From Hurt to Hot: Helping Couples Navigate Sex After Trauma  

By Kate Balestrieri, Psy.D., CST, CSAT-S

PACT Level 3 Candidate

Sexual trauma knows no discrimination. It can happen to anyone, at any age, and occurs across gender, race, religious affiliation, and socioeconomic status. The statistics vary from study to study, but of reported cases, most studies concur that one out of three women and one out of six men will experience some form of sexual abuse prior to the age of 18. More obvious examples of sexual trauma might include molestation, rape, and sexual harassment at work. However, some of the more covert examples include early exposure to sexually graphic content, sexual betrayal, sexual shaming as a child or adult, and repeated sexual objectification.

For most couples, sex is an integral and enjoyable experience. Sex can be a chance to have fun, destress, and reconnect. Survivors of sexual trauma may have a bifurcated relationship to sex. At times they may feel liberated with pleasure, connection, and embodiment. At other times they may feel uncomfortable, obligated, disempowered, disembodied, or disinterested in sex altogether.

A survivor’s relationship to sex can be ever-evolving, as healing from trauma isn’t a finite experience. Safety threats may be real or perceived, current or historical. The need for attunement with a partner may come with an embedded fear of such closeness, complicating the potential for sexual satisfaction and co-regulation between partners. Healing means regulating a nervous system primed for self-protection. Secure-functioning relationships can offer a foundation for redefining relational safety and connection — key ingredients for sexual satisfaction. 

A dysregulated emotional or somatic state can be triggered by a memory, commercial on TV, a phone call from a sibling, or the lyrics of a song, for example. The list of potential triggers is infinite, as what is triggering to a survivor is unique to the survivor and their experience. A moment of trigger can catch the survivor and/or their partner off guard. When partners quickly identify each other’s cues for dysregulation or triggered states, they can more readily help bring each other back to a state of relief.

Hypervigilance and dysregulation are bodily states in direct conflict with sexual arousal. A nervous system in a state of hyperarousal is preparing for the possibility of self-protection, making a fight, flight, freeze, or fawn response more likely. Partners who work together to relieve each other from distress quickly and effectively, verbally and nonverbally, build somatically felt implicit levels of trust and safety with one another, freeing up precious energy for reallocation toward desire. Just as triggers are unique to each survivor, so are the grounding and regulations that can help them.

Eye contact, nonverbal communication, and skin-to-skin contact offer a wellspring of neurobiological exchange in couples and can be a conduit for deep and implicit repair after trauma, for couples who proactively and repeatedly affirm a commitment to safety in their couple bubble. Some survivors may not be able to withstand eye contact or bodily contact in a dysregulated state. When this is the case, helping the couple find other means of co-regulation without touch or eye contact is the conduit to restored safety. In other words, a well-attuned partner can help a survivor feel safe in their body, in the moment, in the relationship, and more vitalized and empowered as it relates to sexual arousal. But rushing can present more dysregulation, so teaching couples how to navigate this process together is what can help them re-establish physical and sexual intimacy.

While there is no linear path toward finding a resolution (healing from trauma is often a stepwise process), there are a few things you can help your couples do to enrich their sexual intimacy and connection, if one (or both) partner’s history is interrupting their present. 

  1. Read each other’s cues and ask questions.

Reactivity to trauma triggers can include a big reaction, or it can look like a shutting down. In nonsexual and especially in sexual situations, ask couples to notice when each partner has a shift in their nonverbal expressions, eye contact, level of vitality, and then check in with their partner. Remind them not to make assumptions; as humans we have all kinds of shifts, and these shifts may or may not be related to historical trauma.

However, subtle changes can lead the way for a couple to be better cued into each other’s sense of safety and comfort. Effective attunement can help couples move toward repair and restoration and vitalized sex. They can practice learning each other’s cues by moving toward each other and away and honing in their awareness of their own bodily reactions and those of their partner.

  1. Don’t make assumptions.

Each experience of sexual trauma is different, as is every survivor’s needs in the aftermath of the experience and across their lifespan. Remind the survivor’s partner not to assume they know what is best for a survivor. Encourage them to ask the survivor how they want to be supported, and then ask them to listen to the survivor’s words and pay attention to nonverbal communication. Some questions that can be a useful place to start: 

  • “How can I support you right now?”
  • “Is it helpful if I put my hand on your back?”
  • “Is there anything I’m doing that is making you uncomfortable?”

A critical aspect element of sexual trauma is a loss of agency, so be sure non-traumatized partners remember to hold space for the traumatized partner’s agency and autonomy in what, how, and when to discuss what happened, what they are feeling, and what they need. This might look like being okay in the grey area of “I don’t know.”

Survivors often experience confusion and dissociation during the original trauma and later triggers. Neurochemically, their brain is full of chemicals that can impede a clear narrative, and if they are experiencing a freeze or fawn response, they may need some time to assess what they want, need, or can’t handle. Holding space for that means regulating themselves, not jumping to conclusions about what will help them and unintentionally stripping away their autonomy to assuage their own anxiety.

  1. Don’t invalidate each other, even if you get frustrated.

It’s hard to believe that something as seemingly innocuous as invalidating an emotional response can impact sexual satisfaction in a relationship, but it does. Partners often get defensive and say things like, “You’re angry for no reason!” Or, “Stop being dramatic!” 

Not only do comments like this add fuel to any argument, invalidation can evoke a perception of threat. It’s as if one partner’s nervous system tells the other, “I override you.” While the conscious experience of invalidation may not seem like a big deal, implicitly, in the body, it can fracture connection and signal threat. Validation is essential in any relationship. For trauma survivors in sexual and nonsexual moments, it plays a considerable role in erotic potential.

  1. Define and prioritize safety together.

Essential to the PACT model are a couple’s shared principles of governance. Safety is one example of a shared principal. While most couples assume a foundation of safety, it is less common that they define it together. Further, how a couple adheres to their other shared priorities offers an implicit level of safety in the partnership. How is safety prioritized in a couple’s relationship?

Encourage them, when they both feel well regulated and not triggered, to discuss needs for safety during sexual moments and nonsexual moments and build into their shared values a plan for establishing and procuring safety in and out of the bedroom. They must make room for safety needs to be emotional, physical, or behavioral.

Remind them that two people are in their relationship, and they may have competing needs, but that doesn’t make either partner’s needs wrong. When one partner’s needs seem to conflict, this offers both partners a unique opportunity to collaboratively prioritize the needs they have, so they can determine where to start and how to negotiate win-win solutions.

  1. Support each other via co-regulation.

In the PACT model of therapy, the focus is on helping the members of each relationship become experts on each other. Why? Because when couples understand each other’s signs of dysregulation, they can more adeptly help each other get back to their baseline through the process of co-regulation. Attending to a partner’s distress and helping them find relief can be a lifeline out of a triggered state.

  • Couples can talk to each other pre-emptively, when they’re not already dysregulated, to find out what soothes their partner in moments of distress.
  • One partner can ask another if they’d like a gentle hug or reassuring arm around their shoulder. Be sure to remind them to ask, because sometimes touch can increase a partner’s distress.
  • Couples can co-create a plan for relief as they are both equal members in the relationship. Even though it might seem like a great idea to rush to their partner’s rescue and assume the role of rescuer, honoring each other’s autonomy, resilience, wishes, and limits is an essential aspect of healing, especially after sexual trauma when a survivor’s autonomy and agency were disregarded or overruled. 
  1. Create a sexual boundary plan together.

It can be very helpful for survivors and their partner to discuss the kinds of things that trigger trauma reactions so that there is more awareness of the sensory, relational, or environmental triggers that can impede sexual vitality. A survivor can outline the known triggers, such as watching a documentary with sensitive material, the smell of a certain kind of cologne, or specific sexual activities. Partners can help survivors regulate their needs when triggered, fostering more security.

While not a guarantee, a proactive boundary plan can help couples identify moments for sexual intimacy as well as cues to warn if one or both of them is not in the right head or body space. With a strong outline in place, couples can feel free to live with more sexual spontaneity and a shared understanding that attention to sexual comfort is a priority and a core pillar to the relationship.

  1. Consult with a therapist, who also specializes in treating sexual trauma, when you need help.

Healing from sexual trauma can be difficult for survivors, for their partners, and sometimes for their therapists. Often provided with minimal training in graduate school, therapists can even feel overwhelmed or unsure at time about the nuances of effective care. A cornerstone feature of sexual trauma is that of helplessness, which can be relived over and over on the path of healing. Therapists can experience vicarious trauma, or share in feelings of helplessness with their clients, without confidence in how best to offer effective care. Consultation in our field is such a gift, and can offer a mountain of resources. If you’re feeling stuck, unsure, or overwhelmed, reach out to colleagues who specialize in this area to help you feel more equipped and grounded, because empowered people empower people.

Having a history of sexual trauma can leave survivors with a lifetime of renegotiating their relationship to sex, as their body and life circumstances change, but it does not have to wreak havoc on their relationships. With a partner dedicated to witnessing their healing experience, survivors can have empowered, enjoyable, and thriving sex lives. A partner may not have been a part of the traumatic experience, but they get to be a part of a survivor’s healing journey, and healing together is a gift.


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