Sexual Functioning After Childhood Abuse: The Influence of Post-Traumatic Stress Disorder and Trauma Exposure

Abstract

Background Impairments in sexual functioning and sexual satisfaction are very common in women who have experienced childhood sexual abuse (CSA). A growing body of literature suggests a high prevalence of sexual distress in patients with post-traumatic stress disorder (PTSD). However, the influence of sexual trauma exposure per se and the influence of PTSD symptoms on impairments in sexual functioning remain unclear. Aim The aim of this study was to investigate the influence of sexual trauma exposure and PTSD on sexual functioning and sexual satisfaction by comparing 3 groups of women. Methods Women with PTSD after CSA (N = 32), women with a history of CSA and/or physical abuse but without PTSD (trauma controls [TC]; N = 32), and healthy women (N = 32) were compared with regards to self-reported sexual functioning and sexual satisfaction. Trauma exposure was assessed with the Childhood Trauma Questionnaire, and PTSD was assessed with the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Outcomes Sexual functioning was assessed with the Sexual Experience and Behavior Questionnaire, and sexual satisfaction was assessed with the questionnaire Resources in Sexuality and Relationship. Results PTSD patients had significantly lower sexual functioning in some aspects of sexual experience (sexual aversion, sexual pain, and sexual satisfaction) but did not significantly differ in sexual arousal and orgasm from the other 2 groups. TC and healthy women did not significantly differ from each other on the measures of sexual functioning or sexual satisfaction. Clinical Translation Results suggest that the development of PTSD has a greater impact on sexual functioning than does the experience of a traumatic event. This emphasizes the importance to address possible sexual distress and sexual satisfaction in women with PTSD by administering specific diagnostic instruments and by integrating specific interventions targeting sexual problems into a trauma-specific treatment. Conclusions The study is the first comparing PTSD patients and TC with healthy women with regards to sexual functioning. Limitations are selection and size of the samples, the assessment of sexual functioning by self-report measures only, and lack of consideration of other potentially relevant factors influencing sexuality. The findings suggest that the experience of sexual abuse does not necessarily lead to sexual impairment, whereas comparably low levels of sexual functioning seem to be prominent in PTSD patients after CSA. Further research is needed on how to improve treatment for this patient group.

Sexual symptoms in post-traumatic stress disorder following childhood sexual abuse: a network analysis

“…First, our results are in line with findings hinting to a high prevalence of sexual symptoms in PTSD (Bornefeld-Ettmann et al, 2018; Büttner et al, 2014). Chart analyses furthermore provided preliminary evidence that suffering from one's sexual preferences in patients with PTSD following CSA is likely due to either high-risk sexual behavior, compulsive sexual behavior, sexual masochism and in particular masochistic rape fantasies, or a combination thereof.…”

“…Apart from a link to sexual preferences causing distress, difficulties engaging in sexual activities were found to be linked specifically to low self-esteem, sleep disorder and lack of energy, stressing the role of depressive symptoms and contradicting prior results linking difficulties engaging in sexual activities in PTSD primarily to PTSD and not depressive symptoms (Bornefeld-Ettmann et al, 2018; Wilcox, Redmond, & Hassan, 2014; Yehuda et al, 2015). In this context, it is important to stress again that our results do not allow to rule out that the associations identified are caused by variables not included in the analysis.…”

“…PTSD symptomatology is especially complex and comorbid following CSA (Bryant, 2019; Karatzias et al, 2019), where sexual symptoms are nearly ubiquitously present (Büttner, Dulz, Sachsse, Overkamp, & Sack, 2014; Pulverman, Kilimnik, & Meston, 2018). Yet, it is only recently that sexual symptoms in PTSD have gained growing attention, and apart from mere comorbidity rates, still too little is known about how sexual symptoms and PTSD are related to each other (Bornefeld-Ettmann et al, 2018; Yehuda, Lehrner, & Rosenbaum, 2015). Sexual symptoms are also still often overlooked in treatment studies and current treatments for PTSD seem to have little or no effect on sexual symptoms (O'Driscoll & Flanagan, 2016).…”

“…Theoretical models of sexual symptoms following CSA should consider physiological, cognitive, and affective processes (Rellini, 2008). Recent studies stress the role of PTSD as a mediating factor between CSA and sexual dysfunction (Bornefeld-Ettmann et al, 2018; Yehuda et al, 2015). However, the links of CSA to both sexual preferences causing distress and sexual dysfunction in survivors of CSA are not yet well understood.…”

How to Treat Childhood Sexual Abuse Related PTSD Accompanied by Risky Sexual Behavior: A Case Study on the Use of Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD)

“…Aside from post-traumatic stress symptoms, victims of childhood and adolescent abuse are also effected in their later interpersonal and relationship functioning. Research assessing the impact of sexual abuse on adult sexual functioning indicates that sexual abuse survivors are not only likely to experience sexual dysfunctions related to desire, arousal, or orgasmic ability, but are also prone to sexual risk behaviors (Bornefeld-Ettmann et al, 2018;Stephenson et al, 2014). Risky sexual behaviors include engagement in unprotected sex, engaging in sex work, having sex with multiple partners or strangers, and engagement in punitive relationships involving sadomasochistic practices (Abajobir et al, 2017;Abrams & Stefan, 2012;Sandnabba et al, 2002;Senn et al, 2008).…”