Traumatic events of both a sexual and nonsexual nature can have a devastating impact on a couple’s sexual intimacy. In the aftermath of rape, for example, female victims may distrust and avoid intimate relationships and often struggle with difficulties in arousal or physical response (Mills and Turnbull 2004). Though male victims are often at first more angry or dismissive of the rape than women, they, like female victims, suffer increased vulnerability, fear of closeness, shame, and self-blame (Mezey and King 1989). Sexual changes or reactions resulting from a trauma of a sexual nature are understandable, but there is increasing evidence of sexual and relationship problems in the aftermath of nonsexual trauma (De Silva 2001). Problems with sex and intimacy have been associated with both war exposure and combat trauma. These problems include curtailment of sexual activity, finding sex boring or burdensome, reduced desire, and erectile dysfunction (Solomon 1993; Wilson 1990; Matsakis 1996; Kulka et al. 1990). Studies of male and female Vietnam veterans reveal troubled marital relationships, with 38 percent of the marriages of Vietnam veterans dissolving within six months of their return from Southeast Asia (Kulka et al. 1990; Galovski and Lyons 2003). Sexual difficulties have also been reported by couples who have suffered the loss of a child. The grief from such loss often moves the partners through cycles of shock, numbing, anger, shame, and blame, which can disrupt patterns of relating for months or years (De Silva 2001). In fact, evidence shows that a broad range of traumatic life events, for example, cancer, abortion, miscarriage, auto accidents, and natural disasters, carry with them anxiety, anger, depression, loss, guilt and other feelings, which create difficulties in personal and intimate relationships and often result in sexual difficulties (Mills and Turnbull 2004; De Silva 2001).

the impact of post-traumatic symptoms on sexual intimacy

Each of the three primary trauma cluster symptoms of hyperarousal, reexperiencing, and numbing and constriction is likely to have an effect on sexual intimacy. The disruption caused by each may be somewhat different as will the strategy that may be most helpful in working through it. Each of these is discussed and described below.

Hyperarousal. Hyperarousal is the persistent expectation of being in danger. This translates into symptoms such as the inability to relax, exaggerated startle response, sleep difficulties, anger, irritability, and hypersensitivity to stimulation, all of which compromise intimacy. It is difficult to feel sexual if you or your partner is frightened and hypervigilant about sound or touch. If exhaustion becomes a factor, or if sleep schedules are out of whack (perhaps one of you tries to sleep and the other attempts to avoid sleep by surfing the Web or watching TV), romance is compromised. Spending time together relaxing, engaging in pillow talk, listening to music, or watching a sitcom together may become difficult and tense and you may ultimately avoid these kinds of activities. Similarly, hypersensitivity often makes erotic or intimate activities like massage, showering together, or just spooning, which you may have shared before, too uncomfortable. Anxiety may well interfere with sexual performance, and the letting-go that is necessary for sexual release and orgasm is understandably difficult to achieve in a state of hypervigilance and tension.

exercise: hyperarousal

Most couples can benefit from relaxation. This strategy will not only help with some of the symptoms of hyperarousal described previously but also reduce general stress and tension. We invite you to try it together.

double deep breathing

Goal: Relaxation

Rationale: You can’t be physically relaxed and stressed at the same time. Controlled breathing techniques are quick and fairly easy ways of lowering physiological stress. With anxiety, a person will often engage in shallow breathing, which brings less oxygen to the bloodstream, in turn setting off warning signals that lead to more adrenaline and increased shallow breathing. Controlled deep breathing provides a way to move your body out of a hyper aroused and anxious state.

Description: You can either sit up side by side or lie down next to each other. One of you can give the directions aloud: “We are going to place our hands on our laps, or next to us if lying down, or gently hold hands. We will close our eyes and slowly inhale to the count of four, feeling our abdomens expand. Then we are going to slow exhale from our noses to the count of four until we have let all the air out. We will continue to do this for three minutes.” (You might want to place a clock in easy view or play a relaxing song—the average song is about three minutes long.)

Variation: Try again using imagery. Many people find that positive imagery adds to the experience of relaxed breathing. Give the directions out loud as follows: “We are going to picture a scene where we would like to be—a beach, a forest, a lakeside. We will try to imagine what wefeel as we lie there, what we see, what we hear, what we smell.”

Guidelines: After three minutes, or when you are ready to stop if you have tried it again or added imagery, slowly open your eyes and take a minute to mentally come back to the room and each other. Look into each other’s eyes, touch in whatever way feels comfortable to both ofyou, and take turns telling your partner about the relaxing place you visited. Feel the deepening of intimacy that comes with this exercise. Repeat, practice, and enjoy.

excerpt from Healing Together: A Couple's Guide to Coping with Trauma and Post-traumatic Stress by Suzanne Phillips, Psy.D., ABPP and Dianne Kane, DSW, CGP