Solving Specific Sexual Problems
Traditional sex therapy techniques for sexual dysfunctions may actually be harmful to survivors, unless they are well down the road to overall recovery from sexual abuse.
—MIRIAM SMOLOVER, Therapist
Practically everyone experiences a troublesome sexual problem sometime in life. Some sexual problems are temporary and go away on their own. Others persist. The sexual problems that result from sexual abuse are usually persistent problems. Solving them requires our active attention.
Problems with sexual functioning, interest, and relating often plague survivors over the course of many years. Some survivors have never felt a strong interest in having sex. For others sexual problems may have surfaced only recently, as a result of their sexual healing work. A survivor who has learned to stop fantasizing about sexual abuse, for example, may now have difficulty becoming aroused.
Now is a good time in the sexual healing journey for survivors to address specific sexual problems. Survivors have gained new understandings about the relationship between sex and sexual abuse, made important changes, and have developed new skills for relearning touch and sex. By this time in the journey, many survivors feel less apprehensive about sexual activity, having learned that sexual touch is just one aspect of full-body sensuality and just one expression of physical intimacy.
In this chapter we will examine the causes of a variety of sexual problems and learn specific ways to solve each of them.
FINDING THE TRUE CAUSE OF A SPECIFIC SEXUAL PROBLEM
Sexual problems have a wide range of causes. Some can result from organic causes, such as medical conditions, physical injuries, and the effects of certain drugs.* Others stem from psychological causes or specific life events, such as stress, inadequate sex education, rigid parental attitudes against sex, interpersonal problems, and bad experiences like sexual abuse. While there may be good reason to believe a current problem stems from early abuse, it is unwise to assume that sexual abuse is the only, or even primary, cause of all our sexual problems.
A good first step is to see a medical professional and, perhaps, a certified sex therapist† to determine if the sexual problem might have an underlying cause other than sexual abuse. Without accurate diagnosis you run the risk of spinning your wheels in trying to heal a sexual problem.
Wanda, for example, was plagued by vaginal discomfort during intercourse. A twenty-five-year-old rape survivor, she assumed this problem resulted from sexual abuse. During intercourse she would focus on relaxing and reminding herself that her present partner was not an offender. She and her partner would begin intercourse slowly, and Wanda would stop frequently to reassure herself that she was in control of her experience. But her discomfort continued. Finally Wanda went to her gynecologist, who examined her and suggested that a minor yeast infection might be causing the problem. Wanda got rid of the infection, and, to her amazement, intercourse felt fine.
When Chuck, a thirty-five-year-old survivor of childhood molestation, entered a sexual abuse survivor support group, he began having difficulty with erection and ejaculation. His erections didn’t seem as firm as they used to be, sometimes he ejaculated quickly, and on a few occasions he felt pain at the base of his penis. Chuck assumed that these symptoms were expressions of unresolved emotional pain related to the abuse. For months his sexual problems continued. Chuck read sex therapy books and tried the techniques in them to no avail. Finally Chuck went to a urologist for a checkup. He had a low-grade prostate infection. After he took antibiotics, his sex problems disappeared.
Like Wanda and Chuck, many survivors may be too quick to assume that sexual abuse is the sole or primary cause of a sexual problem. A number of factors can combine to create a sexual problem for survivors. It may be hard for you to weed out how much of the problem relates to abuse.
Let’s consider Jesse, who has difficulty reaching orgasm. As a child Jesse was taught that masturbation was disgusting and sinful. Because of the messages from her family, Jesse never experimented with touching her own genitals for pleasure. In high school Jesse was raped by a young man she had been dating. During the rape the offender called her a slut. Now in her twenties, Jesse is married and very much in love with her husband. She wants to experience orgasms. For Jesse the combination of sexual abuse and her antisex upbringing lay at the root of her present sexual problem. Becoming orgasmic will require not only her overcoming the sexual trauma experienced in the rape but also her resolving the negative effects of her upbringing.
ANXIETY MAKES SEXUAL PROBLEMS WORSE
Sexual problems may make us worried, guilty, or depressed, further deepening our problem. We may dwell on thoughts like, “I’m not normal,” “I’m inferior sexually,” “No one would want me for a partner if they knew,” “I’ve failed the partner I have,” or, “I’ll never be able to change.”
Lonnie, a survivor of mother-son incest, made himself sick with worry after experiencing a few days of erection problems. His erection problems began after a horrible nightmare in which his mother stood over his bed laughing at him while he was making love to his girlfriend. Although Lonnie had never had difficulty with erections in the past, after the dream he convinced himself his problem now signaled doom. He worried he’d never get an erection again and that his girlfriend would leave him. His anxiety festered, causing the problem to persist. Lonnie was able to overcome his anxiety by realizing his erection difficulty was a normal, although upsetting, response to the nightmare. As his anxiety went down, his erectile capacity went up.
Barry McCarthy, a Washington, D.C., sex therapist, wrote, “The male who can accept an occasional unsatisfactory experience without it threatening his sexual self-esteem inoculates himself against sexual dysfunction.”* Changing how we feel about having a sexual problem is a large part of the solution.
SEXUAL PROBLEMS AND THEIR SOLUTIONS
Let’s examine some common sexual problems involving sexual interest, functioning, and relating that may result from sexual abuse. Some problems may apply to you; others will not.
LACK OF SEXUAL INTEREST
Inhibited desire
Fear of sex
DIFFICULTY BECOMING AROUSED AND FEELING SENSATION
Lack of lubrication in women
Lack of erection (impotence) in men
DIFFICULTY EXPERIENCING ORGASM
Lack of orgasm in women
Inhibited ejaculation in men
DIFFICULTY AVERTING ORGASM
Premature ejaculation in men
Rapid orgasm in women
DIFFICULTY WITH INTERCOURSE, FOR WOMEN SURVIVORS
Muscle spasm, pain, and discomfort
Fear of penetration
Men and women experience many similar problems. Sexually they are alike in many ways, with similar response patterns and physiological likenesses that can be traced to the womb. At about six weeks’ gestation, male hormones influence male embryos to develop a penis and scrotal sac; these organs develop from the same tissues that become a clitoris and the outer vaginal lips in a female. In adults of both sexes, these organs contain sensitive tissues that engorge with blood during arousal as well as muscles that contract at intervals of eight-tenths of a second during orgasm.
When all is working well sexually, women and men both go through the same four stages in the sexual response cycle: excitement (initial building of sexual arousal), plateau (high levels of sexual arousal are maintained and intensified), orgasm (discharging of sexual tension in pelvic floor muscle contractions), and resolution (return to the unaroused state).
Satisfying, healthy intimate relating, of course, involves much more than going through these four stages. Our sexual functioning is a minor part of sexual intimacy. We can soothe and nurture ourselves physically, or cuddle, hug, touch, and whisper sweet words with a partner, regardless of whether we’ve been functioning in a particular way and whether we feel ready to have sex. We don’t have to let a specific sexual problem we encounter get in the way of warm, enjoyable feelings or interfere with intimacy.
Sexual functioning problems occur when we choose to have sex and are not able to move through the sexual response cycle with ease and satisfaction, or when we are unable to share our experience with an intimate partner. We become concerned, and even though these problems don’t preclude physical intimacy, we still want to improve our ability to feel sexually aroused, have orgasms, or engage in sexual relations and intercourse.
During the past fifty years, excellent techniques have been developed to help both men and women successfully overcome their sexual problems. These techniques are based on behavioral methods that reduce anxiety and reshape sexual responses. They were developed on the premise that sexual behavior is learned and therefore can be unlearned and then relearned in a new way.
Sex therapy techniques can be used effectively by survivors but only when the techniques are adapted as they have been in this book—to address survivors’ fears and anxieties about sex. Survivors need to modify the techniques to respect their needs to go slow, feel in control of what’s happening, handle automatic reactions, and deal with feelings that might surface that are related to the abuse.* Without these special adaptations, traditional sex therapy techniques can overwhelm survivors, encouraging them to lapse into old, harmful sexual behavior patterns. Survivors whose needs are not met in sex therapy may resume sexual relations before they are ready or may mentally dissociate from the experience. Their healing journey can be interrupted or pushed back.
Overcoming sexual problems takes time, just as relearning touch does. Healing requires a special time and a private, secure environment set aside for doing exercises. You will use new skills—relaxation, active awareness, and creative problem solving (described in chapter 10)—to make changes gradually. You proceed in small, progressive steps, from less challenging to more challenging experiences. Eventually, you will learn sexual responsiveness and functioning in a new way, free from the negative associations of past abuse.
Sexual functioning is nonvolitional. This means we can’t become sexually aroused or have an orgasm by sheer force of will any more than we can “make ourselves” fall asleep. The best we can do is create situations in which we are likely to have the kind of experiences we want. Then we can let go, relax, and let responses happen.
You may not currently have a specific sexual problem you need to address. Still you will probably find the explanations, stories, and suggestions offered in this chapter helpful in enhancing your sexual experiences.
Let’s take a look at specific sexual problems and see how survivors have addressed them effectively.
Lack of Sexual Interest
Lack of sexual interest seems to be the most common specific sexual problem of survivors. Some survivors have an inhibited desire for sex; rarely if ever do they think about wanting to engage in sex. Other survivors may have a lack of sexual interest because of fears of sex or fears of the automatic reactions and responses that may be triggered during sex. Survivors who have been overly interested or preoccupied with sex may find that their interest in sex plummets when they stop compulsive sexual behaviors. An excessive interest in sex can mask underlying inhibitions and fears.
When we consider how much pain and suffering is often caused by sexual abuse, we begin to understand why, after abuse, many survivors lack interest in sex. When sex hurts it’s natural to want to avoid it. Turning off one’s sexual feelings during abuse is adaptive and protective. We may unconsciously teach ourselves ways to block or muffle awareness of our natural sexual feelings. We may keep ourselves so busy and mentally preoccupied that sexual feelings can’t develop.
Continuing this pattern now cheats you of a chance to enjoy intimacy. By now you have learned that healthy sex is different from abusive sex. Perhaps you are in situations in which sex could be safe and pleasurable. Instead of protecting you, a continuing lack of interest in sex now cuts off your pleasure and robs you of the joy of building a special connection with an intimate partner.
To awaken sexual interest, survivors must believe sex is good and that you can feel good about yourself when you are sexual. You also need to know you can handle whatever troublesome reactions are triggered, including fear, discomfort, overexcitement, and flashbacks.
Relationship problems can also diminish sexual desire. Survivors may feel angry or resentful toward a partner because of unpleasant sexual experiences in the past. Some partners communicate the idea that sex is a duty the survivor owes. When this occurs a survivor may get stuck in a power struggle with the partner and hardened to the position that “you can’t make me want it!” As long as the partner is seen as an adversary instead of an ally, the lack of desire will probably persist.
Survivors may worry that they will be pounced on by their partners as soon as they show some desire for sex. They may fear the partners will be disappointed if they choose not to act on their desire or that they will expect sex more frequently if they do. Assertiveness and clear communication can help survivors feel safe to explore sexual interest as it emerges and as they feel ready to proceed.
Courtship is also important to people. We tend to forget that we have our own unique mating dances. It’s foolish for many of us to think we can go all day without seeing our intimate partner and then expect to get in bed at night and want sex. Sexual desire comes from sharing time, making eye contact, talking, playing, and making nonsexual connections first. You may find your interest in sex increasing as you increase self-respect and caring, build trust with your partner, and practice the relearning touch exercises in chapter 10.
To decrease fear and increase sexual interest, survivors and their partners need to reach an understanding. I believe two ground rules are essential:
1. Expressing interest in sex is not a commitment to sexual activity.
2. Declining sex is not an absolute rejection.
These ground rules about sex are so important that it’s worth taking time to learn them in practice. The following exercise can help you and your partner understand and work through issues related to initiating and declining sex. By relieving interpersonal strain and sexual pressure, you can give sexual interest a chance to evolve naturally (see box below).
Learning skills in initiating and declining sex can increase empathy in couples in which one person has been the initiator more often than the other. A woman survivor who had never initiated sex with her husband was surprised at her reaction when she played the initiator role and her husband declined.
I didn’t expect it, but I felt rejected. I thought I would feel relief when he declined, but I didn’t—I felt sad. Now I know how he must feel sometimes.
The survivor’s husband enjoyed being in the role of decliner. He liked hearing his wife express her sexual interest in him, something he had never heard her say before. He was pleased to hear her tell him that his smooth skin and warm touch attracted her. It made him feel better about not having sex, just knowing his wife had some positive feelings toward him.
When you do feel ready to have sex, it must be for yourself, not mainly to satisfy your partner. You can allow your interest in sex to emerge by increasing communication with your partner and becoming clear on how sexual possibilities will be pursued, as this survivor explained:
I talk openly with my partner about the fears that come up when I’m approached romantically—how I worry that I’ll be expected to engage in sex. He listens, and then we talk together about how we can be more safe and comfortable. Then we gently touch each other, massage and stroke one another. Sometimes this develops into sex and mutual orgasms, but if it doesn’t, that’s okay.
PRACTICE INITIATING AND DECLINING SEX EXERCISE
Purpose: To improve communication skills, increase empathy, and reduce pressure regarding expressing interest in sexual activity
In this role-play exercise you and your partner take turns initiating and declining sexual activity. You merely practice these roles. No sexual activity is to take place as a result of the exercise.
Sit in a comfortable position facing your partner, about two or three feet from each other. The survivor chooses which role he or she would like to start out in. There is an “initiator” and a “decliner.” You are like actors, playing roles. You do not need to feel the feelings you express just now.
The initiator speaks first for about three minutes. The initiator begins by expressing sexual interest—“I am interested in having sex with you . . .”—and then continues by making at least three statements that express why the initiator wants to have sex.
An initiator might then say, “I respect you and like the person you are. I find you sexually attractive. I appreciate our life together and want to be close with you in a special way. . . .”
The initiator then describes what he or she would like to have happen: “I would like to spend some time cuddling with you and talking. Then I would like us to undress and touch each other gently. Then I would like us to kiss.” And so on.
As the initiator speaks the decliner simply listens. It is understood that this is not a “real” initiation but rather a chance to practice. Be honest and specific about what you find attractive in your partner and how you imagine a positive sexual encounter could proceed.
Next it is the decliner’s turn to respond for about three minutes. The decliner begins by thanking the initiator for expressing sexual interest. Then the decliner directly declines the invitation. For instance, “I appreciate your interest in having sex with me; however, I am not interested in having sex right now.”
The decliner continues by repeating back to the initiator appreciative words for the positive things the initiator expressed, such as “I am glad that you find me sexually attractive. It makes me feel good knowing you respect me and want to show me your love sexually. I like the idea that we would cuddle before undressing.” And so on. The initiator listens when the decliner speaks.
The decliner focuses on refusing the sexual initiation in a gracious and respectful manner. The overall message is that you feel fortunate for the invitation, but you’re simply not interested at this time.
When the decliner is finished, take a few minutes to notice how each of you feels. When you are ready, switch roles and do the exercise in the opposite role. When this second part of the exercise is complete, spend some time talking together about what you each felt in the roles of initiator and decliner. Which was easier for you to playact? What did you learn about yourself and your partner? When you initiated sex, did you do it as a statement of your feelings—“I am interested in having sex with you”—or did you slip into making a demand—“I want you to have sex with me.” Demand initiations tend to increase anxiety in the decliner.
Repeat this exercise several times. You may notice that you feel more comfortable in a role the more you practice playing that role.
Relationships are not the only key to sexual desire. Take time to think about how you view sexual desire. Do you see sexual interest as sharp and urgent, like hunger, or do you view it as fulsome, like the ripening of a fruit on the vine? To develop your interest in sex, I recommend you adopt the second perspective. Sexual interest is something we can learn to cultivate and let ripen. (This becomes especially important as we age. A hormonal rush can’t always be counted on to awaken our sexual desires.)
Give yourself permission to cultivate the gentle awareness of your senses. Becoming sensual can naturally lead to becoming sexual. What kinds of sensual experiences do you enjoy? Lying in the sun? Walking on a smooth carpet? Taking a warm bath? Make sensual experiences a priority in your life.
If you want to be more interested in sex, you can take a more direct approach to awakening and developing your sensuality. By engaging in activities that stimulate feelings of sexual arousal or in which you receive and enjoy direct genital stimulation, natural desires are likely to grow.
Here are some suggestions:
1. Do relearning touch exercises.
2. Imagine having sex in a way that you would enjoy.
3. Engage in foreplay such as hugging, kissing, and fondling with your partner.
4. Stimulate your genital area while bathing, resting, or cuddling with your partner.
Sexual interest can be cultivated but not pushed. You need to find a delicate balance between the voice in you saying, “I don’t want to do this,” and the voice saying, “I’ll give it a try.” Remember, you can say no at any time, and you can make little steps forward. You have a right to be sexual. Respectful, healthy sex is good.
Difficulty becoming aroused and feeling sensation
Sexual arousal increases our interest in sex, and it helps our bodies to prepare physiologically for intercourse and other sexual activities. When survivors have trouble becoming aroused, it can be very upsetting. Desire can plummet. Women may notice a lack of vaginal secretions that normally lubricate the vagina. The internal walls of their vaginas may fail to expand adequately. Sexual intercourse and other forms of vaginal penetration may be extremely uncomfortable, if not painful. For male survivors arousal difficulties are more externally obvious. A man may have problems getting and maintaining an erection. Under these circumstances, intercourse and other sexual activities may become difficult or even impossible.
There are many reasons why sexual abuse causes arousal difficulties. During sexual abuse, survivors may have learned to cope with confusing, unwanted pleasurable sensations or to endure violence and pain by numbing their sexual areas. This response, while crucial to enduring the abuse, may have become so ingrained and automatic that it cripples sexual responsiveness in the present. To help themselves overcome problems with numbing, survivors need to remember that the sexual abuse is over. They can control their sexual experiences. Practicing new ways of taking care of yourself during sex, such as asserting feelings and needs, setting limits, directing touch, and stopping sexual activity when necessary, can help you affirm your sensuality rather than deny it.
For both men and women, problems with numbing can also be approached with a process called sensation retraining. Let’s say a woman survivor has little or no sensation in her clitoris, even after ten minutes of touching herself. She does, however, experience pleasurable sensations while stimulating her nipples. The woman can retrain her clitoris to feel sensation by spending time first touching her nipples and then simultaneously touching her clitoris. Through this technique she can begin to pair the pleasurable sensations in her nipples with her clitoris—sensation by association. After several sessions like this, the woman may start to notice warm, tingly feelings starting in her clitoris. Eventually these sensations will be noticeable when she touches just her clitoris.
For some survivors their own sexual arousal triggers negative feelings associated with being sexually victimized. As described in chapter 7, these automatic reactions are the result of a crystallizing of the traumatic experiences that occurred during abuse: strong emotional feelings became unconsciously linked with sensations of arousal. Avoiding arousal may be an unconscious attempt to avoid feeling afraid, angry, disgusted, or confused.
Some survivors block arousal because they maintain a negative view of sex and feel guilty for desiring sexual activity, as this survivor described:
Sometimes when I masturbate to release tension, I lose an erection because I start thinking about how gross sex is and that I shouldn’t be doing what I’m doing. I have to make a conscious effort to remind myself that this kind of self-stimulation is healthy and has nothing to do with sexual abuse.
Some survivors believe that becoming aroused will make them similar to the offender. After all, the offender was sexually aroused during the abuse. For these survivors arousal represents a sudden transformation into a person who is bad, out-of-control, or sexually demanding. A survivor of father-son incest told of his problem:
Sometimes when making love, I lose my erection because I think of how sexually demanding my father was of me. I worry that I’m being sexually demanding toward my wife. It’s a very lonely feeling when you think that you’re demanding sex and you’re unsure it’s really desired by your wife. I need a lot of reassurance from my wife that she’s enjoying the contact before I can continue.
Survivors may have difficulty mentally separating signs of their own healthy sexual arousal from memories of the offender and the abuse. When this happens, arousal symptoms, such as heavy breathing, warm feelings, increasing pulse, and the swelling of sexual organs, can become more disturbing than enjoyable. A man may be upset by his own erection, a woman by her vaginal secretions or the natural swelling of her clitoris.
Mattie, a survivor of father-daughter incest, noticed that during masturbation, as her clitoris became firm, it would remind her of her father’s penis. Immediately she would lose her arousal. Her aroused clitoris had become a trigger for the loss of sexual arousal. Mattie used techniques described in chapter 7 to calm herself, affirm her present reality, and build new associations to her clitoris. She imagined that her clitoris was a button glowing with a pure and healing white light. Its luminescence reflected the love and caring she felt for herself and her partner. By creating her own positive associations, Mattie was eventually able to experience sustained, pleasurable sensations.
It can help to remember that arousal is a healthy human response and in itself has nothing to do with abuse. Sexual arousal represents a desire to feel pleasure and connect in loving ways. Actress Mae West used to tease, “Is that a pistol in your pocket, or are you just happy to see me?”
Survivors can make progress overcoming problems with sexual arousal by paying attention to and challenging their attitudes about sexual arousal. Dennis, a survivor who was upset at the sight of his own erection, said:
During sex, I remind myself that I am very different from my uncle, the offender. My uncle used his penis as a weapon to exploit and hurt me. I think of my penis as a special part of me that enhances my partner’s pleasure as well as my own. I also remind myself that my arousal is different than my uncle’s arousal. He was aroused to sexually abuse. I’m turned on to having healthy, mutually desired and loving sex.
Survivors can also use progressive exercises, such as the genital awareness and pleasuring exercises described in chapter 10, to help them gradually learn to awaken sensation and experience increasing intensities of arousal. These exercises allow survivors to feel safe and become more comfortable with stronger sensations, one small step at a time. Later, when a survivor feels ready, his or her partner can participate in the exercises as well, so that the survivor can slowly become used to feeling aroused in the partner’s presence.
Male survivors can combine the genital pleasuring exercises with other techniques to address impotence and other erectile problems. A man can spend relaxed, private time doing a progressive series of exercises designed to help him tune in to pleasurable sensations and strengthen his erectile capabilities. These exercises include such activities as stroking himself when his penis is flaccid, masturbating until he has an erection and then purposefully stopping until he is flaccid again, and masturbating to fantasies of having sex with a partner, of losing and gaining an erection with a partner, and of having sex in a way that requires no erection at all.
Another approach to solving problems with arousal is to focus on reducing anxiety. Eros is in the mind. If we are physically healthy, our ability to become aroused has more to do with what’s going on in our heads than what’s happening with our genitals. Worry and anxiety potentiate arousal problems. The more anxious we feel, the less aroused we become. Conversely, the less anxiety we experience, the more aroused we can get.
A male survivor can reduce anxiety by learning to sexually satisfy his partner regardless of whether he has an erection, using methods such as hand, mouth, or vibrator stimulation. When the pressure’s off the importance of an erection, a man can create experiences that increase his ability to feel sensations and arousal, and allow him to become more spontaneous in sexual play.
Women survivors can reduce anxiety about vaginal lubrication. While lubrication and relaxation are often signs that a woman is sexually aroused, the absence of lubrication is not an automatic indicator that a woman is not aroused. The amount of lubrication fluctuates throughout a woman’s life, decreasing as women age. Lubrication can also vary with a woman’s menstrual cycle. It often becomes more pronounced during ovulation.
Since lubrication is not always a reliable measure of arousal, it is best to not make vaginal lubrication a big issue. Use saliva to lubricate the genital area during stimulation and penetration, or keep a safe commercial lubricant handy and apply it generously before, and several times during, sexual activities that involve vaginal penetration or touching. In deciding whether you are ready to have sex, pay more attention to what you’re feeling in your heart and mind than whether you’re lubricated.
Learning to feel comfortable becoming sexually aroused opens new doors for self-respect and appreciation. In an atmosphere of safety and support you can enjoy the tingles of sensation and the waves of excitement that your body is naturally capable of experiencing. Allowing yourself to feel sexually aroused is a way of allowing yourself to feel fully alive.
Difficulty experiencing orgasm
Some survivors have difficulty reaching orgasm at all times. Others encounter problems with experiencing orgasm only in certain situations, such as with a partner.
Abuse often inhibits natural curiosity about our genital sensations. We may fail to explore our own bodies and thereby fail to learn how our sexual feelings build to a climax. A survivor said:
In the past my difficulties with orgasm came from not knowing enough about my sexuality and what stimulation would bring me to orgasm. Because of the abuse, I didn’t believe in my right to pleasure and sexual satisfaction, in my right to speak about what I wanted, or in my right to explore and find out what it was I did want in sex. I was depending on my partner to happen to find the right thing to do.
When orgasm problems are due to a lack of self-exploration, survivors can often make great progress by spending time in self-discovery and genital pleasuring exercises.
I never had an orgasm until a few years ago when I started masturbating for the first time. I read a book about masturbation and thought I’d experiment. Before that I thought sex in any form was gross and disgusting. It’s been very healing to have a sexual experience in which I feel satisfied, strong, and sexual. Becoming more comfortable with loving myself in that way helps me know that sex between people can be a nice thing as well.
Because of abuse, some survivors avoided learning about sexual functioning, or they were given false information by the offender. Survivors may fail to reach orgasm because they have been going about it wrong. For example, a heterosexual survivor who has had trouble having orgasm during intercourse may not realize that most women need direct stimulation of the clitoris during intercourse for orgasm to occur. Unless she learns to touch herself, or have her partner stimulate her with his fingers during intercourse, orgasm is not likely to happen. Penile thrusting alone isn’t enough for many women.
Survivors may not understand how pelvic muscle strength figures in orgasms. Pelvic floor muscles must be in good condition for a survivor to feel an orgasm when it does occur. Not only do these muscles facilitate orgasm, strong pelvic floor muscles also are directly related to pleasure and enjoyment of orgasm. Whether you are male or female, you can strengthen these muscles using a series of muscle tightening and releasing exercises, known as Kegel exercises.* In Kegels, you tighten the same muscles you would need to tighten to stop yourself from urinating in midstream. Tighten hard slowly, pause, then release slowly. Repeat. Next, tighten and release in rapid, pulsing succession. Practicing ten minutes of Kegels a day for six weeks is usually sufficient to get these muscles in condition.
Some survivors may have problems reaching orgasm because the sexual abuse damaged their perception of sex and sexual relationships. A survivor told how he solved his inability to have an orgasm:
In the early months of our marriage, I became scared that I couldn’t have an orgasm with my wife. It seemed like we were having sex for hours, but I just wouldn’t come. Then one day a thought flashed to me: Sex equals power. My thinking went, if I don’t have an orgasm, I can prolong sex and be powerful. I realized I didn’t want power over the woman I love. That evening’s lovemaking was different. With the power element gone I had my orgasm and felt closer to her.
Unresolved feelings toward the offender and the abuse can interfere with orgasmic ability. A survivor with inhibited ejaculation problems realized a connection between his orgasmic difficulty and the fear of abandonment he still felt toward his mother, the offender.
Sex will sometimes start my abandonment issues. I become scared that my lover will abandon me, like my mother did. It’s confusing because my lover sometimes enjoys it when I last a long time. But for me it’s torture. I become so anxious, I sweat with fear. I feel I’m withholding my coming and myself from my partner to protect myself. Meantime I’m losing out.
Positive self-talk can help survivors overcome distorted beliefs. These beliefs may have developed as a result of the abuse or as means of self-protection. But allowing them to persist now may be inhibiting your ability to experience orgasm. Positive self-talk is a way to separate your attitudes about sexual functioning from the influence of the abuse. Here is an example of how a woman survivor might challenge her negative and inhibiting beliefs about having orgasm:
Inhibiting belief: When my partner is stimulating me, he’s trying to make me have an orgasm.
Alternative belief: Regardless of whether I am touching myself or whether my partner is touching me, the arousal I experience is something I’m feeling for myself, not for anyone else.
Inhibiting belief: It’s horribly shameful for me to become aroused and have an orgasm in front of my partner.
Alternative belief: My sexual responses are natural and normal. My partner cares for me and enjoys being with me when I’m feeling good.
Inhibiting belief: Having an orgasm is giving in, losing, and getting hurt.
Alternative belief: Sex is something I engage in because I want to. I like the feelings that happen in sex. I am in control of when, where, how, and with whom I have sex. Orgasm is a simple biological response and can’t hurt me. It’s made up of my feelings and sensations, not some concrete or external object. My orgasms are part of me. They emerge from inside me. Orgasms are an intense expression of my aliveness. The feeling I get from them is a natural way for me to feel pleasure.
Another way survivors can facilitate orgasm is by reducing triggers associated with the original sexual abuse. Have sex in a way that isn’t related to what occurred during the abuse. If you were lying down when you were abused and find that climaxing while lying down now is difficult, try having sex while reclining on pillows but still sitting up. If the abuse involved manual stimulation, try oral stimulation instead.
Once you feel confident having orgasms in one way, you can use bridging techniques to have orgasms in other ways. A male survivor who can ejaculate with oral stimulation can bridge to intercourse by fantasizing about intercourse during oral sex. In later sessions he might shift to intercourse once a high level of arousal has been achieved.
Similarly, a woman survivor who can easily have orgasm by touching herself can bridge to becoming orgasmic with a partner by stimulating herself while being held by her partner and then placing her partner’s hand over her own while she self-stimulates. Later she might alternate her hand with her partner’s hand until she is comfortable having her partner stimulate her to orgasm alone.
Massage vibrators* can also help in increasing orgasmic potential by providing a type of stimulation that is different from what occurred in the abuse. “Using a vibrator has helped me release feelings of guilt associated with receiving pleasure,” a survivor said.
Some survivors may have difficulty with orgasm because of the fantasies they rely on to “get them over the hump” and climax. A heterosexual man may feel bad about his homosexual fantasies, a lesbian survivor may feel bad about her heterosexual fantasies. Many survivors may feel bad about sexual abuse fantasies. Accepting the fantasy and learning a technique of switching away from it and back to it can help you. A survivor who had trouble climaxing with her partner explained her approach:
I would use the fantasy to get me near orgasm. Then I’d shift my focus to the real situation with my partner right when I reached the “point of no return” and during my climax. With each time we had sex, I kept shifting earlier and earlier, until I could stay present most of the time.†
It’s important to keep in mind that while orgasm does involve a surrender to pleasurable sensations, it does not bring about a loss of personal integrity or control. Orgasms can range from a barely noticed muscle contraction to an intense feeling of release. We no more lose control in orgasm than we do when we sneeze. We remain ourselves the whole time. Learning to feel comfortable with the intensity of orgasm is like learning to enjoy a good, hearty laugh. These are all natural functions that bring pleasant results.
Difficulty averting orgasm
Some survivors have the opposite problem: orgasms that come too quickly. A survivor may have found a quick orgasm helped in coping with stimulation, tension, or painful emotion felt during abuse. Also, sometimes the abuser left the child alone after orgasm; orgasm was a way to end the abuse more quickly.
As a result of past associations, sexual touch may trigger an early climax. A current situation may remind a survivor of the abuse in some ways. A survivor may feel caught in an intense buildup of anxiety and fear that erupts suddenly in an orgasm, as this survivor experienced:
After our first date I found myself in bed with this woman who wanted sex. We were both aroused. She came onto me, and inside myself I cried a silent cry, “No!” I was paralyzed. I left my body. Before I was inside her I ejaculated. I was crushed. I felt stupid, ashamed. She seemed to ignore what happened. I felt betrayed. I felt demoralized.
Abuse led another survivor to compulsive masturbation that involved rapid ejaculation. The man taught himself to ejaculate quickly to avoid feelings of guilt that accompanied his sexual behavior. “When I’d masturbate, I’d tell myself to hurry up so I won’t get caught and get into trouble for what I was doing,” he said.
Coming too soon may be related to fears of intimacy. A quick orgasm might allow a survivor to avoid building deeper emotional ties to the partner. A survivor might think that if there are no ties, he or she is protected against feeling betrayed and devastated if the relationship doesn’t work out.
Coming quickly may also be an attempt to terminate the sexual experience. Sex in general may be so uncomfortable that the survivor seeks a quick escape. For example, a survivor may want to avoid witnessing the partner’s orgasm if it reminds the survivor of the offender’s sexual response in the abuse.
Anxiety-reduction techniques, such as relaxation and talking out fears with a partner or therapist, can help survivors overcome problems with rapid orgasm. Using a series of progressive techniques designed to treat premature ejaculation,* survivors can learn how to become more comfortable with increased levels of stimulation, how to recognize signals in their body indicating orgasm is approaching, and how to slow down and postpone the orgasm.
If and when early orgasm does occur, it’s best to treat it lightly. Continue with touch and sexual interaction anyway. Don’t let the orgasm get in the way of building emotional intimacy with your partner. When you relax and experiment with further touching, over time you may be surprised that new feelings of arousal will surface. These new feelings can sometimes result in a second orgasm that builds more slowly and is more satisfying.
Don’t avoid sex. The more you engage in sexual play, the more likely you will be to reduce anxiety and overexcitement tendencies.
Difficulty with intercourse, for women survivors
Women survivors may have chronic difficulty with vaginal penetration because they suffer from dyspareunia (pronounced dis-pa-roo-nia), or in lay terms, painful intercourse. In this condition women feel pain, such as burning, cramping, or sharpness, during sexual experiences that involve penetration. Females with dyspareunia typically also have difficulty with other types of vaginal penetration, such as insertion of a finger, sex toy, or medical instrument.
One form of dyspareunia, known as vaginismus, is distinguished by a reflexive tightening of the vaginal muscles. As soon as penetration is attempted, the woman experiences an automatic constriction of the outer third of her vagina. Vaginismus often occurs in female victims of rape and other highly unpleasant or traumatic sexual experiences. The learned muscle spasm closes off the vaginal canal in an unconscious attempt to protect the female from further assault or pain.
Female survivors can also experience painful intercourse that results from irritation to the tissues in the vaginal canal. Many medical problems, such as undiagnosed infections, insufficient lubrication, hormone deficiencies, tight connective tissue, nerve inflammation, glandular problems, and allergies, can be at the root of chronic vaginal discomforts. In some cases, painful intercourse may be directly related to actual physical damage to vaginal tissues, nerves, and internal organs done during brutal sexual assault. Psychological distress, including unpleasant memories of sexual abuse and tendencies to automatically associate intercourse with physical trauma and pain, can also contribute to vaginal discomfort.
Understandably, a woman who suffers pain during intercourse is likely to avoid sex. This avoidance can lead to further anxiety and discomfort. Natural arousal and lubrication may diminish, and vaginal sensitivity may feel more pronounced during the rare times that intercourse is attempted.
Conversely, some survivors have made matters worse by forcing themselves to endure painful intercourse. The abuse gets reenacted, and negative associations with intercourse are strengthened each time. As one survivor explained:
I used to feel I had to put up with pain for a man’s pleasure. I’d make myself have sex even when it hurt like crazy. I was mad at my partner and myself. It was the rape all over again.
No one should have to tolerate these kinds of pain or prolonged discomfort. There is much a survivor can do to eventually be able to enjoy sexual experiences involving vaginal penetration. One way is to improve how you think of intercourse and vaginal penetration. If you conceive of intercourse as intrusion and force—something done to you—you may be setting yourself up for a bad experience. (At a seminar I gave for survivors, one woman pointed out that the term penetration was upsetting to begin with. She suggests survivors think of enveloping instead. A great idea! Imagine that you are enveloping your partner, giving your partner an internal hug. This reduces the sense of threat and reminds you that you are in the driver’s seat.)
Changing our thinking can also be a powerful tool in helping relax muscles in the vagina. When you imagine the inside of a vagina, what do you picture? If you see it as a hard little tunnel with a thick steel door, you will approach the possibility of intercourse differently than if you see it as a warm, moist, earthy nook with soft moss and lovely flowers, or a smooth and stretching balloon capable of expanding to many times its size.
Relaxation techniques can be helpful as well. The Kegel exercises described earlier can give a woman a sense of control over the muscles in her vagina. After a woman becomes practiced at Kegels, she can try tightening her vaginal muscles and then relaxing them fully as entry occurs. Slow breathing techniques, commonly used in childbirth, can be incorporated to further facilitate relaxation during intercourse.
I have known survivors to have excellent success using vaginal dilator exercises to overcome problems with intercourse. Vaginal dilators are tube-shaped medical devices that vary in size from about one-half inch in diameter up to the average size of a penis. There are several different kinds: Some are shaped like small rubber penises, some are made of nonbreakable glass, and others are made of smooth white plastic.* Vaginal dilators allow survivors to slowly and progressively feel in control of and comfortable with vaginal penetration.
Here are some suggestions for how to use dilators in a healing program:
1. Warm the smallest-sized dilator in a glass of hot water by your bedside. Take a hot, relaxing bath. Dry off and sit back on your bed, reclining on soft pillows.
2. Take the warm dilator, dry it off, and cover the tip with a personal lubricant. Place a large dab of lubricant over your vaginal opening.
3. Relax, breathing fully and steadily. Do a few Kegel exercises to tighten and relax your vaginal opening. When you feel ready, slowly insert the tip of the dilator into the opening of your vagina. Angle the tip downward, toward your tailbone, because this will help steer the dilator comfortably into your vagina and under and around your pubic bone. Insert the dilator only as far as you want to, then rest and continue with relaxation techniques to keep yourself calm and your vaginal muscles loose.
4. Work toward being able to insert the dilator three or four inches inside yourself, and rest it there for about twenty minutes a day every day. The more regularly and routinely you do the insertion, the easier it becomes.
5. Once you are comfortable with resting the smallest dilator inside yourself, experiment with moving it around. Remember, the dilator is helping you slowly stretch the inner muscles of your vagina. Move the dilator up and down, back and forth.
6. Repeat this exercise with the smallest dilator for at least one week. When you feel ready, progress to the next size of dilator. Stay with one size of dilator as long as you need to until you feel relaxed and comfortable with insertion and movement. Master each size before moving on to the next.
7. Continue the exercises until you have mastered the largest dilator. Then you can repeat the exercises guiding your partner’s hand as he or she inserts the dilators and moves them around. Eventually, with your partner’s cooperation, you can continue the exercises using your partner’s fingers or penis.
If you reach a block in inserting a particular dilator, use relaxation, breathing, imagery, and creative problem solving to help. You may want to shift down to an easier size for a longer time, or you can bridge from one size to another slowly during the same twenty-minute period.
Self-stimulation can help survivors through impasses with insertion. Stimulate the clitoris before and during the dilator exercises. Sexual arousal increases natural lubrication and causes vaginal expansion, often making insertion easier. This variation is also useful in helping a survivor associate pleasurable sensations with vaginal fullness. Feeling comfortable with these sensations can eventually facilitate the ability to have orgasms during intercourse.
Once a survivor feels successful with dilator insertion on her own, if she wants she can invite her partner to join her during some sessions. The survivor can teach the partner how to comfortably insert a dilator and move it around. Active and specific communication is essential.
Ginny, a survivor of sibling incest, worked with her husband, Ron, to overcome her problem with vaginal pain and fear of penetration.
GINNY: Once I became comfortable with the dilators myself, I asked Ron to do the inserting. We got to a point where he was leaving the dilator in and also manipulating it a little bit. His participation showed me that he wasn’t going to do anything that I didn’t want him to do or didn’t ask him to do. His helping became a positive thing with me and with him.
RON: I felt involved. Ginny was actually sharing a part of herself with me. Though I was glad, sometimes it was frustrating: I’d wish it was me and not the piece of plastic. The exercises gave us guidelines. We knew what we were to do, for how long, and that it wouldn’t go any further. I could relax and Ginny could relax.
Vaginal dilators allow survivors to get used to sensations common in intercourse. Women learn that penetration is not always 100 percent comfortable. Little temporary tugs and pressures are often just part of getting started. If some minor discomfort exists, try moving ahead anyway. If obvious pain persists, however, don’t ignore it—stop.
The transition from plastic dilators to a partner’s penis is often an exciting step for a couple. The male partner becomes, in essence, “the human dilator.” A survivor described her transition:
When we finally did the human dilator exercise, I felt shy, nervous, and embarrassed. There was a conflict going on inside me between wanting to turn off the pleasurable sensations and wanting to experience them. I decided it was okay to enjoy it for myself, and I did!
In the human dilator exercise, a male partner has to learn a passive role, letting the survivor control the insertion and then just resting inside the vagina for a while. One partner was concerned about how to maintain his erection and what would happen if he had an orgasm. I explained in counseling that he could move inside his wife only so much as was necessary to maintain his erection. If he had an orgasm, that was fine, but it would be preferable if he didn’t. He said to me, “I think I get the full thrust of what you are saying.” To which I replied, “What you need to get is the half thrust of what I’m saying.” We all had a good laugh.
Over time the human dilator exercise can be expanded to permit insertion by the man of his own penis, clitoral stimulation, some thrusting, and experimentation with different positions. Eventually a couple can apply the skills learned to regular sexual intercourse. A survivor had this to say:
We go really slowly with intercourse. My boyfriend is very careful to take his time, come into me slowly, a little at a time, and come out if it hurts. I’ve become used to it, and as a result I am not afraid of possible pain. I like feeling free to move around and change positions. I let him know my needs openly.
As sexual problems become resolved, don’t forget this: What’s most important is the emotional intimacy, caring, and respect that you and your partner are creating. That is the goal of your healing.