Let's Talk About (Depressed) Sex
*Content warning: This article discusses mental health (specifically depression) and sex with mentions of assault. If you or someone you know needs help, please seek professional mental health care and stay safe.
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SAMHSA Hotline: 1-800-662-HELP (4357)
Sex and mental health are two of the most ignored and socially stigmatized areas of human existence. Their histories are heavily intertwined and linked to oppression.
The formerly existing diagnosis of ‘hysteria’ (a disease created to control deviant women characterized by sexual desire and nervous ‘breakdowns’) is the reason vibrators exist, as it was a time-saving tool for the normal doctor-patient masturbation treatment. Homosexuality was a diagnosable mental illness in the DSM until 1972, further complicating the tight-knit relationship of mental health and sex.
Setting aside that the institution of mental health care has inserted itself as a policing mechanism for sexuality, mental illness itself impacts sexuality in real individuals’ lives. Sex and depression are like that tangled pile of necklaces sitting in the back of your childhood jewelry box — seemingly impossible to separate.
My depression reared its head in early college, snowballing from a few bad days to a constant, debilitating haze. Since then, I’ve been learning and coping and trying to do the best I can do. But this isn’t just about me — approximately 8% of adults (over 10 million individuals) in the United States have experienced a major depressive episode. Within that, there are people who may have had just one episode, but also people like me who are living with Major Depressive Disorder (MDD) and other related diagnoses.
The cloud of depression can hang over everything. You’re alone, trapped in a locked car, and the windows are starting to fog up from your breath. So the world outside looks blurry and foreign, but at least you’re still breathing. You’re trying to find a comfortable position on the nylon seats as snack wrappers line the floor and a lonely beer can sits in your cup holder. Your connection to the world outside weakens.
Sometimes, the vacuum of the car opens up for a person — maybe it’s your partner, your friend, a fuck buddy, a Tinder rando. As the windows continue to fog up, perhaps though now more quickly, maybe you’re able to finally feel something. Maybe the numbness subsides for a moment. Maybe you drift further into your mental abyss. Maybe your anxiety heightens as you feel nothing; your body doesn’t respond to the sexual conversation trying to be two-way. Maybe someone tries to come in, or maybe even just cracks the door, and you’re so apathetically ambivalent. Maybe they enter the car and your body or mind screams no. Maybe the car door opens, you welcome a partner in, and for a moment, you feel less lonely and you’re able to find comfort in intimacy with another; the cave walls crumble and you see sunlight for the first time in a while.
Sex when you’re depressed can be medicine, self-destruction, boredom-relief, or an attempted remedy for numbness. It can hurt, feel like nothing, feel good, feel wrong, or confuse you.
Depressed sex can make you feel completely abnormal. Feelings of detachment are normal — from reality, your partner, and your body. It can feel like you’re trapped, trapped in your body, or even outside of it.
Physically, depression has noticeable impact on sexuality. Experiences of sex with depression
can include difficulty achieving orgasm, difficulty achieving or maintaining an erection, difficulty ejaculating without pain or at all, and loss of sensation. Antidepressants can also affect sexuality, and often do. Common side effects of many antidepressant medications include reduced libido, lack of arousal, delayed orgasm and even inability to orgasm.
It can be seemingly impossible to reconcile a pill that saves your life but makes you feel like you’re not yourself, a medication that forces the sacrifice of sexuality for basic stability and wellness. The lack of conversation surrounding the impact of medication on sexuality can also be damaging and increase feelings of solitary failure — like there’s something wrong with you.
If antidepressants have these side effects on you and they affect you negatively, always have a conversation with your prescriber. There are so many categories of medications to try and dosages possible; patience is a seemingly-impossible yet vital skill in trying to find medication that works for you. It’s also often easy to forget that there are many other ways to treat depression: talk therapy, group therapy, electronic brain stimulation therapies, and newer experimental methods. Meds don’t have to be your god: you are in control of how you care for yourself and allow yourself to be treated.
Outside of physical impact, sex might trigger specific insecurities or traumas linked to your depression: sexual violence, body image, ability or illness, queerness, as examples. Having sex might make you forget about body dysmorphia or might trigger memories of an assault. Understanding why you’re having sex can be life-saving to avoid triggering, destructive, and harmful sex. The ability to say no without self-criticism is a difficult-to-acquire skill that requires practice in living with your depression, but it starts with simply listening to yourself. This sounds like the opposite of a Kindergarten rule, but treat yourself how you would treat others — with kindness, compassion, and an open mind.
And besides, not wanting any sex at all is normal, but somehow we’ve conditioned ourselves to believe the opposite. But what is a ‘normal’ sex life anyway? Is it a frequency of sex per week? Is it certain acts? Does it require orgasm? Does it mean perfection and conformity to arbitrary societal standards of sex?
Sex exists as a bountiful fruit salad of opportunity.
Want a bunch of cantaloupe and nothing else? Take all cantaloupe.
Want everything but cantaloupe? Go for it.
You hate fruit salad? That’s allowed.
Want only oral and a lot of it? You got it.
Want everything but oral? Sounds good to me.
Don’t want to do a single sexual thing? That’s normal.
Sex can be whatever you want it to be (if you even want it at all). It’s easy to forget as a depressed person that sex doesn’t have a perfect definition or confinement. Tailor your sex to you, instead of trying to tailor yourself to standards of sex.
Here’s the part where I’m supposed to say “it gets better.” It might — many people live functionally and happily with depression, and have adapted their sex lives to best fit their needs. Just as depression is a different animal for everyone, there are many ways to wrangle it so you are in control. What’s vital in coping is remembering that sex doesn’t have to follow a definition that someone has created for you, or even a definition you once created for yourself.
Depression might feel like the road is crumbling beneath your feet, but keep walking. There is so much ahead.
About the Author
Elena Phethean (she/her/hers) is a junior from Pleasantville, NY studying Women’s, Gender & Sexuality Studies and Community Health at Tufts University. There, she is the co-coordinator of Tufts Sex Health Reps, a student group bringing comprehensive and inclusive sexuality education and sexual assault prevention to campus. She also loves music and sings with her a cappella group, the Tufts Jackson Jills. As a queer woman, she is especially passionate about women’s/gender minority health and queer sexual health outcomes, as well as working with survivors.