term relationships. Journal of Sex Research, 57(2), 227-240.
de Jong, P. J., van Overveld, M., & Borg, C. (2013). Giving in to arousal or staying stuck in disgust? Disgust-based mechanisms in sex and sexual dysfunction. Journal of Sex Research, 50(3-4), 247-262.
Fischer, V. J., Andersson, G., Billieux, J., & Vögele, C. (2022). Relationship between emotion regulation and sexual function and satisfaction: A scoping review. Sexual Medicine Reviews, 10(2), 195-215.
Janssen, E., & Bancroft, J. (2007). The dual control model: The role of sexual inhibition and excitation in sexual arousal and behavior. The Psychophysiology of Sex, 15, 197-222.
Peixoto, M. M., & Nobre, P. (2016). Prevalence and sociodemographic predictors of sexual problems in Portugal: A population-based study with women aged 18 to 79 years. Journal of Sex & Marital Therapy, 42(5), 422-439.
van Minnen, A., Zoellner, L. A., Harned, M. S., & Mills, K. L. (2023). The impact of intensive trauma-focused treatment on sexual functioning in individuals with PTSD. European Journal of Psychotraumatology, 14(1), 2220830.
Yehuda, R., Lehrner, A., & Rosenbaum, T. Y. (2015).