Let's Talk About Sex

Mental conditions can have a huge impact on intimacy, but it’s not something to be ashamed of.

By Lauren O'Shaughnessy

Noteworthy

  • Mental conditions can lower sex drive, which when unaddressed, often puts an emotional strain on a relationship.
  • Promiscuity and sexual violence have wrongly been associated with mental instability. Sexually active women are frequently seen as being unstable or erratic, and sexually violent men often use mental illness as an excuse for their behavior.
  • No one should be embarrassed to talk about their sexual health. Doing so comes with a wide range of benefits, including deeper connections with our partners and ourselves.

We see it on posters, commercials and TV shows. Magazine covers. Music videos. Instagram feeds. Even in our politics. But despite its media abundance, sex is often left out of the conversations that matter.

In our personal lives, sex-based discussion can be awkward and tense. We often shy away from it with partners, friends and doctors, leaving us with no real outlet to dissect what is for most people, a huge aspect of life. And to no one’s surprise, miscommunication and sex do not mix well. Unaddressed intimacy issues can put tremendous strain on relationships, as well as a person’s connection with their own body.

“Sexual preferences should be easy to talk about because they ultimately lead to your pleasure,” says sexologist Carli Blau, “but they’re difficult to discuss because we fear judgement.” Women normally worry about coming off too sexually active or promiscuous. Men worry about the opposite — underperforming. In both cases, discussion is sacrificed at our own expense. We all have urges and preferences, we all have questions, and yet we choose to live with them unanswered rather than risk an uncomfortable interaction.

It’s not just sexual preferences that require discussion, but concerns. Portrayals of sex in porn and mainstream media have warped our understanding of what “good” or “normal” sex looks like. They’ve also changed the way we understand sexual stamina and libido. On screen, people are enthusiastic and fully focused. There’s little hesitation or confusion about what is wanted or where things are going. But these scenes aren’t realistic. Our sexual experiences are as complicated and awkward as our non-sexual ones. Holding them to simpler standards undermines how amazing, strange, enlightening and confusing intimacy can be.

When combined with another stigmatized topic, like mental illness, sex becomes even harder to discuss.

Misconceptions, such as the belief that promiscuity and mental instability go hand in hand, keep people from openly sharing their sexual history with others. Sexually active women in particular, are afraid of being labled unstable or erratic for their lifestyle choices. On the flip side, sexually violent men often use mental illness or emotional trauma as an excuse for abusive behavior. In both cases, mental health is leveraged as a weapon, or a justification, for behavior that should be evaluated independently.

That’s not to say that mental health and sexual health aren’t inextricably linked. They are, just in different ways.

Sex is thought of as a hyper-physical experience, but desire actually starts in the brain. When we see or hear something arousing, our mind releases feel-good chemicals, like serotonin, that travel through our body and increase blood flow to our sex organs. During orgasm, regions all over the brain light up, while the ventromedial prefrontal cortex and amygdala shut down, similar to what happens when taking heroin. After sex, activity in the amygdala remains low which decreases fear and anxiety (even if only for a moment). Post-coital cuddling is a part of our biological response too. It’s believed that cuddling releases a cocktail of hormones, including dopamine, serotonin and oxytocin. It’s been shown to lower blood pressure, heart rate and decrease depression.

Since I started treating my anxiety and depression with prescription medication, I have no sex drive. It’s incredibly hard on my partner,” said one sufferer in a round up of sex-related experiences on The Mighty.

Mental disorders can disrupt this system and mess with other emotions that contribute to attraction. Anxiety and depression have been shown to lower sex drive. The stress and mood swings that come with both conditions can make it difficult to relax and focus on the present moment. Medications used to treat anxiety and depression, like SSRIs, can also cause decreased libido.

In men, this may present as erectile dysfunction. In women, sexual aversion disorder. With certain conditions, like PTSD, these could be related to childhood trauma or past sexual abuse. In those cases, sex isn’t only avoided, but a huge source of anxiety that could trigger panic attacks or other episodes.

“Since I started treating my anxiety and depression with prescription medication, I have no sex drive. It’s incredibly hard on my partner,” said one sufferer in a round up of sex-related experiences on The Mighty. “Quite often, I find myself unable to bear the touch and kisses of my fiancé,” said another. “It just feels like my skin is over sensitive and my brain is violently reacting saying, ‘No! Nobody touch me!’ even if the touch is absolutely not sexual.”

Despite how embarrassing these issues may feel, ignoring them will only make things worse. Open communication is a necessity. Establishing comfortability with the topic is key in helping couples work through underlying concerns, desires and frustrations. If it’s a new subject in a relationship, couples should start slow and gauge one anothers reactions. The conversation is imperative, but so is being respectful of boundaries.

Sex is thought of as a hyper-physical experience, but desire actually starts in the brain. When we see or hear something arousing, our mind releases feel-good chemicals that travel through our body and increase blood flow to our sex organs.

Sending links to articles and videos on the topic can help contextualize what someone is going through. The person battling low sex drive or other mental health induced issues should help their significant other understand that these problems exist outside of their attraction to them, and that they haven’t done anything wrong.

Once out on the table, there are a number of next steps to explore. Some people go the couples sex therapy route. Others embark on their own treatment journey, which if successful, often brings back their sex drive. If medication is to blame, discussing a switch with a professional is recommended. And education is never a bad option. Sufferers should read up on what they’re going through, how others have dealt with similar scenarios and how they can become increasingly comfortable with their body and sexual urges (or lack thereof).

Conversations about sex are as uncomfortable as we make them. Getting over that initial anxiety can open up a world of possibilities within relationships and with ourselves. Our advice? Just start talking.

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