Tim is leaving treatment after 4 weeks and is interested in re-establishing a healthy sexual relationship with his partner, only to realize that “the plumbing doesn’t work.” Jane, after 6 weeks rehab. has no interested in being sexual since most of her previous sexual experiences were violent and abusive. Joe is frightened about sexuality, saying, “I’ve never had sex without drinking or drugging. I don’t know how to be sexual and sober.”
Is there sex after recovery? Yes, but there are realities we might need to face. What are the characteristics of healthy sexuality? Sexual health is a state of physical, emotional, mental and spiritual social well-being related to one’s sexuality and sexual activities. A healthy sex life is nurturing, sensual, fun, playful, comfortable, gentle, vulnerable, honest, safe, mutual, trusting, and intimate. Intimacy is defined as “in-to-me-see,” or vulnerability + visibility = acceptance. Healthy sexual practices accept imperfection and are non-judgmental.
Are you ready for a healthy sex life after treatment? Ask yourself these questions:
- I’d describe my attitude about sex as ________________
- The messages I was given growing up about sex were ____________
- My parents told me sex was _________________
- I heard about sex from ______________________
- I overcame negative messages about sex by _____________________
- My definition of intimacy is _____________________
- I’m comfortable talking about sex with my partner. Yes/No
Everyone has some sexual concerns: what is normal, how do I relax after a busy day, what secrets/fantasies do I have, body image issues, life cycle changes, gender identity. Many of us have sexual difficulties: how to be passionate, the frequency/timing/setting for sex, repertoire, positions, and interest in other partners. A few have sexual dysfunctions: for women, desire, dyspareunia, vaginismus, anorgasmia, sexual aversion; for men, desire, erectile dysfunction, ejaculatory problems, painful intercourse.
The first issue is whether these issues are primary (“I’ve never been sexually aroused”) secondary (“I once was able to but not now”), or situational (“I don’t feel sexual with her”). Also, is the problem physical/organic or relational/psychological?
For years we’ve joked that “behind every skirt is a slip,” although this is likely said in a sexist way. What are the characteristics of an addictive relationship? They have communication breakdowns, control and power struggles, role reversals, isolation, depression, low self-esteem, broken trust, and often violence and/or neglect. All of these characteristics can contribute to an unhealthy sex life.
What do we know about alcohol, drugs and sex?
- Alcohol has a disinhibiting effect than can lead to risky sexual behaviors
- Sexual violence is often associated with substance use
- Sedatives can decrease one’s sexual desires
- Opioids decrease testosterone and increase prolactin levels for men, leading to impotence
- Cocaine has a bi-phasic effect. Initially cocaine users say they had their best sex when using, but over time, cocaine use leads to decreased sexual desire and impotence
- Meth can lead to erectile dysfunction
- Amphetamines leads to anorgasmia for women and decreased performance for men
- Marijuana lowers testosterone levels and can lead to a condition called gynecomastia (feminization of the male body). Marijuana also reduces sperm production and alters the growth of somatic and germ cells in the testes, which can lead to testicular cancer.
- 43% of women who abuse substances report to being anorgasmic (unable to have an orgasm), likely as a result of the drying of cellular fluids and lack of natural lubrication.
Research has shown that for women who abuse substances, their highest levels of sexual activity were in their acute drinking/drugging phases and their lowest levels of sexual activity were in their first 3 months of recovery. Women, if you have little interest in sexuality in early recovery, that’s ok, it’s normal. Your sexual desires will return over time.
Men, the research is clear: prolonged substance abuse can lead to reduced ability to have an erection for the first 6-12 months of recovery. The good news is that 50% of male substance abusers who have erectile dysfunction return to “normal” within the first year of recovery. And don’t forget, smoking can also contribute to erectile dysfunction.
Also, when a person is on the following medications they too can contribute to sexual dysfunction: antidepressants, benzodiazepines, antihypertensives, beta blockers.
So, is there sex after recovery? Most definitely, yes, in time. However, some may need therapy for their sexual problems. Here are the recommendations for treatment if you are experiencing any form of sexual concerns or dysfunctions:
- Get a thorough physical/gynecologic/prostate exam
- Watch your nutritional balance
- Look for other medical complications: diabetes, herpes, endometriosis, urinary tract infections, endocrine problems
- Look at the relational factors which might be contributing to sexual problems between you and your partner
- Talk about your sexual concerns with a counselor
- Discuss with your counselor and/or sponsor issues such as sexual attraction at self-help meetings (13th step meetings), jealousy, online sex, not feeling sexual, how to enjoy pleasure in recovery, how to avoid relapse
- Other issues to explore are dating/hooking up, sex-drug-linked relapse risks, body image, out-of-control sexual behaviors (sexual addiction), non-consensual sex, dealing with your sexual past, setting boundaries, relapse triggers, how to be intimate
In the movie, 28 Days, there is a funny scene in which a male patient asks a counselor when he can have sex. The response given is, “Get a plant and a dog. If after the first year the plant is still alive, and after the second year, the pet still is, then you can have sex.” The patient groans in agony, likely thinking, “You have got to be kidding me.” This is a comical version of the approach many of us take about sexuality. It is time we bring sexuality and recovery into the open and realize that recovery includes sexual health as well.