Skip to main content

Saprea > Blog > All Blogs > Intimacy Issues After Sexual Abuse

Share this blog on:

Intimacy Issues After Sexual Abuse

Movies are not real. We view cinematic car chases filled with explosions and near misses as pure entertainment, not something we expect might happen on our drive home from the theater. But that understanding of reality often changes regarding sex. Sexual intimacy in the media is portrayed as fireworks, passion, where everyone experiences life-altering pleasure every time, regardless of what has happened in their past. This depiction is just as fictional as the epic car chase, yet society tends to categorize it as the norm. In turn, people can feel like they are failing when sexual intimacy falls short of an idealized fictional encounter. In reality, at different points in our lives we may struggle with sexual intimacy. This can be due to various factors, including environment, medications, medical conditions, stress, state of a relationship, cultural messages, emotions, and trauma. Although we may not initially connect childhood trauma with adult sexual intimacy issues, the two can be intricately linked.

Can Trauma Cause Intimacy Issues?

Trauma is an experience that impacts a person physically, emotionally, behaviorally, and relationally. As Bessel van der Kolk explains in his book The Body Keeps the Score,1 “Trauma is much more than a story about something that happened long ago. The emotions and physical sensations that were imprinted during the trauma are experienced not as memories, but as destructive physical reactions in the present.” Given that trauma is stored both in the brain and the body, it makes sense that child sexual abuse would impact healthy sexual intimacy as an adult. What may feel like an impossible relationship with physical and emotional intimacy is an understandable and normal reaction to the violation and betrayal of sexual abuse. Touch and sexual pleasure can be linked with difficult emotions and trauma responses. It can be very confusing for survivors if their body responded sexually during the abuse and may lead to feelings that their body betrayed them, further complicating their relationship with intimacy.

It is critically important to understand that physiological reactions to touch or sexual stimuli are not an indicator of wanted sexual arousal. A genital response does not equal desire or pleasure and it does not indicate consent. It is merely a body responding how bodies are built to respond. The term for this is arousal non-concordance. In her TED talk The Truth About Unwanted Arousal,” sex researcher, educator, and author Emily Nagoski explains that “Arousal non-concordance happens with every emotional and motivational system we have. If my mouth waters when I bite into a wormy apple, does anybody say to me, you said no, but your body said yes?”2

If you had a physiological response, it does not mean that you liked, wanted, deserved, or consented to the abuse. Also, given that you were a child or teen, consent could never have happened. You may have cared about the person who hurt you, been dependent upon them, sought out attention from them, kept silent about the abuse, used alcohol or drugs, felt you were in a relationship with them, or accepted gifts from them. None of these are consent.

Common Symptoms Survivors Experience

Not all survivors have the same symptomatic responses to child sexual abuse, and there is not one specific behavior or emotion universally linked to sexual trauma. There are, however, common symptoms of sexual abuse, and sex and relationship expert Wendy Maltz has identified the top ten.3

  1. Avoiding, fearing, or lacking interest in sex.
  2. Approaching sex as an obligation.
  3. Experiencing negative feelings such as anger, disgust, or guilt with touch.
  4. Having difficulty becoming aroused or feeling sensations.
  5. Feeling emotionally distant or not present during sex.
  6. Experiencing intrusive or disturbing sexual thoughts and images.
  7. Engaging in compulsive or inappropriate sexual behaviors.
  8. Having difficulty establishing or maintaining an intimate relationship.
  9. Experiencing vaginal pain or orgasmic difficulties.
  10. Having erectile or ejaculatory difficulty.

For many, not wanting to engage in sexual behaviors or experiencing automatic reactions makes sense based on what happened in the past.

One symptom that can cause a significant amount of confusion and shame for survivors is engaging in compulsive or inappropriate sexual behaviors. It is important to note that the term “inappropriate” is not based on judgements from others about your sexuality, but instead is individually subjective and refers to sexual behaviors that may feel out of control, cause distress, have serious consequences, and/or negatively impact your physical and emotional well-being. Doug Braun-Harvey and Michael A. Vigorito define out of control sexual behavior as “a sexual health problem in which an individual’s consensual sexual urges, thoughts, or behaviors feel out of control.”4 Some may refer to this problematic or out of control sexual behavior as hypersexuality.5 Out of control sexual behavior is often a manifestation of untreated trauma or abuse.6 Because the relationship between trauma and out of control sexual behavior can be complex, gaining control over abuse-related sexual behaviors works best with the support of a knowledgeable, sex-positive, trauma therapist.

Reconnecting With Your Sexual Self

Reconnecting with your sexuality can feel overwhelming. Learning how to feel safe with sexual intimacy is a process and doesn’t happen overnight. One of the first steps in sexual healing is practicing feeling safe and present in your own body. This is particularly important if you experience dissociation. Dissociation is a feeling of disconnection from your senses, thoughts, emotions, identity, behavior, or memories. Depersonalization is a type of dissociation where a person feels like they have left their body and are observing from a distance. Dissociation, including depersonalization, during sexual abuse is common. It is a way the brain tries to keep you safe and distant from what is happening. Because trauma responses are linked to the parts of the brain that do not distinguish between past and present, dissociation during stressful situations may continue into adulthood. Sexual intimacy can be a trauma trigger, and even though the survivor may be with someone they love and trust, automatic responses tied to touch can take over and a survivor may find themselves feeling numb, disengaged, or like they are floating out of their body.

How Can Mindfulness Support Sexual Healing?

Mindfulness is purposefully paying attention with kindness and curiosity to the present moment. It is the opposite of dissociation as it focuses on the here and now. In mindfulness you are engaging all five senses and being present in your body. Humans, regardless of a history of trauma or not, tend to live in past challenges or future what-ifs. We bounce between these two with little attention to the present. Mindfulness helps you stay grounded to the here and now. Practicing mindfulness to support sexual healing does not begin in physically intimate situations, but instead in day-to-day life.

There are three main components to mindfulness: intention, attention, and attitude. Intention is making a purposeful decision to attend to the present moment. This is the choice to practice mindfulness and commit to being in the here and now. Attention, which is frequently associated with mindfulness, involves noticing what is happening in the immediate present, including body sensations, feelings, thoughts, and environment. Attitude plays a key role, allowing a person to choose to observe what they are experiencing through a non-judging, non-striving lens of curiosity, kindness, and compassion.

Mindfulness in Day-to-Day Activities

Meditation and mindful breathing are often associated with mindfulness and are powerful exercises, however mindfulness can also be practiced during routine tasks in your day like cleaning, walking, or brushing your teeth. When taking a walk, notice the crunch of leaves under your feet, the chill of a passing breeze, the blue of the sky. When your mind wanders, as it will, notice the thought and gently redirect your focus to the present walk.

Practicing during low stakes activities can help you develop the skills to use when in potentially more difficult sexual settings. For instance, practicing mindfulness when showering can be a good in-between step toward mindfulness in intimacy. You can notice the texture of soap on your skin, the smell of shampoo, or the sound of hot water as it hits your hair. For survivors who struggle with dissociation, negative emotions associated with their body, or feeling disconnected from their body, this may be more difficult than, for example, mindfully sweeping a room. Remember the attitude component and note what you are experiencing with kindness and curiosity. Mindfulness allows you to create a safe space, so you can observe what thoughts and emotions arise without judgement and without becoming overwhelmed by them, no matter the situation.

Mindfulness During Sexual Experiences

Observing thoughts in a nonjudgmental way is an essential element when practicing mindfulness during sexual experiences. Research on a mindfulness-based intervention with women who had a history of child sexual abuse and experienced sexual distress found that mindfulness practice was associated with a significant increase in arousal concordance and a significant decrease is sexual distress.7 They speculated that one reason for the outcome might be based on participants learning to gently notice challenging thoughts and feelings associated with sexual response or history of abuse and allowing those thoughts and feelings to come and go, rather than avoiding them. A mindful approach during partnered or non-partnered sexual activity allows you to stay present and notice a wider range of reactions, including those that may be difficult and those that may be pleasurable, and direct your focus accordingly.

An example of practicing mindfulness during partnered sexual activity might look like this:
“I have been practicing mindfulness every day and I am going to try it while being physically intimate with my partner (intention). I notice the pleasant warmth of the room, my favorite artist playing in the background, my feeling of hopefulness, and how my body is responding to their gentle touch (attention). My stomach just tensed up, an image flashed into my mind, and I feel shame. Okay, that is interesting to note, but it is just a response, nothing more, nothing less. I take a deep breath and picture the shame, image, and tension floating away like a cloud (attitude). I move my partner’s hand, change the position I am in, and focus on the present—the color of their eyes, the feeling of safety, and the softness of their skin (attention).”

Discover What Works Best for You

Addressing the effects of child sexual abuse on sexuality is not easy. The journey can feel complex, overwhelming, and frustrating. Just like practicing mindfulness outside of the bedroom, working on your trauma with the help of a therapist or support group will lay the foundation for addressing sexual symptoms related to childhood abuse. The road to healthy sexuality may involve changing sexual attitudes and behaviors, learning new ways of experiencing touch, and developing a healthy sexual self-concept.3 This includes learning your likes and dislikes, redefining consent, and exploring how to assertively communicate your wants and needs to others. It is okay to go slow. Listen to your body and be present in it. You get to define what healthy sexuality looks like for you. And in that process, you might even find a few movie-worthy fireworks.

  1. van der Kolk, B. A. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma.Penguin Books.
  2. Nagoski, E. (2018). The truth about unwanted arousal [Video]. TED Conferences.
  3. Maltz, W. (2023). Sex abuse healing. Healthy Sex.
  4. Braun-Harvey, D., & Vigorito, M. A. (2016). Treating out of control sexual behavior: Rethinking sex addiction. Springer Publishing Company.
  5. Mayo Clinic. (2022, December 13). Compulsive sexual behavior.
  6. Cannon, N. (2017). A strength-based approach to treat out of control sexual behavior. [Conference presentation]. University of Denver, Denver, CO, United States.
  7. Brotto, L. A., Seal, B. N., & Rellini, A. (2012). Pilot study of a brief cognitive behavioral versus mindfulness-based intervention for women with sexual distress and a history of childhood sexual abuse. Journal of Sex & Marital Therapy, 38(1), 1–27.

About the author


Betsy Kanarowski , PhD, LCSW,

Chief Clinical Officer
Betsy Kanarowski is committed to helping individuals, families, and communities effectively understand and navigate the many aspects of preventing and healing from sexual trauma. She joined Saprea in 2015 and is an experienced therapist, trainer, and educator with over 25 years of experience as a mental health professional. Betsy is a licensed clinical social worker and certified sex therapist and received her PhD in special education from the University of Utah, her MSW from the University of Denver, and her BSW from the University of Wyoming. She loves the outdoors, travel, reading, and spending time with her family and ridiculously spoiled dogs.