Overcoming Challenges of Intimacy After Sexual Trauma

Sexual trauma profoundly impacts a person's self-concept and ability to form healthy intimate relationships in adulthood.

Sexual trauma is an event involving a sexual act against someone’s will. It is defined as an event involving death or the threat of death or serious injury, where one's response includes fear, helplessness, terror, or horror. This can include experiences like:

• Sexual assault: Any non-consensual sexual act.

• Child sexual abuse (CSA): Sexual activities involving a child who cannot give informed consent or is not developmentally ready.

  
  

Such experiences can cause significant psychological consequences, affecting an individual's ability to trust, feel safe, and engage in healthy intimate relationships.

Impact of Sexual Trauma on Couples' Intimacy

Sexual trauma, particularly childhood sexual abuse (CSA), has wide-ranging impacts on relationships, often manifesting most acutely in intimate partnerships.

Self-Concept and Interpersonal Relations

• Survivors often struggle with a skewed self-concept, low self-esteem, feelings of worthlessness, and self-blame, leading to a belief that they are "bad," "broken," "dirty," or "disgusting."

• It impairs their ability to trust, be vulnerable, and feel safe and secure with another person, even an intimate partner. This can result in a fear of abandonment, fear of being trapped, fear of rejection, and a need for control, leading to an overall sense of interpersonal insecurity.

• Relational difficulties are common, including decreased ability to love and trust, alongside an increased need for love and security.

• Unwanted thoughts or flashbacks, denial, withdrawal, self-loathing, and self-criticism are common symptoms.

• Approximately 20% of adults who experienced CSA may evidence serious psychopathology, such as PTSD, depression, anxiety, substance abuse, and self-abusive behavior, which significantly strain couple relationships

  
  

Sexual Intimacy

Sexual trauma can have profound and serious impacts on a person's sexuality, often disrupting their understanding or meaning of sex. For many survivors, sex, even when loving and consensual, can trigger past abuse or assault. This can lead to confusion between past and present, triggering flashbacks, body memories, and dissociative states.

Survivors may associate sex with pain, trauma, and anxiety. They might view it as an obligation, hurtful, or a means of control rather than an expression of love or pleasure.

Common sexual difficulties include:

• Sexual dysfunction: Over 50% of CSA survivors report some type of adult sexual difficulty, including hypoactive sexual desire, non-orgasmic response, arousal disorder, vaginismus (especially if abuse involved penetration and force), erectile or ejaculatory difficulties, and sexual pain.

• Avoidance or Compulsion: Some survivors avoid intimacy and sex altogether, while others engage in increased sexual activity, promiscuity, or compulsive/risky sexual behaviours as a coping mechanism or to seek affection/validation.

• Difficulty with Presence and Trust: Survivors may struggle to remain "in the moment" during sexual activity, have difficulty trusting sexual partners, or confuse sex with love or caregiving. They might put a pillow over their head to avoid looking at their partner during sex due to intrusive images.

• Body Shame: CSA can lead to body shame, disrupted body boundaries, and discomfort with physical closeness.

  
  

Impact on Partners

Partners may suffer secondary trauma from being exposed to the survivor's distressing symptoms and traumatic material. They may experience symptoms that mimic the survivor's trauma symptoms.

• Partners often report feeling lost, confused, and as if they "could do nothing right" because the rules of interaction seem to change continuously. They may interpret the survivor's trauma responses (e.g., emotional numbing, avoidance, irritability) as intentionally directed at them, which can decrease their supportive behavior and further strain the relationship.

• They may also experience their own isolation due to fear of shame or judgment if they share their partner's traumatic experience.

• Male partners, in particular, may face additional cultural burdens and expectations regarding sexual initiation. They may need to examine their own belief systems about sex and sexual violence to avoid unintentionally victim-blaming or shaming their partner. Some male partners have reported needing to confront coercive aspects of their own sexual behaviors.

• Partners can experience their own sexual dysfunction, such as erectile dysfunction or lack of desire, as a result of the dynamic with the survivor.

Keys to Healing and Improved Intimacy

For couples where one partner is a sexual trauma survivor, healing is a multifaceted process that benefits from mutual understanding, open communication, and shared effort.

• Safety and Trust: A sense of safety and trust is imperative to healing. This includes an absence of shaming, blaming, or criticism, and respect for the survivor's wishes and boundaries. Feeling sexually safe with their partner is crucial, meaning no pressure for sex.

• Acceptance and Validation: Survivors need their experience compassionately witnessed and appreciated. Partners listening compassionately and expressing sorrow for their pain is profoundly helpful.

• Open Communication: Essential for negotiating difficulties, especially around sexual intimacy and boundaries. This means that any topic is open for discussion, and the partner actively listens.

• Emotional Intimacy and Perception of Being Truly Loved: A sense of emotional connection, where the survivor feels truly loved by their partner. This involves understanding, support, and responsiveness, going beyond just sexual contact.

• Support: Including listening, understanding, quality time, verbal affirmations, commitment, encouragement, reassurance, and non-sexual physical touch.

• Empathy: Expressions of sorrow, sadness, care, concern, compassion, and indignation from the partner.

• Freedom of Choice: The perception that it is acceptable for the participant to maintain their own views and make their own choices, with partners respecting their feelings, opinions, and personal boundaries without pressure.

• Positive Growth with Partner: The perception of a successful relationship and mutual growth.

Sexual Consent Model

The sexual consent model is a vital tool for communication, boundary negotiation, and building trust in intimate relationships, especially for survivors of sexual trauma.

• Active Consent: It is not merely the absence of a "no," but a clear, explicit "yes" communicated throughout a sexual interaction. Consent is ongoing and can be verbal or nonverbal.

• Non-Coercive and Ahistorical: Consent is non-coercive and not based on what happened previously.

• Safety and Boundaries: It provides a framework for negotiating sexual intimacy and boundaries that prioritize engagement, safety, and comfort for all involved. This means discussing how to say "yes" and "no," how each partner feels about those responses, and explicitly acknowledging that consent can be withdrawn at any time.

• Beyond Penetrative Sex: Sexual intimacy is a broad continuum that includes touching, caressing, kissing, hugging, napping, talking, or simply being near the partner.

• Open Dialogue: The model encourages continuous conversation about sexual likes, dislikes, and expectations, fostering an atmosphere of safety and trust. It also involves identifying sensitive areas or triggers related to past abuse.

• "Go Slow": Partners should prioritise safety and choice, allowing the survivor to set the pace without pressure. Using a "safety word or sign" can help ensure mutual safety during intimate contact.

Improving intimacy

Improving intimacy in a couple relationship, especially when one partner has experienced childhood sexual abuse (CSA), is a multifaceted process that significantly benefits from mutual understanding, open communication, and shared effort. While all relationships face challenges in maintaining sexual intimacy, a healthy and intimate partnership can be a powerful healing site for attachment injuries and distressing symptoms related to trauma.

Here are practical suggestions for couples to improve intimacy.

Prioritise and Build Safety and Trust

• Cultivate a fundamental sense of security within the relationship, as feeling safe and trusting is paramount for CSA survivors to heal. This includes ensuring physical safety and consistently respecting personal and sexual boundaries.

• Be a consistently trusted friend by being present for your partner, offering companionship when desired, respecting their privacy, and exercising patience, particularly when they need to discuss their abuse experiences. Uphold confidentiality and fulfill commitments to reinforce trust.

• Validate and believe your partner's experiences without minimising the abuse. Express hope for their recovery, reassuring them with statements such as, "It might feel hard for a while, but you will get through it. And I will be beside you the whole time."

• Actively avoid blame, criticism, or shaming, as these actions significantly hinder the healing process. Conversely, acceptance and validation are crucial for healing.

  
  

Engage in Open Communication and Explicit Negotiation

• Ensure all topics are open for discussion, creating an environment where your partner feels safe to talk about anything without fear.

• Practice active and patient listening, dedicating time to genuinely hear your partner. Engage in mutual disclosure and be willing to negotiate needs and preferences.

• Utilise "I" statements to express your own feelings, thoughts, and needs (e.g., "I feel sad and tired..."), rather than using accusatory "you" statements.

• Explicitly discuss sexual preferences and boundaries. Focus on what both partners find sexually arousing and enjoyable. Establish clear boundaries and limits, ensuring both individuals feel safe. For survivors, open conversations about consent are particularly vital.

• Implement an active, ongoing consent model that is more than a one-time "yes" or "no." This means continuous dialogue before, during, and after sexual intimacy to ensure comfort, respect, and understanding for both partners. It should be a non-coercive and evolving process.

• Communicate expectations and interests for the relationship and sexual activity, including discussions on commitment, monogamy, use of pornography, sex toys, various positions, role-play, and differing gender expectations.

• Explore optimal conditions for intimacy by discussing each partner's ideal environment, physical and emotional states, and the overall relationship dynamics that best support intimacy.

Cultivate Emotional Intimacy and Connection

• Express genuine emotional connection and love. This involves being emotionally responsive, offering verbal and non-sexual physical expressions of love, performing thoughtful acts of service, and demonstrating kindness. Simple acts like hugs, holding hands, and eye gazes are powerful forms of intimacy beyond sexual activity.

• Provide active support during times of distress. Support can extend to practical areas like financial assistance or non-sexual physical touch.

• Embrace mutuality and shared experiences. Mutuality is fundamental for safety and intimacy. Partners can deepen connection by acknowledging and processing shared experiences, even if they are emotionally challenging.

• Infuse positivity into the relationship through appreciation, compliments, and small, thoughtful surprises. This builds resilience and a buffer against negativity.

• Practice empathy by striving to understand your partner's perspective, even if it differs from your own. Techniques like "mirroring" (reflecting back what you hear) can enhance listening and understanding.

Navigate Sexual Intimacy Challenges Mindfully

• Do not pressure your partner for sex. It is crucial for survivors that they feel no pressure to engage in sexual activity. Respecting their wishes and boundaries can significantly increase trust and intimacy.

• Explore diverse forms of intimacy. If penetrative sex is difficult or triggering, focus on a broader spectrum of behaviours, including touching, caressing, kissing, hugging, or simply being physically close. Consider periods of putting sex "on the back-burner" to instead prioritise intimacy and playful connection.

• Embrace playfulness and fun in sexual interactions, including laughter, cuddling, and holding hands. Broaden your understanding of eroticism to encompass a sense of "aliveness" shared with your partner, moving beyond solely genital focus.

• Discuss sexual anxieties openly and honestly. This includes expressing fears of rejection or feeling unattractive if one partner is not desiring sex.

• Establish pre-agreed responses to triggers during sexual activity. Agree on a safe word or signal to pause or slow down if either partner experiences anxiety or feels triggered.

• Acknowledge and address other factors that might impact sexual enjoyment, such as stress, alcohol use, sleep difficulties, medication, body image concerns, or other relationship issues, as these can contribute independently of trauma history.

Engage in Mutual Support and Partner Involvement

• Communicate and ensure mutual involvement. Recognising that enjoyable sex is a joint endeavour, partners should openly communicate and be involved in navigating any sexual or relationship difficulties.

• Support each other's individual healing journeys. While the survivor focuses on their trauma work, the partner's involvement is vital for understanding, providing support, and fostering relational healing.

• Partners should reflect on their own beliefs and values regarding sex, sexuality, and consent. This self-examination can help male partners, for example, avoid unintentionally victim-blaming or shaming their survivor partner.

• Foster positive growth together. Partners should encourage and model positive growth for each other, seeing themselves as equal participants in a thriving relationship. This involves a willingness to grow and evolve together.

Prioritise Personal Growth and Self-Awareness

Help the survivor examine the specific impact of abuse on their life. Accepting this impact and sharing it with a safe partner can illuminate areas of need and sensitivity within the relationship.

• Address internalised shame, which is a common and profound barrier to intimacy for survivors. Therapy should help both partners to confront shame and to collaboratively build an atmosphere of emotional safety.

• Reframe and redefine difficult experiences. For instance, understanding compulsive sexual behaviors as a coping strategy to reduce distress (e.g., anxiety) rather than a personal failing can be a crucial step. Redefining intimacy to include broader emotional connection beyond just sexual acts is also beneficial.

Seek Professional Guidance When Needed

• Consider couples therapy if persistent difficulties arise despite trying self-help strategies. Qualified therapists or sex therapists can provide tailored support. Couples therapy can expedite positive changes compared to individual therapy alone.

• Look for trauma-informed professionals who understand the complexities of sexual trauma and prioritise the survivor's sense of choice and control over rigid techniques. They can facilitate essential dialogue around sexual intimacy.

• Explore support groups for partners, as these can offer a space to address their unique concerns and receive guidance.

At Blue Fig Clinic in Sydney, we understand that the journey of healing from trauma, particularly sexual trauma, is deeply personal and can profoundly impact intimate relationships. It's a complex path, and we believe that with the right support, individuals and couples can not only navigate their way through it but also forge stronger, more authentic connections. Our approach is rooted in trauma-informed therapy, recognising that past experiences cast a long shadow, influencing self-concept, emotional well-being, and the capacity for intimacy and trust.