Finding intimacy after trauma and assault

A Q&A with Dr. Holly Richmond

Written by Abby Lee Hood

Sexual assault is extremely common. As somatic psychologist and certified sex therapist Dr. Holly Richmond says: you likely know an assault survivor. And given that the Rape, Abuse, and Incest National Network (RAINN) says that every 73 seconds an American is assaulted, that survivor could even be you.

Given that sex and intimacy are pillars of overall health and wellness, we wanted to know: how can we enjoy intimacy after trauma? Everyone deserves pleasure, and everyone deserves to feel safe with their partners when they’re having sex or being intimate. But trauma makes that difficult, and sometimes it can even make sex painful.

We spoke to Dr. Richmond (who helped create our in-app journey for survivors of sexual trauma) about how survivors can reclaim sexual intimacy and pleasure after trauma. 

How common would you say difficulty or painful sex is after trauma or assault?
I want to impress on readers that they likely know somebody who has experienced assault. Reports of difficulty with sex are very high (over 90%) for survivors of sexual trauma. Pain during sex after trauma is a bit more difficult to quantify because studies are typically divided into different survivor categories, e.g. sexual abuse, rape, sexual assault, etc.

In my clinical experience, about 40% of patients experience painful sex long after their sexual trauma. This can manifest as dyspareunia, vulvodynia, vaginismus or generalized pelvic pain. 

What kinds of traumatic events can create painful or difficult sex? Does it always have to be sexual trauma, or can other things cause intimacy problems?
Any can kind of traumatic event can cause painful sex, but sexual trauma or attachment traumas in particular. Sexual pain disorders do not only follow violent or aggressive nonconsensual sexual acts. They can manifest from any type of nonconsensual experience. To have an experience qualify as traumatic, it does not need to be violent, only nonconsensual.  

What are some common treatment options for people experiencing painful sex? 
Sometimes talking about the pain (and trauma, if that is a factor) is helpful through working with a sex therapist or sexual trauma therapist. This professional could recommend exercises to help with the pain, and certainly to understand it better. However, many people who experience sexual pain need to work with a pelvic floor therapist who has special techniques and tools to assist in healing. 

How can someone best support a partner who is having difficulty being intimate or experiencing pain during sex?
First and foremost, if the person is a survivor of sexual trauma, listen, don’t judge. Do not ask how or why it happened, because that puts blame on the survivor when it should only be placed on the perpetrator.

Ask how you can support that person. Perhaps that would be by researching a professional to help or assisting the person in finding any other support structures they need, e.g. a support group. Go slowly with any sexual initiation, and most likely taking penetrative sex off the menu until the person is feeling better, is necessary.

Be patient. Support, don’t push. 

What are some tips for explaining to a partner that painful sex may not be the partner's fault?
Communicate that you are in pain. No one should ever have painful sex. Tell your partner that you are working on understanding your pain better (if it’s from a past trauma or purely a physiological concern) and that you are seeking the help of a trained professional who works specifically with your concern. Tell your partner it doesn’t have anything to do with them, but you will need their patience and support. If other acts of intimacy feel ok to you, suggest those rather than an act that causes pain. 

When should a person or couple seek therapy or other expert interventions?
If they they tried to understand or heal their pain on their own and are not experiencing a sense of relief, they should see their PCP or OBGYN, and perhaps a certified sex therapist ( has a great therapist finder). Those professionals will have the information they need to refer to a pelvic floor therapist. 

Using what you’ve learned about sexual assault and intimacy, we hope you’ll put the above expertise to good use. Remember, there’s no shame in getting professional help after a traumatic event, and a supportive partner will be happy to hear how they can help you recover and experience less pain and anxiety. You deserve to feel pleasure!

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