Mental Health & Libido

Reproductive wellness is more than just the health of the reproductive system – it also includes human sexuality!

For many folks, sexuality is an essential part of their life and well-being – studies show that many women consider sex important to their quality of life but there are often significant barriers to accessing the resources they need (1).

There is tons of stigma around sexuality, especially for those who identify as women. To this day, there is an incredible amount of shame in discussing sex as both a physical and emotional experience, and almost no high-quality education available to youth or adults about it. It would explain why so many people turn to the Internet for help, where misinformation, pseudoscience and even more stigma floats around.

Studies have even shown that people feel uncomfortable discussing sex and their concerns with their providers – out of fear of embarrassment and perceiving assessment of sexual health as something to be initiated by the provider (2). And on the other side of the coin, providers don’t always have the tools they need to both assess sexual health concerns and treat them appropriately.

A significant contributing factor to changes in libido and sexual health concerns is mental health (who would have thought, hey?). When mental health is impacted, it would make sense that the desire to engage in sexual activity is low, especially if other factors like poor sleep quality, difficulty in interpersonal relationships or other time and body constraints are present.

Newer studies surrounding the COVID-19 pandemic have even demonstrated negative impacts on libido – women reported lower frequency of sexual activity and lower desire to engage, commonly attributed to fears and worries of health conditions of loved ones and themselves and loneliness. Higher use of stimulants such as caffeine and an increase in depressive symptoms have also been associated with drops in libido as well (3).

Let’s be honest for a second - if your focus is on caring for loved ones when they are ill or trying to keep yourself safe during a global pandemic, it doesn’t exactly set the stage for sexy time. A reasonable and valid response to such an extreme scenario.

Now I suppose it’s worth discussing the medical side of low libido. Hypoactive sexual desire disorder (HSDD) is a persistent deficit in “sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty” (2). Note the aspect of causing distress – this wouldn’t apply to folks who don’t express interest in sexual activity and don’t experience negative impacts on their functioning or relationships. It can be tricky to diagnose (and not always necessary, in my opinion) as physicians often report feeling low levels of confidence in identifying it, time constraints in actually seeing their patients, and a lack of treatment options for them to use (2).

Again, likely a result of stigma and shame in discussing sex, and considering how saturated medicine is with men it would make sense that women bringing their questions and concerns about sex to their doctor doesn’t sound appealing.

So what can we do to promote mental health and bring libido into the picture too?

Sexuality can be thought of as a fluid process, where no two people experience it the same way and every experience can be different. It’s been framed as a “more of the gas, less of the brakes” – if you haven’t read it before, I highly recommend Come As You Are by Emily Nagoski where this is laid out in more detail. In essence, identifying the things that reduce inhibitory factors to sex (like medications, discomfort or pain, and trauma history) and bump up the things that are sexually “excitatory” (like adequate sleep, stress support and time to get comfy).

We also need better education for providers to get comfortable asking about sexual health and know what to offer their patients. Better collaboration across medicine and mental health is essential to treat all aspects of a persons’ needs, and give them the right information about their bodies.

There’s also more and more research being published about the benefits of a “slower life strategy” on libido and general health – getting mindful about our lifestyles and creating space to relax is a great way to feel sexy (4)!

In short, mental health translates beautifully into sexual health – it’s important we care for our brains as much as we care about our reproductive organs.

References:

1. Basson, R., & Gilks, T. (2018). Women's sexual dysfunction associated with psychiatric disorders and their treatment. Women's health (London, England), 14, 1745506518762664. https://doi.org/10.1177/1745506518762664

2. Parish, S. J., & Hahn, S. R. (2016). Hypoactive Sexual Desire Disorder: A Review of Epidemiology, Biopsychology, Diagnosis, and Treatment. Sexual medicine reviews, 4(2), 103–120. https://doi.org/10.1016/j.sxmr.2015.11.009

3. Szuster, E., Kostrzewska, P., Pawlikowska, A., Mandera, A., Biernikiewicz, M., & Kałka, D. (2021). Mental and Sexual Health of Polish Women of Reproductive Age During the COVID-19 Pandemic - An Online Survey. Sexual medicine, 9(4), 100367. https://doi.org/10.1016/j.esxm.2021.100367

4. Sýkorová, K., & Flegr, J. (2021). Faster life history strategy manifests itself by lower age at menarche, higher sexual desire, and earlier reproduction in people with worse health. Scientific reports, 11(1), 11254. https://doi.org/10.1038/s41598-021-90579-8