Women who report histories of CSA have significantly higher rates of sexual dysfunction than women without CSA histories. Survivors of CSA report significantly lower sexual satisfaction and higher sexual distress. Beyond the impact on quality of life, sexual problems contribute to relationship distress and have been implicated in the high divorce rates seen in CSA survivors. Despite the high prevalence of CSA there are few treatments for sexual dysfunction that have been empirically validated for adult survivors. Treatments for sexual sex therapy techniques such as sensate focus are overwhelming for many women with CSA histories, and pharmacological treatments that improve sexual response in women without CSA histories, such as sildenafil, do not improve and, in some cases, may even worsen sexual problems in women with CSA histories. This may be because for survivors of CSA, the sexual response can be a powerful reminder of the trauma.

Pennebaker and associates found that writing about emotionally relevant themes causes beneficial changes in numerous psychological, behavioral and physiological indices. We were the first to examine the impact of a writing intervention on relationship-relevant variables in women with a history of CSA. Seventy women with CSA histories completed five 30-minute sessions of expressive writing, either with a trauma focus or a sexual schema focus. Validated self-report measures of psychopathology and sexual function were conducted at posttreatment: 2 weeks, 1 month, and 6 months. We found women in both writing interventions exhibited improved symptoms of depression and posttraumatic stress disorder (PTSD). Women who were instructed to write about the impact of the abuse on their sexual schema were significantly more likely to recover from sexual dysfunction. Our findings strongly suggest that expressive writing may improve depressive and PTSD symptoms in women with CSA histories. Sexual schema-focused expressive writing in particular appears to improve sexual problems, especially for depressed women with CSA histories. These treatments are accessible, cost-effective, and acceptable to patients.

Recommended paper:

Meston, C.M., Lorenz, T.A., & Stephenson, K.R. (2013). Effects of expressive writing on sexual dysfunction, depression, and PTSD in women with a history of childhood sexual abuse: Results from a randomized clinical trial. Journal of Sexual Medicine, 10(9), 2177-2189. PDF (254 KB)

To access the sexual schema writing prompts used in this study click here.