UNC Health Talk

How Depression Can Affect Sexual Health

Clinical depression can affect all aspects of your life, including your sex life. Not only can depression dampen your sex drive, but some medications for depression may affect your libido and sexual function.

But don’t despair—doctors and therapists are aware of these issues and have strategies that can help. We talked to UNC Health psychiatrist Rachel Frische, MD, about the effects depression can have on your sexual health and what to do about it.

The Depression-Sexual Health Connection

Both men and women can experience difficulties initiating and enjoying sex because of depression.

“Untreated depression has been correlated with some form of sexual dysfunction in up to 50 percent of patients,” Dr. Frische says.

Stress, anxiety, guilt and low mood are symptoms often seen in depression. These symptoms can lead to decreased libido (the desire to have sex) and can physiologically impact your ability to become aroused, maintain arousal, and reach orgasm, Dr. Frische says.

Here’s why: The body physically responding to touch is an important part of sexual health. If you are depressed, it can be hard to be mindful and present with your partner in that moment. Negative thoughts and feelings can prevent your body from responding physically the way it needs to in order to “actually enjoy sex, reach full orgasm and participate fully the way that you want to,” Dr. Frische says.

Sexual dysfunction can result in feelings of low self-esteem and worthlessness, which may foster increased anxiety about sex. This leads to reduced sexual enjoyment for yourself and your partner while also contributing to symptoms of depression. It might also make it difficult to “perform” as you’d like. Depression is linked to erectile dysfunction and anorgasmia, an ongoing difficulty reaching orgasm.

The Effects of Antidepressants on Sexual Health

Complicating sexual health problems for people with depression is this: A diminished libido, erectile dysfunction, delayed ejaculation and anorgasmia are also common side effects of antidepressants. But antidepressants are often highly effective and even lifesaving for treating depression.

“Many of our medications to target depression can have sexual side effects, and the challenge we have as providers is always navigating the fact that depression in and of itself contributes to those symptoms, as do some of our medications,” Dr. Frische says.

To help address these side effects, your provider may try to put you on the lowest effective dose of an antidepressant. Or your provider may try switching to a different medication with less likelihood to impact sexual health or add a medication that can counteract the side effects.

“For example, Lexapro or Zoloft are common antidepressants. If they have an adverse side effect for your libido but are very effective in treating your depression, we don’t necessarily need to stop the medication that works. We can actually add Wellbutrin, a different class of antidepressant, to counterbalance sexual side effects,” Dr. Frische says.

In addition, your provider can determine if there are other factors affecting your sexual health, such as hormonal imbalances like decreased testosterone, or other medications you are taking, including birth control.

“There are many different ways sex lives can be impacted negatively by medicine and various other medical diagnoses,” Dr. Frische says. “By reducing potential side effects of medications and diagnosing underlying medical illness, we can make the sex life better.”

Include Your Partner in Finding a Solution

Participating in psychotherapy (talk therapy) with your partner also can help.

“We recommend including the partner in these conversations if possible,” Dr. Frische says.

Partners who are open to talking about these issues and problem-solving together can help reduce pressure the depressed person might be feeling. That support can sometimes pave the way for sexual function to improve because the situation becomes less stressful.

On the contrary, if you suffer from a diminished libido and then feel judged by your partner or your partner has high expectations about performance, it can be really challenging to live up to those expectations, Dr. Frische says.

“The perception of expectations can be really hurtful in the relationship. Be open with your partner and have candid conversations about where you’re at physically and emotionally and talk about the physical and emotional barriers to your sex life,” Dr. Frische says.

The bottom line is that it is important to treat the depression first.

“People often blame psychiatric medications for sexual dysfunction but don’t always take into account how much depression alone may have already been impacting sexual health. The goal is always to treat the depression and once you’re feeling well, then we can address residual sexual symptoms that remain,” Dr. Frische says. “Is that a side effect of medication, or is that something else medical going on that needs to be addressed? Either way, you can work with your physician and your partner to find solutions.”

If you think you are depressed, talk to your doctor. Need a doctor? Find one near you or set up a virtual appointment.