Lela Vásquez, a 23-year-old childhood sexual abuse survivor, never understood why she cried after having sex with supportive partners or masturbating. It wasn’t until she was 18 and had been in multiple sexual relationships hat she realized the deep depression she felt after any sexual experience was linked to her post-traumatic stress disorder from her abuse.
Vásquez dealt with it privately until six months ago, when she learned that her experience was so pravelent among sexual assault survivors that there was even a term for it.
Postcoital dysphoria, also known as post-sex blues or postcoital tristesse, refers to intense feelings of sadness, agitation or anger after consensual ― even pleasurable and intimate — sex or masturbation. Symptoms of postcoital dysphoria include “anxiety, depression, feelings of emptiness, melancholy or crying,” according to Jill McDevitt, a sexuality educator and sexologist at CalExotics, an adult sex toy brand.
That’s precisely what Vásquez was experiencing. Though recovery from sexual trauma is rarely — if ever — a straightforward or predictable process, research shows that PTSD can largely affect both physical and mental health. That includes a person’s sex life.
Yet, the impact of PTSD on survivor’s sexual wellness is still largely considered a taboo topic, and oftentimes, health concerns related to sex and intimacy go unaddressed because of stigma.
It’s time to change that.
Anyone can experience postcoital dysphoria, but research suggests it’s strongly linked with a history of sexual assault.
Forty-six percent of women reported experiencing postcoital dysphoria at least once in their lifetime, according to a 2015 study by the journal Sexual Medicine, and a history of childhood sexual abuse was found to be the most important predictor. A history of physical abuse, emotional abuse and sexual assault in adulthood also appeared to be risk factors. Additionally, new research in the Journal of Sex and Marital Therapy shows that a history of childhood sexual abuse is associated with postcoital dysphoria in men.
Though postcoital dysphoria isn’t widely acknowledged, it’s a common and normative response to trauma, said Patti Feuereisen, the founder of GirlThrive and a psychologist who has worked with sex abuse survivors for more than 30 years.
Many survivors will dissociate, or essentially “tune out” at the time an assault is happening, Feuereisen said, and this feeling can linger long after the abuse is over. In fact, dissociation is one of the common symptoms of PTSD, which makes it more difficult for sexual assault survivors to feel connected to themselves, their bodies, their loved ones and the world around them.
For many sexual assault survivors with PTSD, simply being present during sex can be emotionally painful and triggering — even when they’re with a supportive and respectful partner.
Survivors may experience PTSD-related flashbacks during sex that can bring on post-sex blues.
“Postcoital dysphoria is more common among sexual assault survivors,” said Stefani Threadgill, a Texas-based sex therapist, “because memories of trauma are stored in the parts of the brain associated with survival — the amygdala and the hypothalamus — that can be triggered during a sexual experience.”
Experts agree that practicing self-care, both in and out of the bedroom, is a key component to overcoming the issue on a regular basis.
“You have to just stop at that moment ... do whatever sort of self-care that you do,” Feuereisen said. “Maybe your partner sits up and brings you a cup of tea. That begins to restructure and remap the experience.”
Remapping a traumatic experience — or reframing the negative situation into a positive one — can be empowering and healing.
One way to remap is by practicing intentional intimacy for 20 minutes or so with a partner or by yourself, Feuereisen said. Simply put, intentional intimacy is about setting aside time in a busy schedule to foster connection ― whether that’s sexual, emotional, physical or spiritual connection ― with one another or on your own.
“With intentional intimacy, it’s everything you want — you get to choose it. For survivors, it’s a wonderful thing,” Feuereisen said. “You have to relearn how to enjoy your sexuality. In order to be OK, you have to go through these feelings, [and] you can no longer dissociate from them.”
McDevitt takes a similar approach with clients experiencing postcoital dysphoria. “If the client wanted to feel joyful and relaxed after sex, we’d work to qualify what ‘joyful and relaxed’ means and looks like,” she said. “Then we’d backtrack, breaking down this goal into smaller and smaller steps.”
Summer,* a 41-year-old childhood sexual abuse survivor, lived with PTSD-related postcoital dysphoria for nearly 13 years. (She asked to remain anonymous so she can more freely discuss her mental health.) The condition left her feeling either “dead inside” or shaking and crying uncontrollably, she said. But much of her healing came through remapping her sexual experiences with a trusted loved one.
“Through time with a compassionate, loving and understanding partner, I learned to feel safe and valued,” Summer said, adding that it’s been around a decade since she last had a bout of postcoital dysphoria.
Though stigma around mental illness and sexual health persists, there’s no shame in seeking help from a mental health professional for post-sex blues.
“I still struggle with postcoital dysphoria a great amount, and my intention is to accept the emotions, wait for the wave to pass and plan ahead,” Vásquez said. “Learning to cope with my postcoital dysphoria has definitely been a part of my trauma recovery.”
Dealing with post-sex blues doesn’t mean a survivor dealing with PTSD is broken or that they are “damaged goods.” It isn’t indicative of some moral failing. Experiencing postcoital dysphoria simply means they’re processing and healing, and that ― most importantly ― they’re human.
“The most important thing here is to remember that all of this is about you taking your power back if you’ve been sexually traumatized,” Feuereisen said. “When you work it through, you sometimes may have a moment where the postcoital dysphoria comes back, but they will just be moments.”
“Living With” is a guide to navigating conditions that affect your mind and body. Each month, HuffPost Life will tackle very real issues people live with by offering different stories, advice and ways to connect with others who understand what it’s like. In June, we’re covering trauma and PTSD. Got an experience you’d like to share? Email firstname.lastname@example.org.