Getting Your Sex Life Back After Experiencing Sexual Trauma

Having or maintaining an intimate life can be extremely difficult for victims of sexual violence, whether during childhood or as an adult. Sex is often a territory in which trauma persists long after the fact. Better understanding dissociation, confusion between physical arousal and veritable desire, the way in which some fantasies can be experienced and used as regulatory tools when faced with flashbacks, help to alleviate feelings of shame and self-blaming that often come with trauma. It can also help to pave the way for a chosen, peaceful sex life.

Sexual violence amongst children (under 18 years old), calculated upon retrospective declarations of the fact, concern 19.7% of women and 7.9% of men (Pereda, Guilera, Forns, & Gómez-Benito, 2009). These figures, despite being consequential, are most likely lower than in reality, as trauma-induced memory loss, shame or secretiveness may stop a person from speaking out.

On a sexual level, history of sexual violence in childhood is associated with a significantly heightened risk of sexual dysfunction during adulthood, with this being more pronounced in women than in men (Wang et al., 2023). One transcultural study across 42 countries and more than 82,000 participants show strong links between these types of violence and higher levels of sexual distress and difficulties with sexual function (Gewirtz-Meydan et al., 2025). In sexual assault survivors, the figures are sometimes extremely high: up to 87% describe sexual dysfunction, associated with lowered libido and difficulty orgasming (Garneau-Fournier, et al., 2017).

These data should not be read, however, as a fatality. The most common difficulties don’t concern every aspect of sex (Pulverman, Kilimnik & Meston, 2018). What’s more, some studies have found no significant link between sexual violence in childhood and sexual well-being in adulthood (Bigras et al., 2021). This may suggest that it isn’t exposure to sexual violence in itself that has the biggest impact on sexual function, but also the development of post-traumatic stress disorder. These assessments urge us to normalise what a lot of survivors suffer through in silence, often paired with feeling ashamed or abnormal: sex can carry, even many years on, the traces of trauma.

To understand why an abusive experience can have a continued impact on a person’s sex life, years or even decades after the fact, we need to discuss what trauma actually does to the psyche and to the body. Sexual violence in childhood can cause ‘sexual trauma’: the victim’s relationship to sex is heavily impacted by the abusive experience, at an age or in a context where they do not have the psychological resources to make sense of things (Finkelhor & Browne, 1985). This provides an explanation as to why the sexual sphere becomes a space for trauma to persist.

More recently, researchers have come up with the concept of ‘traumatized sexuality’, to describe the way in which symptoms of post-traumatic stress can resurface during sexual activity. Six key factors have been identified as more common in survivors than those without history of abuse: dissociation, intrusiveness, shame/guilt, pleasing behaviours, interpersonal distress, and hypervigilance (Gewirtz-Meydan, 2025 ; Willard Martel et al., 2025).

In concrete terms, this means that touching, nudity, certain positions or certain sounds can reactivate, without the person always recognising it at the time, feelings or emotions related to an abusive experience. These recollections escape conscious control, which explains why so many survivors feel defenceless when faced with their own reactions during intimate activities, despite being a willing, wanting participant.

The autonomic nervous system has many adaptive strategies in the face of threat and in the aim to survive, specifically mobilisation (flight or fight) and immobilisation (astonishment, freezing) (Porges, 2011). Clinical literature on complex trauma sometimes adds a third response: appeasing the aggressor and their needs through submission and hyper-adaptation, sometimes named the ‘4th F’ (fawn, along with fight, flight and freeze) (Walker, 2013). Understanding that the inability to move, talk, or apparent submission during abuse is related to automatic neurophysiological responses and are not bad choices or weakness is crucial in reducing guilt and shame.

Throughout these reactions, one may experience such extreme stress that their body triggers another survival mechanism: dissociation. This form of protection allows a person to disconnect from their thoughts, emotions and bodily sensations and their sense of identity, particularly when the situation at hand is deemed dangerous or unbearable. Thus, the body can remain ‘in denial’ about the situation for as long as it deems necessary, and some memories or physical states can reemerge once an individual feels safe enough (Almås & Benestad, 2021). This helps us to understand why memories of abuse can resurface long after the fact.

This mechanism, that has allowed a person to survive abuse, may automatically remain in place, even during consensual sexual encounters years later. A study comparing women with and without a history of childhood sexual abuse found that those with a history reported more episodes of dissociation during sexual activity within consensual relationships: a sense of unreality, the feeling of observing the scene from the outside, and emotional or sensory numbness (Bird, Seehuus, Clifton, & Rellini, 2014). Dissociation during sex does not mean that the current relationship is perceived as unsafe, it is rather the mark of a traumatic past that continues to affect the present.

For many survivors, one of the most painful and misunderstood aspects of the post-trauma experience is the confusion between physiological arousal and veritable desire. It is now well-established within literature that genital response (lubrication, arousal, etc.) and subjective arousal (feeling aroused, wanting to engage in sexual activity) are two distinct systems. Moreover, the correlation between these two mechanisms is, on average, weak, and significantly weaker in women than in men (Chivers et al., 2010).

This assessment has considerable clinical importance. Many people experience a physiological response during abuse or aggression (lubrication, erection, sometimes orgasm) despite a lack of desire, consent and physical pleasure. This automatic, instinctive reaction is expressed through genital tissues responding to physical stimulation, independently of what the person is experiencing on an emotional level. In no way does it indicate that a victim agreed to what happened.

On a clinical level, we are thus able to distinguish between two forms of reaction to arousal. Arousal stemming from trauma is activated by fear, hypervigilance or paralysis (freezing), and is often associated with dissociation or a sense of urgency. Secure arousal is anchored in trust, knowing one is able to say no at any time and being both physically and mentally present. This distinction can be learnt through listening to internal signals: does the breath flow freely or become blocked? Is the body at ease or does it tense up? Is there a sense of continuous choice? It’s not always easy to reclaim these sensations, which explains why difficulties with arousal and desire are the most frequent issues cited by survivors of child sexual abuse (Pulverman et al., 2018).

An extremely sensitive yet essential topic that must be discussed without judgement concerns fantasies involving forms of restraint, domination/submission and violence. Contrary to what many people believe, these fantasies are common amongst the general population, and aren’t necessarily linked to a history of trauma. It is essential to highlight that the presence of such fantasies correlate neither to a real desire to be aggressed, nor necessarily a history of sexual aggression. According to studies, between 31% and 62% of women report having already fantasised about sexual restraint, and between 9% and 17% say that it is a recurring fantasy (Critelli & Bivona, 2008 ; Bivona & Critelli, 2009).

Individuals who have experienced sexual violence in childhood generally begin to have sexual fantasies at a younger age, most often describing them as intrusive. For that matter, the severity of violence can predict a tendency to see one’s fantasies as intrusive, shameful and limitless. These subjective experiences affect sexual self-assertion: fantasies deemed shameful hinder sexual initiative, whilst intrusive fantasies hinder self-expression and the ability to refuse what one does not want (Hasson & Ginzburg, 2025). Thus, the way in which a person lives out their fantasies is decisive, more so than their content as such. Indeed, fantasies are less likely to be sexually satisfying when they’re accompanied by confusion, guilt or traumatic memories (Gewirtz-Meydan & Opuda, 2023).

Conversely, for some survivors, these fantasies can also become a form of resilience and a way to reclaim one’s power, as long as they’re explored freely and are completely separate from any form of veritable abuse. The idea is by no means to re-enact a traumatic experience, but to be able to imagine a new and controlled sexual environment, as well as an active and reassuring role, with a trusted partner if needed. This can contribute to reclaiming a sexuality that was once imposed upon them and to building sexual empowerment (Gewirtz-Meydan et al., 2024). Therapeutic support may be necessary if the emotional load associated to this activity becomes too much.

Before looking to restore sexual function, it is important to recognise that sexual dysfunction may in itself have fulfilled a protective role at one point in time: avoiding further trauma, regulating relationship proximity, rediscovering a sense of power and control, or even preserving a reassuring self-image (Gewirtz-Meydan, 2022). Considering one’s symptoms through this lens changes the way a person views oneself. It is no longer a malfunction that requires fixing, but instead an intelligent survival strategy, that can be appreciated for its past usefulness, before gradually working it away.

Flashbacks, intrusive bodily sensations or waves of panic and/or disgust are some of the most destabilising manifestations of trauma within the sexual sphere. A key concept in the field of neurobiology of trauma, called the Window of Tolerance (Siegel, 1999), helps us to understand and appease such feelings. This is a symbolic zone in which a person can feel emotions of varying intensities, all whilst remaining capable of reacting and remaining present.

On a practical level, various tools can help a person to return to their window of tolerance when experiencing a flashback:

• Anchoring yourself in the here and now. Inwardly name what you can see and feel: the colour of a fabric, your partner’s name, the fact that you’re an adult now, noting things around you to refocus your attention on the present instead of the memory.
• Slowed breathing and a long exhale favour activation of the parasympathetic nervous system and a return to physiological calm.
• Contact with a stable grounding point (feet or back against a support, contact with your own hands/those of your partner) can reinstate a feeling of solidity and physical reassurance.
• Verbalising flashbacks or needs, for example: “Am I reliving something unpleasant? Do I need to breathe? Take a break?” contributes both to building relationships and to regaining active control over the situation.
• If you experience a flashback whilst alone, voluntary, orientated movement (getting up, squeezing and releasing your fists, saying ‘no’ out loud) enables a physical defensive response to the initial trauma (Ogden, Minton & Pain, 2006).

These techniques cannot replace therapy if flashbacks are too frequent or intense, but they can act as your first line of defence, and can be applied when alone or with a partner who is aware of the situation.

With a partner, you may also find it useful to indicate the areas of the body that can react to touch in a secure or more difficult way (Zoldbrod, 2015) :

Each one simply needs to draw the outline of a human, front and back, on a piece of paper. You don’t need to be a professional artist, an approximative image will do the trick. Using four colours, each partner can then show how they feel being touched on different parts of their body:

• Green for the areas in which contact is generally welcome and pleasant.
• Yellow for the areas in which the desire to be touched varies depending on the circumstances: emotional state, the person in front of you, the type of touch, the way in which contact is initiated.
• Blue for the areas in which touch is appreciated once arousal is reached, but not necessarily right from the start of an intimate moment.
• Red for the areas in which you don’t want to be touched at all.

Once you’ve both finished annotating, you and your partner can take the time to discover them together. The goal isn’t simply to identify each zone by colour, but to explain what may affect how you experience a certain touch: pressure, duration, the moment in which it takes place, the way it is delivered or the context in which it takes place.

The red zones are limits that must be respected as they are. They do not call for negotiation or persuasion. In the same way, the map is not fixed: preferences, sensations and limits can evolve, and each individual is free to adapt what they are okay with at any moment.

​Exercise adapted from the SexSmart BodyMap© d’Aline Zolbrod¹.

The good news is that there are therapeutic approaches that have been proven effective for treating symptoms of post-traumatic stress and trauma-related depression (O'Doherty et al., 2023).

EMDR (Eye Movement Desensitization and Reprocessing) uses bilateral stimulation (eye movements, tapping) as an individual evokes their traumatic memory, in order to encourage its integration into biographical memory rather than its persistence in a fixed, intrusive format. This approach is recommended by the World Health Organisation in treating post-traumatic stress disorder (OMS, 2013).

Trauma-focused cognitive behavioural therapy (TF-CBT) associates psychoeducation, emotional regulation techniques, gradual reprocessing of traumatic memories and work on beliefs associated with the abuse (guilt, shame, feeling responsible). These therapies can be combined with sex therapy, which proposes certain techniques, such as the Sensate Focus
. This helps an individual to work more specifically on reconnecting the body to pleasure, in parallel with post-traumatic stress treatment. On a therapeutic level, treating trauma alone cannot automatically resolve sexual difficulties. It is recommended that post-traumatic sexual symptoms be addressed specifically through sex therapy (Gewirtz-Meydan & Lassri, 2023).

In this work, healthcare providers grant particular attention to unpredictability, safety and respect, bearing in mind the patient’s history of abuse (Almås & Benestad, 2021). Sex therapy approaches, therefore, offer a gradual and supportive process focusing on touch, body confidence and restoring a sense of agency in one’s sexuality, emphasising the importance of never rushing things and respecting the individual’s own pace (Zoldbrod, 2015).

Caution should be exercised regarding the scope of the findings presented in this article. Men remain significantly under-represented in the literature on this subject, and the associations between abuse and sexual well-being depend largely on the presence of comorbidities and the samples studied, with some studies finding no significant association (Bigras et al., 2021). The diversity of traumatic sexual experiences and fantasy patterns further highlights the need for individualised, trauma-sensitive and culturally appropriate therapeutic approaches (Willard Martel et al., 2025 ; Gewirtz-Meydan et al., 2025).

Rediscovering a secure sex life after sexual violence is a process that involves the body, the nervous system, intimate beliefs and one’s relationship to others. It consists of building a sex life in which arousal isn’t controlled by fear, dissociation or shame. Understanding the mechanisms at play is already an important aspect of mitigating a large part of shame and guilt that often come with such experiences. To finish, the five conditions of the C.E.R.T.S. model, proposed by Wendy Maltz provide guidelines for distinguishing between a chosen sexuality and a sexuality that is imposed or automatic: