Introduction

In recent years there has been a significant shift toward more open conversation related to sexual assault and sexual trauma. Momentum from campaigns such as #MeToo and #TimesUp are giving more attention to the gravity of sexual assault and trauma. As an increasing number of women speak out about their experiences, a clear need has emerged to address the frequency and potential negative consequences of sexual trauma in addition to the process of healing post-sexual trauma. Definitions of sexual trauma vary; however, the current study defines sexual trauma as physical or emotional trauma resulting from a sexual act committed against someone without their consent. Data collected by the National Intimate Partner and Sexual Violence Survey [1] indicate that one in five women in the United States will experience sexual assault in her lifetime. Sexual trauma that results from sexual assault can seriously impact a person’s mental, physical, and emotional well-being and can affect future romantic and sexual dynamics [2–4]. Although several studies look closely at the impact sexual trauma can have on an individual [3–6], these studies do not provide an in-depth examination of specific strategies used by women to not only cope with their trauma but move beyond it toward healthy and happy sexual relationships. In the present study, we interviewed 41 women who had experienced sexual trauma and reported currently being in a healthy relationship to better understand the strategies used to recover from the trauma and move on to a healthy sexual relationship.

Many survivors of sexual assault experience symptoms of trauma such as hypervigilance, avoidance, and re-experiencing because of the assault [5–7]. These sexual trauma symptoms are often associated with negative outcomes such as post-traumatic stress disorder (PTSD), anxiety, depression, substance use, aggression, and self-injury [5–12]. A recent meta-analysis found that sexual assault was strongly associated with PTSD [13] and a qualitative review found that between 17% and 65% of sexual assault survivors develop PTSD [14]. Survivors of sexual assault often experience negative social reactions following the assault, further contributing to symptoms of PTSD [15]. Symptoms of post-traumatic stress can have serious consequences on impairment across multiple domains of functioning such as additional physical health problems, revictimization, problems with alcohol or drug consumption, and an increase in negative social reactions [7, 15–18]. Moreover, individuals who have experienced previous stressful life events, such as childhood sexual abuse (CSA), are at greater risk of developing trauma symptoms from subsequent traumatic events [19, 20].

In addition to mental health problems, especially PTSD, sexual assault is often associated with a decrease in sexual functioning and satisfaction [12, 21–26]. Early studies on sexual assault survivors found that most of the women who had a history of sexual trauma (71% and 88.2%) attributed their sexual problems, including fear of sex, desire difficulties, or arousal dysfunction, to their assault [21, 22]. A more recent survey of college women who survived sexual assault reported similar levels of sexual dysfunction (87%) including a decrease in sexual desire and difficulty achieving an orgasm; they were also more likely to experience multiple sexual dysfunctions [24]. Some of the negative effects of sexual assault on sexual functioning including fear, arousal, and difficulties with desire can persist for years [12]. A recent qualitative study of 45 sexual trauma survivors and their primary informal support providers (e.g., partner, friend, family member) found both an increase and a decrease in interest and participation in sexual behavior. When the sexual behavior increased in frequency, it often involved engagement in sex work or cycling through many sexual partners [25]. Together these studies highlight the extent of the impact sexual trauma can have on the survivor’s future sexual and relational functioning and the importance of better understanding how to mitigate the deleterious effects of sexual trauma on survivors.

The impact of exposure to sexual trauma can be dependent on the presence of PTSD symptoms [27]. Individuals who developed symptoms of PTSD following sexual assault experienced significant decline in some aspects of sexual functioning including sexual aversion, sexual pain, and sexual satisfaction but did not differ on frequency of orgasm or sexual arousal. In contrast, participants who had experienced sexual trauma but did not develop symptoms consistent with PTSD did not significantly differ in their level of sexual functioning from participants who had never experienced sexual trauma [27]. These conclusions highlight the importance of better understanding the strategies and resources that some trauma survivors may have that enable them to recover from the trauma to move toward healthy relationships.

As outlined above, sexual functioning and sexual satisfaction are often impaired following sexual trauma. We know from previous literature that sexual and relationship satisfaction are bidirectionally strongly connected [28, 29], thus it is likely that individuals who experience a decline in sexual functioning and sexual satisfaction are also likely to experience a decline in relationship satisfaction. Indeed, previous studies have found that sexual trauma can impact relationship functioning and dissolution [30, 31]. Fear of re-traumatization often leads to isolation and avoidance, further affecting social dynamics for the individual [6]. Following a disclosure, many survivors and their partners report a change in the relationship, both with positive and negative effects. Partners of survivors sometimes felt their needs were not being met and they experienced strain in the relationship following disclosure of sexual assault [25]. However, although disclosure of prior sexual trauma to a new partner is common, it isn’t always supportively received, and the reception of the disclosure may impact the extent to which the relationship experiences strain [32]. In another study, the results showed that partners were cautious about navigating sexual intimacy with the survivor and survivors reported that they sometimes got triggered by their partner or experienced dissolution of their relationship because of the impact of the assault on sexual functioning [25]. These results suggest that sexual trauma is likely to have a wider impact on the survivors’ relationships in addition to individual functioning.

The impact sexual trauma has on overall health and well-being indicates a crucial need for more information addressing how to cope with sexual trauma and especially how to navigate future sexual relationships post-sexual trauma. While a great deal of research has addressed the potential impact of sexual trauma on individuals’ functioning, surprisingly little research has been conducted on how to minimize the negative impact of sexual assault on the survivors’ well-being. Research addressing the implementation of therapy-related coping techniques on those with trauma indicates that inconsistencies and incompatibility with these techniques can retraumatize the individual [33]. Although some research examines coping strategies implemented or encouraged for those who have experienced trauma, most of the existing research has focused primarily on therapy and cognitive techniques [33–35] these have been shown to be valuable mechanisms. Yet little is known about additional coping strategies used by individuals to move forward to healthy relationships and cope with ongoing symptoms of sexual trauma throughout their lifetime.

The current study

Chanel Miller, sexual trauma survivor and author of the book ‘Know My Name: A Memoir Chanel Miller’ [36] emphasizes the importance of society to address sexual trauma and hold space for survivors. Miller also expresses the value of taking on simple strategies to cope with trauma in daily life. Previous research has addressed the gravity of the impact left by sexual trauma [5–7, 11], but much of the research into treatment of sexual trauma has focused on developing treatment protocols for therapy. However, the extant literature lacks a more comprehensive understanding of the range of strategies survivors can use to mitigate and combat their trauma.

As women are disproportionately affected by sexual trauma [5], women may have more extensive strategies they use to cope with trauma and are particularly poised to give insight. The current study aims to fill a clear gap in the literature by addressing the question of how women move past sexual trauma and into a healthy relationship. We do this by giving voice to a sample of women across a large age range (18 to 55) to identify specific strategies that they used, effective and ineffective, to move beyond their experience of sexual trauma and into healthy relationships.

Method

Results

Five themes were identified in the data that demonstrated effective strategies expressed as coping mechanisms that promoted participants’ progress toward moving beyond sexual trauma and into healthy relationships. Additionally, six themes were identified as ineffective strategies for moving beyond sexual trauma into healthy relationships. We outline each of these below and include an overarching quote that best exemplifies each identified theme. Additional quotes from the data illustrating the themes are outlined in the S1 Table.

Discussion

Sexual trauma is incredibly common [13] and the results of this study provide insight into how individual women navigate relationships after the experience of sexual trauma. There are well-documented negative effects of sexual trauma for women [3–6]. However, far less research examines what happens when these women move into healthy sexual relationships after the experience of trauma. By interviewing women who had experienced sexual trauma and were in healthy sexual relationships at the time of the interview, we aimed to capture the nuance of strategies used to move into healthy relationships after the experience of sexual trauma. These findings have important implications for professionals in the field, survivors’ support networks, other women coping and healing from sexual trauma, and the findings provide some interesting areas for future research. The current study highlights ingenuity, self-love, and resilience in these women as they developed their strategies for coping with sexual trauma; something that is lacking in the sexual trauma literature that so often focuses on women purely as victims. Prior to this study, information regarding individual coping strategies was limited. Even more limited prior to this study were the tangible ways in which women navigate relationship building and sustainability over the longer term after experiencing sexual trauma. We do not aim to minimize the disruptive and damaging impact that sexual trauma has on women’s lives. It remains a crucially important goal to minimize the perpetration of sexual violence in society. However, until that is addressed, we must not ignore the future sexual and relational lives of women who are affected by sexual trauma. Like every other human, it is their human right to experience sexual pleasure and engage in healthy relationships [38]; this paper provides 41 women’s accounts of how they’ve navigated moving from experiencing sexual trauma toward a healthy sexual relationship.

Of the five effective strategies that were highlighted by the participants in this study, social support was by far the most important. Participants discussed how storytelling was a powerful tool in their social support networks, as it allowed them to share through social support. As an effective strategy the women noted that the identification of a “tribe” and finding others to help build that sense of community through similar experiences was critical to healing. Additionally, this social support and the ability to feel seen by others through social support led to feelings of empowerment, which were described as instrumental to moving into a healthy sexual life. Evidence from this study indicating the effectiveness of social support aligns with conclusions made in previous studies related to different types of traumatic stress and the importance of social support in coping with stressors that result from trauma [39]. Moreover, research connecting the negative effects of trauma related PTSD to negative social reactions indicates a relationship between social connections and PTSD regression, further supporting our findings related to the value of social support [15].

Communication was identified in the data as both an effective and ineffective strategy, depending on the context. For women who felt it was effective, they expressed that communicating boundaries and using that to determine who was an ally to share their experience of sexual trauma with. For women who felt communication was an ineffective strategy, the experiences centered around communicating with people who did not believe them or take them seriously. When participants felt like they were not believed or not taken seriously, it was problematic and hurtful and made communicating their experiences feel like something they shouldn’t do. Research has shown that when women are not believed about their experience of sexual assault, there are negative health consequences [40, 41]. Furthermore, previous research using the same sample showed that being able to express consent and communicate one’s sexual needs was important for the development of a healthy sexual relationship [42]. Other recent research has also showed that being able to express consent for sexual activity has been positively associated with sexual satisfaction [43]. However, many women have negative associations with refusing sex [44]. Thus, it is important to help women feel empowered to communicate their needs, wants, and boundaries both with sexual partners as well as with others who they may share their traumatic experiences with.

Although many women expressed how communicating to others about trauma was not always helpful, avoidance was also expressed as a barrier to moving into a healthy sexual relationship. The participants discussed several ways that avoidance was engaged in, and this overlapped with the self-harm theme. Substance use, self-harm, engaging in casual sex to numb, and avoiding communicating about feelings were all soothing for the moment but clearly labelled as an ineffective long-term strategy for our participants. Although labelled as an ineffective strategy, participants overwhelmingly expressed a great deal of grace and understanding toward themselves for the reason they engaged in these avoidant and self-harming behaviors.

Prior research has consistently documented the effects of sexual trauma on many aspects of well-being [3–5] and the positive role that engaging in therapy has had on processing trauma. Although therapy was a successful strategy for coping with trauma for some of our participants, the results indicated that therapeutic fit was particularly important, and some women did not have positive experiences with therapy as a strategy to move beyond sexual trauma. Participants who found therapy to be ineffective mentioned discomfort with the process or specific technique and difficulty to find a suitable provider as an obstacle when attempting to utilize therapy as a coping mechanism. Participants who found therapy to be an effective strategy expressed gratitude that they had access, and this is a call to ensure greater access to therapy services, especially in the United States. Participants expressed feelings of possible judgement on the part of the therapist, and multiple women were dissatisfied with the lack of diversity as they searched for a provider who would be a good fit for their unique experience. One possible interpretation of this is that individuals are seeking professionals who can empathize with their experiences, not only as survivors of sexual assault but as women of color, queer women, and women from different socio-economic backgrounds. As many of the participants cited the benefits of therapy as an effective tool that played an important role in the coping process, taking the time to better understand the ways in which therapy is lacking for others could play a crucial role in informing effective strategies that can be accessed by diverse groups of women. This points to a real need for trained therapists who have knowledge, skills, and perhaps even lived-experiences similar to the clients they serve. The lack of diversity and inclusion and competence with working with diversity in therapists was by far the largest barrier to therapy being an effective strategy for the women in our study. Given that our study consisted of majority white participants, we would imagine this will be even more important in a more diverse sample. Indeed, a recent study found that transgender individuals were more likely to experience sexual assault compared to cisgender individuals [45]. Thus, future research should include people of diverse racial, socioeconomic background, and sexual and gender minority groups.

These interviews provided the opportunity to understand the nuanced experiences of 41 women who experienced sexual trauma and now consider themselves to be in a healthy sexual relationship. As noted above, one of the limitations of this study was that it was a primarily white sample of cisgender women in high-resource settings. It would be helpful for future research to examine experiences of resilience in trans or gender nonbinary participants and additional participants of color. We also see opportunities for future research to include the partner perspectives. Since all of our participants were in a healthy happy relationship, it would have been interesting to also collect dyadic interview data to understand the dynamics in greater depth.

In-depth qualitative research requires the consideration of research positionality; asking researchers to consider their own identities in the context of conducting the interviews and engaging in the analysis [46]. The authors involved in this research are relatively representative of the participant pool in gender (all cisgender women), race/ethnicity (three white and one Latinx researcher), and sexual identity (one bisexual, one queer, two heterosexual). Two of the authors have experienced sexual trauma themselves and two of the authors are practicing therapists who have worked with clients with prior history of sexual trauma to help them into healthy sexual relationships. We recognize these identities may introduce potential biases, emphasizing the importance of reflexivity throughout the research process to ensure the participants’ voices remained the focus of our findings rather than our own experiences [47], and we kept this at the forefront throughout the process.

To conclude, survivors of sexual trauma face many obstacles when it comes to coping and moving forward with their lives, yet the women in this study demonstrated incredible resilience while implementing strategies to cope with their trauma and went on to experience healthy fulfilling sexual lives. Our participants’ experiences clearly demonstrated that sexual trauma does not equate to the end of a healthy relationship with sex or relationships. The participants detailed several strategies that were helpful and unhelpful in their process. Giving voice to survivors of sexual trauma is not only empowering for those sharing their experiences, but also for others who are earlier on in the healing process and can learn from those before them. This study is valuable as it guides researchers, health providers, therapists, survivors, and the broad community toward better understanding the processes involved in effective and ineffective strategies to moving beyond sexual trauma toward a fulfilling and healthy sexual life.

Supporting information