We often think about sex as something physical rather than mental, but a lot of your sex life takes place in your brain—that’s where intimacy comes in Intimacy involves trust, acceptance, and connection with another person. While you can have sex without intimacy and experience intimacy without sex, they go hand in hand and often still impact each other. Physical sex complications can strain your emotional connection with your partner or feeling distant from them can cause functional issues with sex.
Conversations about sex and mental health usually focus on how living with a condition like depression or bipolar disorder can impact your sex life. We don’t often talk about the sex- and intimacy-related challenges that can arise during recovery:
Change in Libido
What is it? An individual’s libido is their sex drive or desire for sexual activities. It is influenced by a variety of biological, psychological, and social factors.
How can recovery impact this? Depending on your relationship to sex, recovery can alter your libido—healing attachment trauma, a need for external validation, or body image issues may increase or decrease your sex drive. Hyper- or hyposexuality can also be symptoms of a mental health condition that change once the condition is being managed. Some people who incorporate medication as part of their recovery plan may experience a change in their libido due to the medication they are taking.
What is it? Sexual dysfunction refers to a problem that prevents you from wanting or enjoying sexual activity. This includes erectile dysfunction, vaginal pain/discomfort during sex, and difficulty with ejaculation and orgasm. (NOTE: lack of sexual desire due to sexual dysfunction is different from and unrelated to asexuality, which is not a mental health symptom or condition.)
How can recovery impact this? Sexual dysfunction can be related to the libido changes that sometimes occur during recovery. It’s also a common side effect of mental health medications, particularly antidepressants and antipsychotics.
What is it? Your body image is the way you think and feel about your body.
How can recovery impact this? It’s common for your body to change as your are in mental health recovery—whether from medication, less stress, or overcoming an eating disorder. Even if it’s for the best, seeing these changes can be distressing and make sex and intimacy uncomfortable or fear-inducing.
What is it? Recovery isn’t linear, so addressing sexual challenges won’t be either—as you go through different phases of your healing journey, your sex life will likely change.
How can recovery impact this? You may feel triggered or elevated during different life stages or have future phases of hyper- or hyposexuality. Fears and insecurities can also be triggered at any time. Even if you feel steady in your recovery, coping with the lack of permanent healing can be difficult.
What to Do
- Wait it out. Especially if you’re on medication—side effects, particularly from SSRIs, can improve over time. One study found that antidepressant-induced sexual dysfunction dissipates in six months for approximately 80% of female patients.
- Evaluate your personal needs and wants. Sometimes dissatisfaction is more related to comparison, or what you think you should want or have, rather than what you truly want. The value of sex is unique to each individual. If you (and your partner(s), if applicable) aren’t bothered, then all is well.
- Talk to your doctor. For many people, sex and intimacy is part of their overall health and wellness. Many things can bring about intimacy issues—your doctor can help you determine what the contributing factors may be. If your sexuality is important to you and you’re on a medication that kills your sex drive, then it isn’t the right fit. Tell your doctor about the challenges you’re facing and see if lessening your dose or switching medications could be a good choice for you.
- Be creative. If you’re in a relationship, challenges with intimacy can cause (or escalate) tension between you and your partner(s). Step out of your comfort zone and try new things—both in and out of the bedroom. New and exciting sexual experiences can boost your sex drive, and non-sexual acts of intimacy can foster deeper trust and romance.
- Get help from a sex therapist. Struggling with your sex life can be stressful. Sex therapists are licensed mental health professionals who specialize in sex-related issues—they can help with challenges like you and your partner(s) having mismatched sex drives, inability to orgasm, and communication about sex.