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What are some of the sexual problems that arise from childhood sexual abuse? And how does healing begin?

Sexual Healing After Sexual AbuseFor the last 22 years, Natalie, a survivor of childhood sexual abuse, has been able to climax during sex with her husband. But she has a recurring sexual fantasy that upsets her terribly. In order to orgasm, Natalie must imagine that she's being raped by Nazis; a fantasy that she has never shared with her husband.

Natalie's personal experience is one of many stories that Wendy Maltz, M.S.W., has heard over the last ten years in her work with men and women who have survived sexual abuse. Maltz estimates that "about four out of five survivors experience unwanted sexual fantasies. The content is upsetting, and they feel out of control."

Unfortunately, intrusive and hurtful fantasies make up only a small part of the sexual problems that survivors of sexual abuse may experience. Both therapists and researchers have uncovered many more. What are some of these problems? Why do they occur? And most importantly, how do survivors begin to heal?

What is sexual abuse? How common is it?

Child sexual abuse is any sexual contact or attempt at sexual contact perpetrated against a child by an older person. Psychologists generally consider "older" to be a seniority of five or more years. On average, sexual abuse begins between ages four and 12, and may involve genital fondling or oral-genital contact, and may escalate to intercourse.

Unfortunately, childhood sexual abuse is not uncommon. One San Francisco-based study found that 38% of women had been sexually molested as children. Another study of nearly 800 students at New England colleges revealed that 1% of women were survivors of paternal incest. A national study in the United Kingdom discovered that 12% of women and 8% of men had been sexually molested as children.


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Several research studies conducted in the last seven years suggest that people may repress and then recover memories of childhood sexual abuse. But this issue still remains controversial among psychologists.

The after-effects of sexual abuse

Not surprisingly, people who have endured sexual abuse often suffer sexual repercussions later in life. As Maltz emphasizes, "You can't overlook the word 'sex' in sexual abuse. It's no wonder that the repercussions of abuse manifest themselves as issues of sexuality, since it was sexuality that was abused in the first place."

But not every person who has experienced sexual abuse experiences sexual problems. In fact, much of the research that has uncovered sexual problems in survivors has been done on people who were seeking therapy for something else.

Still, psychologists agree that sexual abuse can affect a person's sexual health. Touch, in the context of a loving adult relationship, may trigger memories and sensations of the original abuse, causing feelings that seriously interfere with pleasure.

Maltz compares the after effects of abuse to the repercussions of any trauma: "When we experience any kind of trauma in life we associate the emotions with certain sensations and thoughts that were present during the original trauma. Let's say that you were once in an earthquake terrified for your life and it was a hot sunny day. Five years from now, you may encounter a hot sunny day and suddenly be afraid that you're going to die."

Sexual after affects cited by researchers and therapists include unwanted sexual fantasies and flashbacks of the original abuse that regularly occur during sexual activity. According to one study, 80% of incest survivors reported that having sex elicited memories of their original violations.

Like Natalie, some survivors find that their only path to sexual release is fantasizing victimization. When a person's first sexual experience is abuse, that person may later associate sexual arousal with those same feelings of fear and disempowerment. Sexual victimization fantasies are not necessarily psychologically harmful. But it's no surprise that people become very distressed when they can't stop the fantasies, or always need to imagine themselves hurt and victimized in order to climax.

Dissociation and numbness

Survivors of sexual abuse may also experience "dissociation" an impressive defense mechanism formed during ongoing sexual abuse, in which the person being abused "leaves" his body, and watches the abuse from some higher viewpoint. Unfortunately, this defense mechanism may result in a feeling of dissociation during desired sexual activity with a loved one later in life.

Related to dissociation is sexual "numbness," which is the outcome of a child willing her body to numb itself against arousal during unwanted touch. Some adult survivors become so adept at numbing parts of their bodies that they don't feel the pain of appendicitis, or even need Novocaine at the dentist.

According to Maltz, "People who have been sexually abused may also avoid sex or see it as an obligation. Or, at the other end of the spectrum, some people seek sex compulsively," Maltz expresses. "And they often have negative feelings associated with touch, such as fear, guilt, shame and anger."