Is It Trauma or Hormones? What Women in Midlife Need to Know About Desire

Is It Trauma or Hormones Impacting Your Sex Life?

Many women in midlife will notice the body going through "the change." Now, we speak openly, on social media, with friends, about what's happening to our skin. We swap notes on new creams, procedures to tighten, tuck, lift. You know what I mean.

But something I hear far more of in my practice, and far less of everywhere else, is the change that happens to sexual desire and sexual anatomy.

For women with a trauma history, a loss of sexual desire can feel like confirmation of something they already feared: this is just who I am now. I don't enjoy sex anymore. There may be some truth in accepting that parts of ourselves change after trauma but what if what you're experiencing isn't trauma at all? Or at least not entirely? What if part of the story is a lack of awareness about what's actually happening in the body during perimenopause? And just as we've learned to care for our skin and other effects of aging during this transition, what if there are interventions for what's happening below the waist too and we just aren't talking about them?

The body and brain are in constant conversation.

When estrogen levels drop during perimenopause, the tissues of the vagina can thin and dry, leading to itchiness and discomfort. Sex becomes uncomfortable, then painful. And pain is one of the most powerful teachers the nervous system has. It doesn't distinguish between a wound that needs protecting and a body that simply needs medical attention. It just learns: avoid this. I’ve seen how this can destroy a woman’s self esteem as her desire wanes and sex “feels like a thousand papercuts”.

For women with a trauma history, this protective response can feel achingly familiar. The body pulling away, intimacy becoming something to manage and negotiate rather than enjoy. It can be almost impossible to know, whether you’re experiencing a trauma response or a hormonal one or both.

The body keeps the score. So does the endocrine system.

Trauma research has taught us that the body holds experiences in the facia and nervous system responses and so does our biology. Hormones are so much more influential than you may have thought, they influence our mood, thinking, energy, and desire in ways that are profound and often invisible until we’re forced to take a look at it.

What many women, and even many therapists, don't fully appreciate is how dramatically perimenopause can alter the landscape of desire. For many women it's a sudden and confusing disappearance of something that felt fundamental to who they were. And when trauma is also present, reconnecting to that part of themselves at all, or ever can feel like an insurmountable hurdle.

One pattern I often encounter in my practice is a woman who has tried everything. Previous therapy, different retreats and self help practices, and yet this particular piece remains stuck. What I've learned to ask is: has anyone looked at what's happening hormonally? Because what can look like a ceiling in therapy is sometimes a physiological floor that hasn't been addressed. Let’s rule out the medical. Then we can do the deeper work with so much more clarity.

What evaluation and treatment can look like

Estrogen keeps vaginal tissue healthy and responsive. When these hormones decline, the body changes and this isn’t as punishment, not as a sign of damage, but as a physiological challenge that has it’s own solutions.

If what you're reading is resonating, the first step is a conversation with a healthcare provider who takes women's sexual health seriously. Not all do and it is completely appropriate to seek out someone who specializes in perimenopause medicine. The data is growing at a rapid pace so having a provider who’s taken the time to be informed is essential.

A thorough evaluation might include:

·       Hormone level assessment, including estrogen and testosterone

·       Evaluation for GSM (Genitourinary Syndrome of Menopause) or vaginal atrophy

·       Referral to a pelvic floor specialist

·       A review of any medications that may be affecting desire or arousal

·       A conversation that takes your full history, including trauma history, seriously

Treatment options vary depending on the results of the tests and evaluation, but may include localized or systemic hormone therapy, non-hormonal options for vaginal health, or medications specifically approved for low sexual desire. Many women find that even modest interventions produce meaningful change.

And here is what can happen when pain is addressed and the body begins to heal: pleasure becomes possible again. When the body has healed, you can begin to experiment and work with a trauma and sex therapist on bringing pleasure back into your life. With pleasure comes something that is hard to describe but easy to recognize. A returning sense of self. A feeling of being alive in your own body again.

This is one of the reasons I believe pleasure deserves a larger place in conversations about trauma recovery. Trauma narrows life, it requires vigilance, protection, and survival. Pleasure moves us in the opposite direction, it invites safety, presence, connection, embodiment, and engagement with the world around us.

This doesn't mean hormones are the answer to every problem. Relationship dynamics, trauma history, stress, and attachment patterns all matter and need attention and care but it does mean we should stop assuming every loss of desire is acceptable and we should start asking better questions about what the body may be trying to tell us it needs.

If you're in midlife and struggling with changes in desire, intimacy, mood, or your relationship with your body, know that you are not alone and you are not broken. There may be more options available than you realize.

Sometimes healing begins not by working harder, but by looking at a part of the picture that has been overlooked and working with a holistic therapist, one who sees how all these pieces work together, can be a significant game changer in your trauma healing journey.