Sex and Mental Health
Tell Me All I Need to Know About Sex And Mental Health
If you have questions about how sex affects mental health you've come to the right place. Does bipolar really intensify your sex life? Can depression kill your sex drive? Here, frank answers from top experts. Find some answers—and plenty of solutions—now.
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Remember the taunting playground rhyme, Sitting in a Tree? Here’s a modern twist: “Sex and mental health sitting in a tree. S-H-A-M-I-N-G.”
We kid you not. Americans have a long storied history of being close-lipped and cringe-faced about sex and mental health individually. Talking about them together? It’s a one-two stigma punch. But ever so slowly, we’re growing up—and opening up.
And that’s a good thing. Because the link between the two runs deep. We know the amazing things sex can do for your mood and mind—from the release of endorphins and oxytocin to the emotional intimacy you feel with your partner.
The sex and body positivity movement (aka bo-po), greater acceptance for LGBTQ+ and gender-diverse identities, and a booming sexual wellness industry are also ushering in a new approach to sex and mental health, says Janet Brito, LCSW, AASECT certified sex therapist, licensed psychologist, and founder of the Center for Sexual and Reproductive Health in Honolulu, Hawaii. “There’s a greater degree of comfort in talking about sexual health which helps normalize the conversation, add new narratives, and decrease stigma. All of which improve overall mental health.”
But there are still roadblocks, especially if—and when—anxiety, OCD, bipolar depression, or any other mental health condition decides to crash the bedroom. A large, pre-pandemic study of thousands of men and women age 18 to 44 years published in June 2020 in JAMA (the Journal of the American Medical Association) showed convincing evidence that there is less sexual activity going on now than in earlier generations. (For other related content, see our article about Sexual Dysfunction and Sexual Disorders.)
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Study authors speculate that the decline in sexual activity may be linked to rising rates of anxiety and depression. But there’s something else that may be competing for our attention—our screens. (The term phubbing was actually coined to describe the act of snubbing the one you’re with in favor of your phone!)
What’s clear is that sexual health and mental illness can affect and even perpetuate each other. What’s less clear is how or why.
Let’s take a deeper look into how eight of the most common mental disorders can impact your sex life—and how to take control.
Sex and Anxiety: How They’re Connected
Ever heard of arousal non-concordance? It’s when the mind and body are out of sync during sex—the body is aroused when the mind isn’t, or vice versa—and it happens a lot for both men and women with anxiety.
“Anxiety is one of the biggest contributing factors of erectile dysfunction (or ED) in males,” says Joe Kort, PhD, MSW, MA, an AASECT certified sex therapist, psychotherapist, and the clinical director and founder of the† Center for Relationship and Sexual Health in Royal Oak, Michigan. “We’re seeing a lot of younger males in their 20s and 30s come in with ED.” Research has shown that anxiety—especially at the start of a person’s sex life when self-consciousness and stress over performance are big deals—is perhaps the largest and most common cause of ED in young males. “Not ‘performing’ makes them even more anxious, which then perpetuates the erectile dysfunction,” says Kort. “But it’s not really an erectile disorder; it’s anxiety interfering with erectile focus.”
Women who struggle with anxiety also experience sexual dysfunction: They may have trouble getting aroused or having an orgasm, or even experience physical pain during intercourse. From a physiological standpoint, anxiety can override sensations of pleasure in anxious women. In fact, recent research shows that the most common type of sexual pain—genital penetration pain disorder (or PVD)—is 10 times more common in women with previous diagnoses of anxiety disorder.
How to Cope
When it comes to intimacy, sex therapists recommend a technique called sensate focus to help get yourself out of your head and reconnect with your sensual and sexual feelings.
These exercises include “non-demand touching,” which essentially refers to touching (and being touched) without any particular outcome or expectation in mind—with a partner or solo, for however long you want. It’s not about foreplay or arousal, simply touching and being touched (from head to toe) with a sense of curiosity to get reacquainted with your bodies.
The point is not to think too much about what’s happening and just experience what’s happening. If you have a partner, talking openly about your sex life, though it may be awkward at first, can help you work through some of the anxiety.
Sex & Depression: How They’re Connected
Major depressive disorder (MDD) can also cause a host of sexual issues, including impotence and erectile dysfunction in men and sexual pain and loss of desire in women. In fact, a diagnosis of depression increases a woman’s risk for the most common form of chronic dyspareunia, or pain during sex, by three times.
“Broadly speaking, depression puts a damper on your desire to have sex whether or not you’re in a relationship,” says Modesto, California, psychologist Robert Moody, PhD. People living with depression during a dating stage of life may feel less interested in putting themselves out there to make social connections and create opportunities for love and intimacy, potentially perpetuating their depression.
Brito adds that “women are more likely to experience symptoms of depression, causing them to feel insecure about their bodies, feel less desirable, doubtful about their sexual confidence, and insecure about participating in sexual activities.”
In addition to the emotional toll of negative thinking and low self-esteem, physical issues may appear down the road from lack of self-care.
When it comes to sex, women who are experiencing depression may also “experience low libido, low arousal, or have unwanted sexual pain,” she says. “Unfortunately, if an antidepressant has been prescribed, it can worsen sexual dysfunction, as most women may experience no interest in sexual activities or problems with orgasm.”
If you’re currently on medication for MDD, keep in mind that “a number of the SSRIs can take a serious hit on your libido,” says Moody. That’s because they increase serotonin in the brain, which tempers depression and anxiety but can also zap sex drive or inhibit the ability to feel sexual pleasure.
Even if you don’t have MDD, a phenomenon known as postcoital dysphoria (PCD)—when you’re flooded with a wave of negative emotions right after sex for no discernable reason, even if the experience was consensual, pleasurable, and satisfying—is surprisingly common. While the exact cause is unknown, about 46% of women and 41% of men have experienced PCD symptoms—from feeling depressed or irritable to inexplicably crying suddenly after sex—at least once according to research
How to Cope
If you struggle with depression, “talk to your provider about your medication’s side effects and to discover meds that have fewer sexual side effects,” says Brito. “Wellbutrin tends to have fewer sexual side effects” because it doesn’t affect serotonin. Remember that it’s always OK to decide you no longer want to be on a certain medication, and your doctor can start to taper or adjust the treatment or add an additional medication to your regimen.
Either way, keeping up healthy lifestyle habits can help alleviate symptoms of depression (in addition to any current medication treatment you’re on). “Recent research talks about exercise as having an anti-depressant effect,” Moody says. “If my client is physically sound to do high-intensity interval training, then that’s a routine part of what I would suggest to them.”
Brito also recommends talk therapy. “Meet with a therapist to help you heal from trauma, form empowering narratives, reduce psychological barriers, let go of shame, improve body image.”
Additionally, she says: “Practice solo sexual activities, like masturbation, to discover what you like and what gets you aroused in order to coach your partner later—if you so desire—and let them know what type of touch you like. The more you know your body, the more likely you are to enjoy sexual activities. Engage in solo sensate focus, which is a series of mindful exercises that promote body awareness, acceptance, and the ability to be present. And remember, only have sex if you desire, check-in with yourself, and give yourself permission to voice what you need sexually.”
Sex & PTSD: How They’re Connected
We know from studies that people with more traumatic experiences in childhood tend to have less satisfying sex lives in adulthood—sometimes coupled with long-lasting psychological consequences.
Those “post-sex blues,” or postcoital dysphoria (PCD), tend to show up in people living with post-traumatic stress disorder (PTSD). The few studies we have on PCD show a correlation between having a history of physical, emotional, and sexual abuse and a higher incidence of PCD, among men and women both. The general idea is that sex—even amazing, enjoyable sex with a loving partner—can be a triggering experience for you because of past traumas. Studies have shown that even experiencing orgasms can feel awful psychologically.
“If someone has been sexually abused, they’re constantly re-enacting the trauma. I call it returning to the scene of the sexual crime,” says Kort, who adds that PTSD can also interfere with someone’s sex life “by causing hypersexuality, or out-of-control sexual behavior. The individual might think that they’re always aroused, but it can actually be trauma urges, not sexual urges.” On the flip side, PTSD can also cause some people to have low-to-no sexual desire at all, Kort adds.
Brito points out that, “women are likely to experience more sexual violence and thus suffer from PTSD—not to mention domestic violence, role conflicts, gender discrimination, sexual harassment—all of which impacts their mental health. Such events can cause someone to feel inferior, isolated, anxious, and depressed, exacerbating sexual dysfunction,” she says.
How to Cope
In addition to therapy to address underlying traumas, have you heard of a concept called “aftercare”? It’s time a couple devotes to cuddling, talking, and caring for each other after sex, ensuring both partners feel at ease—especially after an intense consensual sexual experience (like kink play). This practice can be effective for those suffering from PCD or PTSD (without engaging in the BDSM behavior).
Aftercare is like a ritual designed to help both people avoid any negative psychological effects of their sexual encounter, stave off the post-sex blues, and help relieve underlying sexual shame—and sex therapists recommend a similarly soothing post-sex practice for people who suffer from PCD or PTSD, even if it’s self-care you do alone, like having a bath or reading a book.
Sex & OCD: How They’re Connected
It’s not uncommon for someone with obsessive-compulsive disorder (OCD), a chronic anxiety disorder, to report feeling bombarded by sexual obsessions, or unwanted sexual thoughts (though it’s proven tough to know for sure if these sexual thoughts occur more than other unwanted thoughts in clinical studies).
Some sexual thoughts that pop up in those with OCD may include the obsessive fear of being or becoming LGBTQ; worry over having inappropriate sexual desires (like an attraction to children, family members, religious figures, or even animals), and inappropriate mental images.
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And beyond having these unwanted thoughts, people with OCD do tend to experience a number of sexual dysfunctions, including arousal issues and a low sex drive. Both of these may perhaps be linked with other OCD-born thoughts like a fear of having sex or disgust when thinking about sexual activities—that one’s particularly common for those with obsessions related to contamination.
How to Cope
OCD, like many anxiety disorders, is marked by low levels of serotonin—a happiness hormone that surges with sex. So, in an Exposure and Response Prevention (ERP) kind of way, actually sharing a bit of sexual intimacy may help reduce compulsive behaviors in OCD.
How to get there? For those with OCD who are coupled up, try sharing a routine or ritual with your partner to help bring you closer together. Simply making physical contact with another person can up your serotonin levels, so even a 20-second hug will do the trick. Staying open with the help of communication and a playful, curious sense of pleasure-seeking can also cultivate a healthy sex life for both partners.
Of course, treatment such as therapy and medication management can help address the underlying OCD condition.
Sex & ADHD: How They’re Connected
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that can cause impulsive behavior, hyperactivity, and difficulty paying attention. Two commonly reported and increasingly studied sexual symptoms of ADHD are hypersexuality (an unusually high sex drive) and hyposexuality (a non-existent sex drive), though neither are recognized as diagnostic criteria for ADHD.
“We know that with ADHD if a person is interested in something that’s where they’re going to spend most of their time and focus. Sometimes that’s the case with sex and porn,” says Kort. From a mental health perspective, that can sometimes look like a separate addiction. Sure enough, studies have shown that hypersexuality and ADHD are common co-occurring conditions and that ADHD can even exacerbate the severity of hypersexuality in both sexes.
On the other hand, if a person with ADHD isn’t as interested in sex, they might not have the energy, desire, or focus to engage in sexual activities. Either sexual symptom can end up causing issues for intimate relationships.
How to Cope
It’s important to remember that ADHD’s most common symptoms include depression and anxiety. All of these conditions (and their medications), as we learned, can have a negative impact on sex drive. Having honest and open conversations about your sex drive with your partner is key here, and don’t be afraid to seek help from a qualified sex therapist.
Sex & Bipolar: How They’re Connected
“Impulse control disorders like bipolar can cause people to be and feel out of control with sexuality,” says Kort. Bipolar disorder commonly affects a person’s sex life by increasing libido during episodes of mania. This heightened sexuality may even receive a diagnosis of hypersexuality, or compulsive sexual behavior, which is associated with an increased incidence of risky sexual behaviors.
“During a manic episode, your sexual behavior may become impulsive and you may engage in behaviors that are not ordinary for you,” explains Brito. “For example, engaging in sexual activities with anonymous partners or more than one partner. You may masturbate or watch porn more than you wish, have an affair.”
“One of the core symptoms of having a hypomanic episode is having a high sex drive. It’s almost right up there with maxing out your credit card,” adds Dr. Moody. “It’s due to having all that energy inside of you, and sex is one of the ways it gets expended.”
On the flip side, if you are experiencing symptoms of depression, “you may experience the opposite and have a low sex drive, fatigue, worthlessness, shame, stressed, and feel worried about not wanting to sexually connect with others,” says Brito.
Interestingly, studies have found that bipolar patients in coupled relationships tend to carry on sex lives that look similar to couples who aren’t dealing with bipolar, except for one important thing: The partner with the disorder typically experiences decreased levels of sexual satisfaction in the relationship.
How to Cope
If you’re living with bipolar disorder and it’s impacting your sexual wellness, Brito offers a few tips for coping: “Maintain your medication regimen and be aware of the side effects. Understand your symptoms and know your vulnerability factors, including triggers, like lack of sleep or alcohol use. Be informed about safer sex practices and harm-reduction approaches such as condom use and STI testing. Communicate with your partner about your triggers and symptoms, as well as ways to support you to lessen the tendency for partners to blame themselves. Engage in psychotherapy or sex therapy to understand your negative cycles and create new patterns that are empowering to you, and find a support system that understands your symptoms and able to assist if needed.”
“I have my clients keep a daily mood log to track their moods on a scale of one to 10,” says Moody, “and after about a month or so, we can start to see patterns.” Tracking your moods can be a helpful tool to learn more about yourself and what might be influencing your mood changes, whether it’s hormonal or environmental. Try tracking your sex drive as well—it can be an insightful indicator of how the two arenas are related and interact.
Sex & Eating Disorders: How They’re Connected
Eating disorders are serious medical conditions that take over the way in which a person views themselves. An eating disorder distorts a person’s self-esteem, body satisfaction, and physicality—all areas that are closely linked with sexuality. These disorders also may overlap with underlying trauma issues that need to be addressed, particularly with bulimia nervosa.
People with eating disorders generally experience a number of physiological and emotional symptoms that severely disrupt their sex lives, including reduced drive, lack of self-confidence, and a fear of rejection and intimacy.
But because eating disorders can cause a person to create a false sense of self, intimacy with anyone—even a loving partner—is impacted on all levels. Spouses and partners of those with eating disorders often report that they feel emotionally distant from them, or that they come second to their loved one’s disorder.
How to Cope
If you have a partner or know someone who is living with an eating disorder, let them know you care about their healing, offer support, and be there to listen as needed. And don’t forget to take care of yourself, too.
For those wanting to enjoy sexual pleasure throughout the recovery process, try carving out time for solo play. Masturbation is a powerful form of self-love, a way to experience and discover pleasure, promote body awareness and acceptance, and build an overall more positive body image. Brito’s suggestions earlier in this article for coping with depression are helpful tips for solo sexual activities.
Sex & Substance Abuse Disorder: How They’re Connected
It’s common for individuals who abuse substances like drugs and alcohol to rely on those substances to “help loosen their sexual inhibitions and be the sexual person they want to be,” says Kort. “Sadly, in the case of methamphetamine, the drug alters the brain so that the person can’t have sex without it once they become addicted.”
Substance abuse can also “rob someone of their sexual arousal, again, causing problems like erectile dysfunction,” he adds.
Substance abuse disorder is a serious and potentially life-threatening disorder that shouldn’t be dealt with on your own. Entering treatment as soon as possible is the most important tip we can give here.
If you or someone you know needs help with a substance abuse disorder, call SAMHSA’s National Helpline (a free, confidential 24/7 treatment referral and information service): 1-800-662-HELP (4357)
In case of an emergency, call 911