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Many gay men have unfortunately experienced sexual trauma, either during childhood or adulthood. We know that trauma leaves lasting psychological effects, leading to anxiety, depression, substance use, low self-worth, and relationship struggles. To make matters worse, sexual trauma is one of the most difficult topics to address. This is particularly true for gay men, as only a small fraction of mental health providers are equipped to treat gay men who are survivors of sexual assault. If you are in this situation and considering therapy, I want to offer you a clear sense of what you can expect in effective psychotherapy. And I want to address one of the most critical components of your healing: detangling arousal and consent.
The Birds and the Bees
First things first: we begin with education about normal sexual development. As a therapist, it’s surprising how many adults—who have been sexually active for decades—are unaware of some basic principles of human sexuality. We need to address these before we proceed. For example: It’s normal for kids and adolescents to be curious about bodily sensations that feel stimulating. Typically, they don’t understand what actual sexual intercourse is until they receive formal education or reach puberty. It is normal for kids, who are roughly the same age, to engage in "sexual play." Many adolescents learn about sex through porn, which can be problematic, as porn often depicts sex in unrealistic ways. Start by revisiting your fundamental understanding of sex. Consider what kinds of sexual acts you enjoy, how you give consent, and what you value in a sexual partner.
Let’s Talk About Sex
Next, we craft a detailed timeline of your sexual development. Taking a sexual history should implicitly communicate affirmation and non-judgment. Here are some questions you can expect: When did you first masturbate? What kind of porn do you enjoy? What were your first sexual experiences like? What sexual acts do you practice most frequently? I've found that people often don’t volunteer this information unless explicitly asked by the therapist. People are often hesitant to bring up these details spontaneously–especially gay people. People vary dramatically in their comfort about discussing sex. Therapy should be a space where all of these topics of conversation are directly encouraged. After all, the therapist sets the tone and holds the space.
Core Sexual Beliefs
One of the most important components of treatment is assessing core sexual beliefs. Simply put, what are your beliefs about sex? Is sex for fun and free, or is it dirty and debauched? Start by reflecting on the earliest messages you received about sex from your culture, peers, and family. We are all deeply impacted by these messages. Almost all gay men were raised with some form of dogma suggesting that sex was wrong—especially gay sex. These messages matter. Men who were taught that sex is simply a healthy part of human expression often adopt a more innocuous perspective about sex. However, those who were told that sex is shameful tend to carry this belief into adulthood. These pre-existing beliefs about sex will dramatically inform the way one processes sexual trauma.
Teenage Dream
It is very common for teenage gay boys to have their first sexual experience with an adult man. Many men may have no idea that this sexual interaction was not only illegal but also abusive. Unfortunately, such occurrences are common. We must address this reality while acknowledging the clear power imbalance in these situations. We start by simply normalizing adolescent curiosity. It’s perfectly normal for teenagers to have sexual fantasies about adults. Young straight boys, for example, may fantasize about Kim Kardashian or Megan Fox. Similarly, it’s perfectly natural for adolescent gay boys to have sexual desires toward their teenage crushes as well. What is not okay are the adults who sexualize teenagers. Think about it: now that you’re an adult, would you do anything sexual with a teenager? But when you were a teenager I’m sure you fantasized about men who were already well into adulthood.
Sharing Your Story
This is the hard part. At some point, you’ll want to share your story. Some people dive into it at the beginning of therapy, while others take their time. There’s no rush. Typically, people will share the bulk of the story relatively early on, but new details will emerge throughout therapy. This makes sense—the more you talk about your trauma, the more thoughts and feelings will surface. Keep in mind that our memories are far from perfect. Don’t worry if you find yourself contradicting yourself or if conflicting ideas emerge. Give yourself permission to revise the story as many times as you need. You’re not on trial. You won’t be cross-examined. You’re allowed to stumble as you find your footing and your narrative.
Arousal is Not Consent
This is probably the most critical and least talked-about component of sexual trauma treatment. Many clients experience physical arousal during their sexual abuse. This often becomes a massive source of shame—particularly for those who experienced abuse as children. Therapists must strongly normalize the biology at play with statements like, “It is okay if your body responded positively to the abuse.” Why? Our bodies respond to stimulation all the time. Someone strokes your arm or rubs your shoulders and, whether we like the person or not, the stimulation feels nice. Male genitalia, in particular, are biologically extremely responsive to stimulation. Involuntary erections are a normal part of life for men. This response does not equate to consent. However, many sexual assault survivors feel complicit in their abuse if they experienced arousal. It's crucial to dismantle this false belief.
Your Orgasm Got Hijacked
There is an overlap between fear and excitement in our nervous system; they can trigger one another. It’s messy—especially when we are overwhelmed. Danger is part of the reason why people enjoy BDSM or risky sex, for example. Sexuality is complex. We can be aroused and scared at the same time. But I’ve been surprised how resistant some folks are to accepting this concept. Many sexual trauma survivors struggle to absolve themselves of guilt. Therapists must be relentless with the truth. I promise this isn’t some therapeutic ploy to feign sympathy. This is the objective truth and biology. Arousal is not consent. Blaming yourself for biologically enjoying part of the sexual abuse will leave you with contempt for yourself and disgust with your sexuality.
Gay Men’s Sexual Trauma Treatment
Let me emphasize again: if you are struggling, you are not alone. I’ve partnered with Impulse United to create a unique service for this very issue. The Gay Men’s Sexual Trauma Treatment Network is a one-stop shop, offering all of the resources you’ll need in one place: therapy, psychiatry, medical care, coaching, group therapy, and more. Our goal is to streamline the process so you can get the healing you deserve as efficiently as possible. If you’d like to learn more, you can check out our website. If you'd like to learn more about my work, feel free to contact me for a complimentary consultation.
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