What to know about bipolar disorder and sex

Bipolar disorder causes a person to experience intense shifts in moods, sometimes from a manic state to a depressed state, for example. These shifts can occur with changes in sexual desire, confidence, or sexual function.

Though the symptoms vary from person to person, bipolar disorder can disrupt several aspects of a person's life, including their sexuality.

In this article, we discuss sexual symptoms of bipolar disorder and ways to manage them.

Links between bipolar disorder and sex

Two distinct moods can characterize bipolar disorder: mania and depression. Episodes of each can cause significant changes in a person's personality and may also affect their sexuality.

There has not been a great deal of research into the connection between bipolar disorder and sex.

However, authors of a small study in the International Journal of Bipolar Disordersreport a high prevalence of sexual distress and dissatisfaction among female participants with the condition.

Results of a 2018 study in The Journal of Sexual Medicine indicate that males with bipolar disorder may be more likely to experience symptoms of erectile dysfunction than those without the disorder.

This does not mean that everyone with bipolar disorder experiences sexual symptoms, only that there is a higher prevalence among this group.

The sexual symptoms typically change, depending on other symptoms of the disorder.

During depressive episodes

These episodes generally cause a person to feel down, anxious, or hopeless. In a person with bipolar disorder, they may also lead to hyposexuality, which is a low or nearly nonexistent sex drive.

Someone with hyposexuality may experience symptoms such as:

• a complete lack of interest in sex
• feeling physically unattractive or undesirable
• a disinterest in personal hygiene or grooming
• feeling vulnerable or worthless sexually, which may keep them from engaging
• physical exhaustion, which makes sex difficult

The person may also feel guilty about their lack of sexual desire, which could feed the cycle of self-doubt and feeling undesirable.

Some side effects of medications may contribute to the issue. Selective serotonin reuptake inhibitors (SSRIs), for example, may cause a decrease in sexual desire. These side effects can also lead to physical changes, such as difficulty becoming aroused.

It may be challenging to explain these changes to a sexual partner or spouse. Also, a person's partner may feel rejected or frustrated.

During manic episodes

A manic episode can cause a person with bipolar disorder to experience hypersexuality. They may feel as if their sex drive is always very high, which can create difficulties.

People experiencing hypersexuality may never feel satisfied with sex. They may want to continue having sex or masturbating for hours without truly feeling that they have completed the act. This can be stressful for the person and any partners.

During manic episodes, some people engage in risky sexual practices or have difficulty controlling sexual urges.

For instance, authors of a study in Psychiatry Journal report that male participants with bipolar disorder tended to have more partners and were more likely to have sex without protection than those without the disorder.

When a person with bipolar disorder experiences hypersexuality, they may masturbate or engage with new sexual partners in a way that puts their job or existing relationships at risk.

Examples of hypersexual behavior include:

• heightened sexual confidence
• more willingness to experiment sexually
• sex with multiple partners
• sporadic sex with strangers
• constantly thinking about sex
• highly frequent masturbation, to the extent that it may disrupt daily activities
• sexual affairs
• increased appetite for pornography
• compulsive sex with sex workers
• visiting sexually-oriented establishments frequently
• risky sexual practices, such as unprotected sex with multiple semi-anonymous partners

Young teens or children with hypersexuality may exhibit sexual behavior such as flirting, inappropriately touching adults, and using sexual language excessively.

Medications and sexuality

There may be links between a person's medications and their sexuality.

For example, doctors commonly prescribe SSRIs to treat mood disorders such as depression. These can help some people with bipolar disorder, but many of these drugs also cause a decrease in sexual desire.

This side effect can pose particular challenges for a person who experiences hyposexuality during a depressive episode.

Anyone who believes that medication may be affecting their sex drive might consider speaking with a doctor about other options. Do not stop taking medications before talking with a doctor. Doing so may increase the risk of triggering a manic or depressive episode.

Sexual health tips for bipolar disorder

Even with effective medical treatment, people with bipolar disorder may still experience hyposexuality and hypersexuality during episodes of depression and mania.

The following strategies can help a person manage these symptoms:

Understanding sexual risks

Unprotected sex can put a person and their partners at risk of sexually transmitted infections or diseases. There is sometimes also an increased chance of pregnancy.

For a person in a committed relationship, compulsive sex can lead to infidelity, which could jeopardize the relationship.

Keeping track of side effects

People who regularly experience sexual symptoms of bipolar disorder may want to avoid medications that make these symptoms more intense.

Anyone with concerns about sexual side effects should talk to a doctor about switching to a different medication.

Understanding and eliminating triggers

Recognizing the early symptoms of a mood change can help people know when to reach out for assistance.

For instance, when high levels of stress contribute to depressive episodes, a person may benefit from practicing techniques designed to manage or eliminate stress and contacting their physician.

Considering therapy

While psychotherapy may already be a component of a person's treatment plan, sex therapy can be key for a person who experiences challenging sexual symptoms.

A behavioral or sex therapist may be able to help with managing sexual symptoms, and couples therapy may help with navigating difficulties in relationships.

Group therapy may also be beneficial. A review in the Journal of Behavioral Addictions notes that the group atmosphere encourages participants to feel less shame and isolation. The authors also report that group therapy may pair well with both individual and couples therapy.

Support groups for people with sexual disorders can also help.

Outlook

Bipolar disorder affects moods and may significantly alter a person's sexuality. An individual may become highly sexual during a manic phase, then have little or no sex drive during a depressive phase.

Each issue can pose different challenges. A treatment plan should include ways to manage these sexual symptoms without putting the person or their sexual partners at risk.

For people in relationships, it is important to include partners in the process and keep the lines of communication open. This can help them gain a better understanding of the symptoms that a person is facing.

Working with a physician and a mental health specialist can help with developing a combination of medication and therapy that manages symptoms. Support groups can also help.

Medically reviewed by Timothy J. Legg, Ph.D., CRNP

Written by Jon Johnson

SOURCE: MEDICAL NEWS TODAY