Mental health and sexuality

Mental health and sexuality…what a tangled web…

I’m talking here about mental health conditions such as depression, anxiety, personality disorders etc rather than learning disabilities although there will be overlapping issues.

I’m also not going to look at vulnerability to exploitation or abuse here. I think that’s a big topic which deserves its own space and overlaps a lot with physical disability.

This blog post will be partly informed by my own experience of mental ill health; anorexia, depression, anxiety and suicidal feelings as well as reading I have done into the subject.

There’s two key areas I want to look at; sexuality causing mental ill health and the impact mental ill health has on sexuality.

Sexuality causing mental ill health

Sexuality is a complicated, very highly personal identity to navigate. In my case I am a bisexual woman who wasn’t really aware that bisexuality was a real thing and an identity I could own until I was about 18. In my case, a history of mental ill health predates the significant stage of forming of my sexual identity. I’ve had depression for as long as I can remember and definitely dating back to when I was seven and experienced my first suicidal feelings. For other people, unfurling sexuality may be the trigger for mental illness.

We still live in a society which makes it hard to be anything other than heterosexual. LGBTQA teens have higher rates of mental illness. You’re at a stage in your life when your creating your sexual identity, you may feel you don’t fit it, you may be persecuted. And there’s a host of additional factors which come in if you don’t think you’re the gender you’ve been performing for the last ten fifteen years. A confusing time for anyone, adolescence as LGBTQA can be far worse.

This increased risk of mental health issues continues past adolescence. For example, in Australia, it’s estimated that 36.5% of trans people and 24.4% of lesbian, gay and bisexual people will at any time meet the criteria for a major depressive episode. Trans women (male to female) are especially likely to suffer from mental health issues. Gay, lesbian and bisexual Australians are more than twice as likely to experience an anxiety disorder as heterosexual Australians are (31% compared to 14%).

Historically, the World Health Organisation only removed homosexuality as a formal psychiatric diagnosis in 1992. It’s still illegal in over 76 countries. Even if you are lucky enough to live in an accepting community, you’re still exposed to discrimination and hatred and it’s hard for that not to impact you in some ways.

The impact of mental ill health on sexuality

Looking now at the impact of mental ill health on sexuality I’m going to talk about the mental illness first and then move on to any effects that medication plays.

  • You may feel increased or decreased sexual desire
  • You may experience low self esteem or symptoms which make you believe you’re unattractive or unworthy
  • You may experience loss of interest in people, activities etc
  • You may experience loss of motivation
  • Your self care skills may be affected leading to poorer hygiene which in term affects confidence
  • You may find it difficult to meet people, for example if you’re spending long periods of time in hospital or find it difficult to leave your home

Obviously a loss in sexual desire is going to have a huge impact on your sexual expression but the other examples show that there’s lots of factors at play here. With my anorexia at it’s worst, I would have struggled to let someone else see or touch my body. I had a head filled with calorie counting and self loathing and there was no space in there for sex. I was also constantly exhausted and had no interest in anything. With depression, I find myself in a place where I think no one can like me, that I’m worthless and horrible and that’s not conducive to a good sex life! I also self harm and again, I would find it incredibly difficult for someone to see recent injuries.

And if your mental health problems are related to issues such as abuse or rape, then the subject gets even more complicated.

And then there’s the medication… Side effects of medication can cause loss of libido, vaginal dryness, problems getting an erection, problems orgasming, weight gain which can affect confidence etc.

I want to briefly mention substance or alcohol misuse (which can occur because of, or be considered, a mental health issue) because that can have quite a huge impact on sexual behaviour. For example, if you’re under the influence of drugs or alcohol, you may do things you wouldn’t normally do; having sex with someone you wouldn’t normally, having unprotected sex or engaging in sexual acts which you wouldn’t normally (eg sex in public places, being filmed, particular types of sex). Similar behaviour may also arise from a manic state.

As you can see, there’s a lot of interacting issues when it comes to mental ill health and sexuality. I could go on and on, but really, the purpose of my post was to highlight the issue. And try and get people talking about it. Mental health and sexuality on their own aren’t topics people talk about much so mental health and sexuality together doesn’t stand much of a chance.  And yet, communication is a key part of building a healthy sex life.

If you need help with any of the issues raised, please speak to your GP, care team, partner, friends or helplines.

In the UK, the Samaritans are open 24/7 to listen to you.

If you’re struggling with your sexual orientation, have a look at Mind’s useful contacts.


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