From the U.S.: I was sexually abused and raped from the ages of 4-8, diagnosed with PTSD as a child, but for various reasons, didn’t start seeking treatment until I was an adult (23, now 25). Therapy has overall been very successful. The next step in my recovery has to do with me having a healthier approach to sex.

For background, I started having consensual sex when I was 14, have gone through phases of promiscuity, and pursued older partners (not understanding why that was unhealthy) but have always gotten physical gratification from sex. I’ve never been submissive during sex, and had partners tell me I was “different” in bed. The whole time, I didn’t know that I was disassociating during almost every single sexual encounter I had. I wanted an orgasm; I had no attachment to the other partner or any emotional feelings towards sex. I eventually had a partner that I fell in love with tell me something was wrong, but I wasn’t in a place to work on it until years later.

Now, I am in a stable, healthy, loving, relationship with someone who is supportive and aware of my abuse, and have started working on being present during sex. It has been okay—sometimes it sucks, sometimes its good overwhelming, sometimes its bad overwhelming, sometime its okay. I’m working on all of it.

My problem is, since I have started having “present” sex, I have a physical reaction. After present sex, I’ll get sharp cramps and will bleed. I know that it’s nothing medical (I don’t have any STIs, same positions as normal, same partner as normal, etc.), and I’m wondering if this could be my body’s reaction to feeling so vulnerable, and it is acting like it did when I was raped. Is that possible?

I know I have a mind-body disconnect (I’ve made a lot of progress though) and that I have pain interpretation problems (I sometimes don’t feel pain or I do and can’t tell where its coming from), I’m wondering if this is something my body will work through on its own? Or will it keep happening to me forever? I can deal with it if I know that one day it may stop happening, but I don’t know if I can do it for the rest of my life, the emotional energy from having “present” sex is already enough to deal with.

A: I’m so sorry you had such a terrible introduction to sex. As you found, the after-shocks can be long and difficult. I’m very glad you are in treatment and working things through. But, since you are in treatment, I am reluctant to comment. I never want to intrude on on-going treatment, however inadvertently and however well-intended I might be.

I do hope you are talking with your therapist about your physical response to present sex. Yes, it is possible that it is related to your history. But before concluding that is the case, I hope you also have seen a gynecological specialist — just to be 100% sure that there isn’t something medical going on. Although cramping might be associated with psychological issues, it would be very unusual for bleeding to be. STDs are only one possible cause of vaginal pain so please do see a specialist.

I applaud you for all the hard work you have ever done and I celebrate with you the fact that you have found a loving supportive partner.

I wish you well.
Dr. Marie