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By Amanda MacMillan/HEALTH.COM
Nov 20, 2018 @ 10:00 am
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Surviving a sexual assault, no matter what the circumstances were or how long ago it happened, can change the way you experience sex. For some, sexual contact can trigger upsetting memories or physical reactions, or leave them feeling sad or distressed afterward. Others may develop an unhealthy relationship with sex; they may have lots of it, but aren’t able to really enjoy intimacy with a caring partner.

Of course, not everyone who survives sexual assault or harassment struggles with these issues later on, notes Kristen Carpenter, PhD, associate professor of psychiatry and director of women’s behavioral health at Ohio State Wexner Medical Center. “It doesn’t automatically mean that your life is going to be upended in this way,” she says, “some people definitely recover from it and are able to move on.”

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But for those women who are struggling, it’s important to know they’re not alone. Research suggests that the prevalence of post-traumatic stress disorder symptoms in sexual assault survivors is as high as 94%, and treatment exists that can help. If you suspect that an assault in your past might be affecting your sex life now, here's what experts recommend.

Recognize the root of the problem

For some women who have been sexually assaulted, it’s painfully clear to them that their experiences have tainted the way they think about sex now. But it’s also surprisingly common for survivors to suppress or downplay the memories of those experiences, and not realize—or be able to readily admit—why sexual intimacy is something they struggle with now.

“Women don’t often come in saying, ‘I was sexually assaulted and I need help,’ says Carpenter. “What usually happens is they go to their gynecologist saying, ‘I’m not interested in sex,’ or ‘Sex is painful,’” she says. “It’s only when they come to me, a psychologist, that we get into a deeper conversation and they realize how much an old experience has stayed with them.”

Get professional help

If you've realized that a past sexual assault is interfering with your ability to bond with or be physical with a new partner, it’s possible that you have a form of post-traumatic stress disorder (PTSD). Those feelings may not go away on their own, but a licensed mental-health provider should be able to help.

“A lot of women are afraid that if they face those emotions, it will become overwhelming and their pain will never stop,” says Carpenter. “But addressing that trauma head-on is really important, with the caveat that you have to be ready for it—because it can be an incredibly difficult process.”

Different treatments are available to help survivors of trauma, sexual or otherwise. These include cognitive processing therapy, prolonged exposure therapy, eye-motion desensitization and reprocessing, and dialectical behavioral therapy. RAINN (Rape, Abuse & Incest National Network) and Psychology Today both keep a searchable directory of counselors, therapists, and treatment centers around the country who specialize in sexual assault.

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Be open with your partner about your experience

How much you want to share with your partner about a previous assault should be totally up to you, says Michelle Riba, MD, professor of psychiatry at the University of Michigan. But she does encourage patients to confide in their significant others if they feel comfortable doing so.

“I talk a lot with my patients about how soon and how much you want to divulge to someone you’re dating,” says Dr. Riba. “This is your medical history and it’s deeply personal, so it’s not necessarily something you want to talk about on your first or second date.”

It can help to anticipate some of the issues that may come up in a sexual relationship, and to talk through—ideally with a therapist—how you will address them, says Dr. Riba. For example, if there’s a certain type of touching or certain language you know might have a visceral reaction to, it can be better to bring up before the situation arises, rather than in the heat of the moment.

Tell your partner about any sexual activity you're not comfortable with

You should set boundaries with your partner, as well. “It’s very important to empower patients who have had a negative experience,” says Carpenter. “That person should drive the interaction with their partner, and should steer where and how far it goes.”

Of course, says Carpenter, it’s a good idea in any relationship—whether there’s a history of sexual assault or not—for partners to disclose what they are and aren’t comfortable with. “But it could be particularly important to be comfortable setting boundaries about likes, dislikes, and any behaviors that could be a trigger.”

    That’s not to say that couples can’t try new things or spice up their sex life when one person has lived through a trauma. In fact, sexual assault survivors can sometimes find it therapeutic to act out sexual fantasies or participate in role-playing, says Ian Kerner, PhD, a New York City­–based sex therapist—and this includes fantasies that involve submission. The key is that both partners remain comfortable with the situation throughout, and that every step is consensual.

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    Shift your thinking about sex

    This one is easier said than done, but a mental-health professional can help you gradually change the way you think about sex, both consciously and subconsciously. The goal, according to Maltz, is to shift away from a sexual abuse mindset (in which sex is unsafe, exploitative, or obligatory) to a healthy sexual mindset (sex is empowering, nurturing, and, most importantly, a choice), says sex therapist Wendy Maltz, author of The Sexual Healing Journey.

    You can help make this shift by avoiding exposure to media that portray sex as sexual abuse, says Maltz. That may include television programs or movies that portray rape; pornography that depicts aggressive or abusive situations; and even news reports about #MeToo accusations. It can also help for you and your partner to use language about sex that’s positive and healthy, rather than terms like “banging” and “nailing” that imply violence.

    Put on the brakes, if needed

    Sometimes it’s necessary to take some time off from sexual contact with a partner—even if your assault happened years ago but you’re just now coming to grips with its effects. “If people are struggling with intimacy, the first thing to do is really address the psychological symptoms associated with the assault,” says Carpenter. “I’ve found it’s best to leave intimacy until that’s concluded.”

    You can use this time to work with a therapist, and—if you currently have a partner—to bond with him or her in other ways. “Once you feel better and some of those symptoms have subsided, then you can start to slowly rebuild your whole self in terms of your sexuality,” says Carpenter.

    This may also be a time for experimenting with sensual self-care and masturbation, so you can rediscover the kind of physical contact you really do desire and enjoy. This can help you feel more in control, and more comfortable, incorporating these elements into your next physical relationship.