Most of us experience ups and downs in our sex lives, where things may be good for a while (or with a particular partner) and then not so good (or non-existent) for a while. A harsh reality for people who grapple with mental health conditions is that they are more likely than others to experience sexual problems that impact their sex lives.
Your Brain and Sex: Why Mental Health Matters
Physical desire begins in the brain. When we feel desire and think about sex, our brain’s feel-good chemicals such as serotonin send messages to our bodies via a complex system of brain circuits and nerve pathways that rev us up and increase blood flow to our sex organs. If the brain circuits that normally transmit these messages aren’t working properly — due to an illness or a medication, for example — our body won’t experience desire or function as it normally would in response to sexual stimuli. This breakdown in our brain’s wiring can affect our intimate relationships and quality of life. Several mental health disorders can negatively impact our sex drive or our sexual function and sensation. Research reveals that both the condition itself and the prescribed treatment can have an impact — lowered libido and sexual dysfunction are effects of some mental health conditions, and also the side effects of some medications. “Many people do not seek psychiatric or medical attention for their sexual problems,” says Olga Yahontova, MD, a psychiatrist at Malibu Vista women’s mental health retreat. “Sometimes they consider these problems to be the result of partner alienation or are simply overwhelmed by the pressures and demands that mental illness puts on them. Others are too ashamed or terrified to raise the issue, particularly in situations of childhood sexual abuse.” Dr. Yahontova notes that while the reasons for not seeking help are different, the outcome is the same — a continued lack of intimacy, constricted experience of life’s pleasures, and accumulation of secrets, self-doubts and negative emotions. She stresses that it is important to educate patients about the effects of their illness and the side effects of their treatment, including impacts on libido and sex, to help address any related sexual dysfunction and improve that area of their life. Here are a few common mental health disorders that can take a toll on your sex life: #1 Trauma/PTSD. Research indicates that men and women suffering from post-traumatic stress disorder (PTSD) may experience sexual problems, leading to difficulties in their relationships. This effect is not necessarily related to trauma stemming from sexual assault or abuse, but can result from any kind of trauma. Researchers believe this is because the presence of PTSD or feelings around any past trauma can cause the sufferer to associate the sensation of arousal to aggression, triggering fear and a fight or flight response, rather than to healthy sexual function. #2 Depression. People who suffer from depression can experience low energy, resulting in a low sex drive or lack of interest in sex. People who are depressed may also experience sexual dysfunction, such as trouble getting an erection or experiencing an orgasm. These issues may be aggravated by certain antidepressants, which boost a person’s mood by altering the brain’s neurotransmitters, but can also throw their sexual response out of whack. This side effect is particularly seen with selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs), though all antidepressants can impact a person’s sexual responses. #3 Anxiety. Studies show that 75% of patients with panic disorder also have sexual problems. Men with anxiety may have erectile dysfunction and women may have sexual aversion disorder, which involves a fear of sexual intercourse and avoidance of sexual contact. These issues may also affect people who have experienced some type of sexual abuse or who grew up in an environment where sex was taboo. People who suffer from social anxiety or obsessive compulsive disorder also can experience low sexual desire or pleasure and have difficulties with interpersonal and romantic relationships. #4 Eating disorders. People with eating disorders report increased sexual anxiety and decreased sexual desire. A negative body image and self-concept, which are often associated with anorexia, bulimia and other eating disorders, may play a role in sexual anxiety, avoidance or dysfunction. There are physical factors as well. Scientific research shows that poor nutrition and low body weight due to food restriction or purging also have a direct impact on the production of sex hormones. For example, healthy fats are necessary for the production of estrogen and testosterone, both of which are tied to libido. #5 Bipolar disorder. This is a cycling or episodic mental health disorder that involves swings from mania or elation (highs) to extreme sadness or depression (lows). One symptom of the high or manic periods can be a marked increase in provocative behavior, sexual activity and sexual risk-taking. These behaviors can damage relationships and lead to feelings of shame or low self-worth. A symptom of the down periods can be low self-esteem that makes the person doubt both their attractiveness and their partner’s desire to be with them. Both the high and low episodes of bipolar disorder can impact the person’s intimate relationships. #6 Personality disorders. A number of personality disorders, particularly borderline personality disorder (BPD), are associated with sexual dysfunction. In BPD, either sexual avoidance or sexual impulsivity can occur, which have been linked to a history of sexual trauma. Sexual dysfunction in these cases typically stems from impaired interpersonal relationships that may be resolved through therapy. For therapy to be effective, the individual psychopathology, specific sexual dysfunction and current medications must be taken into account. #7 Schizophrenia. Depending on its severity, this mental health disorder can limit a person’s capability to engage in interpersonal and sexual relationships. Additionally, the first-generation antipsychotics that are often prescribed for people with schizophrenia can deteriorate erectile and orgasmic function. It is thought that second-generation antipsychotics have fewer sexual side effects, and may be a treatment option for schizophrenia patients with sexual dysfunction.
Tips for Dealing with the Impact of Mental Illness on Your Sex Life
A discussion with your primary care physician is generally a good starting point to figure out how to manage the impact that mental illness has on your sex life, but here are some additional strategies that might help: Request a change in medication. Ask your mental health care provider if a lower dose of your current prescription might reduce the negative sexual side effects, or if you can take an additional medication to counteract these effects. An alternate medication that does not have any sexual side effects may also be a possibility. Be open with your partner. Share information about your mental health and your concerns about sex with your partner. Good communication is critical to a healthy relationship, and this includes any issues that are affecting your intimacy. It may be helpful to explore and discuss your feelings around trust and the sensations of joy and pleasure. Talk to a therapist. Perhaps because it might be perceived as awkward or inappropriate, many therapists may not ask about your sex life. If you can muster up the courage to introduce the topic yourself and explain what you are experiencing, this will allow your therapist to discuss the issue and help you address it. You might also consider consulting a trained sex therapist and, if possible, including your partner in this therapy. Work on other areas of your relationship. It can be helpful to remember that sex is just one aspect of a fulfilling relationship. Other aspects include being able and willing to communicate openly with each other, sharing a sense of humor, and sharing values as well as common goals and lifestyle preferences. A shift in focus to these other aspects of the relationship may strengthen it and improve emotional intimacy, while easing tensions around physical intimacy. “The sexual lives of patients are rarely simple and getting care from both medical and non-medical professionals — where psychiatrists and therapists collaborate in providing care — is often needed to address complex issues of sexual dysfunction,” says Dr. Yahontova. “Recovering from trauma and related symptoms of depression, anxiety and various forms of self-harm restores a person’s sexual health and their ability to experience healthy relationships, improving their quality of life.”