Sad After Sex? New Study Suggests 'Postcoital Dysphoria' Is Widespread

For Kim, a 30-year-old teacher in North Carolina, it happens pretty much every time she has an orgasm: a feeling of profound sadness washes over her and she experiences a sense of regret. "It's not that I don't like sex," she said in an interview. "I enjoy sex, I like to have orgasms, but after an orgasm, I feel this wave of sadness. It only lasts around a minute, but I'm just like, 'Ugh, that doesn't feel good.' "

For Kim's sister, Rachel, 27, it's even worse. She says that since she was a young adolescent, around 12 or 13, after an orgasm darkness and despair descends on her for 10 to 15 minutes. "It's just really sad," she said. "Almost like a feeling of homesickness, but I'm home. It happens every single time."

Kim and Rachel (both happily married, they say, and both asking that their last names be omitted) had shared their intimate distress in the past — the topic came up when they both had a similar sadness breast-feeding their babies; a condition, they discovered, that's known as dysphoric milk ejection reflex, or D-MER. But they didn't fully realize their post sex sadness was "a thing" until they came across a Facebook post about a new study that called it by its official name: postcoital dysphoria, or PCD.

Also called "postcoital tristesse," literally "sadness" in French, it's a condition marked by feelings of melancholy, agitation, anxiety or sadness after intercourse that can last between five minutes and two hours. Sometimes there are tears.

If you look it up on Wikipedia you'll learn "the phenomenon is traced to the Greek doctor Galen, who wrote, 'Every animal is sad after coitus except the human female and the rooster.' "

Not true, according to the new study, published in the journal Sexual Medicine and led by researchers in Australia. They found that 46 percent of women reported experiencing PCD symptoms at least once in their lifetime with 5.1 percent experiencing symptoms of the condition a few times within the past four weeks.

There are big caveats. Data for the study were collected through an online questionnaire; female students over 18 who reported being sexually active were recruited via email at Australian universities and through Facebook. Ultimately, the total sample included 195 heterosexual, mostly white women, the study notes, and so the results can't necessarily be generalized to the broader population. (Earlier estimates of the condition vary.)

"We go through life with our defenses up, and after sex, with that release, sometimes the feelings just flood in."

Psychologist and sex therapist Judy Silverstein

There are a number of theories on what's behind PCD, and clearly more research is needed. Some say it's hormones, others suggest the intense emotional release after sex let's loose other deep emotions. Past sexual abuse may play a role in some cases, but this particular study suggests it's not the main driver.

Judy Silverstein, a psychologist and sex therapist in Needham, Massachusetts, says she's worked with many women who have tears or sadness after sex. She said she believes that biology, in addition to psychology, could be a factor.

"When orgasm occurs ... there is a physiological release — after a buildup of sexual tension — which may lead to tears (or laughter) not accounted for by psychological variables," she said.

Silverstein added that if there's no orgasm, sheer "physical frustration" may lead to PCD. Also, she said, sexual experiences may bring up past or current hurt or disappointment that could include physical, emotional or sexual abuse — or not. "We go through life with our defenses up, and after sex, with that release, sometimes the feelings just flood in," she said.

The study's lead researcher, Robert Schweitzer, a clinical psychologist and professor of psychology at Queensland University of Technology in Australia, said via email that it appears this sadness can arise even in the context of a happy, functional relationship.

"There are a group of women in presumably secure and loving relationships who consistently experience some level of distress following sexual intercourse in the absence of any known medical reasons for this response," he said.

So what might be trigger this condition? Here, edited, is some of my conversation with Schweitzer:

Rachel Zimmerman: What do you think is causing these feelings of sadness after sex?

Robert Schweitzer: This is still speculative ... [but] to enjoy the intimacy associated with sex, there is a degree to which we “lose ourselves in the experience.” This may be particularly true when a person experiences orgasm. There may be a group of people who find that this “loss of self” sets off a response of dysphoria [a general state of unease], particularly when the individual feels a vulnerable sense of self, which may result from a number of developmental issues. For example, we know that early abuse has a pernicious effect on later sense of self.

What made you even pursue this area of research?

I was supervising a psychologist, and she described a woman presenting with crying following sexual intercourse. There seemed to be no literature on the phenomenon, other than an old reference in a classic text by Kaplan and Saddock. In discussing this with students, it emerged that this was more common than I had envisaged, so I thought that it was worth exploring.

Did you follow up with any of the women who experienced this problem to get more details?

We have interviewed women and I have also received emails from women from all over the world (and I am happy to get more feedback, in fact, I would appreciate hearing from men and women who identify with this phenomenon). One woman wrote to me and described having a similar experience when she breast-fed her children, which may point to a hormonal component. We really do not know, it is probably multi-factorial and needs further investigation.

Do you have any advice or guidance for women who have experienced this?

I think that an initial step is to talk about the experience with trusted others and “own” one's responses, as one's experience. Sharing with a partner is also important, rather than hiding or feeling shameful about one’s response. I am aware that this is a response of some women whom we have interviewed and this is more likely to perpetuate the difficulties. We can also think of sexual experiences as occurring along a continuum, with some diversity, and not make judgments re good vs. bad.

Anything else of note, and where do you go from here research-wise?

We want to undertake a large online survey. The next stage for us is the development of a measure of postcoital experience which can be administered to both men and women.

As for the sisters, Kim and Rachel, they say they've just learned to live with the condition, somewhat reassured that they're not alone.

"But I wonder," Rachel says, "how many other people are suffering and just afraid to say something?"

Readers, please share your experiences with us in the comments.

Headshot of Rachel Zimmerman

Rachel Zimmerman Reporter
Rachel Zimmerman previously reported on health and the intersection of health and business for WBUR. She is working on a memoir about rebuilding her family after her husband’s suicide. 



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