How I Manage the Sexual Side Effects of PTSD

“What you are exhibiting are classic signs of PTSD,” my psychiatrist said during our session. Earlier that morning, I’d had an encounter with someone at work that left me rattled. I was having trouble dealing with the aftermath. As far as I knew, I had anxiety, not post-traumatic stress disorder.

I’m not a veteran, I thought to myself. I need a second opinion.

“What do you mean?” I asked. I was confused, but I was also curious to know why he thought PTSD was causing my symptoms. My psychiatrist said he believed I’d been misdiagnosed with generalized anxiety disorder and that the sexual assault I experienced as a teenager was still affecting me in my adult years. The insomnia, the constant night sweats, the splitting headaches, the muscle tension, the hypervigilance — those were all symptoms PTSD.

And PTSD isn’t exactly rare — 1 in 11 Americans are diagnosed with PTSD, and women are twice as likely to have this disability. Lucky for me, I had access to a mental health team to help me figure out a plan. I was prescribed gabapentin. I was advised to seek out cognitive behavioral therapy and build out a regimen centering high intensity exercise. And after some time, I could tell the plan was working. I was finally sleeping well, identifying my triggers and finding security through community. For the most part, my physical symptoms were under control, and I was feeling somewhat whole again.

But no matter what I did, there was one symptom that didn’t improve at all — my issues with sexual functioning. Sexual dysfunction is a little known and rarely discussed symptom of PTSD. In my case, I had a very low sex drive and difficulty climaxing. Every night I would hope my partner wasn’t feeling intimate either so I wouldn’t have to deal with the fact that I just did not want to have sex. On days where I felt motivated, I spent hours trying to connect with myself in a sexual way.

All of this was taking a toll on my relationship, and I wasn’t making much progress in this area of my life. It was frustrating — what was once a pleasurable experience was turning into a place of shame. No one understood what I was going through. When I looked over my care plan, I was surprised to see that my mental health team hadn’t collected much information about my sexual history, especially considering my experience with sexual assault.

I asked my team for help. Psychiatrists recommended additional medication to counteract the side effects of other medication, therapists recommended I see sex therapy, which is rarely covered by insurance, and the internet — well, it wasn’t helpful. I had to figure this one out on my own. Unsure of what to do, I started by having a conversation with my partner.

This was a real lesson in vulnerability. It is saddening to realize that you don’t have the type of sexual relationship you want with someone you love deeply. Even though my partner was understanding, I had no idea how long my symptoms would last, and I wondered aloud if I was letting him down.

Part of my journey towards sexual liberation through a PTSD diagnosis was finding alternate ways to be intimate. There’s an unfair expectation that everyone should experience sex in a certain order. Knowing that my partner and I could build a ritual of our own took the pressure off of me to be the perfect partner. We also took it upon ourselves to go to couple’s therapy, not sex therapy. My partner wanted to understand more about my PTSD and support me across all areas of my life. He wasn’t just interested in our sexual relationship — he was also invested in our emotional and physical relationship. This was a game changer.

Developing my own sensual rituals was also paramount. Every night for the last year, I prioritized a nighttime routine. Before I went to bed, I would dim the lights, turn on the hot water, light a candle, infuse lavender into the room and allow myself to just be. All the tension I was holding in my body seemed to wash away, and I much more open to sexual exploration. When taking time to masturbate, instead of focusing on the destination (climaxing), I would prioritize the journey. I carved out a process of self-pleasure. Watching porn, reading erotica, hanging out naked and daydreaming became my ways of coping.

Healing was very important to me. So many of us feel like we have to compromise our sexuality in the face of a chronic illness. But I needed to find a way to meet my sexual needs in the middle of a crisis. It was the only way I was going to make it to the other side.

Although I’m still working towards a complete recovery, knowing that I can be comfortable in my own body and experience sensuality in new ways has been profoundly liberating. I keep a journal where I note my daily moods and emotions around sex, and when I look at the data over the past six months, even though my healing journey hasn’t been linear, it’s clear that I’ve been improving.


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Varuna Srinivasan

Varuna is an immigrant bisexual South Asian woman. She writes and creates spaces around sexual health and reproductive justice. You can keep up with her at @drvarunasrinivasan.

Varuna has written 1 article for us.

10 Comments

  1. Thank you for sharing this! I’m so glad you were able to access things that contributing towards healing. I want to put out there for anyone else that might be reading this – I am a sex therapist, and insurance typically covers sex therapy exactly the same as it covers any other type of therapy services. If you are hoping a sex therapist can help you move forward from sexual trauma, please do not be scared off by worrying that insurance won’t cover it!

  2. I am so thankful to you, Varuna, for writing this. Thankyou to Autostraddle for publishing it.

    In my experience, there are very few published, authoritative resources available for navigating sex after sexual abuse (and PTSD).

    “This was a real lesson in vulnerability. It is saddening to realize that you don’t have the type of sexual relationship you want with someone you love deeply”. This resonated so strongly; in my case I found that leaving space to grieve the Could Have Been, and openly speaking this truth to my Significant Other, helped greatly. Despite hours of specialized therapy, I’m still incredibly angry at what is lost.

    “There’s an unfair expectation that everyone should experience sex in a certain order. Knowing that my partner and I could build a ritual of our own took the pressure off of me to be the perfect partner… my partner wanted to understand more about my PTSD and support me across all areas of my life. He wasn’t just interested in our sexual relationship — he was also invested in our emotional and physical relationship. This was a game changer”.

    My Significant Other invested in knowing my trauma. We began our relationship knowing sex may never happen and surrendering the expectation that it should. Instead, we invested heavily in enthusiastic consent for even the smallest gesture of physical intimacy – holding hands, sharing space, kissing + being kissed. Emotionally, they understand my trauma and the affects/effects it creates. We guide each other through, patiently, acknowledging the limits of our abilities to deal with it.

    Other things we have found useful as a couple:
    – Taking the sex survey available on Autostraddle.
    – Establishing The Leaving Rule: At any time my Significant Other/I can use this understanding/rule to immediately leave the situation or stop it (vocalising or through A Look). It is particularly useful when I find myself overwhelmed or unsafe. It makes me feel incredibly safe and seen; it allows my Significant Other to help me when I freeze or can’t muster enough autonomy to remove myself.
    – Establishing clear understandings around personal sexual activity. This included open discussion regarding masturbation/pornography/erotica/desire.
    – Complete honesty & No Means No. Practicing this in small, unrelated areas (no, I don’t want a cup of coffee) helped me to find my voice for the big issues. I trust my Significant Other, completely.

    I feel so fortunate that as my Significant Other and I have become more intimate, these new memories together are overriding my trauma and replacing them. It is painfully slow and often a case of regression after progression…but it is movement toward a brighter future.

    • Thanks for this comment. I didn’t knonw about the Autostraddle sex survey, so I will need to explore that.

      Also love your rules and how you and your significant other have worked together as partners through the process.

      It’s really quite beautiful what you have there….it made me tear up some…..thanks for sharing….all the best.. <3

      Christina

      • By the way, love your list of virtues:

        “Honest, hardworking, introvert, slow to anger, loves deeply”

        That sounds a lot like me especially the honest, introvert, loves deeply parts…..hardworking / slow to anger – maybe I need to still work on…. :)

  3. Varuna, thanks for sharing your intimate story and journey towards wellness and happiness.

    I can relate personally to a number of your stops on your journey and like you….I am still treking forward toward full wellness…..

    Years of taking anti-depressants have wreaked havoc on my sexuality…I too found the journal very useful…and is now an essential routine first thing in the morning and at end of day…..

    Wishing you all the happiness and love you deserve….

    <3

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