Postcoital Dysphoria - Causes, Symptoms, and Management

What Is Postcoital Dysphoria?

Sexual activity generally results in a resolution phase, where a sense of well-being, intimacy, and general mood improvement is experienced due to the release of dopamine and serotonin hormones. However, when people do not share that sense of well-being and instead feel distressed after sex, that can be due to sexual dysfunction or other reasons. One particular post-sex phenomenon experienced by many people is postcoital dysphoria.

Postcoital dysphoria (PCD) is an unexplainable feeling of sadness and irritability after sexual activity (masturbation or intercourse). The affected individual may be tearful, angry, irritated, and occasionally aggressive towards their partner, even though sexual activity may have been consensual and satisfying. Orgasm may or may not have been achieved and has no bearing on the appearance of this phenomenon. PCD lasts for around 5 minutes in some cases and up to 2 hours in others.

Who Is Affected by Postcoital Dysphoria?

While the numbers vary, the consensus on the prevalence of PCD is that it commonly affects women. However, men are not immune to such feelings - one study reported a prevalence rate of 41% among the males in their sample.

What Are the Causes of Postcoital Dysphoria?

Theories on the causative factors for postcoital dysphoria have run the gamut from abuse to hormones. However, the available data is limited and understanding the cause and other characteristics of PCD has proven difficult. Nevertheless, PCD has been understood as possibly multifactorial, with psychological factors occupying the number one spot.

The causes attributed to PCD include:

• Hormonal Factors - Sexual activity and orgasm usually result in releasing happy hormones or pleasure hormones, including dopamine and oxytocin. These chemicals surge to a peak in the immediate moment when sexual resolution is achieved. However, in the aftermath, the levels of these hormones begin to fall. For some individuals, this may seem like a lot to cope with, and the sudden regression might result in symptoms of PCD.

• Anxiety and Depression - People struggling with anxiety and depression may experience negative emotions, regardless of whether or not sexual activity and resolution were satisfactory. Such individuals are prone to overthinking, unexplained sadness, and an inability to handle the overwhelming emotions that sexual activity may make them feel.

• Stress - Stress and stress-induced anxiety can imply that the cause for worry is always at the back of the mind. People struggling with these feelings will only be able to temporarily experience the pleasure of sexual arousal and activity before reverting to pre-coital emotions and worries. This may occur in tandem with the drop in hormones.

• Sexual Abuse - Sexual abuse can profoundly affect how people react to sex and affect postcoital emotions, whether during childhood or adulthood. This may include a fear of being touched, fear of pain if sexual intercourse is engaged, and a need to control the situation to avoid vulnerability - all these reactions may manifest as fear, guilt, anger, and irritability.

• Physical and Emotional Abuse - In addition to sexual abuse, it is also worth considering physical or emotional abuse as possible factors for postcoital dysphoria. Individuals who have suffered from abuse may find it challenging to engage in regular sexual activity and experience symptoms of postcoital dysphoria.

• Resentment - The resentment is often related to underlying anxiety and fears of losing control or vulnerability and may also be secondary to abuse. This resentment can cause aggressive, reactive postcoital patterns.

• Communication Gap - When partners fail to communicate what they expect from a sexual relationship, they might be surprised or unable to deal with the feelings evoked by sexual activity and experience postcoital dysphoria.

• Sexuality Issues - People who are confused about their sexuality and struggle with self-doubts, low self-esteem, and fears are likely to experience symptoms of PCD in their sexual encounters.

• Sexual Beliefs and Desires - Some people have specific beliefs and views on the topic of sex while also struggling with conflicting desires. The attempt to repress their desires while conforming to the ideas and values they espouse is a challenging experience. This leads to stress and anxiety in the aftermath of sexual activity.

• Fear of Danger - The belief that sexual activity may be dangerous, particularly when attempting it with someone unfamiliar or new, may cause negative postcoital feelings. This feeling may also be due to negative connotations ascribed to sexual activity, such as the fear of pain and trauma, fear of getting pregnant, and subsequent pain of pregnancy and labor.

• Body Image Issues - A typical issue with nearly all sexual dysfunctions and negative emotions, body image issues can contribute to unpleasant sexual experiences. The result may be sadness and depression because of the underlying shame and persistent overthinking associated with body image.

• Relationship Issues - How people feel about their relationships is often responsible for worry or associated sexual dysfunction. Feeling too attached or contrarily unattached to partners may influence negative feelings after sex.

• Postnatal Depression - Postnatal or postpartum depression refers explicitly to the depression that may occur in women after giving birth due to hormonal fluctuations. It is as responsible for negative postcoital emotions as other forms of depression. Estrogen is a hormone that is mainly associated with this phenomenon. The body’s response to fluctuating estrogen levels can increase the risk of postnatal depression and postcoital dysphoria.

• Intimacy - While studies have found that the level of intimacy between partners does not seem to be related to postcoital dysphoria, there have been suggestions that the two factors that constitute intimacy can have a role in developing postcoital feelings. These components of intimacy are:

• Role of Attachment - This refers to the attachment styles and levels in relationships that contribute to intimacy and may cause a surge of emotions after sex that rely heavily on the relationship status.

• Differentiation of Self - This refers to the ability to differentiate between self and the relationship and view oneself as an individual and a component in a relationship. When this distinction has not been created, the feelings that emerge after sex may be harmful and rooted in insecurity.

Although intimacy seems like a significant guiding factor for the experience of PCD, anxiety can occur after sex, even in a relationship with clearly established boundaries and healthy intimacy. This implies that intimacy does not necessarily have a bearing on the development of PCD.

What Are the Signs and Symptoms of Postcoital Dysphoria?

The symptoms are similar in presentation for both men and women, with some differences.

Symptoms noted in both genders may be:

• Anxiety.

• Depression.

• Feeling of dissatisfaction.

• Agitation.

Symptoms more often found in women:

• Mood swings.

• Sadness.

• Low self-worth or feeling of worthlessness.

• Guilt.

• Frustration.

• Tearfulness.

Symptoms more often found in men:

• Unhappiness.

• Low energy levels.

The presentation of postcoital symptoms can be varied and sometimes specific to a particular sexual situation or activity. For example, some may experience symptoms of PCD after masturbation but not sexual intercourse, while others may experience it after sexual intercourse. Another pattern of note is that most instances of PCD occur after orgasm or termination of sexual activity rather than during or before. This does not apply to all sufferers of PCD but is the most likely presentation.

How Can Postcoital Dysphoria Be Dealt With?

Dealing with postcoital dysphoria can begin at home for those who feel able to cope. The onus rests on the individual and their partner to acknowledge the feelings being experienced and attempt to find ways to combat the post-sex blues. If that does not work, therapy may be the best resort. Seeing a psychotherapist, engaging in the therapeutic confrontation of the underlying problem, and undergoing behavioral therapy where necessary will help bring about a change.

1. Self-Help: For people interested in attempting to find a solution by themselves before consulting a therapist, there are a few pointers that therapists usually recommend:

• Acknowledge and Accept- Denial is often the knee-jerk reaction to potentially embarrassing situations like crying after sex. Instead of allowing denial to take over, acknowledging the feeling and accepting that there may be a problem is the first step to self-help.

• Breathe- Breathing exercises are an excellent way to center oneself and calm recurring and overwhelming emotions and thoughts.

• Ask the Hard Questions - Asking oneself the obvious questions that follow episodes of PCD and trying to answer them honestly could lead to answers that give some clarity. These questions may typically include identifying what feels unsafe at that particular moment, what may have triggered the episode, what the individual’s safe space looks like and what they think needs to be done by themselves or their partners.

• Communicate - If communicating with the partner feels like a good option, then explaining the feelings being experienced and what the partner can do to help (for example: talking, holding the sufferer, finding ways to engage in intimacy without a sexual undertone) might provide some comfort.

• Assess Relationship Dynamics - Often, feelings of sadness and inadequacy may crop up when the relationship is still new and undefined or when issues between the partners create friction. These feelings may be suppressed during sexual intercourse but pop up again soon after sex. If it feels like the relationship needs a lot of work or things are worsening, it might be helpful to take a breather and work out the issues separately and then come together if that feels right. Taking some space and time will contribute to maintaining a good relationship and avoiding an escalation of PCD symptoms.

2. Therapist’s Intervention: When self-help does not seem to improve the symptoms, it may be necessary to consult a therapist. The therapist will then try several therapeutic interventions, which may include:

• Psychotherapy - Psychotherapy as a whole can help confront the underlying and sometimes unidentified causes of PCD. Anxiety, stress, history of sexual or other abuse, and relationship problems can all be treated with the therapist’s help.

• Sex Therapy - If the sexual act or specific components of the sexual activity the partners engage in are causing the problem, then a sex therapist can provide counseling and specific sex exercises to enhance the experience and prevent PCD symptoms from arising.

• Cognitive-Behavioral Therapy (CBT) - CBT can bring about behavioral changes that are extremely useful in instituting behavioral changes to convert negative associations and thoughts into positive ones. With proper therapy, the affected person can often recognize and change how they respond to activities, including sex.

How to Support a Partner Who Suffers From Postcoital Dysphoria?

Partners may often bear the brunt of the emotional consequences of PCD. This may leave them feeling like they are somehow at fault or inadequate. Partners must try to understand the causative factors behind the affected partner’s symptoms. When the couple tries to work through the issue together, they may realize that it has nothing to do with their relationship. This will prevent unnecessary arguments and create a better relational space for them.

Supportive partners can do a lot for their suffering better halves:

• Ask What Can Be Done - Ask how the affected partner would like to be helped.

• Listen - Listening non-judgmentally to the sufferer’s concerns and struggles might validate their feelings and help them feel heard. This can be especially helpful when it is their partner doing the listening.

• Give Space - Giving a partner space does not mean leaving them for good or breaking things off. It simply means allowing them some time to figure out their needs and problems while also being available when they are ready.

• Encourage Therapy - If the affected partner has not thought about it or is resistant to the idea, it might help to bring it up and encourage them to pursue therapy without forcing it on them.

Conclusion-

Postcoital dysphoria can cause extreme stress and worry in affected people and their partners. However, it should never be a reason to avoid sexual activity or engage in blame and fighting. Accepting the unexplainable feelings that keep cropping up and attempting to face them together with the help of a supportive therapist can work wonders in bringing balance, peace, and joy to the relationship.