I have sat across from a lot of men in my office who had no idea they were in an abusive relationship. Not even close. They came in describing insomnia, or work stress, or the fact that they had completely lost interest in sex. A few came in because their partners sent them, convinced that the problem was their emotional unavailability or their difficulty connecting.

What they did not come in saying was: I think I have been abused.

That word did not belong to them yet. And honestly, it rarely does for men until something forces the confrontation. Most of the time, that something is the body. Specifically, it tends to show up in bed.

There is a reason for that. And understanding it can be the difference between years of confusion and finally getting clarity about what actually happened to you.

The Problem With How We Think About Abuse

Our cultural script for abuse is narrow. It involves physical violence, a clearly identifiable aggressor, and a victim who knows they are one. That script fits some experiences, but it leaves out an enormous swath of what actually happens in relationships, particularly in relationships with people who use psychological tactics rather than fists.

Narcissistic abuse, at its core, is a pattern of psychological and emotional manipulation that erodes a person’s sense of reality over time. It includes gaslighting, intermittent reinforcement, coercive control, sexual weaponization, and chronic invalidation. None of these leave visible marks. And none of them feel like abuse while they are happening, at least not clearly.

Research published in Sex Roles (Green et al., 2024) found that narcissistic intimate partner violence is associated with coercive control and psychological abuse perpetrated in response to perceived ego-threats, including challenges to status, entitlement, or dominance within the relationship. What that looks like in daily life is a partner who uses emotional volatility, withdrawal, and manipulation as tools to maintain control. Not screaming. Not hitting. Managing.

Most men are not trained to recognize that as abuse. They are trained to push through it.

Why Men Stay Confused Longer

Research from Taylor et al. (2022) identified a specific pattern among male victims of intimate partner violence: many remained in what the researchers called a psychological position of denial long after the behaviors they were experiencing crossed clear lines. The barrier was not lack of intelligence or awareness. It was identity.

Acknowledging victimization meant compromising a masculine self-concept built on strength, competence, and control. Being a victim, as one study participant put it, was still perceived as a weakness. That stigma was not coming from outside. It was fully internalized.

Hine et al. (2022) found similar results when interviewing support counselors for male domestic violence victims. Callers would describe what was clearly abuse, and then say something like, I know this sounds ridiculous, but. The knowledge was there. The permission to claim it was not.

So men stay. They rationalize. They absorb the narrative that the problem is them, because that narrative is being delivered continuously and skillfully by someone they love. And they try harder. They become more accommodating, more agreeable, more disconnected from their own sense of what is real.

That disconnection does not stay psychological. Eventually it finds the body.

The Bedroom as Diagnostic

Sexual function in men is deeply connected to the nervous system, and the nervous system does not lie about safety. When a man is chronically hypervigilant, emotionally dysregulated, and operating under ongoing psychological threat, his body registers that whether his mind has labeled it or not.

Research on PTSD and sexual dysfunction has found that trauma-related symptoms disrupt sexual function across every domain, including desire, arousal, performance, and satisfaction. A systematic review of 11 studies found that all but one demonstrated significantly elevated rates of sexual dysfunction in men with PTSD, with erectile dysfunction and decreased desire being the most consistent findings (Cosio and Bhagwati, 2015). A later review in Frontiers in Psychology found that 60 to 85 percent of male veterans with PTSD also reported significant sexual dysfunction (as cited in MDLinx, 2024).

The underlying mechanism matters here. Yehuda et al. (2015) described it this way: physiological arousal, which should normally lead to pleasure during sex, becomes dysregulated in PTSD such that the same neural and hormonal activation that drives arousal instead signals threat. The nervous system has been conditioned to associate heightened activation with danger. So the body cannot access pleasure the way it once did.

Men in narcissistically abusive relationships are not in combat. But the neurological experience has significant overlap. Chronic unpredictability, emotional threat, coercive control, and sexual manipulation are all forms of psychological stress that over time produce nervous system responses that parallel trauma.

What men notice first is usually not the psychological pattern. It is the fact that they no longer want sex. Or they want it but cannot perform. Or they perform mechanically and feel nothing. Or they feel vaguely ashamed of their own body without knowing why. Or they find themselves avoiding intimacy entirely and cannot explain it.

That is the moment many of them finally come through my door. Not saying I think I was abused. Saying, I think there is something wrong with me.

What Sexual Dysfunction Is Actually Telling You

Loss of sexual desire or function after a relationship that wore you down emotionally is not a coincidence. It is physiological information. Your body is registering what your mind has not yet caught up to naming.

Research specifically examining long-term effects of male sexual trauma found that men who had experienced abuse reported intimacy and sexual problems at a rate of nearly 79 percent, and erectile dysfunction at over 51 percent (Petreca & Burgess, 2024). These were not men with physical causes for their difficulties. These were men carrying something unresolved that had never been accurately named.

When the body stops working the way it used to in the context of intimacy, several things may be happening simultaneously. The autonomic nervous system may be stuck in a state of chronic low-level activation that interferes with arousal. Trust has been so thoroughly damaged that vulnerability feels dangerous even in theoretically safe situations. Shame from repeated sexual invalidation or coercion within the relationship may have become fused with sexual experience itself. Emotional numbing, a common response to chronic stress, may have flattened not just painful emotions but pleasurable ones as well.

None of these are permanent. All of them make sense given what the nervous system went through. But none of them resolve simply by leaving the relationship.

The Path Forward Starts With Accurate Language

One of the most important things I do in early sessions with men who have come out of narcissistically abusive relationships is help them find accurate language for what happened to them. Not to label a former partner or assign blame, but because the nervous system cannot begin to regulate something it has not been allowed to name.

When a man can say, what I experienced was psychological abuse, something shifts. Not immediately, and not completely. But the rationalizing stops. The self-blame loosens a little. The part of him that has been asking what is wrong with me starts to hear a different answer.

Recovery from this kind of abuse is not about learning to perform better in bed. It is about rebuilding a relationship with safety, with your own body, and with the reality of what happened to you. That process takes time and it takes support. Trauma-focused therapy, including approaches like EMDR or somatic work, addresses the physiological components of what the nervous system has been carrying. Reconnecting with honest, reciprocal intimacy, when the person is ready, is part of it as well.

What I want men to know is that the sexual symptoms are not the problem. They are the signal. And the signal is pointing toward something that deserves to be taken seriously.

If you have been carrying unexplained sexual dysfunction, a loss of desire, difficulty with intimacy, or a general sense of disconnection from your own body after a relationship that left you diminished, it is worth asking the harder question. Not what is wrong with me, but what happened to me, and do I have the full picture of it yet.

The answer to that question may be the beginning of getting your life back.

About the Author

Gregory Harmeling, Psy.D., LMFT, is a licensed marriage and family therapist specializing in men’s sexual health, narcissistic abuse recovery, and travel therapy. He works with men who are done being confused about why they feel the way they do — and are ready to do something about it. Learn more at fenixtherapeuticservices.com.

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References

Green, A., Hart, C. M., Day, N., MacLean, R., & Charles, K. (2024). Gendering narcissism: Different roots and different routes to intimate partner violence. Sex Roles, 90(6), 723-741. https://doi.org/10.1007/s11199-024-01471-4

Hine, B., Bates, E. A., & Wallace, S. (2022). “I have guys call me and say ‘I can’t be the victim of domestic abuse'”: Exploring the experiences of telephone support providers for male victims of domestic violence and abuse. Journal of Interpersonal Violence, 37(7-8), NP4454-NP4481. https://doi.org/10.1177/0886260520944551

Petreca, V. G., & Burgess, A. W. (2024). Long-term psychological and physiological effects of male sexual trauma. Journal of the American Academy of Psychiatry and the Law, 52(1). https://doi.org/10.29158/JAAPL.230076-23

Taylor, J. C., Bates, E. A., Colosi, A., & Creer, A. J. (2022). Barriers to men’s help seeking for intimate partner violence. Journal of Interpersonal Violence, 37(19-20), NP18537-NP18564. https://doi.org/10.1177/08862605211035870

Yehuda, R., Lehrner, A., & Rosenbaum, T. Y. (2015). PTSD and sexual dysfunction in men and women. Journal of Sexual Medicine, 12(5), 1107-1119. https://doi.org/10.1111/jsm.12856

Text © Gregory Harmeling