Ep. 142 - Sex After Trauma: How PTSD Affects Sexual Intimacy
The invisible connection between trauma and sexual intimacy affects countless relationships, yet remains largely hidden in silence and shame. In this episode, we dive deep into why PTSD creates significant barriers to healthy sexual function—even when the original trauma had nothing to do with sex.
Sexual arousal shares remarkable physiological similarities with threat response, creating a devastating paradox for trauma survivors. The racing heart, flushed skin, and heightened sensitivity that should signal pleasure become warning signs of danger to a traumatized nervous system. Beyond the physiological responses, trauma rewires our capacity for connection. Partners often interpret this withdrawal as personal rejection, creating a destructive cycle that leaves both feeling isolated and misunderstood.
If you or someone you love struggles with trauma's impact on intimacy, know that recovery is possible. Effective trauma treatment can help break the association between arousal and threat. Partners play a crucial role by educating themselves about PTSD, creating safety without enabling avoidance, and maintaining patience through the healing process. Digital self-help resources and specialized trauma therapy can provide accessible starting points for reconnecting with your capacity for intimacy after trauma.
**Have you noticed how trauma affects your relationships? Healing happens when we break the silence around these struggles. If you walk to talk through it and get help, book a call with Dr. Kibby.
Resources:
If you have a loved one with mental or emotional problems, join KulaMind, our community and support platform. In KulaMind, work one on one with Dr. Kibby on learning how to set healthy boundaries, advocate for yourself, and support your loved one. *We only have a few spots left, so apply here if you're interested.
Follow @kulamind on Instagram for science-backed insights on staying sane while loving someone emotionally explosive.
For more info about this podcast, check out: www.alittlehelpforourfriends.com
Follow us on Instagram: @ALittleHelpForOurFriends
-
Speaker 1: 0:00
Hey guys, welcome to A Little Help for Our Friends, a podcast for people with loved ones struggling with mental health. Hello, little Helpers. So some of you may know that I have worked at the Bronx VA for the last eight months, and so I have been steeped in trauma training, and today I wanted to bring a topic that I think is really interesting and not talked about enough, which is the effect of PTSD on sex. So, um, kibbe and I love talking about interpersonal topics, romantic topics, and this is one that is so hyper-relevant to PTSD, but it's not even a symptom of PTSD, like it's not a diagnostic criterion, um, and so I think a lot of people who maybe are in relationships with people who have experienced significant trauma or who have PTSD themselves, can be extremely confused about why they are experiencing so much sexual dysfunction. So that's what I want to talk about today, but I'm going to kick it over to Kibbe to talk to us about Glow Mind.
Speaker 2: 1:14
Thanks. I'm really excited about this topic because trauma we've seen can really affect everything. It could affect your health, could affect self-esteem, the way you see the world. Your health could affect self-esteem the way you see the world right. It really has such profound effects on someone and we've been really seeing it in relationships, whether it's like anger issues or just problems with trust or intimacy and I know that the sexual intimacy is something that's really impacted by trauma. So I'm really excited to hear from you all about this.
Speaker 2: 1:45
But if you have a loved one who has experienced trauma and you don't know how to help them maybe it's been tough on your relationship or vice versa you have a trauma and it's affecting your relationship let us know. We'd love to figure out ways to help you. I have a few spots for individual coaching in skills about emotion, regulation and communication and setting boundaries and working through the trauma in order to connect to your loved one or just support yourself. And also we have this amazing community and, because we've been listening to what you guys want, we're going to start a group, so like a weekly class on all these topics so we can learn from each other and in a really safe and supportive environment. So if you're interested in any of that, check out Kulamind K-U-L-A-M-I-N-Dcom, or there's a link in the show notes for how to book a free 30 minute call just to chat with me about what you're going through and what you might be interested in.
Speaker 2: 2:51
So we also want to do a shout out to some of you who've written us messages through the show notes, like where it says send us a text. We got a lovely message. We've got a bunch, but we got a lovely message from someone who said she's a teacher and she has listened to our episodes, has really helped her go through a really hard time, and that those kind of messages mean the world to us. So whoever wrote that, I mean we you know, annoyingly we can't write back on that feature, so just know that we really appreciate it and this is why we do what we're doing to help people like you. So please send us notes and thank you so much for listening and being part of our community. So thank you, teacher.
Speaker 1: 3:33
Thank you, teacher. So there's so much to talk about here because practically every symptom of PTSD can be related to sexual dysfunction in some way, and I think when most people think about sex and PTSD, they're thinking about sexual assault in particular. But what has actually been found is that the presence or absence of PTSD is actually the more proximal cause for sexual dysfunction than trauma type. Yeah, so that means that somebody who has been sexually assaulted but does not have PTSD is has a lower likelihood of having sexual dysfunction than, like, a combat vet with PTSD. Obviously, if somebody has both sexual trauma and PTSD, then that's another story, but the presence or absence of PTSD is really crucial here For people who might not know what PTSD is.
Speaker 2: 4:36
can you go through some of the hallmark signs of post-traumatic stress disorder?
Speaker 1: 4:44
yeah, so they're. They're basically symptom clusters. So one symptom cluster is um, basically like intrusive, like intrusive um memories or kind of re-experiencing. So people who basically it's kind of like you're just going through your day and these memories of the trauma keep kind of intruding on your awareness that you're in. You're trying really, really hard to, you know, just to get through your day, but you're, but you're constantly kind of ambushed by these thoughts or feelings. You may all of a sudden feel similarly to how you did when the trauma took place.
Speaker 1: 5:21
Um, you may have triggers that remind you of what happened, and they they're not necessarily direct triggers, like if, if there was a fire, you know, you might actually be triggered by being on the subway, even though there was no subway in the fire catastrophe that you were in. It's just the feeling of being potentially trapped or having a lot of people around or something like that. So then there is this avoidance symptom cluster, so where you're really trying to do anything you can to kind of keep away from the trauma. So this might mean you avoid those triggers, but it also might mean that you avoid any kind of like physical state that reminds you of the trauma. So you might avoid being like, um, really like, uh, emotionally, like aroused, physically, you know, aroused, which we'll talk about as relevant to this. Um, you might be doing a lot of mental work to try to constantly distract yourself from these memories or these feelings.
Speaker 1: 6:26
So, um, this is when you'll get people who can be very kind of numbed out or have difficulty concentrating because, um, basically, like, if I do an exercise with you right now, like, hey, kibbe, how many times in the last month have you thought about a big yellow Jeep? How many would you say Zero, okay, cool. Last month, have you thought about a big yellow jeep? How many would you say zero, okay, cool. So for the next 10 seconds I want you to do, to think about whatever you want, but not about a big yellow jeep one two, three, four, six, seven, eight, nine, ten.
Speaker 1: 7:02
Did you think about a big yellow Jeep? I did, okay, how many times? Twice, twice, okay, the rest of the time, what were you doing?
Speaker 2: 7:11
I was trying to focus on your face and and I know the trap of like I'm like I'm looking at her face, so I don't think about a big yellow Jeep. And then I was like, ah right, I thought about it.
Speaker 1: 7:26
So when we have, when we have people who are constantly trying to avoid thinking about something, two things happen. One, they think about it more, and the other is they put so much effort into not thinking about it that they're kind of constantly distracted. Like if you were to, if you were to do a math problem while trying not to think about the big yellow Jeep, while concentrating on my face, that would be very difficult. Right, you've got this one strategy of concentrating on my face to keep you away from the big yellow Jeep. It's going to be hard for you to then concentrate on anything else. So you also see that their worlds become smaller because they're avoiding trauma triggers. They're avoiding any place that might make them feel the way they did when they were traumatized.
Speaker 1: 8:10
Another symptom cluster is like hypervigilance, arousal. So you might see that somebody with PTSD gets. They go from like zero to 60. So they'll be kind of walking around to do and suddenly they're fucking mad or they're freaking out or they're really stressed out, and the reason is because they're not going from zero to 60, they're going from 40 to 60. So that means that they are kind of constantly in a state of arousal, hypervigilance.
Speaker 1: 8:42
They're kind of always got this like irritable edge to them, um, because it's taking so much work to detect threat everywhere and to keep themselves safe and to, you know, not think about certain things. It's just it's it's kind of throwing the body out of whack a little bit and so they can have they can be very easily startled, um, looking around like um like looking over their shoulder, kind of constantly, this constant kind of low level irritability, that kind of thing. And then beside that you've got kind of this like negative beliefs cluster so people can start to really blame themselves or blame the world for what happened, kind of seeing themselves as inherently dirty, shameful, guilty, worthless, or the world as like a totally dangerous place. And then so these beliefs can really kind of take you as well, because you're just thinking such negative things all the time and you're viewing yourself and the world and others in such negative ways. So it's a really tough disorder and all of those symptom clusters can influence your relationships and then also influence sex.
Speaker 2: 10:05
Got it, got it.
Speaker 2: 10:09
This is kind of going off topic, but I'm wondering, now that you're learning so much about PTSD and trauma, but yet now these days, our idea of trauma has really expanded right so like you know, some people have like capital T, capital T trauma of like they were in a war and some people were, you know, have had years of criticism from their family and they also have trauma symptoms or feeling like they've been traumatized. Can you have you learned any any more more about you know, like what, how we understand trauma these days? Because it's now kind of now it's, it's kind of everywhere. It's like everything that's stressful and painful is called a trauma, and now I hesitate to say what's a trauma and what's not a trauma. But like what are your thoughts on that right now? I have a bunch of thoughts.
Speaker 1: 11:02
So one thing you need for a PTSD diagnosis is what we call a criterion, a trauma, and that is I'm not going to go into like everything that that could possibly be, but generally what you're looking for is that you have gone through an experience that was terrifying or horrifying and that made you feel powerless, out of control and like your life was threatened. And what often happens when people come in for trauma treatment is that they can feel invalidated or the therapist can feel like they are invalidating by saying no, your experience of emotional abuse, for instance, or neglect, or your even your child dying from cancer, is not a criterion, a trauma you wouldn't meet for PTSD. And what's important to note here is that criterion a should not be understood to mean worse, like watching your child die of cancer is likely to be the worst thing that can ever happen to you, worse than being sexually assaulted, for instance. Obviously not saying everybody, but we're really not trying to categorize traumas as like better or worse, or more severe or less severe.
Speaker 1: 12:26
It's really about what kinds of traumas are going to lead to PTSD symptoms Other kinds of traumatic experiences can lead to other symptoms, um, but PTSD like it's, you're probably not going to have those hyper arousal symptoms and hypervigilance symptoms from watching your child die of cancer, because that was like a slow process right, where you're terrified of losing her but you're not terrified in the same way. It's not this like ambush of terror and, like you know, I don't know whether I'm going to live or die, I don't know what's happening to me, I'm completely thrown out of control. It's just a different kind of like emotional process, um, and so it's going to lead to different symptoms. So like having PTSD does not mean that your trauma was worse or better. Um, another kind of thing is I'll talk like when we think about like early childhood and validation, right, right, so like what's going to lead to something like bpd. Bpd and ptsd are certainly like comorbid a lot of the time, but that kind of like persistent, pervasive, like invalidation through childhood might lead more into something like a personality disorder than again that kind of like hypervigilant, um, you know, or like numbness or just basically what you'd see in PTSD.
Speaker 1: 13:53
And the third thing is that you can have a criterion, a trauma, without developing PTSD, and the major kind of understanding of that is like, let's say, you know you were like shot at in war, like some. Basically, when you, when most people, go through a trauma, like a criterion, a trauma, they're going to experience symptoms of PTSD during that first month or so, but it's not PTSD. That's why it actually we don't give a PTSD diagnosis until like 30 days have passed, and the reason is because it is not pathological for after you've been traumatized, to be attuned to threat and to not want to think about it and you know to have negative beliefs. So the difference is that what makes it pathological quote unquote is that it doesn't recover. So most people they undergo a criterion, a trauma, they're able to recover because they're able to process the experience of it. They have loved ones who support them, they can cry, they're held, they get to feel safe, they get to talk about it. So they basically go through this recovery process.
Speaker 1: 15:18
The people who develop PTSD typically were prevented from going through that and it's one of the reasons you see it a lot in veterans, because when you're at war there's no time to process your trauma. You have to keep going and you know like the military is very, very good at meeting the aims of the military, but it's not very good at turning out healthy civilians because the military has really really different goals and needs than civilian life does. So one thing you'll hear from veterans constantly is they went through this trauma and they were told get over it, it's not that big of a deal, you've got to move on, push it down, shove it down, do whatever it takes, keep going. And they and that's because they have to, because who's going to give you a hug? Who's going to let you fall apart? Right, you can't do that in active combat, and so they are prevented from going through that recovery process and then they come home and they have PTSD.
Speaker 2: 16:18
So sad, and also why invalidation after something like rape is such a problem because what you really need after sexual assault is to be believed and heard. Symptoms can affect relationships. Intimacy and sex is what we're talking about Like. How does it affect relationships like broadly?
Speaker 1: 16:52
Yeah, I mean.
Speaker 1: 16:53
well, the way it affects relationships is, I mean, I'm sure, not all in one way, but I mean, I think it'd be hard for PTSD not to affect relationships, because if you're fundamentally spending all of your time trying to squash down any triggering memories, then how connected can you be? Right, so I'll just start with the symptom cluster. Which one should I start with? Let's do hyperarousal. Which one should I start with? Let's do hyper arousal. So they're all kind of interconnected.
Speaker 1: 17:27
But basically, if you look at sexual arousal and, um, like, like threat, like threat arousal, ptsd kind of arousal, they look very, they're very similar processes. So you might get someone who finds a beating heart and a flushed face very threatening, because that is how, that, that those were the physical symptoms they had when they were traumatized and any kind of sense of arousal. Right, and we know, like I mean, there are experiments where if you, if you have like a participant, watch a video of like a rollercoaster or do like a VR on a a roller coaster, they'll like be hornier after like there'll be, you know. So like the there's a cross-contamination between just like regular emotional arousal and sexual arousal. But for these people this is kind of complicated because in a sense they're always emotionally aroused but they're also always trying to avoid being really emotionally aroused and so getting into like sexual arousal itself can be, can feel really threatening. They start having all of these physical symptoms that were associated with threat and danger. And the other thing is that sexual arousal requires it's kind of like a bell curve. So it requires like a certain amount of arousal, a certain amount of norepinephrine, a certain amount of like limbic system activation, but once you get past that, then it's an inhibitory.
Speaker 1: 19:13
So you know, this is like we see this when, um, we think about the, the model of the dual control model. So if you've got like you've got breaks and the gas pedal with sexual desire, and if you've got too much on the brakes, meaning like if you're too stressed out, if you're too tired, um, if you're too angry to whatever, like you're not going to want to have sex, those are like the breaks. But at the same time you want like some excitement, some novelty, some fun, some arousal to get it going. And this gets all screwy in people with PTSD because they go from 40 to 60 so easily.
Speaker 1: 19:56
So, a, there's kind of like this fear associated with getting aroused in the first place, and, b, they risk getting too aroused, not too sexually aroused, but to just like hyperactivated, basically to a point where then they're disinhibited again. So if you, you know like, for instance, sexual arousal requires, you want activation of the limbic system, so that's like the emotional center of the brain, but you don't want the amygdala, which is part of the system. You don't want that to be firing off too much. When you have PTSD you've got an amygdala that's extremely sensitive.
Speaker 1: 20:30
So, when that limbic system gets activated, so will the amygdala gets activated, so will the amygdala, and so again. So you're like with when you have PTSD you're working with such a fragile and sensitive bell curve here of okay, I have to get aroused, but that's threatening. And then as soon as I feel that's threatening, then I'm likely to go over overboard and then I'm disinhibited again.
Speaker 2: 20:52
Interesting. So what, what is has? What does this look like, either in your experience or the people you worked with, where people have PTSD or trauma and then they, you know, are at risk for you know, feeling really complicated about feeling aroused.
Speaker 1: 21:13
Yeah, well, I mean I'm trying to think it hasn't been as much of a topic of conversation, but that could be for a variety of reasons. I mean, one thing I've seen is sex becoming uh I almost want to answer this question later Um, sex can become kind of associated with like conquering and aggression.
Speaker 1: 21:39
And the reason for this is so just what I just talked about right, that these systems of arousal are so linked, is that you know how, like in the in old, like in medieval times, whenever there was a war, there would be like a lot of raping and pillaging. This is likely partly because it's actually extremely common to have an erection or be sexually aroused when going into a threatening combat situation, because your general arousal is so high.
Speaker 2: 22:15
So no way, I mean, that makes total sense.
Speaker 1: 22:18
But yeah, oh my God, my supervisor was talking about, um, a patient had said like we would all point to each other's like boners on our way, like to combat, like kind of making fun of each other. Um, because, yeah, because you're in this like state of arousal that's so similar to sexual arousal and this can do a couple of different things Like.
Speaker 2: 22:44
One is it can associate sex with aggression, pillaging, conquering right, and that is a very different emotional experience than you necessarily want to have with your girlfriend or your wife and it's probably definitely different than what she's looking for, except in certain exciting exceptions okay, that's so like sad and disturbing, but also really helpful, because I was wondering if that there's some mixing like if there's some mixing of aggression and violence with sex, because there's some times where I really think to myself like why would anyone rape someone else?
Speaker 1: 23:28
Like.
Speaker 2: 23:28
I, just I. That is so far from anything that I've felt before and I'm a very like aggressive. You know me like. I'm really an intense aggressive, like woman. But the idea of sex like fundamentally doesn't, like it doesn't make any sense to me, right. And I want, like you were saying, that someone going into war and like a battle situation would be sexually aroused. But I wonder if the sexual arousal then would be tied to this feeling of violence, so people might get aroused by the idea of hurting someone else, exactly.
Speaker 1: 24:04
Well, right, and this is extremely complicated. So one thing is that we find in PTSD they have higher testosterone and lower oxytocin. So already you see, like if you're with your wife and you've got high testosterone but low oxytocin, so already you see, like if you're with your wife and you've got high testosterone but low oxytocin, that is likely to be a situation where you may be more like sexually aggressive, but feel lower intimacy, trust and connection, um. But the other problem is that it's not like these men are, are monsters, right? They get maybe sexually aroused by this, and I'm not saying they're getting sexually aroused by dead bodies or anything, but it's just like going into combat raises the arousal level and like being kind of, like being in a situation of threat, like sharpens, sharpens everything right and like increases blood flow, yada, yada, yada. Um, they don't want to associate sex with violence. So this thing can happen where they get very, very confused and ashamed by the fact that there was any kind of sexual arousal during these situations and then they start, um, not wanting to do it right, because they're like who am I Like? Why am I feeling this way? This is so fucked up and I really don't want to associate the girl I love or the guy I love, you know, with this.
Speaker 1: 25:26
So, um, you know, and that's probably very hard to explain to your civilian partner of like, yeah, I experienced sexual arousal in con, like while doing or experiencing like horrific things. It's hard for your partner to even understand that. And so we see the sense of disconnection that people with PTSD have from their loved ones and from other people, where and this you know, this happens for multiple reasons. Like one, lowered oxytocin means that it's just hormonally, like, you're less connected and intimate, um, but b, it's like, how can other people even understand what I'm, what I'm going through? And then c, right, like all of the mental energy it's taking to avoid trauma reminders, um, so there's just this kind of a lowered sense of like, intimacy in general and a lot of beliefs about like, what does it mean about me that I've experienced sexual arousal? In these contexts, you know, when you get this, a lot with, like, with like rape survivors too, right, like, a lot of rape survivors experienced sexual arousal while it was happening and this is really, really triggering for them and shameful for them.
Speaker 1: 26:35
But it makes sense, right, because the brain and the body are very connected, but in some ways they're not always connected to you, your observer self, like your higher order self, and what's happening to the body during rape is its threat, its threat response is heightened. There's heightened arousal in general and also their sexual content. That's happening, arousal in general and also their sexual content. That's happening, um, and the body is kind of primed to respond to that. Um, and there are even potential evolutionary explanations, like it is just safer to become aroused when you are being assaulted from a lubrication perspective, from a cooperation perspective. Right then, like then not doing that, and so it's just another thing, that's just like another layer of complication.
Speaker 2: 27:23
I'm trying to think of what this looks like, because now I'm picturing this, like this aggression and sex, right, but I'm also thinking about, like, the shutdown right of people who might not feel sexy, might not feel like they might be tired or their bodies aren't, you know, the more quieter, like I just don't want sex right.
Speaker 2: 27:45
And it's just scary, it's confusing because when I think about when trauma and sex, kind of you know, conflict with each other, are times when you know some of our the cool of mind clients are, they've they've had some problems with their partners and their partners, for example, they've had like really bad fights, um, and maybe it's more often husbands but it can be wives, but like, or um, same sex or same sex relationships, but the husband, for example, was violent or aggressive during a fight, through through a piece of furniture or maybe shoved the partner, and then then there's a shutdown of sex. Then the other then like, let's say, the wife is like, like you know what? I don't, I don't want to have sex anymore, I, I don't really feel safe, I don't feel comfortable. Every time he touches me, I kind of get jumpy. And then the sad part is that that shutdown will lead the husband to feel even more rejected and ashamed and angry. And then it's kind of like this, this terrible cycle of wanting. Both sides want to connect, but maybe they they're just too scared.
Speaker 2: 28:59
So that's what I've seen, but that's a little bit more about like sexual trauma and aggression with that person. Um, interfering with the, the feeling of like, yes, I want to. I feel safe enough to have sex with this. You know my partner again partner again.
Speaker 1: 29:15
Well, yeah, I mean, but this exists in a system, right? Like if I, if Jason, had PTSD and was aggressive in some way, or disconnected, or treating me like a conquerable object, yeah, or you know, whatever the case may be, like I would not and I would not want sex either, and then he is going to then get messages that he's rejected and unlovable and unwanted, which might map on directly with the messages he's already giving himself because of the negative sort of self beliefs that come with PTSD. So I think that it's really important for partners to understand what's going on, because this sucks for them and because probably their responses are going to exacerbate the problem. But it's kind of like, what else are you going to do? Just be infinitely patient and, like you know, fawning over that person. So it's, it's really tough.
Speaker 2: 30:18
It's making me think of, like this connection between violence and sexual arousal makes me think of this scene. And have you ever watched Euphoria? Yeah, yeah. So there's a scene that really sticks in my head, because it was so disturbing, where I don't want to give too much away, too many spoilers, but, um, there was a couple and they're um, they're you know, they're hanging out. I think they're almost having sex. Um, in the dorm room and the a fraternity bursts in and does a hazing ritual on the boy right and he, they like pin him down and they're really rough, they're really like scary and aggressive and they like laugh and run away and he is so shaken up and he goes to the bathroom and you could see that he is really like traumatized.
Speaker 2: 31:05
He's like shaking and scared, um, and the girl goes like are you, uh, sydney, sweeney? She's like amazing. And she's like, are you okay? And then he's like yeah, I'm fine, and goes in and they have really aggressive sex and she looks really upset and confused after and I remember thinking like I wonder if that's just a um, like almost kind of like this ego protection, like I was so humiliated that I want to feel powerful over someone or something, but I didn't think about the, the, the. I mean this kid was about to have sex. He was just traumatized and then all these feelings of arousal just was like pent up in him. So that's really interesting and sad to think that something so loving and intimate and safe can also be tied to something so terrifying and unsafe.
Speaker 1: 31:58
Well, yeah, I mean it's probably both and right, like he was just humiliated, and so I'm sure there was a desire to reclaim his masculinity. And I think that is a problem here is that sex and masculinity are so culturally tied that when, when this dysfunction shows up and I mean I've got some numbers here 73% of OIF veterans with PTSD had diminished libido. That's Operation Iraqi Freedom Um 49% have ED, um 15% ejaculatory dysfunction.
Speaker 2: 32:39
Yeah, yeah and this is all. This is all men and women, I mean. I'm sure it's like most, mostly men, but I think so yeah, um yeah, just says oia, veterans, so it's a big deal, I mean does this happen similarly to men and women, like with the fear of arousal or negative associations with feeling aroused affects both men and women, because I imagine I would think so, but I don't.
Speaker 1: 33:09
I'm sure that these studies had primarily men yeah, you know so, cause it's in, it's in it's in combat veterans. So, um, it would be interesting. I mean, when we think about like people with PTSD have higher testosterone, like women have much lower testosterone than men to begin with, so I assume there's like some differences there. Um, yeah, and then, you know, for women the trauma is so likely to be sexual trauma, even within the military, like rates of military sexual trauma are extremely high. So I don't know, it seems a bit confounded there. But I mean, if we think, even like, even without the hormonal aspect of this or the arousal aspect of this, like if we just imagine having sex, it involves things that are very vulnerable, like being naked, um, like being in a, you know, in bed in a horizontal position, concentrating on a partner instead of what threats could be existing out in your environment. Right Like it. It's not an optimal setup for somebody who's constantly hypervigilant.
Speaker 1: 34:22
It's like very hard to be vulnerable and soft when you're like I can't see what's going on. I can't attend to threat right now. I have to like attend to this other person, but this itself is making me feel vulnerable.
Speaker 2: 34:35
I'm thinking about also talking to people recently about how confusing toxic relationships can be. Where you might have a part, you might be drawn to these, like these narcissistic, emotionally unavailable men, and you have lots of fights, lots of breakups, a lot of you know hot makeup sex, and I've experienced this myself. I'm talking to some people who say that they almost feel kind of sad and ashamed that they don't feel as attracted to safe, nice partners.
Speaker 2: 35:14
There's something I mean, this is super complicated has so much to do with like infatuation and chase and something, something that's beyond sex, yeah, and so some people who might associate conflict, fight, argument, argument, with like emotional, emotional strife, with sexy, with being turned on in situations that are toxic, and then you know, seeing the other side, where people feel really, you know, almost like ashamed that safe, loving, comfortable relationships don't feel as sexy. I mean, yes, there's also just the plain like are you attracted to this person or not? Right, do you actually just have chemistry or not? But I felt this in myself and I've seen people struggle when they go from these abusive relationships to a safe one. They're surprised that they don't feel that same sexual attraction. Is this? Do you think that the arousal piece is part of that or do you think that that's also?
Speaker 1: 36:13
I mean, it would be speculative.
Speaker 1: 36:16
I don't like, if you're thinking about PTSD, it's.
Speaker 1: 36:23
I mean, I think that oftentimes I think, when we're talking about people who are like repeating relational patterns, where they are going into like only high arousal situations, that might be something more related to like how they were brought up than having like a single criterion a trauma.
Speaker 1: 36:42
But I think maybe a related factor might be like if, like, there's so much shame and guilt associated with trauma, so much of the time that it may that there can be feelings of like not deserving to be intimate or have like a loving, trusting, safe relationship, not deserving to have sex, and so I could see an argument for it's like, you know, maybe finding somebody who's more toxic or chaotic wouldn't generate those feelings as much Like I think. I think there can be this issue where, when people have been horribly traumatized and they have a partner who is healthy, it's kind of like I'm this broken mess of a human being with this intact, loving, you know, person who's too, who's too good for me, who couldn't possibly understand me, who I'm just going to sully with my badness, right, yeah, and maybe that could go down in a more toxic relationship that sounds super complicated.
Speaker 2: 37:50
What have you seen? What have you seen be helpful? When someone has this mix of, like, sexual dysfunction and trauma, well, can they come back from it, is it is like sex ruined forever. I mean, I'm sure a lot of patients worry about that, where they're like oh, you know, I'm broken sexually. I'm broken in all these ways.
Speaker 1: 38:11
No.
Speaker 2: 38:11
I think a lot of things can help.
Speaker 1: 38:12
I mean, the thing is like there's probably I think it would be interesting to see some specific like sex and PTSD protocols. Then they might exist. I'm just not trained in them. But I think one thing that helps is just psychoeducation, because these men and women are probably so confused and so ashamed of having this dysfunction and especially something like like some people like combat vets, who went from feeling like complete badasses, you know, who have like higher testosterone, right, and they're like really masculine and the whole like mantra of the military affirms masculinity and all that. Then they come home and they can't have sex.
Speaker 1: 38:54
It's like that is going to be really shameful whiplash and so understanding like there's nothing wrong with you this is what PTSD does can be really helpful and especially having helping the partners understand that that's what's going on, that they're not just being rejected, right Like their partner isn't just hasn't just suddenly decided they don't love them anymore, it's just that there's so there's so much numbing associated, right Like there's so much numbing and arousal.
Speaker 1: 39:22
It's a really kind of confusing condition because people can either feel numbed out or they can feel full of rage or full of terror, and that feels that conceptually seems very different. But numbing out can mean that all your emotions are so high they're all bleeding together and turning to mud and you kind of aren't willing to feel any of them, so you're pushing them down at the same time and it's just this whole complicated process. So I really I think just knowing that can be really helpful. I mean, one piece of advice is just, if you are a therapist, like ask about sexual function in the people, in your patients with trauma, because it's not part of the DSM criteria, it's not an obvious thing to ask about and the veteran is unlikely to bring it up because it's so associated with shame. Um, but you know, like doing something like prolonged exposure that treats the PTSD could also go a long way to treating the sexual dysfunction. And then, of course, couples therapy can be helpful.
Speaker 2: 40:23
That's interesting. I imagine that people with trauma and PTSD might then also for these like secret and what feels like shameful reasons, might not be open to SSRIs or other antidepressants. Because we also know that people on antidepressants often get sexual dysfunction and they don't like to talk about it, don't like to admit it to their partners or their doctors. But that's like one of the number one reasons why people don't take meds and then have that be on top of trauma. I imagine that you know it's just.
Speaker 2: 40:59
It's one of those things where if there is sexual trauma or, sorry, sexual, if there is sexual dysfunction, it really we tie it so quickly to our sense of self, our sense of worthiness as a sexual attractive person. Right, like anytime I haven't felt, especially, like you know, going through cancer treatments or all the things that I've been going through. Um, anytime, like my body or I don't work sexually there, even though, even though I knew, like of course, I'm not feeling horny, I can't, I don't feel left out, I'm literally going through chemo, there's still something about. Oh, this is. But this is so tied to me as a woman, this is so tied to me as like a, a wife and a worthy partner. This is what you know I do to connect to my partner.
Speaker 2: 41:47
You know, there's just so much of my sense of self that's tied into, like how sexy I am in ways that I wasn't even aware of, and I imagine that if you have trauma, you have a really hard time feeling comfortable in sex. That could like add to any of these negative feelings you have about yourself. Right, if you have any kind of like blame or shame about yourself, this would be even worse.
Speaker 1: 42:13
I mean, I still have so many thoughts. I mean we haven't talked much about sexual trauma because we did a separate episode on it, but I think you know for for for sexual trauma especially. It's kind of like, okay, I was raped and now not only did they terrify me and violate me, but now they've taken away my intimacy, my what you're talking about, right, like my sense of sexiness and connectedness and intimacy, and that's really hard to have to enjoy sex after rape for so many reasons. One is like you know, you've been treated as though you are nothing, as though you're an object, and then sex becomes associated with, like, how are you going to feel? Like sex is an, it is an act of love and care.
Speaker 1: 43:03
When you've had this experience, that rips all of that away and is an act of violence. And you know, valuelessness, worthlessness. It's also like when you're with a safe partner, it might be your body's first chance to say no. That's really interesting. I mean, it's probably going to take it so, um, so that can be really confusing. It's like, why am I turning against my safe, loving partner? I think there are all sorts of reasons, um, and then for SSRIs, I could see it going going both ways. Like SSRIs are not a very good treatment for PTSD.
Speaker 1: 43:41
Basically all they can do is take the edge off but they are also the only medication that is sort of prescribed for for PTSD I mean, maybe like a Xanax or something, but I don't think that's a very good idea. And SSRIs do dampen sexual desire and arousal.
Speaker 2: 44:00
So that's an issue Can you make a note about? Can you say why Xanax is not a good idea? I feel like it's so common for us psychologists to know that benzos are not great for PTSD, trauma and really high anxiety, but most people don't. Most people are prescribed and take Klonopin or Xanax all the time. So for trauma like, let's say, I'm hearing this and I'm like, oh, I have PTSD. Why don't I just take a benzo before I have sex? Maybe that will help take the edge off, why not?
Speaker 1: 44:32
Because, for several reasons, ptsd is chronic and you don't want to be using benzos chronically. It's a high addiction potential. But I mean, the main kind of conceptual reason is, if you are taking benzos every time you feel triggered, you are never like the way. The way PTSD works is basically there's a big, scary monster that you feel is chasing you around everywhere and your whole brain becomes an alarm system. That's like do not let the monster in, don't let the memory of the monster in, don't let the image of the monster in, don't let the physical sensations experienced with the monster come in, don't let reminders of the monster come in, right. And so the more the brain becomes a threat system, the more it kind of reinforces itself as a threat system and as the monster is terrifying. So the more you basically say this is terrifying, you can't go near it, the more your brain is going to be like oh okay, yeah, yeah, it's terrifying, I can't go near it. I have to do everything in my power to stay as far away from it as I can. And so the treatment for trauma is to say no, no, no, you are going to go towards it Once you, once you go towards the memory, right, like prolonged exposure, involves closing your eyes, going to the present tense and giving every detail you can about the trauma memory over and over and over and over again.
Speaker 1: 45:59
Because what that does is it says brain it's okay, you can go, you can hold hands with the monster, it's not that scary, it's okay. And the brain calms down like oh, okay, okay, okay, I don't have to be scared of this. Well, instead, when you give somebody a Xanax, they learn. The only reason I'm safe is because I took a Xanax. But fundamentally, this thing is still incredibly threatening and I will not be okay if I have any contact with it. So that's why there's like a high abuse potential with Xanax. It doesn't interfere on the product. It's not going to cure your PTSD in any way. Going to cure your PTSD in any way. It just might give you a few hours of like relief, which a lot of people would opt for, right, but it's just going to make your your PTSD more chronic.
Speaker 2: 46:46
That's interesting, but SSRIs.
Speaker 1: 46:49
I can also see an argument where they bring down your emotional arousal just enough to where you're actually more capable of having sex. So I don't know. But the problem is like SSRIs aren't very good at PTSD because they don't fix that underlying psychic process. So the only thing that's really going to help is to do the trauma treatment. But the trauma treatment is so aversive that people avoid it and then we're in a cycle again.
Speaker 2: 47:12
Well, I'm also wondering too, if someone has trauma and they feel, without even realizing it, that arousal, being vulnerable, is so scary, right, which makes them not want to have sex, that it would also help to do like almost exposure to sex, um with sex therapy. I remember we talked about this with dr rosenthal, with um in the sex therapy episode of um. If you have, you go to a sex therapist and sometimes the homework is let's take penetrative sex off the table and you're just going to explore each other in other ways, whether it's just like touching, like touching or any other sexual activity. That's not sex, just kissing. And I wonder if, along with treatment for trauma, but you could also just start to get habituated and comfortable with like slower levels of sexual arousal until it starts to feel more safe. Do you think that would help? Or do you think no, you need to just get trauma treatment to get through that?
Speaker 1: 48:13
No, I think that could help. I don't know enough about it so I don't want to say anything definitively. But I mean, if we think about what trauma treatment is, it means getting exposure to your triggers, and sex can be very triggering for people, and so it's like okay, well, what do you do about that? You don't want to avoid them forever, so you've got to go towards them and then you know. But I would work really heavily with the partner I mean, I guess you would have to with sex therapy anyway but really getting the partner to understand exactly what's going on, how to create a sense of safety, how to not create a sense of like rejection you have a partner who's been through trauma, let's say the wives of veterans or people who have experienced like really bad trauma.
Speaker 2: 49:01
They have a hard time with sex, what can? Because I'm sure as a partner you just want to step back or you might get frustrated, you might get sad of the disconnection, but I imagine it might be like, okay, I'm too scared to upset my partner and not have my needs, but we won't have our needs met. So what can they do to help the situation?
Speaker 1: 49:24
Get educated as much as possible about PTSD would be the first thing, so that your partner doesn't feel so alone and confused and like they have to explain everything to you when there's a lot of shame involved anyway, lot of shame involved anyway. So, um, you know, like if you can get involved in your partner's treatment to any extent, that can be helpful. That doesn't mean, you know, like interrupting his trauma treatment or busting in or, like you know, getting confidential information or anything like that, but just rather saying like I would be super appreciative if I can join you for a session just to understand more about PTSD in general and like PTSD and sex. I just, I just want to know so that I can better support you, and I and I know you probably don't want to spend all your time telling me about it, so I would really like to hear it from your therapist. So kind of being that supportive ear, trying to de-shame it as much as possible, trying to resist the urge to be rejected and act from a place of rejection and defensiveness, because that's going to shut them down further, having a lot of patience for what they are going through.
Speaker 1: 50:35
You know, I think just being like slow, kind, patient, um, understanding can go a long way and then just trying to be, you know, basically trying to create a safe space where it's something that can be talked about, um, but I I also think this, this thing can happen with partners called accommodation, where they kind of collude with avoidance with their partner, and to some extent that's okay. But you don't want to be basically facilitating your partner, avoiding life and avoiding sex and avoiding absolutely everything all the time, because then that's not good for you and it's not good for them. And so that's another where, like place where I would probably talk to therapists about like how can I support and be patient? And I certainly, especially with sex, don't want to push myself on that but at the same time not just say it's okay, we'll never have sex again.
Speaker 2: 51:37
I would love for us to do an episode on accommodation, because I find that really, really complicated to know what's right or wrong right If you love someone or you're close to someone who has a lot of anxiety, a lot of PTSD, and you know that bringing up stories, bringing up situations or activities that would trigger them, like I imagine, like the the most natural thing is to help is to protect them from that right like to to, you know, like to say okay, I don't, I really don't want to upset them, let's just not.
Speaker 2: 52:12
I won't even just initiate sex. I won't talk about this, you know. But then how do you know when that is like too much right, when you're just like reinforcing that avoidance too much? That's such a complicated. I just imagine that with sexual like, if my partner, husband, for example, had some sexual dysfunction from trauma, I would feel really hesitant to bring up sex at all and really like I would be a horrible person and partner, so selfish or whatever, if I, like I say I want sex or initiate, knowing that it would put them in this state of being you know, and like triggered, like and that's hard for me because I'm like, oh, I don't.
Speaker 2: 52:55
I'm like, oh, I don't want to, like I don't want to feel like my, my sexual needs or me wanting to have sex with my partner is like triggering their trauma.
Speaker 1: 53:04
That would just feel so like sad, like the thing that I want to connect them with so much would be something that's like threatening right especially with sex, that you know consent is such a big deal with sex right it's different from like playing a song that might be triggering, right, like this is like a really consensual process.
Speaker 1: 53:23
I'd probably do it with a therapist and just basically be like hey, I've learned a lot about what this might be like for you. I'd love to hear it from you. But ultimately, like, I don't think either of us want to have a sexless life. So how could I support getting that? You know, how can I support you and like coming back alive in that way? Um, you know, but like can our, can our goal be to have a sex life again? Yeah, be connected again. And how can we do that? And I hope that more people with PTSD will be open to treatment. The treatment can be rough, but it is effective, and really suffering in silence and trying to suppress and push it down is incredibly ineffective. Yeah, yeah.
Speaker 2: 54:13
I'll put a plug just because I'm in that now in like mental health world, mental health like digital, digital companies and apps and stuff like that. I'm in that world and there are actually a lot of really great resources out there. There's my friend made a rebound. She was Aaron Barron. She was on our podcast before Wonderful trauma psychologist who made an app that basically walks people through some exposure, some prolonged exposure, but for people who might not be ready to or not able to find like a full trauma therapist.
Speaker 2: 54:50
There's, I think Nima is a company that does like online PTSD treatment. I mean, if you're, you know if any of your family is in, you know the military. There's a veterans affairs where Jacqueline works. I mean there's a lot of resources out there and um yeah, just like explore different options.
Speaker 1: 55:09
Yeah, ptsd coach can also be helpful. Um, pe coach is also CPT coach. These are like, um, you know, meant to kind of facilitate like homework with PE and CPT. But but PTSD coach I mean it's got like breathing exercise, coping strategies, a lot of stuff that you can try on your own to, you know at least like kind of bring that arousal down, get into more relaxed state.
Speaker 2: 55:33
So I'll link those in the show notes, because there's so much crap out there. There's so much like on social media. There's like so many people talking about trauma that really don't know what they're talking about. But I'm going to link PTSD, coach and rebound and like resources that we know is legit in the show notes.
Speaker 1: 55:51
So, all right, little helpers. Well, it feels a little dark to come up with a quippy one letter for rating us on Apple podcasts and Spotify, but if you'd like to give us five stars, we would love it and we'd love to read your comments. So we'll see you next week. By accessing this podcast, I acknowledge that the hosts of this podcast make no warranty, guarantee or representation as to the accuracy or sufficiency of the information featured in this podcast. The information, opinions and recommendations presented in this podcast are for general information only, thank you, and do not constitute the practice of medical or any other professional judgment, advice, diagnosis or treatment, and should not be considered or used as a substitute for the independent professional judgment, advice, diagnosis or treatment of a duly licensed and qualified healthcare provider. In case of a medical emergency, you should immediately call 911. The hosts do not endorse, approve, recommend or certify any information, product, process, service or organization presented or mentioned in this podcast, and information from this podcast should not be referenced in any way to imply such approval or endorsement.xt goes here
