Sexual Health and Mood Disorders

Sexual health is defined by the World Health Organization as freedom from sexual diseases or disorders AND a capacity to enjoy and control sexual behavior without fear, shame, or guilt. A person’s sexual health can be impacted by symptoms of as well as medications for mood disorders.

While many think of sex as being a function of simple biology, there are many other factors that contribute to your sexuality.

The biological factors include not only genetics, but our overall physical and mental health, how your body works within itself and the presence of any outside substances like prescription or over-the-counter medications, illegal drugs or alcohol.

Psychological factors may include an impaired self-image, history of abuse or trauma, depressed mood or performance anxiety.

The quality of your relationships, the availability of a partner, or life stressors are all examples of interpersonal factors.

Sociocultural factors focus on your upbringing and family influence as well as cultural and religious norms and expectations.1

Mood disorders tend to impact sexual health both through symptoms of these conditions as well as treatments commonly used.
Experiencing a depressed mood can lead to:

  • lack of energy
  • isolation
  • decreased sexual desire
  • negative thoughts about self

Experiencing an episode of mania may lead to:

  • loss of inhibition
  • promiscuity
  • inability to connect with a partner emotionally

Medications commonly used to treat mood disorders sometimes impact:

  • sexual desire
  • amount of sexual lubrication
  • ability to achieve orgasm
  • weight, which may lead a person to perceive a negative change in their physical appearance

If you are experiencing sexual issues that you believe may be connected to your mood disorder due to either symptoms or treatment, it’s important to realize that there are different levels of sexual concerns. The DSM-IV places sexual concerns into four categories:

  • Sexual complaint: an expression of discontent related to a phase of the sexual response cycle or sexual pain
  • Sexual dysfunction: sexual complaint plus distress
  • Sexual disorder: persistent or recurrent complaint which causes personal distress and is not better explained by another condition2

Regardless of the level, it’s important to take any sexual concerns seriously as they can impact your overall quality of life.

Sexual functioning changes can occur for many reasons, but if you think you may be experiencing sexual side-effects from your medication, complete the following questionnaire and share your results with your healthcare provider.

What can help?

Talk Therapy
Talk therapy can be an important part of treatment for depression or bipolar disorder (manic depression) and is often very helpful when sexual concerns are present. A good therapist can help you realize and work through many of the psychological factors mentioned above as well as help with interpersonal issues. They can help you cope with feelings and symptoms, encourage open communication and change behavior patterns that may contribute to your concerns. 

Changes in Medications
Side effects of medications can sometimes be dealt with by small changes to dosing or the time of day that you take the medication. Sometimes giving your body time to adjust to the medication will reduce or eliminate side effects. In certain cases, a health care professional may advise a delay of taking the medication or a “medication holiday” where medication is skipped for a pre-determined amount of time. When making any changes to medication, it is extremely important that you do so under the council of a medical professional.

It is also important to remember, while some medications used to treat mood disorders can lead to a reduced sex drive and/or reduced lubrication, medications don’t affect everyone the same way. You may not experience a side-effect that is commonly reported or you may experience a side-effect that isn’t commonly reported. Trying different medications may be one strategy you and your healthcare provider consider in order to reduce or eliminate sexual side effects.

Open Communication
Open communication with both your healthcare provider(s) and, if applicable, your partner is vital to handling sexual concerns related to your mood disorder. Many people find it difficult to discuss, but the only way to improve the situation is to begin the conversation. 

Talking with Your Healthcare Provider

Often times we are reluctant to bring the topic of sex up at appointments with our healthcare providers. Many of us have been taught to keep talk about sex private and to be embarrassed by discussing any sexual concerns we may have. Additionally, many people believe that their healthcare provider does not care about their sexual health and feel reluctant to bring it up as they believe it may make the doctor uncomfortable.  It can be helpful to remember that healthcare providers see many patients and the likelihood is you are not the only one to have had this problem. If you find it difficult to start a conversation about sexual concerns with your healthcare provider, here are some tips that may help.

  • Make a list of concerns and questions about sexual functioning before your appointment with your doctor
  • Try to identify what kinds of problems you are having and their frequency in advance of your appointment
    • Desire (thoughts, fantasies, motivation for sex/masturbation)
    • Arousal (excitement/lubrication/erections)
    • Orgasm
    • Relationship issues
  • Consider speaking with your therapist or counselor first as they may be able to help you formulate a plan for starting the conversation
  • Practice what you will say in advance, try to be as direct and specific as possible
  • Ask if your sexual concerns may be related to medication side effects and if so, are there any remedies or different medications which may not have this side effect?
  • Bring your partner with you to an appointment so that they can assist you in bringing up the concern
  • Print out the results of your screening questionnaire and share them with your provider (questionnaire for men (PDF)) (questionnaire for women (PDF)
  • If you feel your provider may be judgmental or negative, consider starting the conversation by saying, “I have a personal concern that I would like to talk to you about” or “This is awkward for me to say, but…” This helps give the provider a sense that they need to respond more carefully than they may have otherwise.
  • If you feel your provider has responded in a judgmental or hurtful way, express this concern. If it is not addressed to your satisfaction, you may want to seek out a new provider.

Talking with Your Partner

While it may seem like it should be easy to speak with our partners about sex, it often is not. We may feel uncertain as to what the problem really is, fear hurting our partner by indicating that we have not been enjoying sex, or even believe that it is not that important and is easier to just ignore. However, it is important to discuss these concerns with your partner in order to maintain a fulfilling relationship. Here are some tips that may help you get started:

  • Set a time to talk when neither of you are pressed for time, overly stressed, frustrated or angry at one another
  • Consider speaking with your therapist or counselor. Sometimes there may be events or experiences that have clouded our feelings about sexual intimacy. Therapists and counselors may be able to help you uncover these issues and help you work through them as well as offer suggestions on improving communication with your partner.
  • Encourage your partner to take the Questionnaire for Partners so that you can discuss the answers (link to handout for partners)
  • Do not blame your partner or yourself
  • Share how your medications or symptoms may be impacting you sexually
  • If there are changes your partner can make that you think may help, state them in a positive manor and avoid expressing displeasure in past experiences.
  • Bring your partner with you to an appointment, so that they can ask questions and hear the recommendations that made
  • Be open to your partners thoughts, feelings and ideas

Restoring Intimacy Webinar

Common Questions and Answers

Dr. Rajnish Mago answers common questions about how mood disorders affect sexual health. See Q&A

Sexual Health Questionnaires

1) Althof SE, et al. J Sex Med. 2005;26:793‐800.  Rosen RC, Barksy JL. Obstet Gynecol Clin North Am. 2006;334:515‐526; Meston CM. Western Journal of Medicine 1997;167(4):285‐290 

2) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Washington, DC, American Psychiatric Association, 2000; Basson R, et al. J Urol. 2000;163(3):888‐893