What Sexual Assault Leaves Behind
What more than twenty years of clinical work has taught me about trauma, sexuality, and the questions we need to ask
by Dr. Denise Renye
For more than twenty years, I have worked closely with people to understand their sexual lives. Together, we have explored desire, intimacy, shame, sexual difficulty, and the ways past experiences can shape what becomes possible in the present. Some of those experiences were chosen freely and enthusiastically. Others were endured because, for reasons a person could not yet fully understand, saying no did not feel possible.
I have also learned that some of the most consequential sexual experiences in a person's life may initially appear only at the edges of the story. They emerge as an aversion to a particular kind of touch, an inexplicable loss of desire, an inability to remain present during sex, a body that freezes when intimacy deepens, or a persistent conviction that something is fundamentally wrong with them. Sometimes, after months or even years of psychotherapy, a person will mention an experience from long ago and almost immediately minimize it: "But that wasn't really sexual assault." Those are moments that call for careful clinical attention.
Long before I became a psychologist and sex therapist, I worked for years at Women Organized Against Rape in Philadelphia, now called WOAR, Philadelphia Center Against Sexual Violence. Founded in 1971, WOAR is Philadelphia's rape crisis center and one of the earliest organizations of its kind in the United States. My work there became part of the foundation upon which I later built a clinical career focused on sexuality, trauma, relationships, and the body.
It taught me something I have never forgotten: sexual assault does not necessarily end when the assault ends. An experience may take place over minutes or hours, yet its effects can become threaded through a person's sexual life, intimate relationships, bodily responses, sense of agency, capacity for trust, and understanding of what they are allowed to want for decades afterward.
This is one reason the current public conversation surrounding Andrew Tate interests me, although perhaps not for the most obvious reason. Tate and his brother Tristan are currently contesting extradition to the United Kingdom, where Andrew Tate faces charges including rape, assault, and facilitating human trafficking for sexual exploitation. The brothers deny wrongdoing, and the allegations remain matters for the courts to adjudicate.
Public cases like Tate's understandably generate arguments about guilt, evidence, credibility, misogyny, and punishment. As a clinician, however, I find myself thinking about something that receives considerably less attention: what happens after an unwanted sexual experience becomes part of a person's life, particularly when neither the person nor the clinicians treating them have understood its significance.
The person in front of us may not call it assault
One of the persistent cultural myths about sexual trauma is that people who have experienced it necessarily know exactly what happened to them and arrive with a coherent narrative about its meaning. Clinical experience tells us otherwise. People frequently organize difficult experiences gradually, sometimes over many years, and the words available to them at one point in their lives may be very different from the words they are able to use later.
A person may enter psychotherapy because they cannot tolerate being touched in a particular way. Another may have stopped wanting sex altogether. Someone else may desperately want sexual closeness but discover that their body seems to disappear from the encounter just as intimacy becomes possible.
A man may seek treatment because he cannot maintain an erection with a partner. A woman may tell me that she can participate in sex but cannot remain psychologically present during it. Someone may orgasm easily alone but lose access to sensation with another person, while another person may repeatedly find themselves consenting to sexual encounters they did not actually want and feel baffled by their inability to stop what was happening.
The clinical presentation can include panic, numbness, hypersexuality, sexual avoidance, shame, compulsivity, difficulty with orgasm, difficulty identifying desire, dissociation, chronic vigilance, confusion about boundaries, or an ingrained sense of responsibility for someone else's sexual satisfaction. Beneath these symptoms there is often a much harsher interpretation: "Something is wrong with me."
Sometimes there is something quite different happening. The person's sexual and nervous systems may have learned something about closeness, danger, compliance, power, or survival that continues to organize experience long after the original conditions have changed.
Perhaps closeness became associated with danger. Perhaps physiological arousal became entangled with fear. Perhaps compliance once reduced the likelihood of greater harm, or psychologically leaving the body became the most adaptive response available when physically leaving was impossible. What can appear years later as dysfunction may have begun as adaptation.
This does not mean that every sexual difficulty is rooted in trauma. It does mean that a clinician working with sexuality needs to know enough about trauma to recognize when the possibility deserves thoughtful exploration.
Sexual assault rarely conforms to our cultural script
We have made sexual assault simultaneously ubiquitous in cultural conversation and strangely narrow in our imagination. The version most readily recognized involves an unmistakable perpetrator, overt force, vigorous resistance, immediate awareness that a crime has occurred, and a survivor who can tell a linear story about what happened.
Human sexual experience is considerably more complicated. Sexual violation can occur between strangers, but it also occurs between spouses, romantic partners, friends, acquaintances, colleagues, and people who have had consensual sex with one another many times before.
Consent to one sexual act does not establish consent to another, and consent at the beginning of an encounter does not eliminate the possibility of changing one's mind. People also respond to threat in different ways. They may fight or flee, but they may also freeze, submit, appease, become confused, dissociate, or continue participating while becoming increasingly disconnected from themselves.
The presence of physiological arousal does not establish desire or consent, although survivors can spend years interpreting their body's involuntary responses as evidence against their own experience. Some people know immediately that they were violated. Others know only that something felt wrong. Still others do not recognize an experience as sexually traumatic until years later, when they acquire language, context, or enough psychological distance to consider what actually happened.
In my work, I have encountered people who carried memories for decades without thinking of themselves as survivors of sexual assault. Sometimes the important therapeutic work is not uncovering something forgotten. It is becoming willing to look differently at something that has never been forgotten at all.
Why clinicians need to know how to ask
Assessment for sexual trauma requires more than including "history of sexual abuse" on an intake form. It requires clinical judgment, comfort with sexuality, patience, and an ability to tolerate ambiguity without rushing to name another person's experience for them.
How we ask matters. When we ask matters, as does the quality of the relationship in which we are asking. A clinician's own discomfort with sexuality can determine whether the subject is explored carefully, reduced to a checklist, or avoided altogether.
Patients are extraordinarily perceptive about our capacity to hear them. They notice when a clinician becomes visibly uncomfortable, overly solemn, sensationalistic, intrusive, or anxious to establish what "really happened." They also notice when we can remain present without recoiling, collapsing, or forcing their experience into a predetermined narrative.
The question "Have you ever been sexually assaulted?" is important, but it is often insufficient. A person may truthfully answer no because the experiences they have had do not fit their own definition of assault.
Over time, I may ask about unwanted sexual experiences, sexual coercion, experiences in which someone felt unable to say no, sexual contact while substantially intoxicated or incapacitated, times a person froze or felt unable to respond, encounters they remember only partially, or sexual experiences from childhood and adolescence whose meaning was unclear at the time. These questions should never feel like an interrogation. They should emerge from genuine curiosity about how someone's life came to take the shape it did.
Assessment is also not an exercise in assigning retrospective labels. The task of psychotherapy is not to tell someone what happened to them, particularly when they themselves are still making meaning of an experience. The task is to create enough psychological space that aspects of experience which have been minimized, fragmented, rationalized, or disconnected from the body can become available for thought.
The body may tell a different story
As a sex therapist, I am particularly interested in what happens when trauma enters the erotic system. The body does not organize experience according to legal categories, and the nervous system does not require intellectual certainty before learning that a particular form of intimacy may be dangerous.
Someone may know cognitively that their present partner is trustworthy while their body responds as though something threatening is happening. A particular position, smell, expression, pressure, sensation of being physically contained, tone of voice, or kind of touch can produce an intense response that seems inexplicable in the present relationship.
Sometimes even tenderness or pleasure becomes destabilizing. For someone whose sexual development intertwined intimacy with threat, genuine safety may initially feel unfamiliar rather than immediately soothing.
This can be confusing for partners as well. They may wonder why someone no longer desires sex, why an affectionate touch produces withdrawal, why pleasure is possible alone but much harder in partnered sexuality, or why a person who had many sexual experiences earlier in life now finds themselves avoiding sex.
Without an understanding of trauma, these difficulties can quickly become personalized. One partner experiences rejection while the other experiences pressure, and both become increasingly organized around a symptom neither fully understands.
The work I am interested in is therefore rarely limited to getting a person to resume sexual activity or eliminating a particular symptom. A much deeper question is whether someone can reclaim authorship of their erotic life.
What do I actually want? How do I recognize wanting in my body? What does reluctance feel like before it becomes a no? What does an authentic yes feel like? Can I disappoint another person and remain intact? Can I change my mind once sexual activity has begun? Can I remain connected to myself while becoming deeply connected to someone else?
Those are not simply questions about sexual functioning. They are questions about agency, embodiment, intimacy, and selfhood. When those capacities change, we are talking about something more substantial than symptom reduction; we are talking about structural psychological change.
The manosphere and the education of men
It is impossible to think seriously about Andrew Tate without also thinking about the manosphere, the loose network of online communities, influencers, men's-rights spaces, pickup culture, incel communities, self-improvement entrepreneurs, and anti-feminist ideologies that have become an increasingly influential source of information about masculinity and relationships.
Not every man who watches fitness videos, listens to a men's podcast, wants to improve his dating life, or searches for advice about masculinity is participating in misogyny. That distinction matters, particularly because the genuine needs that lead young men into these spaces should not be dismissed. Loneliness, sexual insecurity, confusion about gender roles, fear of rejection, desire for belonging, and questions about what it means to become a man are real developmental concerns.
The problem arises when those vulnerabilities are met with an ideology that translates hurt into grievance and relational uncertainty into domination. Parts of the manosphere turn men's insecurity into a cultural and commercial ecosystem organized around resentment, status, sexual access, and adversarial ideas about women.
Andrew Tate has become perhaps the most internationally recognizable expression of that world. His popularity has helped place aggressively hierarchical ideas about men, women, dominance, sexuality, and power into the feeds of millions of people, including boys who may encounter those ideas long before they have had their first intimate relationship.
This matters clinically because ideas about sex do not remain online. They enter bedrooms, dating relationships, marriages, and people's developing understanding of what intimacy is supposed to be.
Performance is not intimacy
The manosphere exists within a much larger cultural ecosystem devoted to male optimization. Men are offered endless instruction about testosterone, strength, productivity, attractiveness, sexual performance, fitness, status, dating strategy, pornography, discipline, longevity, and how to become more desirable.
Some of that information can be genuinely useful. The difficulty is that an education in performance is not necessarily an education in relationship.
Andrew Huberman belongs in this conversation for different reasons. His public authority is built around discipline, self-regulation, mastery, health, and optimization, yet reporting about his intimate relationships raised serious questions about deception, relational ethics, power, and the distance that can exist between a highly controlled public persona and private conduct. In that sense, he is part of the same broader cultural landscape: one in which influential men become authorities on how others should live while often receiving far less scrutiny for how they understand intimacy, mutuality, accountability, and the people with whom they are in relationship.
I am less interested in collapsing these men together than in noticing the enormous authority our culture now gives male influencers who tell other men how to live. Tate represents one extreme expression of masculinity organized around domination, while the broader optimization culture offers a more socially acceptable language of mastery, control, performance, and self-improvement.
What remains remarkably underdeveloped in much of this discourse is an equally sophisticated language for intimacy. Where are boys and men learning to perceive another person's ambivalence? Where are they learning to tolerate sexual disappointment without translating it into humiliation or entitlement, and to understand that a partner's changing desire is not necessarily an injury inflicted upon them?
Where are they learning to notice whether another person is psychologically present during sex rather than simply whether that person has technically said yes? Where are they learning that consent is necessary but does not, by itself, describe the entirety of ethical or satisfying sexuality?
Where are men learning that vulnerability does not make them weak, that mutuality does not diminish erotic charge, and that another person's subjectivity is not an obstacle to their sexual experience? A partner is not an instrument through which one achieves sex, validation, masculinity, or status.
These are sexual competencies too, and they are ones I believe our culture urgently needs to teach.
Sexual assault can alter the architecture of a life
When I worked at Women Organized Against Rape many years ago, I could not have anticipated how deeply that experience would inform the clinician I became. Decades later, working at the intersection of sexuality, trauma, relationships, embodiment, and depth psychotherapy, I continue to encounter the long reach of sexual experiences that occurred years before a patient ever entered my office.
Sometimes the connection between past and present is obvious. At other times, an old violation has become so thoroughly incorporated into a person's way of relating that it appears to be personality, preference, sexual dysfunction, relationship difficulty, or simply "the way I am."
Sexual trauma can become woven into partner selection, responses to power, the capacity to trust, the experience of being desired, the ability to disappoint someone, the meaning of sexual attention, and beliefs about what must be provided in exchange for love. It can enter marriages, parenthood, aging, dating after divorce, changes in the body, and the experience of becoming sexual with a new person after years of avoidance.
It can also shape the relationship a person has with themselves. Some people learn to override bodily information so consistently that distinguishing desire from compliance becomes difficult. Others become exquisitely attuned to everyone else's needs while remaining almost entirely unfamiliar with their own.
This is why, after more than twenty years of clinical work, I continue to ask about sexual experiences carefully and directly. I do so not because every sexual concern is caused by trauma, and not because I believe every complicated sexual encounter should be retrospectively named as assault.
I ask because sexuality is part of a whole life, and because the meanings carried by our sexual experiences do not remain politely contained within the moments in which they occurred. They enter the body, relationships, fantasies, defenses, choices, and stories we tell about who we are.
Our responsibility as clinicians is to become skilled enough, steady enough, and sufficiently unafraid of sexuality that our patients do not have to protect us from what they may discover. We need to be able to hear complexity without sensationalizing it, recognize trauma without reducing a person to it, and remain curious without taking ownership of another person's narrative.
Public cases involving sexual violence will continue to dominate attention and then disappear from it. The news cycle will move on to another accusation, another trial, another powerful man, and another cultural argument about consent, masculinity, credibility, or punishment.
Meanwhile, in therapy offices everywhere, someone will say that they have never really enjoyed sex and do not know why. Someone will describe freezing when a loving partner touches them, or repeatedly agreeing to sexual experiences they do not want, or feeling inexplicably frightened when pleasure begins to deepen.
Someone else will mention an experience from twenty-five years ago, watch the clinician's face carefully, and say, "But it wasn't really a big deal." When we have spent enough years doing this work, we learn that this is not the moment to rush toward reassurance, interpretation, or a label. It is the moment to become very curious about the life that may be waiting inside that sentence.
If something in this piece resonates with your own experience, you do not need to have the right language for what happened before seeking support. You may know that you experienced sexual assault, or you may simply know that something about a past sexual experience continues to live in your body, your relationships, or your sexual life. A trauma-informed therapist with expertise in sexuality can help you explore those experiences without imposing a conclusion about what they mean. Survivors in the United States can also contact RAINN’s National Sexual Assault Hotline for free, confidential, 24/7 support at 800-656-HOPE (4673), by texting “HOPE” to 64673, or through RAINN’s online hotline. For those in Philadelphia, WOAR, Philadelphia Center Against Sexual Violence, offers a 24/7 crisis hotline by phone or text at 215-985-3333. If you are in immediate emotional crisis or concerned about your safety, the 988 Suicide & Crisis Lifeline is also available by calling or texting 988. Seeking support does not require certainty about what to call your experience. Sometimes it begins simply with allowing yourself to wonder whether what happened to you deserves care.