The Connection Between Intimacy and Mental Health
Written by Leann Poston, M.D.
Mental health and intimacy are two critical aspects of our lives. Healthy and intimate interpersonal relationships are an important part of one’s mental health. Sex and intimacy release a flood of neurotransmitters such as dopamine, serotonin, and oxytocin, which can ease some mental health symptoms. However, some people may find it difficult to engage in physical intimacy due to mental health conditions.
The ability to establish and maintain sexual intimacy is heavily influenced by one’s mental and emotional health. Marriage and sexual activity are on the decline, according to studies, even among younger generations. Is it possible that mental health conditions like anxiety and depression played a role in this finding?
If you are more focused on career than relationships, at this point, other studies show that sex affects work productivity. Mental health, intimacy, and sexuality are all facets of being a healthy human and, as such, play an important role in happiness at home and work, as well as productivity.
Mental health issues can impact both men’s and women’s sexual lives. What follows summarizes the key symptoms many people with mental health conditions experience and what researchers have discovered about the links between these conditions and sexual dysfunction.
Anxiety is that uneasy feeling that something bad is about to happen. Anxiety can be beneficial by warning us that something is not right. It can be protective and even motivating. It becomes a problem when it is generalized and affects our ability to function. Symptoms of excessive anxiety include stomachaches, shaking, avoidance behaviors, and excessive worry. All of which can negatively impact libido and feelings of intimacy.
Generalized anxiety and performance anxiety are common causes of erectile dysfunction. Inability to perform increases anxiety, triggering a vicious cycle. Sexual performance anxiety affects 9-25% of men and contributes to premature ejaculation and erectile dysfunction (ED). ED can affect a man’s self-esteem, which can increase stress in a relationship. Oral ED medications are effective for psychogenic ED and premature ejaculation (Pyke, 2019). For men in whom oral ED medications are ineffective or cause unwanted side effects, injectable ED medications, such as Trimix, are a potential solution.
Besides performance anxiety, ED can be caused by vascular, neurogenic, and hormonal factors. One common cause is testosterone deficiency (Rew & Heidelbaugh, 2016). If you feel that testosterone deficiency contributes to your ED symptoms, contact the medical professionals at Invigor Medical to see if you are a candidate for testosterone replacement therapy.
Sexual performance anxiety affects 6-16% of women (Pyke, 2019). Women who are experiencing anxiety may have difficulty becoming aroused or having an orgasm. Anxiety-related muscle tightening can cause pain during intercourse. The physical sensations associated with arousal can also be associated with threatening feelings in anxious women. Letting go and becoming vulnerable can be unsettling and be misconstrued as thoughts of potential harm (Basson & Gilks, 2018).
ADHD is a disorder marked by impulsive behavior, hyperactivity, and difficulty paying attention. If you are living with ADHD, you may struggle with hypersensitivity to sensory stimuli, making touch feel irritating or stress-provoking at times. You may also be easily distracted and lose focus. Distraction may be interpreted as rejection by a partner. Individuals with ADHD also report hyposexuality and hypersexuality, or unusually low or high sex drives.
Researchers found that the most prevalent findings reported by men with ADHD include orgasmic problems, premature orgasm, and negative emotions during or after sex. Males also reported a higher level of sexual aversions and decreased desire when compared to the general population (Bijenga et al., 2017).
Researchers found that the most prevalent sexual dysfunction reported by women with ADHD was difficulties attaining sexual excitement, orgasmic problems, and sexual aversion (Bijenga et al., 2017).
Bipolar disorder is characterized by having episodes of both mania and depression. Symptoms of manic episodes include endless energy with euphoria, a decreased need to sleep, racing thoughts, and poor decision making. Mania can result in hypersexuality, which can be destructive when coupled with impulsivity, risk-taking, poor judgment, and expansiveness. During the depressive phase, you may feel overwhelming sadness and reduced energy. Depression can lead to a decreased sex drive. Medications used to treat depression can exacerbate symptoms (Bella & Shamloul, 2013).
Men may experience hypersexuality or an increase in sexual activity during episodes of mania. Impulsive behavior may increase the risk for sexually transmitted diseases. During depressive episodes, men may lose interest in sex which can lead to relationship problems. Bipolar disorder has been linked to an increase in the prevalence of sexual dysfunctions such as ED.
Women living with bipolar disorder may experience different symptoms that adversely affect intimacy than women with depression alone. Those with bipolar disorder often experience difficulties with desire, arousal, and achieving orgasm. They may also engage in more risky sexual behaviors, change partners more frequently, and have increased thoughts of suicide and death (Basson & Gilks, 2018).
Depression is defined as having a period of at least two weeks during which a person experiences a depressed mood or a lack of interest or pleasure in daily activities and had symptoms associated with depression. According to one study, when people with depressive symptoms were not taking medications, 70% lost interest in sex. Participants in the study reported that losing interest in sex was the worst symptom of depression they had experienced. There was a direct relationship between libido loss and the severity of depressive symptoms. Certain antidepressant medications can also cause a decrease in libido (Phillips et al., 2000).
Men are likely to lose interest in activities such as sex when struggling with depression. Antidepressants can increase the risk of impotence, delayed orgasm, and premature ejaculation. Antidepressants increase serotonin levels in the brain, which helps with symptoms of depression but can inhibit sex drive and feelings of pleasure.
Depression can lead to a decreased interest in sex, difficulty having an orgasm, and increased sexual risk behaviors. Depression is associated with a lack of desire and increased pain with sex. Genital penetration pain disorder is three times more common in women diagnosed with depression (Basson & Gilks, 2018). Women in their late reproductive years who take oral contraceptives and women receiving estrogen therapy post-menopause may see an improvement in depressive symptoms but a decrease in libido.
Both men and women have fluxes in their hormone levels at different stages in their lives. Lifestyle changes can help smooth out some of these peaks and valleys.
Read 7 Ways to Naturally Regulate Your Hormones to learn more about how small changes in your daily life can help improve your sense of well-being.
Eating disorders are serious medical conditions in which a person has a distorted view of their appearance, leading to lower self-esteem. The four main eating disorders are anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant restrictive food intake disorder.
Men make up approximately 25% of individuals living with anorexia and bulimia. Men with eating disorders can have a decreased sex drive due to a combination of low energy and reduced testosterone levels. Low levels of testosterone can lead to muscle weakness and bone loss. Approximately 50-70% of men with eating disorders also have depression. Anxiety is also common (Rosen, 2015). To learn more about testosterone replacement therapy, contact the medical professionals at Invigor Medical.
Sexual dysfunction is common in women with eating disorders. A low BMI is associated with a loss of libido, sexual anxiety, and avoidance of sexual relationships. Sexual intimacy is more likely to be disrupted in couples in which one has an eating disorder (Pinheiro et al., 2010). Women with low self-esteem, depression, or anxiety can fear or avoid intimacy.
PTSD is difficulty coping and adjusting to life after a terrifying experience. Some traumatic events can be so overwhelmingly frightening that they can permanently impact how someone physically and psychologically responds to stress. Not everyone who experiences a traumatic event lives with PTSD. PTSD can cause avoidance behaviors, intrusive thoughts, negative thoughts and moods, and changes in your emotional reactions to life events. PTSD affects 5.7% of men and 12.8% of women over a lifetime (Yehuda et al., 2015).
In one study, 41% of men reported experiencing postcoital dysphoria at some point in their lifetime, and 20.2% experienced it within the previous four weeks (Maczkowiack & Schweitzer, 2019). The overactive neural circuits and hormones associated with PTSD and sexual activity mean that sexual arousal may lead to anxiety and fear. In one study, war veterans with PTSD had less sexual activity, hypoactive sexual desire, and erectile dysfunction (Yehuda et al., 2015).
Women with PTSD may experience postcoital dysphoria, an intense feeling of sadness, agitation, or anger after consensual and even pleasurable sex. Sex can be a triggering event for survivors of sexual assault. In one study, 32.9% of women had experienced postcoital dysphoria at some point in their lifetime (Schweitzer et al., 2015)
Obsessive compulsive disorder (OCD) is a chronic mental health condition characterized by unwanted thoughts called obsessions and repetitive behaviors or compulsions. Obsessions can trigger unpleasant emotions. Compulsions are actions taken to decrease stress or cope with unpleasant feelings (Pozza et al., 2020).
Men with OCD frequently experience lower sexual arousal, premature ejaculation, erectile disorder, and overall feelings of sexual dissatisfaction (Pozza et al., 2020).
Women with OCD may experience difficulty becoming aroused, low sex drive, fear of having sex, difficulty having orgasms, and obsessions that interfere with sex and intimacy. Medications that increase serotonin in the brain may compound these problems (Aksaray et al., 2011). In one study, OCD was one of the strongest predictors for female sexual dysfunction (Pozza et al., 2020).
Substance abuse can affect the ability to feel intimacy and can cause sexual dysfunction. The effects can be as diverse as the medications. Alcohol consumption, tobacco smoking, and illicit drug use are all associated with sexual dysfunctions. Opioids can increase prolactin levels in both men and women. Cannabis smoking can inhibit the ability to orgasm (Diehl et al., 2013).
In one study, 36.4% of men who abused drugs reported erectile dysfunction, decreased sexual desire, and had more difficulty achieving orgasm. ED and decreased sexual desire were most commonly reported by heroin abusers, followed by amphetamine and MDMA users. Delayed ejaculation was widely reported in all users (Bang-Ping, 2009)
Drug abuse in women is associated with increased risk-taking and chronic pelvic pain syndrome. Women who abuse alcohol can have pain with sex and difficulty with arousal. Women in recovery can sometimes relapse to treat sexual dysfunction (Diehl et al., 2013).
In addition to drugs, food can be abused, resulting in weight gain, which can have physical and psychological consequences that affect intimacy. For example, men who are obese are 2.5 times more likely to experience ED than men of average weight. Making dietary changes and increasing physical activity are the keys to losing weight. Invigor Medical offers lifestyle medications to assist you in your weight loss goals. Speak with a health care professional at Invigor Medical today to learn more.
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.
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