Reprinted from the "Couples" issue of Visions Journal, 2015, 10 (4), p. 27
For many adults sexuality forms an integral and cherished part of their lives. Whether that sexuality is expressed with a partner, with several partners, or solely with ourselves, our sex life can be a source of meaning and great pleasure in our lives.
According to the Canadian Mental Health Association, 20% of us will struggle with mental illness in our lifetimes.1 That means that even if you don’t struggle with mental illness yourself, it’s likely that mental illness will affect your life through someone you know or love—including those we may be sexually intimate with.
Does a struggle with mental illness mean losing one’s cherished sexuality? No, it certainly doesn’t. But many people struggle far more than necessary because they don’t have the information and support they need to address the challenges that can arise around sex and mental well-being.
Sex is a matter of mind
We often think of sex as something our bodies are doing, but a lot of our sex life takes place in our brains. It’s important to realize that, for all genders, our thoughts and feelings play a vital role in getting us turned on and keeping us that way.
Anxiety or depression can strongly affect arousal and can definitely ruin the mood sometimes. Anxiety and other related mental health struggles can make it hard to be relaxed enough to have or enjoy sex, overshadowing it with a host of worries or intrusive distractions. When we are very unwell and struggling just to function, sex is rarely at the top of our mind.
The struggle with mental illness in a variety of forms can hurt a person’s self-esteem and make them feel unworthy of sexual attention. For example, a person may have an unrealistic view of their own body and may actively seek to deny or discipline the body as a way of coping. In these cases, it’s important to be critical of the beauty norms we are shown by the media, step away from the practice of measuring or defining ourselves, and to seek to rediscover our love and appreciation for our bodies and our sexual selves.
Substance use may put limitations or restrictions upon one’s sexual interest. Some drugs can affect your brain in ways that make you less able to feel pleasure from sex for periods of time after their use.
Substance use can be a problem when it leads to sexual behaviours one may not feel proud of. Under the influence of drugs, you may do things that you regret, such as having sex with someone you wouldn’t have while sober, or doing things you normally might be uncomfortable with; such as being filmed or photographed during sex, or having sex in public spaces. These personal-boundary transgressions can lead to shame and loss of self-esteem and cause conflict in relationships.
Additionally, addiction or mental health problems like mania may be associated with intentionally seeking risky situations such as having unprotected sex with strangers or seeking ever escalating levels of violence, humiliation, and bodily harm (both in real life and in the pornography one is consuming). This can impact a person’s ability to find interest in having sex with their steady partner, because the sought-after thrill or risk is no longer present.
The social stigma of mental illness and addiction can make finding partners difficult for some. It’s important that we work together as a society to promote inclusive and supportive attitudes around addiction and mental illness.
Medication can affect sex too
It’s important to know that some medication for mental illness may have side effects that can affect sexuality. For example, several antidepressants can inhibit arousal. Other medications may cause weight gain or temporary impotence, both of which can impact a person’s sexual self-confidence. As a patient, you have a right to know about those effects.
It’s a good idea to ask your doctor about the impact of your medication upon your sexuality and to strategize with them about what is best for your individual situation. With good treatment and communication, however, there’s every reason to believe your sex drive will come back.
If you find it difficult to talk to your doctor, it might be worth connecting with a sexual health clinic. Clinic staff can give you some advice on how to broach the topic and give you names of clinicians with particular training in this area of concern. A list of clinics throughout BC can be found on the Options for Sexual Health website at www.optionsforsexualhealth.org.
Sensuality can help sexuality
Sex is not the experience depicted in movies, whether from Hollywood or the porn industry. Sex is far more complex.
Real sex includes creativity and laughter, but also confusion, mistakes, clumsiness, misunderstandings and varying intensity of desire. These are all healthy parts of sexuality, and by creating space for all of these in our relationships, we make it harder for anxiety and negative thoughts to undermine our sexual well-being.
If my clients are finding sex stressful, or if they are struggling with arousal or orgasm, I often suggest they take the pressure out of sex. I suggest they do this by committing to be sensual with a partner without planning to have things end in penetrative sex or orgasm. This means focusing on sharing different types of pleasure and intimacy with your partner. These can include back rubs, intimate massage, tickling, hugging, synchronized breathing or just holding each other while naked.
By changing the “end point of sex,” we allow ourselves to explore the variety of experiences that exist when we sensually relate to another human being. And, we take the anxiety-inducing focus off erections, penetration and orgasms.
For people whose partners are struggling with mental illness, several common concerns can arise. When your partner’s struggle is affecting their desire level, it’s hard to not get frustrated or feel like you’ve done something wrong. Sometimes these frustrations and fears can leave you doubting your attractiveness or desirability. This can hurt the self-esteem of both parties and really impact intimacy and closeness in the relationship.
In these cases, it’s really important to open up lines of communication and to recognize that the illness, not the other person, is getting in the way of you both having a great sex life. By allying with each other against the influence of the mental illness, you can work together to overcome the isolation and blame that mental illness feeds upon.
Be tentative and sensitive to your partner’s anxieties around mental health when you are beginning this conversation. It’s best to ask permission before trying to ‘fix’ or ‘help.’ If they are open to working with you, you can then strategize together and come to an understanding and acceptance of the effect mental illness might be having on the relationship.
When you become an ally to your partner and deepen your communication, your sex life is certain to benefit. Great sex is often based on great connection, and by working on your communication you are nurturing that connection.
Get educated—get 'sex positive'
One of the best things you can do for yourself and your relationship when struggling with mental well-being and its impact on your sex life is to get educated about sexuality. This can be done through good resources or by going to see a “sex positive” counsellor or psychologist for help with these issues. Depending on your comfort level and openness with your partner you may wish to go to sessions alone or together.
Sex positivity is the assertion that sexuality is fundamentally a good thing in life and not something naughty, shameful or only healthy in certain types of relationships. Sex positivity asserts that expression of our desire, our gender identity and sexual orientation is a basic part of a healthy lifestyle.
Sex positive mental health workers believe that we are all entitled to knowledge about our sexuality and that good scientific knowledge about sex is necessary for us to be able to make informed sexual choices. By educating ourselves, whether we are young or old, we can make sex better for everyone.
We all have a right to enjoy and appreciate our sexuality. Do your best to not let mental illness steal that away from you and the ones you love!
About the authorDaniel is a counsellor with Dr. Bianca Rucker and Associates, a sex and relationship therapy practice in Vancouver. He also works for BC Society for Male Survivors of Sexual Abuse. Trained as a sexual health educator by Options for Sexual Health, Daniel advocates for sex positivity and wellness
Canadian Mental Health Association. (2014). Fast facts about mental illness. www.cmha.ca/media/fast-facts-about-mental-illness.