The Secret Cause of Sexual Dysfunction: Trauma
After recording our latest episode of A Little Help for Our Friends, I sat with a heavy heart—but also with a sense of clarity. Jacqueline and I talked about something that comes up all the time in our work with trauma survivors, yet rarely gets named out loud: how post trauma stress disorder (PTSD) affects sex and intimacy.
It’s a topic that feels too tender for the DSM, too personal for most therapy sessions, and yet it lives in so many of our clients' homes and relationships in silence.
Here are some major takeaways from this episode:
Sex and PTSD: Why This Conversation Matters
We know trauma can affect the body, the brain, the heart but we rarely talk about how it impacts our sex lives. And it absolutely does.
I’ve worked with so many people who have experienced trauma, whether they’re veterans, survivors of abuse, or people who’ve lived through chronic emotional pain. Often, by the time sex comes up, it's framed as "something's wrong with me" or "my partner thinks I'm broken."
Because no, nothing is wrong with them. They're not broken. Their nervous system is doing what it thinks it has to do to survive.
Arousal Doesn’t Always Feel Safe
One thing Jacqueline explained so beautifully in this episode is that sexual arousal and fear-based arousal feel almost identical in the body—racing heart, flushed skin, emotional intensity. For people with PTSD, these sensations can be overwhelming or even terrifying because they can be associated to a traumatic memory when they were scared for their life.
So what happens when arousal starts to feel unsafe?
Often, people either avoid sex entirely, or they dissociate- numbing themselves just to get through it. Others might find themselves stuck in cycles of aggression, confusion, or shame, especially when past trauma gets tangled up with present desire.
None of this is about not loving your partner or not being attracted to them. It's about the body remembering something the mind can’t always control.
The Shame Is Real And So Unnecessary
One of the most painful things I hear in my practice is when someone says, “Why am I like this?” Or, “Why can’t I just be normal?” Especially when it comes to sex.
I get it. Our culture ties so much of our identity, especially for men and veterans, to sexual performance and desire. And when that changes because of PTSD, it can feel devastating. But here’s what I want everyone to know:
You are not broken. You are not alone. And you can heal.
What Partners Need to Understand
If you’re in a relationship with someone who has PTSD or other trauma symptoms and you’ve noticed distance, disconnection, or sexual withdrawal, it’s easy to feel rejected. Please hear me when I say: it’s probably not about you.
When people are trying to suppress trauma symptoms all day, it takes an enormous amount of mental and emotional energy. Sometimes, there just isn’t much left for closeness. And when intimacy feels physically unsafe, even the most loving partner can trigger fear.
That doesn’t mean we accept distance forever. But it means we approach it with compassion, not blame.
What Helps
Here’s what I’ve seen work—both in research and in real life:
1. Psychoeducation
Sometimes the most powerful thing we can do is name what’s happening. When people understand why they’re feeling disconnected or scared during sex, the shame starts to ease. We stop thinking, “What’s wrong with me?” and start asking, “What happened to me—and how can I heal?”
2. Evidence-Based Trauma Therapy
Treatments like Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) are some of the most effective tools we have. They help the brain reprocess trauma, so it stops responding to non-threatening situations (like sex) as if they’re dangerous.
3. Sex Therapy and Gradual Exposure
If sex is triggering, avoiding it forever doesn’t help—but jumping in too fast doesn’t either. Couples can work on slowly rebuilding intimacy, sometimes by taking penetrative sex off the table entirely and just exploring touch, eye contact, or being physically close again.
That’s exposure therapy, too. It teaches the body that arousal can be safe.
4. Partner Involvement
The best outcomes often happen when partners are involved in treatment- not to fix the trauma, but to understand it. When both people learn what’s happening and how to move through it, intimacy becomes possible again. Maybe even deeper than before.
Trauma Changes Intimacy But It Doesn’t Have to End It
I don’t believe trauma ruins sex for life.
Trauma can interrupt it or complicated it. With the right support, knowledge, and time, I’ve seen people reclaim pleasure. Rebuild safety. Rediscover desire. Not despite the trauma, but because they faced it, and grew through it.
You’re Not Alone
If you’re reading this and struggling with sexual dysfunction after trauma, or loving someone who is, please know that what you’re feeling makes sense.
And you don’t have to do it alone.
There are resources out there. Jacqueline and I mentioned a few on the episode, including:
PTSD Coach – a great free app for managing symptoms
Rebound – an app developed by trauma psychologists for exposure-based healing
Kulamind.com – my own practice, where we’re launching support groups and coaching for partners and individuals navigating trauma
I hope you’ll check them out. And I hope you’ll keep talking, learning, and leaning in.
Because sex isn’t just about pleasure. It’s about connection. And that’s something all of us deserve.
– Dr. Kibby
