Intimacy and Mental Illness

We live in a hyper-sexualized society, but we seldom talk about the reality of sex, and even less about the reality of sexual problems.

If depression doesn't sap any sexual desire you have then the meds you're on may well take care of that for you. On the other hand, if you have bipolar disorder and you get manic, you may be ready to get it on with the next eligible (or not-so-eligible?) person that happens to walk through that door.

So, how does one navigate sex and mental illness?

Illness and Sex Drive

We'll get to medications in a minute, but let's start off with the illness itself. Different mental illnesses have the potential to get in the way when it comes to a number of different aspects of sexy time.

One of the major symptoms of depression is anhedonia, an inability to feel pleasure—even with things that are normally pleasurable. This can totally shut down the sex drive.

People with bipolar may move from the lack of libido in depression to the raging sex drive of mania. Unfortunately, the filter that most of us have when deciding whether or not to take our pants off can go flying right out the window in mania. And using protection? Pshaw! Of course, all of this can come right back to bite the person in the butt (or wherever) once the mania subsides.

For people with psychotic illness like schizophrenia, the illness may put a damper on the libido, but occasionally sex-related things may become involved in the delusional system, at which point judgment can be pretty iffy.

Many people with PTSD are hyper-vigilant. They have an exaggerated startle response, and they may have difficulty feeling safe, especially in intimate situations. Whether their trauma is sexual or not, the vulnerability of an intimate encounter may trigger flashbacks or other trauma-related symptoms.

Psychiatric Medications

Unfortunately, some meds can just shut that sh*t down. Antidepressants, in particular the SSRIs, are notorious for sexual side effects. Luckily, some are better than others—bupropion being one example.

Antipsychotics can also impact sex drive and sexual functioning. Certain drugs are much more likely than others to have this side effect, so talk to your prescriber about switching if this is an issue for you.

Some medications, like the mood stabilizer valproic acid, can cause birth defects, so it's important to make sure you're using protection. The mood stabilizer carbamazepine can also cause birth defects and can get in the way of birth control pills doing their thing, so it's important to use another form of protection. This can require some thinking ahead for gals with bipolar who get hyper-sexual when manic.

It's important to talk to your health care provider about theses issues. They're well aware of these potential side effects from medications, but they have no way of knowing that it's happening to you unless you tell them.

Autoerotic Activity

If there's no partner in the picture (or even if there is), a little self-love can't hurt. Orgasm releases feel-good chemicals like dopamine and oxytocin, so don't let your illness/meds prevent you from orgasm, work it! It might take a bit more time and stimulation than usual, and that's where toys can come in handy.

Issues around sex and mental illness might feel hard to talk about it, but that's why it's really important that we do talk about it. It's okay to have problems with sex, and there's no reason to do that in silence. It's important to realize that you're not alone in whatever challenges you may be experiencing. Your sexual health and well-being matter, and the fact that you have a mental illness doesn't make it matter any less.

Finally, I wanted to mention this book for any women who struggle with vaginismus, or other conditions, that cause pain during sex. There is often a major mental component that goes along with the physical component, and Victoria Johnston does a great job of addressing that in her book Living with Vaginismus.