Prevalence and emotional valence of genital responses related to sexual abuse memories in patients with PTSD.

Background: Genital responses during sexual abuse memory recall are rarely studied, but may be clinically relevant in individuals with PTSD following sexual abuse.Objective: This study examined both the prevalence of genital responses related to sexual abuse memories, and the emotional valence and impact of such responses on daily life, and their association with PTSD severity.Method: A total of 1057 patients with PTSD and a history of sexual abuse (84.7% female, M = 38.81 years, SD = 12.59 years), referred for trauma-focused treatment between August 2024 and May 2025, underwent clinician-administered assessment of PTSD severity and completed self-report measures to assess the presence of genital responses linked to sexual abuse memories, their emotional valence, and impact on daily life.Results: Genital responses related to sexual abuse memories were reported by 34.4% (n = 364). These individuals showed significantly higher PTSD severity, a younger age at the time of sexual abuse and more repeated occurrences of sexual abuse than those without such responses. Negative emotional valence with regard to the genital responses was prevalent: 91.8% reported shame, 87.6% disgust, and 70.6% self-hatred. Disgust and self-hatred, but not shame, were significantly correlated with greater PTSD severity. Positive affect was reported by 23.1% and was negatively associated with PTSD severity. Among those reporting genital responses, 38.2% described its impact on daily life as (very) strong.Conclusions: Genital responses during sexual trauma recall occurred in one-third of individuals with PTSD and a history of sexual abuse and were linked to higher PTSD severity after controlling for age at time of abuse and abuse frequency. Given their frequent emotional burden and interference with daily functioning, systematic assessment of these responses is recommended in clinical practice to improve treatment planning and to address associated appraisal.