The Restoration Gap
Why do we instinctively restore male sexual function, yet teach women to live with the consequences of sexual violence?
One of the clearest ways to understand what a society truly values is not by listening to what it says, but by observing where it chooses to invest its time, research, funding and innovation.
Actions speak louder than words, and budgets rarely lie. Neither do research priorities.
When governments, healthcare systems and pharmaceutical companies identify a problem worth solving, remarkable things begin to happen. Scientists collaborate across borders, universities receive funding, clinical trials accelerate, treatments emerge, healthcare pathways become established and public conversations begin to shift with the aid of the mainstream media. What once seemed impossible gradually becomes routine because enough people have collectively decided that restoring that aspect of human life matters.
Progress always follows investment.
Which is why I’ve found myself asking yet another increasingly uncomfortable question: If we understand the profound psychological, neurological and physiological consequences of sexual violence, why have we not invested with the same urgency in helping survivors recover?
I don’t ask these questions as an observer, or someone simply reading textbook theory.
I ask them as someone who has spent years searching not simply for legal answers, but for medical, neurological and physiological ones. Someone who has experienced forensic examinations, sat in waiting rooms, interrogated in interviews, navigated referrals and attempted to understand changes taking place within my own body whilst discovering that many of the restorative approaches emerging through research remain inaccessible to the very people whose lives they could transform – and serving only those who discover the breakthrough theories.
Like many survivors, I’ve often felt belittled, patronised, and as though I was being taught how to accommodate the consequences of trauma, rather than being offered every possible opportunity to restore what trauma had taken.
This is not a criticism of the remarkable progress made in other areas of healthcare. It is precisely because that progress exists that the comparison becomes so revealing.
Take erectile dysfunction, for example.
Few people would argue that it deserves to be ignored, nor should they.
Society rightly recognises that sexual function forms an important part of health, identity, confidence, relationships and quality of life. Over several decades, billions have been invested globally into understanding erectile dysfunction, developing pharmaceutical treatments, refining clinical guidance and encouraging men to seek support without shame. It has also received campaigns supporting the destruction of stigma and resulting mental health issues men face when their sword of intimacy doesn’t perform. Those advances have improved lives, strengthened relationships and demonstrated what medicine is capable of achieving when it decides that restoring function is both possible and worthwhile.
The issue isn’t that we invested too much in supporting the rise to attention, but why we appear willing to invest so much less when sexual violence fundamentally alters a woman’s relationship with her own body, sexuality, intimacy and sense of safety.
Perhaps the most revealing set of distinctions lies not in the treatments themselves, but in the questions we instinctively, and intuitively, ask:
- When a man experiences erectile dysfunction, medicine asks: “How do we restore function?”
- When a woman experiences sexual violence, society often asks, “How does she learn to live with what happened?”
These are fundamentally different questions because, as we can see, one begins with the assumption that restoration is both possible and desirable. It mobilises research, innovation, funding and clinical pathways around the belief that a better quality of life can and should be achieved.
The other, all too often, begins with adaptation.
Survivors are offered coping strategies, resilience programmes, mental health apps, and ways to manage symptoms, whilst comparatively little attention is given to restoring what was actually taken. And in most cases, the counselling offered is less time than if the woman was seeking cosmetic surgery.
The expectation quietly shifts from rebuilding to surviving, from recovery to accommodation, as though learning to carry the injury somehow becomes an acceptable substitute for healing it. But acceptable to whom?
Some won’t see the distinction, but it is the distinction that matters most, because sexual violence does not simply interrupt one moment in a woman’s life. It creates a ripple effect that fundamentally alters her relationship with herself and those around her.
One of the least discussed consequences of sexual violence is the profound disruption it can have on being touched, hugged and the exchange of romantic intimacy itself.
For many women, even being hugged by their husband, or grown sons in my case, makes us shut down and freeze, even though we longed to be hugged by them.
Romantic, healthy, consensual intimacy is not simply about sex. It is one of the ways human beings experience trust, affection, emotional safety and connection. Through affectionate touch, dialogue, socialising, closeness and vulnerability, our brains release oxytocin, dopamine and endorphins, neurochemicals that play important roles in bonding, stress regulation and psychological wellbeing. As I’ve covered in previous articles, safe relationships can become part of the body’s natural process of regulating the nervous system. Yet, sexual violence fundamentally changes every relationship.
The very thing that should represent comfort and connection can become associated with fear, hypervigilance and danger.
One consequence that is rarely discussed openly is that many survivors choose celibacy, not necessarily because they no longer desire intimacy, partnership or love, but because the perceived risks of entering new relationships far outweigh the potential rewards.
For some, dating no longer feels exciting. It feels dangerous. For others, finding a sexual partner is the only way to make sure that the last man to penetrate them is not the man, or men, who raped them.
As someone who has chosen celibacy, not because I no longer value love or companionship, but because rebuilding trust has felt safer than beginning again, I have come to realise that this, too, is part of the recovery that society rarely sees.
Every new relationship requires a level of trust that trauma has taught the nervous system to question. Every stranger represents uncertainty. Every invitation carries calculations that many people never have to make. Is he safe? Will he believe me? Will he respect my boundaries? What happens if I am wrong? Navigating the compliments, identifying ‘love bombing’ or ‘trauma bonding’ takes too much out of us, so we channel that energy into other areas of life.
From the outside, this can appear as though the survivor has chosen to remain single. From the inside, it is often a complex negotiation between the very human desire for connection and a nervous system whose primary responsibility has become survival.
That, too, is part of what sexual violence takes away.
For many survivors, the assault does not end when the violence ends. It continues every time intimacy is avoided, every time a relationship breaks down because trust feels impossible. Every time affection feels unsafe, every time a partner mistakes self-protection for rejection. And every time a survivor chooses celibacy because her nervous system has learnt that vulnerability carries consequences.
For some women that period lasts months. For others it lasts years, and for some… the rest of our lives.
Sexual violence quietly reshapes the entire course of adulthood, the way we raise our children, and the way we appear within public conversations about recovery. Instead of surface-level conversations, we choose to speak about criminal justice, counselling, compensation, healing, and not just for ourselves either; we do it so we can help prevent it from happening to ‘just one other person’. We become activists and advocates, often changing careers to pursue a new role that protects our nervous system, reduces hypervigilance, and helps others transform their organisations, institutions and sectors.
And whilst many of us speak up, a large majority keep their abuse hidden, pushing it down so even they never acknowledge it ever happened. On a wider scale, we less often acknowledge that many survivors have been deprived of one of the most fundamental experiences of being human: the ability to feel emotionally and physically safe with another person.
Another question we need to be asking is this: If society rightly recognises that sexual wellbeing forms an important part of men’s health, surely we should be equally committed to restoring a woman’s sense of safety, trust, bodily autonomy and confidence after sexual violence, so she too can improve her own sexual well-being and mental health? Or are we still in the days of chastity belts?
Restoring sexual function isn’t just about the excitement, orgasms and ejaculations; it is about restoring the conditions in which intimacy becomes possible again, including the ‘mindgasms’ and ‘soulgasms’, so both men and women thrive together, equally, with respectful and mutually enjoyable intimacy.
The lack of investment and action creates a pattern that extends far beyond this single comparison. Over the past two decades we have rightly witnessed extraordinary progress in encouraging men to speak about mental health. Campaigns have challenged stigma and peer-support organisations have grown, such as Tough To Talk, a charity dedicated to breaking the stigma and reducing male suicide in England and Wales. Research has expanded. Conversations that were once hidden have entered mainstream public life. That progress deserves recognition because it has undoubtedly changed and saved lives.
It also demonstrates something important: When society decides an issue matters, it is capable of extraordinary change.
The evidence for that already exists.
When the COVID-19 pandemic emerged, governments, researchers, regulators and pharmaceutical companies collaborated at an unprecedented pace. Vaccines that would ordinarily have taken many years to develop, test and approve were researched, trialled, authorised and rolled out within months. Extraordinary funding was released, international collaboration accelerated, and barriers that had previously been considered immovable were overcome because the world collectively decided that protecting lives demanded exceptional urgency.
The same principle can be seen beyond healthcare.
Following the highly publicised deaths of Thomas Kelly and Daniel Christie in Sydney, the New South Wales Government introduced sweeping reforms aimed at tackling alcohol-related violence, including lockout laws, restrictions on alcohol service, tougher sentencing provisions and a range of additional public safety measures. Whether one agrees with every aspect of those reforms is not the point. The response demonstrated that when governments believe a pattern of harm has become unacceptable, legislation, regulation and public policy can change remarkably quickly. Research later found substantial reductions in alcohol-related assaults within the affected entertainment precincts.
Those examples reveal the profound importance that our greatest limitation is not always scientific knowledge, nor is it necessarily political capability; it is political priority.
We already know that government, media and societies are capable of mobilising billions of pounds, accelerating scientific discovery, changing legislation and reshaping public behaviour when they decide that enough is enough.
- So why then, even with the vast amount of women suffering at the hands of men, do we continue to ignore what is happening? Especially when it is becoming increasingly difficult to ignore?
- Why has the long-term restoration of women following sexual violence never inspired the same urgency?
- And not simply to prevent the next assault, but to also restore the lives of those who have already survived one?
- Why has the long-term recovery of women following sexual violence never generated the same national urgency?
- Where are the equivalent conversations about restoring lives rather than simply surviving them?
- Where is the sustained investment in emerging trauma therapies?
- Where is the same determination to reduce waiting times, accelerate research and create genuinely restorative pathways rather than asking survivors to become increasingly resilient whilst they wait?
The number of questions is vast, but even when they are asked, they are dismissed, minimised, side-stepped or placated.
We are living through one of the most exciting periods in neuroscience. Researchers continue to deepen our understanding of how trauma reshapes the brain, alters the nervous system and affects the body over time. Clinical research into treatments such as MDMA-assisted therapy and psilocybin-assisted therapy for PTSD and C-PTSD is producing promising results, while trauma-informed care is becoming increasingly recognised across psychology and psychiatry – and restricted in the main for veterans. Access remains limited, waiting lists remain long, and many survivors continue navigating fragmented systems years after the violence itself. Emerging evidence is encouraging, but the translation from research to routine care remains slow. Studies published in leading journals have shown substantial improvements in PTSD/C-PTSD symptoms among carefully selected participants receiving these therapies alongside psychotherapy. Further regulatory approval, long-term follow-up and wider implementation are still needed. Having conversed with Professor David Nutt, Founder of DrugScience.org.uk and former Chair of the Advisory Council on the Misuse of Drugs, a few months back, he told me, “Accessing women, and approving psychedelic research for women who have gone through sexual violence is difficult,”. Multidisciplinary Association for Psychedelic Studies (MAPS) at Imperial College London Centre still do not provide Psychedelic Research for survivors of sexual violence, even though they offer it for those who self-harm, those who do not have a history of psychiatric, neurological or cardiovascular disorders, chronic physical illness and who are not currently taking psychotropic medication, and those who have abused opioids.
Like many survivors, I have spent years searching for answers. Not just the legal answers, but the medical, physiological answers. The answers to what is happening within my nervous system and answers to questions my mind cannot put into words, but my own body was asking long before healthcare systems demonstrated they were ready to listen.
That search has taught me that the greatest gap is philosophical, not always scientific. And it is one of morality and humanity in terms of whether we have truly believed that women’s recovery after sexual violence is worth pursuing with the same determination we use to help a man ‘get it up again’. Because when we ask the right questions, we determine the systems being built. If we ask how someone can learn to live with profound loss, we will create systems that teach survival. And if we begin asking how we restore what trauma has taken from almost a third of the global population, by a large proportion of half of the global population, we create the possibility of building systems that heal.
In my view, this is the real measure of a compassionate society, not whether it can acknowledge suffering with Band Aids and lip service, but the intention and preparation to invest in restoring the lives that suffering interrupted.
Every major justice movement began with ordinary people refusing to accept that “this is simply the way things are”. Women have stood at the heart of many of those movements, often carrying change long before institutions caught up. If we can summon that same courage again – and see it through to completion, then restoring the lives of survivors need not remain an aspiration of a few, but can become an international expectation, and a reality for all.
