Sex After Trauma
Sexual trauma is one of the leading causes of pain with intercourse. When an event happens that is traumatic and/or painful, not only does our brain hold onto these memories, but every muscle in our body does as well. The pelvic floor muscles are typically the first muscle group to contract, and the last muscle group to relax when a traumatic event occurs. Our bodies are amazing and become very good at protecting ourselves. So when we engage in sexual intercourse after sexual trauma, our body, and more specifically our pelvic floor muscles, will tense in order to protect ourselves. That tension will result in decreased blood flow, decreased lubrication, and muscle tightness which will most likely be painful with any penetrative intercourse. This may happen after any traumatic event, including and not limited to: physical abuse, sexual abuse, emotional abuse, surgery, or childbirth. What you’re feeling is normal, understandable, and valid. It is common to respond with dismay and discomfort. Many doctors will tell their patients that they just have to deal with painful sex. They are just wrong. Here’s what we can do:
Psychotherapy - research shows that those who engage in psychotherapy along with physical therapy typically have the best outcomes when it comes to pain with sexual intercourse. Processing our trauma will help us understand what has happened and we can better cultivate tools to regulate our systems. Finding a therapist you connect with and trust is vital for optimal outcomes. From first hand experience I can testify that it is really painful and uncomfortable to relive and process your sexual trauma. I can also testify that it has helped me better understand why I respond/act/feel the way that I do. This has allowed me to give more grace and compassion to myself. I’ve learned how to cultivate healing and supportive relationships that make me feel safe and warm. This has helped me set firmer boundaries and stick up for myself. I can better tune into my body and understand where this tension is coming from.
Body work + mind body connection - connection to our body can be really difficult, especially if we have experienced a lot of trauma. Typically in order to protect ourselves we have to dissociate from our bodies. This can lead to lack of body awareness and lack of tension recognition. Before revealing my own trauma in therapy, I was unaware of how tense I was all of the time. I was unaware of my shallow breathing and constant anxiety. Working with a psychotherapist in addition to a body worker such as a massage therapist, acupuncturist, somatic therapist, Cranio-Sacral therapist, and/or physical therapist can help you reconnect your mind to your body.
Pelvic Floor Physical Therapy - we are highly trained in helping our patients re-connect their mind to their bodies, especially providing that reconnection to the pelvic floor. Trauma that occurs in our pelvic girdle can cause muddled signals from our pelvic floor to our brain and it can be very difficult to even feel what is happening in our pelvic region. Pelvic floor therapists can help you re-connect to those muscles, allow you to relax + strengthen the muscles, while also relaxing and strengthening other muscles in your body. We can also help treat pain with manual techniques that can help release tension and increase blood flow to the pelvic region, ultimately decreasing pain and discomfort. We will provide you with any bowel/bladder health tips if that is an area you are also in need of help with. We are able to help provide sexual health tips that can optimize arousal, decrease pain, and help you achieve that orgasmic, blissful, beautiful sex that you so deeply deserve.
Self love + forgiveness. What happened to you is NOT YOUR FAULT, and I believe you. Shame + guilt is not welcome here. Take a deep breath and give yourself so much love and comfort.
Solo Sexy Time. Touch yourself. You can start slowly. Maybe you start with touching your inner thigh and slowly work your way up towards your labia and stop there. Once you can feel safe and comfortable with this, you can slowly start to move inwards and start touching your labias, clitoris, vaginal opening, etc. If you feel triggered, you can stop. You can also stop, breathe, remind yourself that you are safe, breathe again, and continue if you feel okay doing so. During solo sexy time you can imagine being with someone you trust. Or just being with yourself. For a while I could only imagine being with females because my trauma was from males. Slowly I've worked through the trauma so I can now imagine anyone I feel safe with regardless of gender.
Find a partner you feel safe with - physically and emotionally. When you feel ready to have sexual intercourse again, it can be helpful to choose a partner you feel physically and emotionally safe with. Someone who will stop when you need them to stop, and listen to your wants and needs. You don’t ever have to engage in unwanted pain during intercourse. Tell your partner sex may be triggering for you and you need support and patience. If they don’t understand and don’t support you, they may not be the best sexual partner.
Meditation. Take it slow. Breathe. Practicing whole body relaxation while meditating can be really powerful. Try this: download the app ‘Insight Timer’ and set the timer for 8 minutes to whatever sound you prefer. Find a very comfortable position and during the meditation do a body scan and try to relax every.single.muscle in your body starting from your toes all the way up to your crown. While doing this, practice deep diaphragmatic breathing (belly breathing). This feeling is how we should feel most of the time. I argue that most of us rarely feel this much ease during our days. You deserve ease.
Presence - that was then, I am safe now. Practicing meditation and mindfulness can help you live each moment in the present. When we are present and truly want to engage in intercourse, our bodies will prepare with arousal: vaginal vault increase, self lubrication, and muscle relaxation. You may need to ask your partner to pause for a moment so you can regroup, take a deep breath, remind yourself that you are safe right here and now, and then continue. You may need to repeat this (pause, breath, & go again) several times during intercourse, and that is okay.
This road may feel tedious or frustrating. I hear you. I see you. I feel you. I know. You are not alone, and I am here for you. There is hope. There is healing. There is orgasmic + blissful sex with no pain. We’ve got this.
Xx Dr. Laura