Q: I was sexually abused as a child. Will I ever learn to enjoy sex? I am a married man and I just can’t get excited about it at all, even though I love my wife.

First, I am sorry that you ever had such things happen to you. No child should ever be hassled with unwanted touch. Not only can sexual abuse cause sexual problems later in life, but it can create low self-esteem, mistrust of others, and feelings of shame.

Guesses are that about 25% of people who were sexually abused have sexual problems as adults. Women may have trouble getting aroused or having an orgasm. They may have low sexual desire or even an aversion or hatred of sex. Men may also struggle with arousal. They may have trouble getting or sustaining an erection. They also may have low desire or a sexual aversion.

Another problem that can happen to men or women is “triggering.” Triggering occurs when something that reminds the person of the abuse causes them to have a flashback. A trigger can be a sound, a touch, a smell, or a taste. It can even be very subtle, such as seeing light outside the bedroom door in a certain way.

Triggers can also cause flooding. Flooding happens when a person feels overwhelmed with negative feelings. They may cry or shut down emotionally. The survivor of abuse may also disassociate, which is when the survivor “checks out” during a sexual experience as a way of coping.

Naturally, when these things happen during sex it can be pretty distressing for the survivor and the partner. This means that treatment for sexual problems caused by past sexual abuse are best treated with a combination of individual and couples therapy.

The treatment for overcoming sexual problems caused by sexual abuse is highly individualized. But the goal of treatment is making sex something that the survivor enjoys. This requires knowing how to manage triggers, flooding and disassociation. It also means excellent communication about sex with one’s partner. There are several good books to be read and many discussions about sex to be had.

Don’t be afraid to seek treatment. Even though you may feel nervous about talking about sex with a stranger, remember that therapists are trained to help you. You deserve to have a healthy sex life with a partner you love.