Does sex ever make you feel sad?

If so, you could be suffering from a very rare sexual dysfunction…

You’ve probably not heard of PCD – post coital dysphoria, but you might have felt it. Imagine this: you have just had sex. It was good, really good even, when you suddenly get sad, start crying maybe or even become angry. Within a few minutes, your mood lifts, but still, you don’t know why you got so upset. Your partner thinks it was them. It wasn’t. You brush it off. Maybe it was just one of those things. Except it happens again. And again. And that’s when you know you have PCD.

Postcoital dysphoria is sometimes known as the post-sex blues because sadness is the most common feeling, although some report anxiety and irritability too. The French call is post coital tristesse. It tends to happen after an orgasm, be that through masturbation or sexual intercourse. Usually, episodes only last a few minutes. But for some the feelings can linger for several hours. Confusion often comes because most sufferers have no other mental health problems, no history of low mood and it happens after what was otherwise an enjoyable sexual experience. PCD is more common in women than men and although it’s thought to be rare and not well researched, what we do know suggests that 41 per cent of men and 32 per cent of women will experience PCD at some point in their life. Chronic PCD is more common in men, with approximately 3-4 per cent of men and 2 per cent of women suffering from it regularly.

Symptoms can include…

  • Unexplained sadness, depression, or general unhappiness
  • Crying or feeling teary
  • Anxiety and even panic attacks
  • Anger or frustration
  • Lack of energy or motivation
  • Feeling numb or empty
  • Feeling worthless, even self-loathing
  • Difficulty regulating your mood

Possible causes can include…

Genetics: In just over a quarter of cases there is a genetic history of PCD. As many families don’t talk about sex and are not aware that PCD is a recognised condition, that number could actually be considerably higher.

Childhood sexual trauma: Several studies suggest that for those people who have experienced sexual abuse in their childhood, PCD could be a delayed response to PTSD triggers or flashbacks that can be experienced during sex.

Sexual trauma as an adult: For those who have been the victim of an assault or abuse, sex, even consensual and enjoyable sex with someone who feels safe can trigger upsetting feelings.

Insecure attachment: people who find it hard to trust and feel secure, possibly due to adverse childood experiences, may struggle with the natural feelings of separation post orgasm.

Postnatal depression: Close to two thirds of women who have suffered with depression may experience PCD, suggesting that PCD could be at least partially caused by hormone imbalances.

Neurological changes: When we orgasm the brain releases high levels of dopamine, the chemical which gives us that intense feeling. But after that dopamine rush another hormone, prolactin kicks in, which suppresses our dopamine levels to return us to our original state. That drop in dopamine could explain the depressive or anxious feelings.

Risk factors for PCD

If you have any of the following, your chances of experiencing PCD are that much higher…

  • High levels of stress and low levels of mental health
  • Poor body image
  • Low self-esteem
  • Anxiety or dissatisfaction in the relationship
  • Sexual anxiety

How to get diagnosed

PCD is not currently an officially recognised sexual disorder and so it is often diagnosed in the absence of other conditions. Women with PCD don’t normally have other sexual dysfunctions, but men with PCD are more likely to have sexual anxiety, performance problems and feelings of shame or guilt attached to sex. Research is lacking in this area, but it is possible that those dysfunctions contribute to PCD. A sexual health practitioner will be able to best advise you, although they may prefer to diagnose you with what they prefer to call an ‘unspecified sexual dysfunction’. Regardless of what name they give it, it is important that an expert recognises there is a problem and helps you accordingly.

Treatment can include…

Psycho-education provided by a trained mental health provider can explain the symptoms and what you can do to reduce or manage the symptoms.

Personal therapy can address underlying psychological issues that might have contributed to the problem.

Trauma-informed therapy like EMDR can address symptoms of PTSD, unresolved trauma, or sexual trauma that may be contributing to PCD.

Couples therapy can be helpful if relationship or intimacy problems might be behind your PCD.

Psychiatric medications such as anti-depressants may help reduce symptoms of low mood.

A full sexual assessment might reveal other sexual problems that could be aggravating symptoms.

Other helpful tips

Learn how to discuss it: Your partner needs to understand why you might suddenly feel low or tearful. Open communication will ensure their support and acceptance.

Reflect on your beliefs: In case PCD is symptomatic of unresolved conflicts around sex and relationships, it’s worth reflecting on your attitude to all things sexual and if needed, talking it out with a qualified therapist.

Change your post-sex routine: A cuddle after sex can trigger the release of oxytocin and other feel-good chemicals, which can stave off your low mood.

Take time out: It’s OK if you need to take a few minutes to yourself to help restore some balance. Often PCD passes quickly, so a few minutes of quiet or a quick visit to the bathroom might be all you need and that’s OK.

Want to learn more? 

This research paper gives you an idea of what people with PCD experience…


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