Sex is generally a great way to relax, have fun and feel blissful. But for unknown reasons, some women end up feeling sad after what is often one of the most enjoyable activities. This condition is known as postcoital dysphoria or PCD.
A recent study from Australian researchers and a professor at the University of Utah stated that PCD “is the experience of negative affect following otherwise satisfactory sexual intercourse.” People who experience PCD do not have the usual happy feelings; they feel sad, anxious, irritable or melancholy. It is not generally referred to as depression after sex.
The study, published in the International Journal of Sexual Health, found that 1.8 percent of women in a sample of 222 sexually active female college students experienced PCD most of the time in their lifetime sexual experiences, and that 0.5 percent of women experienced PCD most of the time in the last four weeks.
Those numbers might seem small, but “32.9 percent of women reported having experienced the symptoms of PCD at some point in their lives,” according to the study. This means that the experience of PCD might not have been consistent, but they did experience it at some point at some level of frequency (a little of the time, some of the time, most of the time and all of the time).
The study looked at relationships between PCD and other sexual difficulties, psychological well-being and sexual abuse. There was some evidence to support relationships between PCD and all three, but more research needs to be conducted because there wasn't a strong correlation.
The Diagnostic and Statistical Manual of Mental Disorders doesn’t include this condition, but it’s clear that at least some women, and even men, suffer from it.
Robert Schweitzer, one of the researchers from the Queensland University of Technology in Australia, said in an email that as far as he knows the condition is not being considered for the DSM 5.
“I suspect that it is one of those issues that is not talked about or considered,” Schweitzer said. “It certainly goes against the ‘cultural stereotype’ in terms of the usual associations with sexual intercourse within the confines of a ‘good’ and consensual sexual relationship.”
Although not many women are affected by PCD, it can be a “major issue for a small number of women,” he said.
“Based upon my experience as a clinical supervisor, I recall a student presenting to a health service in some distress due to the fact that her experiences were followed by sadness and tears, which was distressing to the woman concerned and her partner,” Schweitzer said.
One middle-aged woman in a “committed and satisfying relationship” shared her experience with Schweitzer.
“The best way for me to describe the phenomena is as a feeling of melancholy,” she said. “I often used to think I felt 'homesick,' that I had 'lost something' or yearned for something that was missing.”
The woman said she had these feelings after orgasm and not before.
“The feeling has not been isolated to one sexual partner,” she said. “I did not associate the feeling with an absence of love or affection for my sexual partner nor with an absence of love or affection from them towards me because it seemed so unconnected with them.”
She said she can’t control the feeling, it doesn’t last long, and it doesn’t always happen after sex, so she is trying to figure out what the cause could be.
“I made sense of it by believing that it was a result of post coital excitement and the resulting return to a normal emotional state,” she said.
There doesn’t seem to be a lot of research on PCD, but Schweitzer said he has found a lot of evidence on Internet blogs.
Richard Friedman, a psychiatrist, wrote in a New York Times article that one cause of PCD could be “that some patients have particularly strong rebound activity in the amygdala after orgasm that makes them feel bad.” He also referred to more of a depression after sex. He treated patients who experienced this with SSRIs, a type of antidepressant. It managed to make sex “less intensely pleasurable,” but “no emotional crash followed.”
Schweitzer hasn’t treated patients for PCD, but is unsure that he would endorse treating patients with SSRIs.
Robert Simmons, a clinical psychologist in Virginia, said in an email that PCD shouldn’t be considered as a diagnosis but as “ a descriptive term without any formal definition.” He said he is acquainted with the term but hasn’t encountered many patients who have experienced PCD.
“In my over 30 years of clinical practice, I think I have only talked with one woman who became acutely and consistently dysphoric with a committed partner that [she] loved after having intercourse,” Simmons said.
He has some guesses for the causes of PCD.
“There is some speculation that hormonal swings might contribute to this experience,” Simmons said. “On the other hand, I have talked with many people who regretted their choice of sexual partners and subsequently felt ‘blue,’ regretful, and experienced lower self-esteem as a result. Clearly that is not rare, and is at least as common in men as women.”
However, feeling “blue” after sex because of regretting a choice of partner does not fall under the definition of PCD and is not a type of sexual dysfunction.
Simmons suggests treating PCD with insight-oriented psychotherapy.
According to the University of Toronto website, insight-oriented psychotherapy is “a form of treatment that helps people through understanding and expressing feelings, motivations, beliefs, fears and desires.”
Schweitzer plans to continue his research, including “[testing] out some theories to explain the phenomenon.”
He finds the general concept intriguing.
“I think that the most interesting finding is a very simple one: that is, that there is this phenomenon, which is counter intuitive, we know little about it, and women who have this experience are not alone,” Schweitzer said.
He said if any women have experienced PCD, he would be interested in hearing from them about their experiences. This includes women who have male partners who could have PCD. In men, PCD might appear as “avoiding physical contact after sexual intercourse” or distancing themselves in general from their partners after consensual intercourse in a committed relationship.
Schweitzer can be reached at [email protected].
Other sources:
http://www.nytimes.com/2009/01/20/health/views/20mind.html?_r=1
http://www.caps.utoronto.ca/Services-Offered/Individual-Psychotherapy/Insight-oriented-Psychotherapy.htm