Till very recently, it was understood that only sexually-related trauma could impact subsequent sexual activity, but recent studies of PTSD have proven otherwise. This is in a large part due to the biological fact that both fear and arousal share the same hormonal and neurological network. Past trauma can lead to sex being perceived as a surrender of control, a “letting go” that the brain considers dangerous due to memories of past traumatic experience. Clients may also experience acute feelings of stress or anxiety not during, but after sex. This is a recognised condition known as postcoital dysphoria, which is common not only in survivors of sexual but also of physical and emotional abuse.

In this practical and engaging workshop, which will be especially relevant for psychotherapists, psychologists and counsellors, we will learn how to address sexual issues with confidence and sensitivity, even when clients initially present with past trauma, as we explore the finespun ways trauma can permeate into our clients’ sexual lives. We will then explore a range of psychosexual interventions and trauma-informed therapy techniques, such as Trauma-Focused Cognitive Behavioural Therapy (TF-CBT), and Mindfulness-Based Interventions for targeted intervention strategies.

Drawing on extensive research and clinical experience, Silva Neves will illuminate the specific types of trauma most likely to affect sexual functioning. We will begin by exploring the impact of sexual trauma caused by experiences of sexual betrayal, infidelity, rape or sexual abuse; and move on to examine in-depth the sexual issues resulting from physical trauma such as an accident, invasive surgery, prolonged illness or traumatic childbirth. We look into how physical trauma can compromise the biological underpinnings of the sexual response system while emotional trauma can lead to the shutting down of deep, heartfelt, intimate communication in relationships. Struggling with feelings of inadequacy, anger, or shame; clients may, in their quest to appear normal, find it frightening to express their needs, desires, or boundaries.

Participants will gain insight into the multifaceted nature of sexual trauma and its wide-ranging manifestations including:

• Hypersexuality or Hyposexuality: Clients who have suffered mental or emotional trauma may experience extremes in sexual desire. Some may become hypersexual, engaging in risky or compulsive sexual behaviours as a way to cope with their trauma. Others may experience a significant decrease in sexual desire or avoidance of sexual activity altogether (hyposexuality).
• Intimacy Issues: Trauma, especially caused by sexual betrayal or infidelity, can also affect one’s ability to form and maintain intimate relationships. One or both partners may struggle with trust, emotional closeness, or vulnerability in sexual relationships, leading to difficulties in forming healthy intimate connections.
• Sexual Dysfunctions: Mental or emotional trauma can contribute to various sexual dysfunctions such as erectile dysfunction, premature ejaculation, anorgasmia (inability to achieve orgasm), and dyspareunia (pain during intercourse).
• Body Image and Self-Esteem Issues: Trauma can negatively impact one’s body image and self-esteem, which may affect how a person perceives themselves as a sexual being. A difficult childbirth, for example, can lead many women to feel disconnected from their bodies or experience shame and guilt surrounding their sexuality.
• Flashbacks and Triggers: Sexual trauma survivors may experience flashbacks or intrusive memories during sexual activity, leading to distress and avoidance of sexual situations. Certain cues or triggers related to the trauma can also evoke intense emotional or physical reactions during sex.
• Difficulty Establishing Boundaries: Trauma survivors may have difficulty establishing and maintaining boundaries in sexual relationships. This can manifest as either being overly submissive or passive, or overly controlling and aggressive in sexual interactions.
• Avoidance and Dissociation: Following traumatic experience(s), clients may dissociate or mentally detach from their bodies during sexual activity as a coping mechanism. This can lead to feelings of numbness, disconnection, or a lack of pleasure during sex.
• Sexual Avoidance or Compulsivity: One or both of the partners may either avoid sexual activity altogether or engage in compulsive sexual behaviours as a way to cope with unresolved trauma. These behaviours can include excessive pornography use, masturbation, or seeking out multiple sexual partners.

Through an in-depth exploration, therapists will learn effective assessment techniques to identify and understand these issues, laying the groundwork for targeted intervention strategies. Silva Neves will elucidate key psychosexual therapeutic approaches tailored to addressing sexual problems arising from trauma, including trauma-focused cognitive behavioural therapy, mindfulness-based interventions, and more.

This workshop will not only equip therapists to work with sexual problems arising from trauma, but is also an invitation to engage in self-reflection. Through interactive discussions and exercises, participants will reflect on their own comfort levels and biases surrounding discussions of sex and relationships in therapy. By fostering greater awareness, therapists can cultivate a more empathetic and inclusive therapeutic environment.

Learning Objectives:

• List the main types of trauma impacting individuals’ sexual lives and how to recognize their effects
• Assess and identify common sexual problems associated with trauma, including vaginismus, dyspareunia, inhibited sexual desire, and more
• Discuss psychosexual interventions and trauma-informed therapy techniques, such as Trauma-Focused Cognitive Behavioural Therapy (TF-CBT), and Mindfulness-Based Interventions.

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