Exploring the Connection Between Mental Health and Sexual Health

The health of the mind and health of the body are deeply connected. How we feel emotionally can affect our bodies, and how our bodies feel can influence our emotional state. As a result of this connection, mental health and sexual health are also closely related; however, they’re often discussed separately in healthcare and education.

In the sections below, we explore how mental health and sexual health influence each other and how communication, self-awareness, and support can contribute to a healthy, positive experience. If you're aiming to become a counselor or sex educator who advocates for integrated care, understanding this connection is key to overall wellness for clients (and yourself).

Understanding the Connection Between Mental Health and Sexual Health

To maintain sexual and mental health, it's necessary to understand how the two influence each other. Sexual health affects mental health, and mental health affects sexual health in several ways.

How Mental Health Affects Sexual Health

People often associate sex with their bodies and their sex organs. However, most of our sexual experience occurs inside the brain, which is responsible for controlling desire, arousal, and sexual function. This brain-centered sexual experience is the result of our innate ability to create, signal, and feel emotions with self-made chemicals, including:

• neurotransmitters like pheromones, dopamine, epinephrine, and serotonin.
• endocrine factors like estrogen, progesterone, androgens, testosterone, prolactin, oxytocin, and cortisol.
• neuropeptides like adrenocorticotropin and α-melanocyte-stimulating hormone.

Due to the neurophysiology of sexual arousal, desire, and function, brain function and mental health are vital to sexual health. Many mental health disorders, and even the pharmaceuticals that are designed to treat them, can influence the chemicals in our brains, resulting in psychological effects on sexual health.

Mental Health Disorders

Mental health challenges are often closely linked to difficulties in sexual health and well-being.

For example, individuals with schizophrenia can experience sexual health problems due to the nature and side effects of the disorder. Some of these are anhedonia and avolition (lack of pleasure and motivation), in addition to reduced activity in certain brain areas that are central to sexual function.

While schizophrenia only occurs in about 1% of people worldwide, much more common mental health problems like depression, anxiety disorders, and elevated stress levels can interfere with sexual health as well. Depression, the most widespread mental health disorder, is estimated to involve 21 million adults, just under 10% of the population of the United States. Psychological effects on sexual health of depression, stress, and anxiety include reduced libido, erectile dysfunction, and the inability to reach orgasm.

How Sexual Health Influences Mental Health

Aside from the mind's role in sexual health, sexual issues can impact mental health, too.

For example, sexual dysfunction and anxiety are closely related, as experiencing sexual health challenges (such as low sexual desire, decreased arousal, premature ejaculation, or erectile dysfunction) can cause sexual performance anxiety. This in turn can lead to feelings of stress, increased self-consciousness, and shame. The emotions caused by sexual health problems can create a feedback loop of sexual health issues that lead to mental health concerns and, as a result, exacerbate sexual health challenges.

The Role of Communication in Navigating Both Health Domains

Communication is the key to success in any relationship, including with partners and healthcare providers. Many people feel uncomfortable talking about sex—even some counselors and therapists—but discussing the sexual experience is crucial to solving sexual health problems and achieving satisfaction. Individuals can work to develop open dialogues with partners, and healthcare providers can develop positive and inclusive language to create a safe, nonjudgmental space.

Importance of Open Dialogue With Partners

Sexual communication is critical for partners to develop and maintain a healthy sexual relationship. Research shows that couples who struggle with or don't participate in sexual communication have more frequent sexual problems. Additionally, open communication has been positively associated with:

• sexual desire
• arousal and lubrication
• erectile function
• less sex-induced pain
• overall sexual function

Working with Healthcare Providers

According to a 2019 study, 23–42% of adults in the United States reported persistent sexual health problems, but only 8–15% discussed their concern with a healthcare provider. Plus, many healthcare providers experience challenges with talking about sexual health with patients.

General healthcare providers (primarily focused on the body) are trained to discuss the five P’s of sexual health:

1. Partners
2. Practices
3. Protection from STIs
4. Past history of STIs
5. Pregnancy intention

While these talking points support physical health, they do not address the mental and emotional aspects of sexual health. Thus, many individuals do not discuss these aspects with a professional.

Healthcare professionals—such as sex health providers, sex therapists, sex educators, advocates, and allied health professionals—receive additional education and training in sexual health, where they learn how to:

• create spaces where their patients feel safe.
• build trusting professional relationships.
• talk about sexual concerns and topics without shame or judgment.
• understand the nuances of sexual health.

Talking with patients and clients about the physical, mental, and emotional aspects of sexual health can ultimately help them lead happier, healthier lives and enjoy more fulfilling relationships.

Identifying the Warning Signs: When to Seek Help

Recognizing the warning signs of mental or sexual health issues helps individuals know when to seek professional help. It also enables healthcare providers to spot when a patient may need support.

Mental Health Symptoms That May Affect Sexual Health

Some signs of mental health challenges may also influence your sexual well-being, including:

• Mood swings
• Fatigue
• Insomnia or hypersomnia
• Loss of interest in activities
• Inability to experience pleasure
• Social withdrawal
• Heightened irritability, restlessness, or frustration
• Persistent feelings of sadness, hopelessness, or emptiness
• Feeling worthless or helpless
• Feelings of guilt
• Feelings of shame

Mental health issues can also result in:

• Appetite changes
• Weight gain or weight loss
• Difficulty concentrating
• Memory issues
• Inability to make decisions

Sexual Health Symptoms that May Signal Mental Health Issues

Examples of sexual health symptoms that can signify a mental health issue include:

• Decreased desire or low libido
• Difficulties with arousal
• Erectile dysfunction
• Inability to reach orgasm
• Avoidance of intimacy
• Pain during intercourse (without a physical cause)
• Risky sexual behaviors
• Compulsive sexual behaviors

These symptoms can sometimes indicate the presence of mental health concerns or underlying physical issues. Experiencing them warrants speaking with a healthcare professional.

Treatment Strategies and Holistic Approaches

A holistic approach to healthcare considers the whole patient. This requires an understanding of the strong connection between a wide variety of factors and considers the effects that each of those factors has on an individual's overall mental, emotional, physical, and sexual health. A number of treatment approaches can be used to address mental and sexual health concerns while improving multiple aspects of an individual's wellness.

Evidence-Based Therapies

Evidence-based therapies and treatments used to address mental and sexual health problems can include:

• Cognitive behavioral therapy (CBT) and trauma-focused CBT
• Couples therapy
• Mindfulness-based therapy
• Hypnotic relaxation therapy
• Behavior interventions (e.g., sex education, communication training and exercises, emotional skills and communication, sexual fantasy training, orgasm consistency training)
• Medications for mental health concerns or sexual health concerns (though patients and prescribers should be wary of potential side effects that could worsen the patient's concerns)

Lifestyle and Self-Care Practices

For many individuals, lifestyle changes aimed at reducing stress, prioritizing self-care, and connecting with their partner can have a positive influence on both mental and sexual health. These self-directed and self-empowered approaches include:

• Assessing and reducing stress
• Learning and prioritizing healthy communication with a partner (especially sexual communication)
• Recognizing, understanding, and accepting that desire is not always constant
• Learning to access pleasure, even in the absence of desire
• Exercising regularly to release endorphins and improve mental health
• Eating healthy to support physical and mental function and health
• Prioritizing restorative sleep
• Making meaningful social connections
• Practicing mindfulness meditation
• Avoiding harmful substances such as tobacco, alcohol, or drugs

Supporting Others and Reducing Stigma in Academic and Professional Spaces

The more health professionals and advocates talk openly and honestly about sexual health and its importance for mental health and overall wellness, the more normalized the topic will become.

Creating Inclusive and Safe Environments

In addition to promoting awareness and openness, providers should work to create safe and inclusive environments where their patients and clients feel comfortable discussing sexual health. They can do this by:

• understanding the nuances of sexual health topics.
• allowing patients to create their own definitions of good or bad sexual health.
• ensuring the provider's own reactions to discussions are controlled.
• helping to provide patients with language for discussing sensitive topics.

Understanding Intersectionality in Healthcare

Healthcare professionals should also understand that the interplay between various intersecting identities—socioeconomic status, race, disabilities, gender identity, or sexual orientation—can shape an individual's experiences with healthcare, mental health, and sexual health.