It's very common for depression, anxiety, PTSD and more to affect a couple's sex life.
By Stephanie Buehler and Rachel Needle — Written on Sep 09, 2013
According to YourTango Expert Dr. Stephanie Buehler, "many people are completely unaware that they have a mental illness, let alone that the mental illness is affecting their sexuality." Here, two experts discuss the ways in which mental illness affects a central aspect of couples' lives—their sexual enjoyment of each other. It is a highly unexplored topic with little research, and we think it's incredibly important to shed light on it so that couples can begin to work toward happiness in this area. After all, according to our survey of mental health professionals, 15-30 percent of married couples struggle with mental illness (that's as many as 3 in 10!)
From Dr. Stephanie Buehler:
When it comes to having an effect on sexual enjoyment, mild depression and anxiety are very common. Depression can cause someone to feel shut down and withdrawn. Depressed people will often say that they no longer enjoy something they used to, sex being one of those things.
Anxiety disorders are also very common. They include not just panic attacks, but also generalized anxiety, which are symptoms like worrying a lot more than would be expected for a given situation. Anxiety disorders also include post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder. PTSD can cause sexual problems, and not just if the trauma is a result of sexual molestation. Sexual problems from PTSD are also experienced by returning soldiers.
Obsessive-compulsive disorder is rare. Most people know someone who has obsessive-compulsive personality disorder, not full-blown OCD. When someone has OCD, they can get distracted by little things during sex, like the creak of mattress springs.
It's important not to diagnose mental disorders on your own. People sometimes read things online and come in having diagnosed themselves with OCD, ADHD, and so forth, when really they just have normal problems or habits. You also should not diagnose your partner. For example, not everyone who was molested as a child has PTSD. You can't always point to that as being the factor that causes a sexual problem. You have to look at many, many factors to really understand what is going on.
If you already have a diagnosis from a mental health professional such as a psychologist or marriage and family therapist, then you can explore whether or not it is contributing to problems in your sex life. Unfortunately, extremely few psychotherapists are aware of the connection between the two, which is why I wrote my book Sex, Love, and Mental Illness: A Couple's Guide to Staying Connected.
Here is a case study about sex and mental illness from an article I wrote for The Therapist, the magazine of the California Association of Marriage and Family Therapists.
Case study: Clyde and Paula. Clyde and Paula, a Caucasian couple in their 40s and married for 15 years, were facing serious difficulties stemming from the fact that Clyde suffered from Bipolar I Disorder. Like many people with Bipolar I, Clyde felt flat and lifeless when he was on his medications. When he went off his medications, he would become hypersexual, contacting escorts and spending thousands of dollars. His wife would recognize that he was manic and insist he go to the psychiatrist, who would put him back on medication. Despite medication, Clyde still had a strong drive. However, Paula would feel so betrayed by Clyde that she would not want to have sex with him, leaving Clyde feeling confused and rejected. Clyde needed to better understand his sexual needs and energy, and find appropriate ways to channel his attention toward Paula.
From Dr. Rachel Needle:
Sexual satisfaction is an important component of a relationship, as it contributes to both relationship satisfaction and overall quality of life. Mental disorders, such as substance abuse, mood disorders (such as bipolar disorder and depression), anxiety disorders, and eating disorders, introduce challenges to a relationship and can interfere with sexual functioning and satisfaction. In addition to the symptoms and characteristics of certain mental illnesses affecting sexual function, the side effects of some psychotropic medications can exacerbate these problems, or can lead to problems with sexual function when they don't already exist.
There is a high prevalence of sexual dysfunction in the U.S. in both males (31 percent) and females (43 percent). Studies have shown that when mental illness enters into the picture, those numbers increase. Sexual dysfunction is a frequent symptom of depression. Depression is characterized by anhedonia (a loss of interest in previously enjoyed activities), decreased energy, lowered self-esteem, and irritability. Needless to say, any combination of these symptoms can impair sexual relationships. Approximately 35-47 percent of people with depression will experience some sexual problems. Additionally, being depressed makes it more difficult to experience orgasms.
In addition, sexual dysfunction is a potential side effect of all classes of antidepressants. Antidepressant medication can contribute to sexual dysfunction when it does not already exist, or can worsen sexual problems. "Between 30 and 70 percent of people who take antidepressant medications experience sexual problems," which can range from decreased sex drive to difficulty with orgasm, difficulty getting or sustaining an erection (erectile dysfunction), vaginal dryness, and decreased sensation. Sexual dysfunction caused by depression or antidepressants can impact the relationship in general, and can lead to psychological distress, lowered self-esteem, and decreased quality of life.
More sex advice from YourTango:
But there is hope! First, there are a number of new medications that may boost mood and decrease other symptoms of depression without impacting sexual function. It is important to communicate honestly with your doctor about your sexual issues so that he or she can adjust your medication as needed. Individual therapy and therapy with your partner can help with issues regarding your sexual functioning caused or exacerbated by depression. Individuals with mental illness can have a healthy sexual life with their partner. No matter the limitations you or your partner might face emotionally, mentally, or physically, you can find viable solutions that will help you have a pleasurable sex life and relationship.
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Case study: Pam and Bob. Pam is a 25-year-old Caucasian female who recently got married. Throughout her life, Pam had experienced episodes of Major Depressive Disorder (MDD). Six months after marrying Bob, Pam began to experience symptoms of depression including feelings of sadness, loss of interest in activities she previously enjoyed, excessive sleeping, irritability, and decreased appetite. Although she managed to go to work on most occasions, there were some days where she found it difficult to even get up. Pam went from initiating sexual activity with Bob at least twice a week to not reciprocating when he initiated. When Bob would confront Pam about not being sexual with him (about once a month), she would agree to have intercourse, but was unable to become aroused or have an orgasm. Pam stated that her decreased mood and lack of interest in sexual activity was significantly impacting her relationship, as Bob was becoming irritable and angry that she never wanted to do anything fun—including have sex.
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