A couple whose hands make the shape of a heart; Developing intimacy when one of you has PTSD

When we hear the word “PTSD,” we often think of soldiers coming home from war, triggered by loud noises or surprise touches. But shell-shocked veterans make up only a small fraction of those suffering from PTSD.

Post-traumatic stress disorder and its cousin, complex PTSD, can arise from many dangerous situations, be they physical or psychological. Women suffer at a much higher rate than men, but men also deal with the effects. Those who have escaped (or are still enduring) domestic violence often develop complex PTSD through long-term exposure to abuse and trauma. People who grew up in both physically and psychologically abusive households often suffer from C-PTSD too. Regardless of the cause of someone’s PTSD, sexual or otherwise, 90 percent of women with the disorder report reduced libido.

Scientifically speaking, PTSD and C-PTSD arise from the amygdala’s response to danger. “SPIDER! AHHHH!” is the amygdala’s response, while the hipocampus perceives the danger and chimes in, saying “Calm down, dude, it’s a spider on TV.” Catecholamines are there to help control how your brain thinks about a situation, but those thoughts can trip the distress signal. Distress can trigger more of the chemical, which triggers more frightened thoughts building a vicious cycle of panic and distress.

Dr. Rachel Yehuda of the International Society for the Study of Women’s Sexual Health (ISSWSH) says if catecholamine levels are too high, it results in an “overconsolidation” of a memory. This overconsolidation — too much detail, too many looped thoughts — all lead to PTSD. This happens during incredibly stressful situations when normal coping mechanisms cannot be engaged for one reason or another.

This might seem simple, but PTSD and C-PTSD are anything but. They interfere with almost all levels of intimacy among family and friends, as well as in romantic partnerships. Trust, closeness, communication, responsible assertiveness and effective problem-solving all fall victim to the disorder. For some, everything that was once bright becomes lackluster, including their own formerly glowing, vibrant personalities. They may become irritable, easily startled, anxious and feel the need to control everything (and everyone).

What does all of this have to do with sex? Well, it’s hard to get down if every little thing triggers you. Partners of those with PTSD have to be especially sensitive to the needs of their loved ones.

Here are some tips for how to approach intimacy when your partner suffers PTSD:

1. Stop romanticizing spontaneity and start embracing structure (as told by someone who hates rules):

I suffer from C-PTSD, and right now spontaneity is especially tough. Nearly every time my partner and I make love, we have to rebuild trust. This is incredibly hard on our sex life, as we don’t always have the hour or two that I need in order to talk, snuggle and build up to sex with foreplay and familiar touches.

In order to do this, sometimes you have to schedule time within your week for intimacy. This does not mean that there is no other time for sex aside from what you’ve scheduled; it just means that you’ve set aside time to say “time out” to the rest of the world, lie in bed (or wherever you are most comfortable being intimate) and simply be in each others’ arms, talk and touch until the moment feels right — if it ever does feel right. It’s OK to not have sex during your intimate sessions with each other. Intimacy is not defined by sex. For me, it is defined by trust and comfort.

2. With PTSD, patience and flexibility is a must

As with all parts of life, you have the right to change your mind at any point. This cannot be emphasized enough for those who have PTSD/C-PTSD and their partners. Regardless of the scheduled “intimacy sessions,” “date night” or whatever you and your partner call your time together, either of you has the right to say, “I cannot do this right now” if you are not in the space for physical touch or going too deep psychologically.

Consent — whose violation may have triggered the PTSD in the first place — is utterly important as you navigate intimacy with a fragile partner.

For some, especially those dealing with severe sexual assault or DV issues, no touch can be taken for granted. You are not doing your partner any favors by having sex when you do not want to, either, assuming they are a caring partner that does not wish to hurt you.

A partner to a woman with PTSD said,

“I have hated when — even when I am assured it’s OK and I say ahead of time that it’s OK to stop at any time — I find out later that there were flashbacks and memories, and it was somehow suppressed at the time, dissociation or whatever. I feel terrible, and after this happens several times, I am less inclined to believe it IS OK. I’d rather not do anything than to re-traumatize. I understand that, given an abuse history and all the powerlessness that implies, it is hard to voice “stop.” But it is very hurtful to me to find out after the fact that those feelings occurred. And it’s not that I am not trying to watch for any sign of a problem. Just TELL me! I DO NOT want mercy sex. I will not HAVE mercy sex. If, as a sufferer, you cannot do it, let me know. Don’t just go along. You have the right to say NO. No matter HOW long we have been married. You can say NO.”

Regardless of your past experiences, you have the right to say “no” and be heard. Anyone who loves you will hear it. Use the word to set boundaries for yourself and the relationship so that you can build a better base.

3. Create games or activities to build intimacy.

As someone who has been recovering from C-PTSD for many years, I can tell you that it creeps up at strange times. Sometimes it pops up when it feels as though your life is coming together and you are AT LAST! in a safe place. Sometimes that mere feeling of safety, however fleeting, is enough for the dam to break. Everything that you have been holding back all of those years comes pouring out — because it’s safe to exist, to breathe.

One thing that you can do to build that intimacy and finally, perhaps, reach the point of sexual closeness is exposure therapy through couples’ games. As cheesy as it may sound, it can really work. For instance, some victims of sexual assault are triggered by the sound of a heartbeat. If that’s the case, you and your partner can try sitting across from each other. Place your hand on your partner’s heart so that you can feel their heartbeat while staring into their eyes for five minutes. You start fully clothed and do it for as long as you can. If it triggers you, step back for a few days and then return to it. Keep adding a minute at a time until you can get to five.

The goal is to slow your heartbeat to the speed and rhythm of your partner’s heartbeat. Once you get to that five-minute point, you take off an item of clothing and keep doing it until your beats build up together. There’s no sex involved; this is all about exposing yourself to your own triggers while having your partner, your safe person, mirroring you.

These tips and tricks may not fix things, but they certainly helped my partner and I bounce back a bit into a slightly more “normal” life. Just keep in mind that your partner is there because they love you — but it is your job to set the pace for your recovery.

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