Sexwalking causes episodes of involuntary rape and lewd acts

Imagine waking up in the morning with your partner all bruised after being sexually assaulted in your sleep and having no idea how it happened? Or, being in the military, masturbating at night around the base, and then waking up thinking your colleagues are playing a bad joke?

Both cases are real and were reported by patients diagnosed with sexsomnia or sexwalking, a rare sleep disorder that leads to involuntary and inappropriate sexual behavior, often violent.

The disorder is medically known as a parasomnia, which is recognized by the ICD (International Classification of Diseases) as abnormal movements or psychological events that occur during sleep.

Specialists consider, however, that the dysfunction needs to be better known and studied, especially when it involves aggression. In these cases, they say, the judiciary must differentiate the patient with the parsomnia from the rapist without the pathology seeking innocence.

The first is common to three different men who had the disorder confirmed in Brazil by physician Luciana de Oliveira Palombini, a specialist in sleep medicine. The second case is of an American soldier, cited in the article “Sexônia: que sexo é esse?”, published by the Revista Brasileira De Sexualidade Humana, in 2019, by Palombini and the psychotherapist and sexologist Glaury Coelho.

Palombini, who is a doctor at the Sleep Institute of São Paulo, says that it is a very difficult diagnosis, but real and capable of generating emotional damage to the patient and risks for those who sleep next to him.

“Parasomnias are inappropriate behaviors during sleep, over which the person really has no control”, says the expert.

Sexsomnia, like other sleep disorders, happens because there is an inadequate dissociation of the different elements of sleep. “When there is normally no muscle activity to perform these behaviors, the person does not have this inhibition”, summarizes the doctor.

The causes of dysfunction range from genetic and physical factors, such as sleep apnea and respiratory problems, to psychosocial factors, such as drug use or the presence of mental disorders such as borderline.

Treatment includes changes in habits with the aim of reducing stress, avoiding sleep deprivation and eliminating a sedentary routine. Therapy and the use of night aids to correct breathing can be associated.

“When we address all these aspects of parasomnia, these abnormal behaviors do cease, but if there is a tendency, there must always be monitoring and maintenance of good sleep hygiene”, reinforces Palombini. Sexsomnia investigation includes polysomnography examination with a specialist and psychotherapeutic evaluation.

Sleep psychologist by the SBP (Brazilian Society of Psychology) and ABS (Brazilian Sleep Association), Coelho says that this disorder is still little known and demands more studies for better prevention. Although rare, this “sexual sleepwalking” is controversial, as it involves from marital disorders to criminal situations.

“The judicial system has to prove whether it is a parasomnia or a rapist trying to get away from the intent. It is essential to make the distinction. There are still few specialists, but clear and endorsed information already contributes to prevention”, says the psychologist.

Prevalent in men, this distorted perception of sexual awareness can also happen in women and the focus is always on the genital region. Arousal and orgasms during sleep are not considered sexsomnia.

The disorder can manifest itself in both genders as violent masturbation of the other (rape) and of oneself, and through speeches with sexual content during sleep. In its most aggressive phase in men, it leads to the attempt and consummation of the act through oral sex, vaginal or anal penetration until reaching orgasm.

The article by Palombini and Coelho points out that in clinical practice “sexual advances during sleep are underreported and, therefore, underdiagnosed”, since there are episodes in which the partners do not reject physical contact or report it. In the international scientific literature, there are less than 100 reported cases, most of which originated in sleep clinics and in the Judiciary system itself.

“Because it happens between couples who sleep in the same bed, it is possible that there is not a complaint that leads the partnership to comment with the doctor, or make a police report”, says Coelho.

The main characteristic of sexsomnia is that the person acts sexually as if he were awake, with lubrication, erection, orgasm and ejaculation.

“The physiological reaction is associated with non-conscious sexual behavior and, very importantly: the person has confusional arousal and amnesia”, describes the sexologist.

The greatest damage, according to Coelho, is always for those who have been victims of abuse or rape, because the sleeping person is defenseless, but the patient also suffers from consequences. “And then comes the guilt and shame that can lead to violence against oneself”, points out the psychotherapist.

The sexologist recalls that some parasomnias such as sleepwalking, sleep talking and night terrors are common in childhood and serve as a warning if they reappear after adolescence, since other sleep disorders may be associated with sexsomnia.

“In childhood, it is necessary to investigate whether there were any neurological impairments, which stressful factors are associated with crises and to propose a psychoeducational intervention in the family environment”, says Coelho.

The two professionals warn that sexual episodes followed by amnesia of the partner are indicative to seek specialized help in sleep problems, as in addition to potential violence, they create great stress for the couple, which hinders the ability to rest and trust in the other.

“We need to make a good assessment of the emotional balance and of everything that has to be controlled and managed to stop the problem”, concludes Palombini.