Making the connections between mental and sexual health: some examples

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Before, during, and after pregnancy

  • Experiencing depression or anxiety – or both – during or after pregnancy is common. Ten to 15% of people who have given birth are affected by perinatal mood disorders like postpartum depression or anxiety, and about the same amount of people experience symptoms of a major depressive disorder during their pregnancy.
  • In rare cases, people might experience postpartum psychosis, a psychiatric emergency in which symptoms of mania, depression, severe confusion, loss of inhibition, paranoia, hallucinations, or delusions begin suddenly in the first two weeks after childbirth.
  • Trying to conceive, navigating infertility, and/or being involuntarily childless, and having experienced a pregnancy or infant loss are all important reproductive health issues that can have significant impacts on our mental health and wellbeing.
  • Some of us can experience post-weaning depression and anxiety when weaning children from breastfeeding.

Menstrual cycles

  • Hormonal fluctuations during our menstrual cycle can have significant impacts on our mental wellness. One way these hormonal fluctuations might show up is through premenstrual syndrome, or PMS. PMS can show up as emotional and physical symptoms we experience in the one or two weeks before getting our period. people can feel irritable, depressed, anxious, hungry, hopeless, or sad, but everyone’s experience will be different. On the more severe end of the spectrum is Premenstrual Dysphoric Disorder (PMDD), which is more rare than PMS and can cause severe depression, anxiety, and extreme irritability. This can impact a person’s daily life and their relationships with others.
  • Polycystic ovary syndrome (PCOS) is a set of symptoms caused by increased androgens, group of hormones in our bodies, in people with uteruses. Signs and symptoms of PCOS include irregular or no menstrual periods, heavy periods, excess body and facial hair, acne, pelvic pain, difficulty getting pregnant, and patches of thick, darker, velvety skin. Physical impacts of PCOS can include irregular menstrual periods that come at different times during the month, infertility, or increased body hair growth, acne and baldness. PCOS can also lead to severe mental health issues, including anxiety, and depression.
  • The end of a person’s reproductive years can bring mental health challenges, including depression during perimenopause, the time when transition to menopause begins. Perimenopause causes intense hormonal changes, and during that time, people are more likely to experience depression and other changes in their moods.

Depression and sex drive

  • Depression can impact every part of someone’s daily life, including how they feel and express their sexuality. This might look like a lowered interest in or enjoyment in sex, which can affect relationships and the ability to feel intimate or close with partners.
  • Some anti-depressants can curb people’s sex drive, cause erectile dysfunction (ED), a decrease in vaginal lubrication, or difficulties achieving orgasm. This can be complicated, because often, closeness and intimacy can be extremely comforting during periods of depression, so if you are having a lowered sex drive, it can be helpful to find other ways to be intimate with your partner(s).

HIV, syphilis, and other sexually transmitted infections

  • Some mental illnesses can increase the likelihood of getting HIV and other sexually transmitted and bloodborne infections. Studies show that between 5% and 23% of people with chronic mental health issues have HIV. That’s because the risk of HIV transmission is higher in people with mental health conditions mostly because they are more likely to engage in high-risk activities related to sex and drug use.
  • Living with an STI can have mental health impacts. For example, people with HIV may experience depression and anxiety as a result of living with a complex and stigmatized illness. When it comes to having HIV, often the mental health impacts are a result of stigma, not the infection or virus. Things having to disclose an HIV+ status to potential romantic and sexual partners, as well as fears of criminalization can cause anxiety, depression and other impacts on people’s mental wellbeing.
  • While many of the mental health impacts of HIV stem from stigma, HIV can also produce psychological impacts due to its effects on the central nervous system.
  • The relationship between HIV and mental health can be particularly pronounced for people who are pregnant or trying to get pregnant. This can be due to concerns and stresses around pregnancy outcomes, navigating questions of how living with HIV will impact child-raising, and navigating the risk of perinatal (parent-to-child) transmission of HIV.
  • When syphilis, a sexually transmitted bacterial infection, is not treated, it can evolve to neurosyphilis, which can lead to serious health complications, including blindness, confusion, sudden personality changes, changes in mental stability, dementia, depression, and more suicidal ideation.
  • Because of stigma around being diagnosed with an STI or living with one, people may experience stress and depression. And since we know that a lot of the mental health impacts of living with an STI come from stigma¸ it’s important that we don’t judge, shame, or “out” someone who is living with an STI. Read more about STIs here

Hormonal contraception and depression

  • Some studies suggest a possible association between hormonal contraception and depression. In these studies, progesterone-only forms of hormonal contraception, including IUDs, are linked with a higher risk of depression. So far, a lot of the science is inconclusive and more research is needed. When deciding on your contraception method, it’s important to consider and discuss all the possible side effects, and that includes mental health impacts.
  • Chat with your health care provider if you are concerned about the mental health side effects of contraception. If you already living with a mental health diagnosis, chat with your health care provider about how your choice of contraception might impact your mental wellness and, if relevant, your treatment.

Endometriosis and mental health

  • Endometriosis occurs when the lining of the uterus, called the endometrium, grows in other places, like the fallopian tubes, ovaries, or along the pelvis. When that lining breaks down the way it normally would with a period, where the menstruation would then exit the body through the vaginal canal, the lining has nowhere to go to exit the body. This can cause cysts, heavy periods, severe cramps, severe pelvic pain, and even infertility. This can also lead to scar tissue formation, blocked fallopian tubes, and bowel problems.
  • Endometriosis, and the pain it causes, is often linked with symptoms of depression and anxiety. A 2015 study found that people who experience endometriosis related pelvic pain may be more susceptible to mental illnesses, or have their quality of life impacted in other ways.
  • Many people also people experience long delays in receiving an endometriosis diagnosis, which can further impact your mental health. This is in part due to the unconscious biases that health care providers may unknowingly have around how pain is experienced across different genders and ethnicities.

Genital sexual pain and anxiety and depression

  • Vulvodynia is a chronic syndrome that causes burning, stinging, irritation, or sharp pain in the vulva. For some people, this pain happens spontaneously, with no obvious cause, while for others it can caused by stimulation, like penetrative sex or putting in a tampon.

Vulvodynia, and the pain and potential strain on relationships it can create, can cause psychological impacts that result in anxiety or depression. Vulvodynia is also more common among people who have depression or Post Traumatic Stress Disorder (PTSD). The relationship between mental health and vulvodynia goes in both directions.

  • Other forms of chronic genital sexual pain are vaginismus, a painful vaginal spasm occurring during penetration, and dyspareunia, genital pain associated with sexual intercourse. Chronic genital sexual pain can have significant impacts on mental health and wellbeing.

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