EMDR for Trauma Affecting Sex and Intimacy

Simon Wilson

Sep 6

5 min read

Updated: 6 days ago

Sex and intimacy can become connected with fear, shame, distressing memories or a sense of being unsafe. Someone may understand intellectually that they are safe in the present while their body continues to respond as though an earlier experience is happening again.

Eye Movement Desensitisation and Reprocessing—usually known as EMDR—is an established trauma-focused psychotherapy. It may be helpful when identifiable traumatic experiences continue to affect a person’s psychological wellbeing, relationships or sexual life.

EMDR is not, however, a universal treatment for sexual difficulties. Sexual problems can have physical, medical, psychological, relational and social causes. A careful assessment is therefore essential before deciding whether trauma-focused treatment is appropriate.

How trauma can affect sex and intimacy

Traumatic experiences can influence how someone responds to closeness, vulnerability, touch and sexual contact. This may follow sexual assault or abuse, but sexual difficulties can also be affected by other experiences, including coercion, humiliation, violence, medical procedures, frightening relationship events or significant breaches of trust.

Possible experiences include:

• Intrusive memories or images during sexual contact.

• Fear, panic or a strong bodily alarm response.

• Avoidance of touch, intimacy or particular sexual situations.

• Feeling emotionally absent, detached or disconnected from the body.

• Shame or negative beliefs about the body, sexuality or personal worth.

• Difficulty distinguishing present safety from an earlier threat.

• Distress associated with particular sensations, situations or relationship dynamics.

These experiences do not prove that someone has post-traumatic stress disorder. Nor should every sexual difficulty be attributed to trauma. Similar problems can arise through anxiety, medication, illness, relationship conflict, sexual pain, cultural messages, habit or other psychological processes.

The purpose of assessment is to understand what is happening for the individual rather than imposing a predetermined explanation.

What is EMDR?

EMDR is a structured psychotherapy in which a person is helped to process distressing memories while attending to bilateral stimulation. This commonly involves guided eye movements, although alternating taps or sounds may sometimes be used.

Treatment involves more than eye movements. It includes history-taking, assessment, preparation, identifying appropriate memories, processing associated emotions and beliefs, and reviewing whether change has been maintained.

The aim is not to erase a memory. Rather, treatment seeks to reduce the intensity with which an earlier experience continues to be relived or activated in the present. The event remains part of the person’s history, but it may become less disturbing and less influential over current responses.

The evidence for EMDR is strongest in the treatment of post-traumatic stress disorder. NICE recommends EMDR for adults with PTSD or clinically important symptoms of PTSD and states that it should be delivered by trained practitioners using a phased approach.

What does the research tell us?

Research supports EMDR as a treatment for PTSD, including PTSD arising from childhood trauma and sexual assault.

A controlled study involving adult rape survivors found that EMDR and prolonged exposure both produced greater improvement in PTSD symptoms than a waiting-list condition. A later international trial found substantial reductions in PTSD symptoms among adults receiving EMDR for childhood-related trauma.

The evidence also requires careful interpretation. A trial examining two early EMDR sessions shortly after rape did not find EMDR more effective than watchful waiting in reducing post-traumatic stress, sexual dysfunction, guilt or shame over the follow-up period.

There are individual reports and small studies describing EMDR in relation to particular sexual difficulties, but this evidence is not sufficiently strong to present EMDR as an established treatment for sexual dysfunction itself.

The most defensible conclusion is that EMDR can treat relevant traumatic memories and post-traumatic symptoms. Improvements in sexual or relational functioning may follow when those symptoms were contributing to the difficulty, but this cannot be assumed or guaranteed.

When might EMDR be considered?

EMDR may be considered when assessment identifies a traumatic experience that remains active in the person’s present life. For example, someone may experience intrusive memories, intense fear, avoidance or bodily distress connected with intimacy.

Before proceeding, assessment should consider:

• The nature and timing of the traumatic experience.

• Current post-traumatic symptoms and their effect on daily life.

• Whether there is a clear memory or group of memories to address.

• The person’s capacity to manage emotional activation during and between sessions.

• Dissociation, substance use, self-harm or other mental-health difficulties.

• Physical and medical factors affecting sexual functioning.

• Current relationship circumstances.

• Safety, consent, safeguarding and risk.

• Whether EMDR is the person’s informed preference.

Preparation may need to include emotional-regulation strategies, grounding, psychoeducation and the development of sufficient stability. Trauma processing should not begin simply because a trauma history exists.

Can EMDR treat compulsive sexual behaviour?

There is not currently sufficient evidence to describe EMDR as a direct treatment for compulsive sexual behaviour disorder, problematic pornography use or “sex addiction.”

For some people, repetitive sexual behaviour may partly function as a way of escaping distress, interrupting emotional numbness or regulating trauma-related states. For others, trauma may have little or no role in maintaining the behaviour.

Where a specific traumatic memory is relevant, EMDR might form one part of a wider treatment plan. It would not replace assessment of impaired control, consequences, relationship dynamics, shame, secrecy, risk or co-occurring mental-health and substance-use difficulties.

Understanding trauma does not remove responsibility. If behaviour has harmed another person, crossed boundaries or involved risk, trauma-focused work must remain alongside accountability and appropriate risk management.

EMDR following betrayal or disturbing discovery

The discovery of secret sexual behaviour or an affair can be profoundly destabilising. A partner may experience intrusive images, hypervigilance, disturbed sleep, avoidance and a loss of confidence in their understanding of the relationship.

These reactions should not automatically be labelled as PTSD. EMDR would only be considered where assessment identifies clinically significant trauma-related symptoms and appropriate treatment targets.

It also does not replace the relational work that may be needed. Questions of disclosure, honesty, boundaries, decision-making and rebuilding—or ending—a relationship generally require a broader therapeutic approach.

EMDR within psychosexual and relationship therapy

EMDR may address traumatic memories, but it cannot resolve every factor contributing to a sexual or relationship difficulty.

Depending on the presentation, treatment may also involve:

• Psychosexual assessment and therapy.

• Medical investigation or liaison with another healthcare professional.

• Individual psychotherapy.

• Relationship therapy.

• Work addressing anxiety, avoidance and sexual communication.

• Specific treatment for compulsive or repetitive sexual behaviour.

• Safeguarding, accountability or specialist forensic intervention.

An integrated formulation helps identify which approach is required, how different elements should be sequenced and whether professionals from more than one discipline need to be involved.

A careful and proportionate approach

Trauma should neither be ignored nor used as a universal explanation for sexual difficulty. EMDR is most credible when it is used for the problem it is best supported to treat: disturbing memories and clinically important post-traumatic symptoms.

In my practice, EMDR is considered for carefully assessed, suitable single-incident trauma presentations and undertaken with specialist supervision. It does not replace my wider psychotherapeutic, psychosexual or relationship work, and it is not presented as a direct treatment for every sexual difficulty or repetitive behaviour.

The initial consultation provides an opportunity to understand what is happening, consider whether trauma is relevant and decide what form of therapy is most appropriate.

For information about assessment and suitability in practice, see Trauma Therapy & EMDR.

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Related specialist services

• Psychotherapy for Men

• Clinical Sexology

• Therapy for Compulsive Sexual Behaviour

• Relationship Therapy

• Forensic Sexology and Assessment