Post-traumatic stress disorder (PTSD) is a common mental disorder that can develop after a person experiences trauma.¹ PTSD can affect anyone regardless of age, sex, ethnicity, or background. Although PTSD is most commonly associated with war or military experience, PTSD can also develop following a natural disaster, accident, sexual assault, or other traumatic or life-threatening event.² For some, even the death of a friend of family member can trigger PTSD. In addition to affecting a person’s emotions and behaviors, PTSD can also impact an individual’s sex life. Fortunately, PTSD can be treated and there are many resources available to help individuals with PTSD.

Symptoms of PTSD

Symptoms of PTSD typically begin within three months of experiencing trauma; however, in some cases, symptoms do not become present until years after the traumatic event.¹ While it is normal to experience some of the symptoms of PTSD in the immediate aftermath of trauma, most people tend to recover after a few months. A person diagnosed with PTSD may experience these symptoms for months or even years following a traumatic experience.³ PTSD affects each person differently; however, there are four main categories of PTSD symptoms: re-experiencing, avoidance, arousal and reactivity, and cognition and mood symptoms.

Re-Experiencing Symptoms

Re-experiencing symptoms involve a person reliving their trauma through flashbacks or memories that return to their consciousness at unwanted times.¹ It is common for re-experiencing symptoms to be accompanied by physical symptoms similar to those felt during the initial traumatic event such as elevated heart rate, sweating, and heavy breathing. Re-experiencing symptoms are often triggered by events that remind the victim of their trauma. For example, a war veteran hearing a loud firework or a sexual assault survivor hearing a story about rape on the news could trigger re-experiencing symptoms.⁴ Individuals with PTSD may also have re-experiencing symptoms in the form of nightmares or intrusive thoughts that interfere with their day-to-day activities as well as their emotional wellbeing.¹ Re-experiencing symptoms are some of the most severe symptoms of PTSD.

Avoidance Symptoms

Avoidance symptoms are behaviors that purposefully distance the victim from reminders of their trauma. These behaviors include avoiding people, places, objects, or circumstances that remind the victim of their trauma.² Experiencing avoidance symptoms can often cause a person to change their daily routine. For example, a survivor of a motor vehicle accident may avoid driving a car. Individuals with avoidance symptoms also often avoid discussing their trauma with friends, family, and mental health professionals.²

Arousal Symptoms

An individual with arousal symptoms may feel constantly alert after their trauma. Arousal symptoms can also include high reactivity such as being easily startled or frightened, feeling frequently irritable and angry for no apparent reason, and behaving recklessly without concern for themselves or others.² Unlike re-experiencing and avoidance symptoms, arousal symptoms are not typically associated with triggers; rather, they are a constant state of being for individuals with PTSD.¹ Arousal symptoms can be particularly distressing because they are present regardless of circumstance, causing people with PTSD to experience stress, hopelessness, and depression.

Cognition and Mood Symptoms

Cognition symptoms include difficulty recalling aspects of their trauma and trouble concentrating on and understanding tasks.¹ PTSD victims, on average, report reduced cognitive skills compared to before developing PTSD. The most common mood symptoms associated with PTSD are negative feelings and beliefs about themselves and the world. These negative feelings include feelings of guilt and shame, lack of trust in others, loss of interest in previously enjoyable activities, withdrawal from socializing with friends and family, and depression and anxiety.³ People with PTSD may begin to rely on drugs or alcohol in order to cope with their symptoms.

The symptoms of PTSD can be all-consuming, often making it difficult for people with PTSD to be gainfully employed or to be in healthy relationships. PTSD is often associated with unemployment and divorce in addition to substance abuse and depression.³

Risk Factors for PTSD

Approximately 70% of adults in the United States have experienced a traumatic event in their lifetime, and up to 20% of these people eventually develop PTSD.⁵ Although anyone can develop PTSD, there are several factors that increase the likelihood of a person developing the disorder. The most important risk factor for developing PTSD is experiencing trauma.⁶ The most common traumatic experiences that can trigger PTSD are military combat; life-threatening natural disasters; terrorist attacks; witnessing death; severe motor vehicle accidents; being assaulted, physically, sexually, or verbally; and the unexpected death or severe injury of a loved one.⁷ Medical professionals are uncertain as to why some people who have experienced traumatic events develop PTSD while others who have experienced similar trauma never develop the disorder; however, there are some correlations suggesting who is more at risk for developing PTSD following a traumatic event. A person is more likely to develop PTSD if they have a history of mental illness or substance abuse, if they lack strong social support, and if they experienced any childhood trauma, such as sexual abuse, physical abuse, or neglect.¹ Conversely, those who seek out support through friends, family, or support groups, develop effective coping mechanisms, and educate themselves surrounding their fears are less likely to develop PTSD.¹

Sex and PTSD

Recent studies have found that there is a strong correlation between sexual dysfunction and PTSD. Previously, sexual dysfunction and PTSD were only considered related in the cases of PTSD stemming from sexual assault; however, individuals with PTSD from other traumatic experiences also show higher rates of sexual dysfunction.⁸ A comprehensive study of 4,500 war veterans concluded that PTSD increased a male’s chances of having erectile dysfunction by almost 300% compared to veterans without PTSD.⁸ Studies involving males and females with PTSD from sexual assault produced similar findings. Females with PTSD were more likely to have insufficient lubrication, low sex drive, and painful intercourse.⁸ PTSD is strongly correlated with sexual dysfunction in both males and females.

Many of the most common symptoms of PTSD inhibit a person’s sexual response cycle and ability to feel pleasure, love, and attachment.⁸ For example, a person with PTSD may associate feelings of arousal with danger rather than pleasure. Additionally, depression and anxiety associated with PTSD may contribute to low sex drive.⁸

Treatment for PTSD

Although there is no known cure for PTSD, there are several effective treatments that can alleviate many of the symptoms of PTSD, and improve the lives of those affected by it. The most common forms of treatment are psychotherapy and medications.

Psychotherapy

Therapy involves meeting with a mental health professional either individually, or in a group setting. Most forms of therapy are designed to help individuals with PTSD process their trauma in an effective manner so as to reduce their symptoms. Although there are many different types of therapy for people with PTSD, the three most common forms of therapy are prolonged exposure, cognitive processing therapy (CPT), and eye movement desensitization and reprocessing (EMDR).⁹

• Eye Movement Desensitization and Reprocessing (EMDR): Eye movement desensitization and reprocessing. (EMDR) therapy involves the patient focusing on the memory of their trauma while performing instructed eye movements.¹² The directed eye movements aim to diminish both the vividness and emotion of recalling a traumatic event. EMDR therapy is focused exclusively on reprocessing an individual’s memory of their traumatic experience. Reducing the intensity of the memory allows the patient to recall the traumatic memory with a less severe emotional response.¹² Eye movement desensitization and reprocessing therapy is a more experimental, therapeutic approach to treating PTSD; thus, it is less commonly practiced than prolonged exposure or cognitive processing therapy.
• Prolonged Exposure: Prolonged exposure therapy involves a gradual approach to an individual’s traumatic memories. This type of therapy is designed to reframe an individual’s feelings surrounding their trauma, allowing them to manage their anxiety and reduce their avoidance symptoms.¹⁰ Typically, prolonged exposure therapy occurs over a matter of months. In the early therapy sessions, the patient focuses on describing their trauma in detail. The therapist and patient then work together to process the emotions surrounding the event as if it were happening in the present. Additionally, the therapist records the patient so they can listen to their sessions again, further processing their trauma.¹⁰ In later sessions, the patient gradually begins to confront stimuli associated with their trauma. These stimuli can be anything that reminds the patient of their traumatic experience. The patient approaches the stimuli at a pace in which they feel comfortable and safe.¹⁰ Taking control of their fears and anxieties surrounding their trauma can alleviate a patient’s depression, anxiety and other cognitive and mood symptoms. Prolonged exposure therapy can be very successful if executed on the patient’s terms and within their comfort zone; thus, this type of therapy is strongly recommended for people with PTSD.¹⁰
• Cognitive Processing Therapy: Cognitive processing therapy (CPT) is a type of therapy that challenges patients’ beliefs surrounding their trauma with the purpose of developing a new and healthier understanding of their traumatic experience.¹¹ CPT initially involves educating the patient on PTSD. The patient will learn the relationship between their trauma and their thoughts and emotions. The patient then learns to recognize their immediate thoughts surrounding their trauma.¹¹ In the subsequent sessions, the patient will write detailed accounts of their trauma, which they will re-read in later sessions. The purpose of writing and reading about their traumatic experience is to identify their emotional response and attempt to break the pattern of unproductive or negative thoughts such as self-blame or shame.¹¹ Eventually, the patient will be able to recognize their unhealthy thought processes surrounding their trauma and can develop a new and healthier emotional response.

It is important for a person with PTSD to find the form of treatment that works best for them. It can be helpful to discuss the different types of therapy with a mental health professional as well as a person’s loved ones in order to determine the best course of action in treating PTSD.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Individuals with PTSD may also develop depression. Fluoxetine, citalopram, and paroxetine are all selective serotonin reuptake inhibitors (SSRIs), medications that help treat depression. SSRIs work by blocking serotonin reuptake, increasing the levels of serotonin in the brain. Higher levels of serotonin help to improve a patient’s mood.¹³ SSRIs can cause various forms of sexual dysfunction, but most commonly patients taking an SSRI experience dysfunctions involving sexual arousal, orgasm, and libido.¹⁴ These medications cause sexual dysfunction by inhibiting the production of nitric oxide, which is the main mediator of both the male and female sexual arousal response. Nitric oxide is a neurotransmitter that widens blood vessels to allow more blood flow into the penis and clitoris, the erectile tissues of males and females, respectively. This leads to complaints of vaginal dryness, diminished genital sensation, and often times orgasmic difficulty.¹⁴

Potential treatments for SSRI-induced sexual dysfunction include the following.¹⁴

• Decreased dosage regimens: Decreasing the daily dosage may resolve or significantly reduce the sexual side effects. If the patient’s complaint is delayed orgasm or anorgasmia, the patient can be instructed to time intercourse either soon before or soon after taking their SSRI dosage. This timing allows for the drug level to be at its lowest during intercourse, hopefully decreasing sexual side effects.
• Drug holiday: A drug holiday is taking a two-day break from medication, in order to lessen sexual side effects,  and plan intercourse during that period of time. The idea first emerged when patients informed their physicians that they had tried stopping their medication for a day or two and that this resulted in an improvement of sexual functioning without a worsening of depressive symptoms. Due to this finding, a study was performed to determine whether drug holidays were effective strategies for treating SSRI-induced sexual dysfunction. The patients taking sertraline and paroxetine reported improved sexual functioning, while the patients on fluoxetine did not. None of them experienced a worsening of their sexual dysfunction symptoms.
• Pharmacological antidotes: Although not approved by the FDA for this particular use, numerous pharmacologic agents have been successfully used for treatment of sexual dysfunction caused by SSRIs. However, most of the information obtained regarding these antidotes has come from case reports and not double-blind comparative studies, which means the data is significantly less reliable.

Some patients report that sexual dysfunction decreases over time, a phenomenon also known as spontaneous remission. However, this data is limited and it seems as though improvements occur when the initial complaints are mild and associated with delayed orgasm, rather than desire or arousal disorders.

Concluding Remarks

Post-traumatic stress disorder can not only decrease a person’s health and emotional wellbeing, but it can also cause sexual dysfunction in both males and females. The symptoms of PTSD can prevent a person from engaging in sex, intimacy, and relationships. Fortunately, PTSD can often be managed through therapy and medications, and individuals affected by PTSD can go on to have healthy and happy lives.

If you or a loved one are experiencing any symptoms of the disorders mentioned in this article, contact your doctor or mental health care provider. Here are some resources:

• Military Helpline: 1 (888) 457-4838 or text “MIL1” to 839863 24 hours a day, 7 days a week, or visit http://militaryhelpline.org/.
• United States National Sexual Assault Hotline: 1 (800) 656-4673 24 hours a day, 7 days a week, or visit https://www.rainn.org/.
• United States National Suicide Hotline: 1 (800) 273-8255 crisis call line 24 hours a day, 7 days a week, or visit https://suicidepreventionlifeline.org/.
• United States National Institute of Mental Health Information Center: 1 (866) 615-6464 Monday through Friday, 8am-8pm (EST) or visit https://www.nimh.nih.gov/site-info/contact-nimh.shtml.

References

1. Post-Traumatic Stress Disorder. National Institute of Mental Health: 2016.
2. What is Posttraumatic Stress Disorder? American Psychiatric Association: 2017.
3. What is PTSD? National Center for PTSD: 2017.
4. What is PTSD? Nebraska Department of Veterans’ Affairs: 2007.
5. PTSD Statistics. PTSD United: 2013.
6. Post-Traumatic Stress Disorder (PTSD). Mayo Clinic: 2017.
7. Post-Traumatic Stress Disorder (PTSD). National Health Service UK: 2015.
8. Yehuda, Rachel. PTSD and Sexual Dysfunction in Men and Women. The Journal of Sexual Medicine: 2015.
9. Treatment of PTSD. National Center for PTSD: 2017.
10. Prolonged Exposure (PE). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder: 2017.
11. Cognitive Processing Therapy (CPT). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder: 2017.
12. Eye Movement Desensitization and Reprocessing (EMDR) Therapy. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder: 2017.
13. Medication. Anxiety and Depression Association of America: n.d.
14. Major Depression with Psychotic Features. Medline Plus: 2016.

Last Updated: 14 February 2018.