Why Oral Sex Can Trigger Anxiety for People With PTSD

Sex should be fun, but it can also be complicated. Welcome to Sexual Resolution, a biweekly column by sex therapist Vanessa Marin answering your most confidential questions to help you achieve a healthy, joyful sex life. Here, she answers a reader who wants to enjoy oral sex but has a history of abuse.

DEAR VANESSA: I read the question a few weeks ago from the woman who doesn’t feel comfortable receiving oral sex. Your advice was helpful, but I have one added complication that I was hoping that you could address. I am the victim of sexual abuse, and my abuser repeatedly performed oral sex on me. I have done a ton of therapy around the abuse and am in a good place about it, but oral sex still feels very uncomfortable for me. I’m with a kind, caring partner now, and we have a decent sex life, but it seems to be the one hurdle I can’t get over. I get anxious the second my partner starts moving their head down. When they make contact with my labia, my stomach does flips and turns into knots. What can I do to help myself relax and receive? —Anxious About Oral, 29

DEAR AAO: First of all, I am so sorry to hear that you’ve experienced abuse in your past. At the same time, I’m glad to hear that you’re invested in reclaiming your sex life and looking for ways to make sex feel safe again.

I wasn’t sure from your question whether you actually want to receive oral sex or if you’re asking the question because you feel like it’s something you should get more comfortable with. You absolutely do not have to have oral sex if you don’t want to. It’s your body, and you get to decide what you want to do with it.

The first step I recommend is to get clear on your goals. Do you actually want to learn how to enjoy oral sex? Do you want oral sex to be a part of your sexual repertoire? If you do want to learn how to experience oral sex that feels safe, I also recommend spending some time thinking about the specific reasons why you want to enjoy this act. This might seem like overkill initially, but I find it to be very powerful to think of the specific reasons why you want to do something. Possible answers could include, “I want to reclaim oral sex for myself,” “I want to feel deserving of pleasure,” or “I want to decide what I get to do with my body.” Notice that those all have slightly different feels to them.

Next, I want to address your partner. If you haven’t already, and if you two have developed a level of trust, I highly recommend talking to them about the abuse you’ve experienced. Get your partner on your team in helping make oral sex more comfortable for you.

<h1 class="title">Sexual Resolution: Oral Sex + Trauma</h1><cite class="credit">Getty Images</cite>

Sexual Resolution: Oral Sex + Trauma

Getty Images

Work together to find ways they may be able to help you feel even more relaxed when it comes to sex. Maybe you like when they hold you or make eye contact with you. Ask yourself, is there a certain message you would like to hear from your partner about oral sex? Perhaps there’s something they could say to remind you that you’re safe and in control. For example, they could tell you, “You deserve pleasure” or something like “I’m going to stop whenever you tell me to stop.”

When it comes to the oral sex itself, it sounds like you may be rushing and pushing yourself past your comfort zone. That’s why your body is having such strong physical reactions. I would try breaking it down into a series of really small baby steps and explaining these steps to your partner. Let them know not to do anything unless you explicitly tell them to do so. Give yourself the time and patience to get comfortable with each step. Have your partner start by kissing you, then move their head down your neck an inch and stop there. Focus on keeping your breath even and calm and reminding yourself that you’re safe and in control.

Keep saying to yourself, “I can stop this at any time. I don’t have to do anything I don’t want to do.” If and when you feel ready, tell your partner to move down another inch.

Keep saying to yourself, “I can stop this at any time. I don’t have to do anything I don’t want to do.” If and when you feel ready, tell your partner to move down another inch, and focus on your breath and safety again. The first few times you try this, you may just want to have your partner move down a few inches, but not actually end up performing oral sex. Maybe the next time you let them go down a few inches more. Once they make contact with your genitals, you can still take baby steps. Maybe the first time they try, they’ll just give you a few kisses along your labia and then stop there for the day. Seriously, take your time. There is no need to rush.

At this time, you can also experiment with positioning. The position most people have oral sex is with the person receiving on their back and the partner on their stomach, lying between their legs. But this position pins you down onto the bed and doesn’t give you much control. I recommend having your partner lie flat on their back, with their head on a pillow. You can straddle their face. This way, you’re in full control of your body, so you can lower your vulva down onto their lips and pull it away whenever you want. It really helps emphasize that you’re in control and you can stop whenever you want.

As you’re doing these experiments, allow yourself to take breaks whenever you need them. So many sexual abuse survivors try to force themselves to keep going, even if they start to feel uncomfortable. However, that only makes your body feel less safe and less in control. The second you start feeling any sort of anxiety, fear, or discomfort, tell your partner that you need to stop. Either take a break or stop for good for that particular day. When you stop, tell yourself, “I am stopping because I respect my own reactions, and I want to learn that oral sex can be safe.”

Finally, my last suggestion is to consider sex therapy. It’s fantastic that you’ve gotten a lot of therapy, but unfortunately, most therapists don’t have much training in sexuality, so they skip over the sexual impacts of abuse. It may help to see someone who specifically specializes in that area. Wishing you the best.


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Vanessa Marin is a licensed sex therapist based in Los Angeles. You can find her on Twitter, Instagram, and her website.