Feeling Sad After Sex? Understanding Postcoital Dysphoria

You’ve just finished a satisfying, enjoyable sexual experience — and all of a sudden, you’re hit with a wave of sadness. This can be disorienting and confusing, because as far as you can tell, you have every reason to feel good. What’s going on?

Experiencing sadness, anxiety, or irritability after otherwise pleasurable sex is known as postcoital dysphoria. And no, it’s not necessarily a sign of a psychological disorder. It can put a strain on your sex life if it keeps happening, though. 

This article will discuss what we know about the phenomenon of postcoital dysphoria, which will hopefully help you better understand and manage your emotions around sex. We’ve also provided mental health resources to help individuals whose sexual experiences are impacted by postcoital dysphoria improve their sexual health. 

What does postcoital dysphoria mean?

Sexual experiences can be a source of joy, pleasure, and connection. Most people, most of the time, feel good after having sex. That’s a broad generalization, of course, and it may not be true for every kind of sexual encounter. If you’re experiencing postcoital dysphoria, commonly referred to as PCD, it can feel like an isolating experience that nobody else understands. But it’s important to know that you’re not alone. 

In sexual medicine, post-coital sexual dysphoria refers to feelings of sadness, agitation, or anxiety following sexual intercourse. Current research examines postcoital dysphoria prevalence and psychological correlates among males and females, seeking to understand its impact on sexual well-being and mental health. Understanding the prevalence and psychological correlates of post-coital sexual dysphoria is crucial in addressing its effects on individuals' emotional responses to post-sex experiences.

Feeling sad after sex may be more prevalent for people who have experienced sexual trauma, are experiencing hormonal fluctuations, or have postnatal depression or underlying relationship problems. For example, negative feelings are common when sexual activity is unsatisfying, painful, or non-consensual. But if an encounter is fully desired and mutually pleasurable, most people can expect to feel an “afterglow” of contentment and affection.

Postcoital dysphoria (PCD) refers to negative emotions following the kind of sexual activity that would normally trigger positive feelings. It’s also sometimes called “postcoital tristesse”, or PCT. This name may be less accurate — “tristesse” translates to “sadness”, but upsetting emotions following sex can also include:

• Irritability or anger

• Anxiety

• Depression

• Panic attacks

• Emotional “numbness”

• Shame

• Desire to be alone or not be touched

Some people report from a convenience sample that these symptoms appear only after orgasm, while for others, any kind of sexual activity can bring about negative feelings. It doesn’t necessarily have to involve another person — postcoital symptoms can happen within close relationships but also a substantial percentage of people also experience PCD after masturbation.If you’re experiencing postcoital dysphoria, you may feel confused and distressed. It can be jarring to feel unhappiness after doing something that usually sparks contentment, tenderness, and intimacy. Your sexual partner may also feel hurt or wonder if they did something wrong.

How common is it to feel bad after sex?

This phenomenon of postcoital dysphoria prevalence may be nearly as common among men. A 2019 study reported that 41% of men had experienced PCD symptoms within their lifetimes. The study sample reported experiencing PCD within the previous four weeks, with 20.2% of participants said it had happened recently, and 3-4% said it was a regular occurrence.

What causes postcoital dysphoria?

Postcoital distress isn’t necessarily an indicator of any other psychological problems. People without a history of mental health conditions or depression are not immune to postcoital dysphoria PCD episodes. Sexual activity often involves strong emotions and sensations, and people’s reactions to this type of intense stimulation aren’t always predictable. 

Some therapists have suggested that PCD may sometimes be simply an unusually strong response to the end of a highly intimate experience. If you’re feeling extremely close to your partner during sex, the end of the experience may feel like a separation. Your mind may interpret the withdrawal of this closeness as loss, emptiness, or sadness.

Hormonal changes may exaggerate this effect. Sexual intercourse and masturbation can boost your levels of brain chemicals like dopamine and oxytocin that help promote positive moods. Following orgasm, these hormone levels drop back down, sometimes falling lower than they were before sex. This kind of rapid hormonal shift could make you more susceptible to mood changes and negative feelings.

Factors contributing to unhappiness after sex

There is some evidence that certain kinds of negative experiences and mental health conditions can make unpleasant feelings after sex more likely. For instance, researchers found that PCD prevalence and psychological correlates were slightly more common among people who had survived sexual abuse. It’s possible that in people who’ve undergone this incredibly difficult experience, engaging in sexual activity could stir up traumatic memories. This could partly explain the fear, shame, sadness, and defensiveness that sometimes occur in PCD.

Postcoital dysphoria appears to be even more likely among people who are currently in psychological distress. If you’re already under mental strain, it may be easier for the emotionally charged experience of sex to trigger rapid mood changes.

Studies have also shown correlations between PCD and other sexual difficulties, such as sexual aversion, low libido, and recurrent pain during intercourse. It’s not clear if these other symptoms contribute to postcoital dysphoria or if they point to some underlying factor that contributes to several different kinds of sexual challenges.

Is postcoital dysphoria a mental illness?

In psychology today, there is no established diagnosis that refers to postcoital dysphoria. Current diagnostic guidelines don’t recognize PCD as a diagnosable mental health disorder. For many people, it’s a rare occurrence, happening only a handful of times over the course of their life. Others experience it with greater frequency, but at a low intensity, so that it’s only a minor annoyance. 

On the other hand, some reports indicate that certain individuals can experience frequent, intense, and long-lasting dysphoria after sex. When severe symptoms happen often and take a long time to clear up, it can become difficult to maintain an active sex life. 

This, in turn, may lead to relationship difficulties. Some may feel insecure, hurt, or guilty when sex repeatedly provokes unhappy feelings in a romantic partner. You may be understandably reluctant to engage in sexual activity which could provoke severe PCD, and this avoidance might lead to relationship tensions. Negative feelings can also interfere with post-sex bonding activities like cuddling and pillow talk, which may be important for sustaining relationships. 

Managing and improving postcoital dysphoria

If you’re experiencing sexual and relationship difficulties as a result of PCD, is there anything you can do? Research in this area is still in its early days, so there are no clinically-tested treatments. However, the following approaches may be useful, since many people find them helpful for managing difficult emotions or improving sexual functioning.

Seek relief for stress

General stress is an unavoidable part of life, and it can take a toll on both our physical and mental health. As we discussed above, psychological distress may be a risk factor for postcoital dysphoria. If you’re experiencing prolonged stress, it could make you more susceptible to emotional instability after sex. Stress can be one of the common underlying mechanisms behind postcoital dysphoria prevalence and correlates. You may find that your symptoms improve if you make some changes to your life to relieve stress, including:

• Taking small breaks or vacations when necessary

• Spending time in nature

• Getting regular physical exercise

• Practicing deep breathing

• Engaging in mindfulness meditation

• Keeping a journal

• Getting more sleep

Acknowledge and accept your feelings

Many of us make unwanted emotions worse by trying to push them away. By attempting to control your feelings after sex, you may only be putting more psychological pressure on yourself. This could make it harder for your sadness, anxiety, or irritability to fade away. If you’re trying to gain complete control after you’ve experienced postcoital dysphoria, it could be helpful to practice self-compassion. 

The next time you experience PCD, you may want to acknowledge your emotions and wait for them to dissipate instead of clamping down on them. It may help to remind yourself that these feelings are temporary and that you don’t have to feel bad for feeling bad.

Communicate with your partner

Feeling distressed after sex may sometimes be just a reaction to an intense experience. But research suggests that in some cases, it can be linked to dissatisfaction with your relationship. Having an honest, empathetic conversation with your partner may reveal some things in the relationship that aren’t working for you. Addressing these problems might be important in enabling you to feel happy and affectionate after sex.

Even if your postcoital dysphoria isn’t related to relationship troubles, communicating about it may be important. Your partner may be blaming themself for your PCD, or wondering if you’re blaming them. It’s also possible that they feel frustrated or alienated if it’s led to a decrease in intimacy. Reassuring them that you still care for them, and approaching the situation as something for the two of you to work through together, may go a long way toward maintaining the health of your relationship.

Can therapy help with PCD?

Psychotherapy might help you identify and resolve the psychological factors behind postcoital dysphoria. A therapist can provide a safe space to talk through your feelings about sex and suggest ways to address them constructively. Marital therapy or couples therapy, combined with sexual medicine might be a helpful option for couples who are facing sexual difficulties.

Many people seeking help for issues related to sexual functioning prefer online therapy over face-to-face treatment. Talking with a therapist over the internet creates a sense of discretion that may make it easier to open up honestly about intimate personal matters. If you plan to attend therapy with your sexual partner, it may also be easier to schedule time for therapy when you’re able to attend sessions from home using a computer or mobile device.

Studies have repeatedly shown that online therapy works, and can be just as effective as in-person treatment. Couples who’ve engaged in internet-based counseling for relationship difficulties have reported high levels of satisfaction with their experiences and outcomes. Some even found that it was easier to establish a connection with their therapists due to the greater sense of “comfort and control” the process provided. If you’re interested, you can get started with online therapy right away through BetterHelp’s platform.