I’ve said it once, and I’ll say it again, sexual health is an integral part of mental health, which is why on this World Mental Health Day I wanted to make a point of acknowledging some of the many ways in which our mental and sexual health are connected. Talking about sexual or mental health is taboo for many people, so it’s even harder to talk about all of the ways in which they are connected. Getting to know how they are related can help us make important connections, start crucial conversations, and when it makes sense, seek the support we need and deserve.
So what do I mean when I say sexual health?
Sexual health refers to physical, mental, emotional, and social well-being in relation to one's sexuality. It is essential for well-being, general health, and overall quality of life. Sexual health is not solely the absence of an illness or dysfunction, rather, it entails a respectful and positive approach to life, toward sexuality and sexual relationships, and the ability to make pleasant and safe sexual experiences that are free of coercion, discrimination, and violence.
People often think about sex as something that happens in our bodies, but much of our sex life occurs in our brains. It's critical to understand that, for all genders, our feelings and thoughts play a significant role in arousal and maintaining it.
Anxiety, depression, or other mental health problems can make it difficult to be relaxed enough to have or enjoy sex, overshadowing it with intrusive distractions or worries. When a person is extremely ill, overwhelmed with daily life stressors, and struggling just to function, sex is rarely on the mind. In addition, various problems in mental health, can harm a person's self-esteem and make them feel undeserving of sexual attention.
Effects of Mental Health on Sexual Health
Healthy sexual functioning is among the most important aspects of quality life and having a satisfying intimate relationship. Sexual dysfunction is widely known in the general population, affecting approximately 31% of men and 43% of women in the United States. The most notable dysfunction among women is decreased sexual desire, as reported by approximately one-third of the women, while premature ejaculation and erectile dysfunction are the most common sexual dysfunctions reported among men.
Depression and Sex
Around 10% of the population suffers from episodic depression that severely impairs their quality of life and functioning. A decrease in libido is frequently associated with a major depressive episode. Depressed people may also have a reduced ability to maintain their sex drive or achieve orgasm. In men suffering from severe depression, the rate of erectile dysfunction may reach up to 90%. In terms of sexual dysfunction, depression affects women more than men. Women are more likely to experience depression symptoms, making them feel undesirable, self-conscious regarding their bodies, unsure about their sexual confidence, and hesitant to engage in sexual activities.
Anxiety and Sex
Anxiety plays a significant role in developing sexual dysfunctions. Despite the popular notion that erectile dysfunction is caused by low testosterone, the most common reason that people with penises experience ED is anxiety! Performance anxiety is a well-known phenomenon, particularly in men worried about erectile response and erection durability. Other psychological effects of erectile dysfunction that increase anxiety include deterioration of the individual's self-esteem and raising concerns for himself and his partner. This may lead to behavioral changes in the individual, such as avoidance of intimacy and temper outbursts. These factors contribute to increased anxiety and erectile dysfunction, resulting in a vicious cycle of elevated anxiety and the inability to maintain an erection.
Sexuality and Mental Health
Lesbian, gay, bisexual, and queer people are much more likely to experience mental health concerns because of the stigma, prejudice, and discrimination they experience. Similarly, discrimination and violence experienced by trans folx can result in being excluded from social spaces, higher likelihood of unemployment, avoidance of health care, and poor mental health outcomes.
Furthermore, many LGBTQI2S+ folks often go without treatment or care for their physical and mental health concerns due to not having access to a healthcare provider, because of concerns, or because they cannot find a provider who can understand and speak to their needs and realities as an LGBTQI2S+ individual.
Experiences of homophobia or transphobia, whether on a daily basis or when growing up, the loss of community and family support that often come from disclosing (or not disclosing) sexual orientation and gender identity, and having to deal with that reality and history are things that can impact our health and wellness in big ways.
The stigma, prejudice, and discrimination the LGBTQI2S+ people experience both in their daily lives can result in higher rates of depression, anxiety, obsessive-compulsive and phobic disorders, suicidal thoughts and acts, self-harm, and alcohol and drug dependence. These impacts can be worse if people also face compounded discrimination of their race, class, ethnicity, or disability.
Sexual Trauma and Mental Health
Sexual violence is any unwanted act of a sexual nature that is imposed on another person. It is an all-encompassing, non-legal term that refers to crimes like sexual assault, rape, and sexual abuse, often leading to the experience of sexual trauma. People who experience sexual violence can feel like they lost their sense of safety and their bodily autonomy. That can take a toll on mental wellness. Following sexual trauma, some may be at higher risk of experiencing depression, anxiety, post-traumatic stress disorder, personality disruption, attachment disruption, or addiction.
Survivors of sexual violence are more likely than the average person to attempt suicide. This is in part because in addition to the violence itself, survivors have to deal with rape culture and myths about sexual assault that can make it difficult to be believed and get support, protection, and justice.
In addition to negative psychological effects, sexual abuse causes serious, often chronic, problems with sex and intimacy. A national study on sexual dysfunction in the U.S. found that victims of unwanted sexual contact exhibit much higher rates of sexual functioning problems. Women who were forced to engage in sex were more than twice as likely to have arousal disorders compared to women who did not have this experience. These findings are consistent with many earlier studies that demonstrate high rates of sexual dysfunction among survivors of abuse. Other sexual repercussions of sexual abuse include (1) avoiding, fearing, or lacking interest in sex; (2) approaching sex as an obligation; (3) experiencing negative feelings such as anger, disgust, or guilt with touch; (4) having difficulty becoming aroused or feeling sensation; (5) feeling emotionally distant or not present during sex; (6) experiencing intrusive or disturbing sexual thoughts and images; (7) engaging in compulsive or inappropriate sexual behaviors; (8) experiencing difficulty establishing or maintaining an intimate relationship; (9) experiencing vaginal pain or orgasmic difficulties (women); (10) experiencing erectile, ejaculatory or orgasmic difficulties (men).
So What Do We Do With All of this Information?
Though the information above can seem daunting, even painful. There is clearly a link between sexual health and mental health, and these are just SOME examples of how they are connected. But there is a bright side. It is important that we know about these impacts because they can help us understand our needs better, become better advocates for ourselves and others, and build stronger communities. We all have different bodies, minds, and contexts in which we are navigating sex, relationships, and our health and wellness. Starting to see those connections can help us take better care of ourselves. Taking care of our health means taking care of our whole selves. If this is your experience, you deserve support and care. Know that there are many mental health providers out there who can support you through ALL aspects of your mental health, even the sexual. References
Kline, D. (2015). Sex, Intimacy and Mental Well-Being. Here To Help. Retrieved 15 January 2022, from https://www.heretohelp.bc.ca/sex-intimacy-and-mental-well-being.
Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual dysfunction in the United States: prevalence and predictors. Jama, 281(6), 537-544.
Maltz, W. (2002). Treating the sexual intimacy concerns of sexual abuse survivors. Sexual and Relationship Therapy, 17(4), 321-327.
Maltz, W. (2012). The sexual healing journey: A guide for survivors of sexual abuse. New York, NY: William Morrow.
Montejo, A. L. (2019). Sexuality and mental health: the need for mutual development and research. Journal of clinical medicine, 8(11), 1794.
Sex & Mental Health: Why You Need to Understand the Connection. Psycom.net - Mental Health Treatment Resource Since 1996. (2021). Retrieved 15 January 2022, from https://www.psycom.net/sex-and-mental-health.
Seitz, T., Ucsnik, L., Kottmel, A., Bitzer, J., Teleky, B., & Löffler-Stastka, H. (2020). Let us integrate sexual health—do psychiatrists integrate sexual health in patient management?. Archives of women's mental health, 23(4), 527-534.
Zemishlany, Z., & Weizman, A. (2008). The impact of mental illness on sexual dysfunction. Sexual dysfunction, 29, 89-106.
Finding a Sexologist or Sex Therapist
Are you struggling with any of these concerns or another sex-related matter? If you are in search of someone who is certified, you can check the listing at the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) online directory. Lastly, if you are interested in working with a sexologist, I encourage you to ask about their area of focus and their background or credentials. That way, you can make the most informed decision about who to trust with your sexual health.
Who am I? A message from Holly…
My name is Holly and I am a Trauma-Informed and Board Certified Clinical Sexologist. I provide sex therapy and coaching to individuals and couples that are struggling with reaching their full potential. As a clinician, I am passionate about helping people achieve their goals and live happy, healthy, rewarding lives. I truly believe that trauma is the source of pathology, and that everyone has within them the capacity to heal. Furthermore, I am dedicated to fostering a safe environment, working with each individual to develop the necessary skills to achieve lifelong change to improve their quality of life. As your therapist, I can’t guarantee that I will be able to fully understand what it is like to walk in your shoes, but I can guarantee that I can help you to sort things out, let go of what does not serve you, and create the life you truly want. Peaceful. Connected. Powerful. And Pleasurable.
I offer a judgment-free zone, hold space for healing, and offer straight forward, no-nonsense feedback (if that’s what you need). Overall, I offer you the tools and guidance to get past your past and develop the necessary skills to achieve lifelong change and truly start living. - Holly Wood, MS., PhD(c), LMFT
Visit www.thehollywoodsexologist.com to learn more and request a consultation.