Unforgotten Pain Past sexual abuse matters in the present

Every time she neared a climax, the memories came flooding back. Her pleasure stopped.

"The abuse was buried," said Kathe Stark, who was molested by an authority figure at her church when she was 8 years old. "But then in my second marriage, my husband said the same things that were said to me when I was 8, and it brought the flood" of memories.

Adult survivors of sexual abuse often experience problems with intimacy, arousal and trust. But experts say there are ways of dealing with the old, undealt-with pain.

Rape, incest and molestation are "harm done to a person’s sexuality," said Wendy Maltz, a therapist and author of The Sexual Healing Journey: A Guide for Survivors of Sexual Abuse. "Survivors have a hard time even conceptualizing sexual intimacy — they learned sex in the context of pain, domination, humiliation."

Frigidity, Promiscuity

Some survivors are left with nearly every possible dysfunction: fear and avoidance of sex; vaginal pain and erectile dysfunction; inability to reach orgasm; and problems becoming aroused and or even feeling pleasurable sensations.

Other survivors fall prey to unhealthy patterns like compulsive promiscuity, masturbation and the use of certain fantasies and pornography — things that they feel they have to use to be aroused at all.

Shutting down all sexual feelings and an unhealthy, out-of-control sexuality represent two sides of the same coin: They're both ways that people disassociate themselves from the painful emotions sex can produce, Maltz said.

Maltz's female patient who had trouble achieving orgasm realized that "the experience of a climax was associated with her sexual abuse experience with her father. Every time she got close to climax, memories of the abuse would come up, so she was protecting herself by not climaxing," Maltz said.

A male patient with a premature ejaculation problem revealed that when he lasted longer, he experienced feelings of anger and violence toward his partner; the premature ejaculation was a way to protect himself from those feelings.

"Circumstantial erections," in which men can become erect only in certain settings, are a common problem for male survivors, according to therapist Stephen Braverman of Monterey, Calif. "Boys can get an erection when they're being abused — it may even produce pleasurable sensations, so sex and good feelings become related to abuse," he said.

"Men may end up going to a prostitute, somewhere they can shut down emotionally — but they can't have an erection or orgasm with their wives."

Partners in Pain

Some adult survivors find themselves in loving relationships but are unable to negotiate physical intimacy.

"When you're trying to connect a person with a healthy sexuality with someone who is not healthy, the other person has needs that you cannot meet," said Stark, whose book Helping the Adult Survivor of Child Sexual Abuse: For Friends, Family and Lovers grew out of her own experiences as a survivor.

"I'd try to compromise, but in attempting to do that, I would reach the point where the rage would come loose. ... I was always uncomfortable sexually, but the abuse issue reared its head and took over my life 14 years ago," Stark said.

Partners must deal with a unique set of issues and difficulties, experts say. "They quite frequently think that the problems are their fault, that there's something wrong with them," said Braveman, "that if they would only do something different, their partner would be OK."

Friends and family may also feel like their hands are tied, wanting to help but unsure of how. "My family and friends were watching the disintegration of my life, and saying 'What can we do?'" Stark said. "'One day if I hug her she screams at me and the other day it's OK.'"

Getting Better

There is a difficult but traversable road that leads victims to a healthy sex life. It takes more than patience, experts emphasize; waiting out the problems and hoping things get better is simply not a good strategy.

"A lot of partners are so patient that they haven’t had sex for 10 years, and that doesn’t do any good," said Maltz. "This is something people need help with, and people eventually realize, 'It isn’t us, and we don’t have to just wait it out — we can take action.'"

She uses a variety of exercises and games to help couples communicate and to teach survivors to take control and express their needs.

In one of her exercises, the survivor holds a pen. They let their partner know when to hold onto the other end. The survivor moves the pen around, and the partner learns how to follow without taking over; the survivor tells the partner when to let go.

"This sounds simple, but you’d be surprised how difficult these games can be for survivors," Maltz said. "Some feel really uncomfortable saying 'Hold on now’ or ‘Let go now.’ The permission to give that specific direction can feel very foreign to people who have been abused."

After trust and intimacy have been strengthened, couples can move on to non-demanding, non-sexual touching exercises like foot rubs and back rubs. Setbacks are inevitable, but they needn't bring the process to a halt, Braveman said.

"If problems come up, if their buttons get pushed, they stop, communicate with their partner and stick it out and start again," he said. The important thing is to break the connection between sexual feelings and abuse — something that's impossible without help and hard work.

"Sexuality doesn’t heal spontaneously," said Maltz.