Emily Jamea, Ph.D., is a sex therapist, bestselling author, and keynote speaker. You can find her here every month to share her latest thoughts on sex.
May is Mental Health Awareness Month.
If you’re in the middle of your life, you may be wondering why you went from “Let’s get it on” to “Please get off me.” And you wouldn’t be alone. Many women assume that changes in libido in their late 30s, 40s, or 50s are purely hormonal. Although hormones certainly play a role, they are just one of many possible pieces of the puzzle.
Sexual desire can be affected by relationship conflict, stress, and more, including an often overlooked aspect: mental health. Anxiety, depression, ADHD, trauma, and other mental health issues can have a significant impact on your sex drive.
A lot happens psychologically in midlife. Hormonal changes, changing identities, caregiving pressures, and relationship changes all come together at the same time. Research consistently shows that the transition to menopause is associated with an increased risk of depression and anxiety, even in women with no history of it. The number of ADHD diagnoses among women ages 30 to 49 nearly doubled between 2020 and 2022. Although trauma-related disorders are not increasingly diagnosed, they can play a role in dampening your sex drive.
The onslaught of midlife stressors can destabilize coping systems that have kept previous traumas at bay, causing symptoms to emerge for the first time or to intensify.
Each of these mental health issues impacts cravings in a unique way, and understanding the pattern is the first step to taking back control.
Fear
Fear has a specific and direct impact on sexual desire. Clinically, fear activates the brain’s threat detection system. The nervous system enters a state of alertness, scanning for danger and preparing for what comes next. For most people, this state is fundamentally incompatible with desires that require a sense of security.
For women with anxiety, this may manifest itself in the bedroom as hypervigilance to a partner’s reactions, anticipatory concerns about performance or vulnerability, or a persistent inability to truly feel comfortable in their own bodies. Even when nothing is obviously wrong, the nervous system functions as if something were wrong, and this faint alarm makes it nearly impossible to feel joy.
A client in her early 40s described feeling physically present during sex but emotionally reserved, as if she was waiting for something to go wrong. Her description was a decidedly disturbing experience. There was more to her racing mind than just a busy calendar. It represented a nervous system that had forgotten to settle down and surrender.
depression
If anxiety is too much activation, depression is too little. Women who suffer from depression often describe a loss of interest in things that once brought joy, including sex.
One client in her late 30s described it this way: “It’s not that I don’t love my husband. I just don’t feel anything.” Her days felt flat, her energy levels were low, and even small tasks felt overwhelming. It wasn’t that she was against sex, it just seemed irrelevant to her.
Depression weakens the brain’s reward system. The pathways that support motivation, anticipation, and pleasure become less responsive. It can also affect self-esteem and body image, making it harder to feel desire or openness to connection.
ADHD
ADHD is increasingly being recognized in women, particularly because it has historically been underdiagnosed in female patients, whose symptoms often appeared different than the hyperactive appearance more commonly seen in boys.
Research has shown that ADHD can affect your sexuality in a number of ways. ADHD can lead to hypersexuality, but in some women it is associated with both low sex drive and low sexual satisfaction. Perhaps most obvious is that women may not be able to calm down and focus their minds enough to immerse themselves in the sensations of sex. Being easily distracted by a noise in the next room or realizing you forgot to buy milk at the store can be enough to completely ruin the mood.
Another way ADHD can affect your sex life is emotional dysregulation, which is a well-documented feature of ADHD. When daily life involves heightened emotional reactivity, frustration, or a chronic feeling of being overwhelmed, it can undermine the emotional ease and security necessary to experience desire. It’s less about a lack of interest and more about having difficulty achieving fulfilling intimacy when you’re already exhausted or your emotions are no longer regulated.
trauma
Trauma-related disorders can have profound effects on sexual desire. Trauma exists on a spectrum. “Big T” traumas (as we call them in the clinical world)—think sexual assault or a car accident—can affect desire more obviously. But we often don’t pay enough attention to “small” traumas – think ongoing relationship conflicts, dealing with a child with special needs, or unresolved issues in your family of origin. “Small T” trauma can also affect desire. Desire is not just mental but deeply embodied. A client in her early 50s had a history of sexual trauma that she believed she had “worked through.” Still, she found herself shutting down during intimacy with her partner. She described a pattern of becoming numb or suddenly feeling irritable without understanding why.
Trauma can live on in the nervous system long after consciousness has understood it. Intimacy, vulnerability and physical touch can unconsciously trigger protective responses – fight, flight or freeze. For many women, this manifests as avoidance, low desire, or difficulty staying present during sex.
What about medication?
Many women wonder whether their medications are to blame for decreased libido or even decreased sexual desire. And sometimes they actually play a role. Certain antidepressants, particularly SSRIs, are known to affect libido, arousal, and orgasm. Medications used to stabilize anxiety and mood can also have sexual side effects. ADHD medications, on the other hand, rarely have sexual side effects. If you suspect that your medication is affecting your sex life, it’s worth having a conversation with your prescriber. There are often adjustments or alternatives that can help.
Regain sexual desire
If you see yourself in any of these patterns, know that you are not alone and that there is a way forward.
First, ask yourself:
- How does my nervous system function most of the day? Is it overactivated, underactivated, or scattered?
- Do I feel safe, present and connected in my body?
- What emotional weight am I carrying that might crowd out the desire?
From there, small changes can make a significant difference:
- One of the most effective strategies is to allow for a transition period between the demands of the day and intimacy.
- Practice mindfulness or grounding to help your body calm down.
- Communicate openly with your partner about what you are experiencing.
- Seek support from a therapist who is knowledgeable about both mental health and sexuality.
Desire does not exist in a vacuum. It is a reflection of your inner world – your stress, your emotional state, your sense of security and your ability to be present. The good news is that when you start taking care of your mental health, the desire often returns – not as an achievement, but as a natural consequence of feeling more like yourself again.
From your website articles
Related articles on the Internet
