Q&A on Sexual Wellness After Trauma

Q&A on Sexual Wellness After Trauma

Sep 19th 2022

September is Sexual Health Awareness Month, and we’ve been celebrating by writing about increased sexual wellness. But we also honor sexual wellness all year long, and sexual trauma is unfortunately, a topic we talk about no matter day day or week it is.

Sexual wellness isn’t always a celebration; sometimes it’s a journey, and not always an easy one. Because 81% of women have experienced sexual harassment (and that doesn’t include the nuances of being trans, queer, etc., where numbers are likely higher), we expect many of our readers will have been through traumatic experiences. Others may have known someone who has, or may have experienced harassment or assault.

Since it impacts so many, it’s important to pause and talk about how we practice sexual wellness after trauma. We’re excited to present a Q&A with sexologist Mx. Rebecca Alvarez.

Mx. Alvarez holds a dual degree in social work and human sexuality from Widener University, and they generously gave us information about handling sexual health and pleasure for survivors.

Lora DiCarlo: Can you briefly define what a sexologist does?

Alvarez: Sexology is split into two camps. One is clinical, one is research-based. You have people who are more influenced by queer theory, linguistics work, policy work, potentially even more thought and philosophy work.

Then you have clinical sexologists—this is the camp I fall into. I’m a clinical social worker, so for those of us who fall into this camp, oftentimes you’re doing work where you’re working as a sex therapist or a sex educator in the field. That’s a broad overview.

LD: What kinds of trauma impact sexual wellness?

A: Sometimes we think of trauma as an event, but it’s an experience. Each person experiences trauma differently. You might have three people in a car crash, and only one person is exhibiting signs of trauma. That’s perfectly reasonable.

I try never to assume trauma from whatever people describe to me. I will give them a definition: Trauma is when we experience something so horrific we cannot assure our bodies and minds we’re safe, and we re-experience that feeling or sensation in different ways.

LD: Can you define sexual wellness? Is that different from sexual health?

A: I don’t think that they are interchangeable. Typically when we think about health we’re thinking about the western medical model, or at least that’s what Americans think of. “Is my body okay?” Only more recently are we thinking about mental health, and that’s usually what we’re thinking, not about how we’re feeling.

Sexual wellness is a more maybe individualized explanation of overall emotional, physical, perhaps spiritual—connected not only to the outside.

LD: What are some ways to get back into our sexuality and practice sexual wellness after trauma?

A: The caveat here is it’s really individualized. There’s no one-size fits all, and I also think this is a two-parter. I come from an intimate partner violence background. One of the things we know about trauma is before we can move through it, we have to feel it. [Another] sexologist says, “You have to feel it to heal it.”

That’s a two part process. One, we have to experience the grief of what we’ve lost, then find a safe space to explore what pleasure looks like. Not just a baseline of sexual safety, but after that, a kind of sexual self-actualization. Keeping the conversation of pleasure on the horizon.

LD: What does that mean? Keeping the conversation of pleasure on the horizon? Is it something to always strive for?

A: It’s something that a lot of times after trauma, and when I say we, I mean therapists and social workers, we’re focusing on how to create sexual safety, and that might look like helping people identifying triggers, or sitting with the grief. Those things are incredibly important.

However, I think the pleasure work is where we're also having conversations that pleasure is possible. The aspirational tone. “This is hard and I’m gonna be with you as long as this is hard, and also, we’re driving somewhere.” That horizon line is whatever you define pleasure to be.

That means things like not only identifying triggers but talking about the possibility that people can, as opposed to building a map around their triggers, using these hot buttons where they’re using these hot buttons as trailheads. “I can work toward this if I want to.” It’s two fold: holding onto the grief and the loss but also, talking to people about where do you want to be getting to? And making that our goal.

LD: At LD we talk about how orgasm isn’t always the goal. Do you talk to clients about the importance of pleasure exploration without the orgasm pressure?

A: We really live in such a goal-driven society and there are so many people who are aorgasmic or pre-orgasmic and they feel they’re missing something. Sexual exploration and sexual satisfaction doesn’t have to include orgasm.

So this is a bit of a revision from the book “Healing Sex,” by Staci Haines. Some of the outline is, right when triggers happen, we’re not trying to move away from it but understand what’s happening.

First, notice what’s happening in our body. We not only notice the outside trigger but really try to anchor ourselves in one or two recognizations of “oh, I’m getting triggered, I know because my heart beat is up, I’m sweating.” The tricky thing is sometimes sex that isn’t triggered or connected to a traumatic memory can [have those effects.] That first step can be a doozy, “wait is this the feeling of excitement or danger?”

The second step is pausing. You get to take your time. That can be rolled into your sexual experience. You’re pausing, usually for people to ground themselves physically. Is that about, “name three green objects,” or getting a cold glass of water, doing your breath work. We talk about how to cue people with a safe word or a gesture, so making sure that pause is welcome.

The third part is really what I get excited about. This is pleasure-based work, this is the foundation of them tuning into what their needs are, which is asking them to tune into their thoughts. “What are the thoughts and feelings I’m having right now?” Noticing without judgement, you’re slowing things down, giving the body a chance to come back to baseline. Centering here and now.

After the third step of noticing their feelings, that’s when we enter the empowerment model of choice. What do you want to do now? Do you want to stop, slow down, try a new course? Then rinse and repeat.

LD: What are some common obstacles or hang ups people face on their healing journey?

A: It’s not like one-size fits all, but I do find that I’ve had a number of clients talk about how oral sex can be difficult. I don’t have research that backs this up, but my hypothesis is that folks find [receiving] oral sex deeply intimate, a very vulnerable position.

Conversely, when people are in a position of merely giving, that can be activating. Being in that submissive position can remind people of early sexual trauma. Power and control comes into it in the experience.

LD: How can we talk to our partners better about what’s going on?

A: Again, it’s individualized. When I’m working with a client therapeutically, I’m looking for a sense of self-alignment. Has this person had a chance to turn inward and consider what they want ahead of time, or are they feeling like they’re on auto-pilot? That’s for them to determine.

If that means sharing a lot of the details, great, let’s know that. If it means sharing broad strokes, or nothing but what you need or have boundaries around, let’s make that determination for you. It’s figuring out what feels right to that person.

LD: Anything we missed or forgot?

A: I really encourage people to see pleasure as their right. Seek that out and to be patient with themselves as they move towards that as part of overall wellness.