How Bipolar Disorder Affects Sexuality

What Is Bipolar Disorder?

Bipolar disorder is a type of mood disorder which impacts one’s mood, energy and communication. Those with bipolar disorder may struggle to appropriately communicate their issues and needs. They may have aggression and drastic mood swings in their communication and way of being around you. It can be really hard to navigate the highs and lows of someone with bipolar disorder and it is important to be mindful of your own needs. Some may not be sure what type of bipolar types there are and it is important to consider their diagnosis of bipolar disorder or bipolar I vs. bipolar II and set clear boundaries around how you want to communicate.

How Bipolar Disorder Affects Sexuality

Bipolar disorder manifests itself in two ways: manic states and depressive states.

During manic states, one may feel an increase in their desire for sexual activity and find themselves engaging in riskier sexual activities and can pose risks to relationships. The duration of this state of mind can vary, however many experience feeling one way for days to weeks at a time.

During a depressive state, one may feel a complete lack of interest in sexual activity or sexual intimacy. Having a lack of interest can create different types of issues in a relationship and can cause depressive symptoms to worsen. It can be challenging to come out of a depressive state as the depression symptoms likely impacted the relationship in a negative way. Having open, non-judgmental discussions around goals, hopes and challenges with your partner is very important.¹

Bipolar Sexuality & Manic Episodes

A manic episode in bipolar disorder can drastically increase one’s sexual drive. The increase in hypersexuality during a manic episode is marked by a noticeable excess of sexual activity compared to non-manic states. To add, sex addictions are more common among those with a preexisting mental health condition such as depression, anxiety, bipolar disorder and OCD.

Sexual behaviors during a manic episode may include:¹

• Sex with multiple partners
• Frequent masturbation
• Risky sexual behaviors
• Sexual affairs
• Constant fantasizing about sexual activities
• Breaking boundaries to engage in sexual activities

Bipolar Sexuality & Depressive Episodes

A depressive episode in bipolar disorder dramatically reduces sexual activity, desire and interest. Sexual drive is non-existant and can be considered hyposexuality during this time. People who experience this often report feeling guilty about their lack of sexual interest as it can negatively impact intimate relationships. The sudden sharp decrease following a sharp increase can leave their partners feeling confused, frustrated and rejected. Those who have bipolar disorder are also more likely in general to experience sexual dysfunction. The extremely low sex drive can trigger mania and perpetuate a cycle of continued ups and downs in sex drive.

Sexual behaviors during a depressive episode may include:¹

• Complete lack of interest in sex
• Feeling unattractive/poor body image
• Feeling low self-worth
• Lack of interest in being touched

How Medications Affect Sexuality in Bipolar Disorder

It is important to note that there is a connection between commonly prescribed bipolar medications and sexual desire. Some of the side effects of these medications include experiencing lower sexual drives. This negative sexual impact of bipolar medications can make some parts of the condition managed while exacerbating other parts. Research supports the hypothesis that bipolar medications can negatively impact sexual arousal, ability to reach orgasm, and sex drive.

Medications for bipolar disorder that may impact sexuality include:¹

• Antidepressants: SSRIs can help treat depressive symptoms however potential side effects include a lowered sex drive.
• Mood stabilizers: These medications can impact ability to reach orgasm and respond to sexual stimuli.
• Antipsychotics: These medications can decrease sex drive and limit the ability to become aroused.

How to Manage Bipolar Disorder & Sexual Symptoms

There are many tips for people who want to manage sexual symptoms associated with bipolar disorder, even if they take medications. It is important to treat their bipolar first, rather than focus on the sexual symptoms as treating just sexual symptoms can mask underlying issues which can persist and perpetuate issues in other ways. There are many lifestyle tips on living well with bipolar disorder you can try as well.²

Below are tips for coping with sexual side effects of bipolar disorder:

Learn Your Triggers

Learning your triggers can take time and it is important to take the time to do the work needed to learn these triggers. When we do, we may notice we have sexual triggers as well, especially if we are going into a manic state. It is important to be aware of this as much as possible to help you avoid making poor sexual decisions. This can help you keep your relationship from damage related to the bipolar symptoms and give you your sexual power back.

Understand Sexual Health Risks

Understanding and knowing the risks associated with certain risky sexual behaviors is important. These behaviors can look like multiple sexual partners, sexual activity outside of the relationship, increase in frequency of sexual activity and engaging in unprotected sex with multiple partners. The risk of these behaviors include unplanned pregnancy, STIs, STDs, HIV and pelvic floor dysfunction.

Keep Taking Your Medication

Keeping track of your medications when treating bipolar disorder is very important. These medications need to be followed according to the dose and frequency provided by the doctor and continue taking the medication until they can get their doctor’s guidance on going off or switching these medications. Suddenly stopping these kinds of medications can lead to a rebound of a certain state and trigger worse symptoms. It is important to journal side effects and symptoms while you are on and off medications to learn more about your body and how it responds to medications. You can also use online psychiatrists to help if you have a long wait time to see your doctor.

Keep Track Of Side-Effects

Keeping track of side effects is critical to make sure you are on the best medication for you. If you have some side effects but are not bringing awareness to your doctor about them, you could be missing out on trying another drug that works better. You don’t have to sacrifice the quality of your life or sexual desires.

Consider Therapy

It is also important to consider therapy as a part of your treatment plan for bipolar disorder.  Treatment for bipolar disorder typically includes self-management and lifestyle changes, journaling, medication and therapy. CBT for bipolar disorder is beneficial as it works by addressing the thoughts which drive behavior. There are many online therapy options to consider as well if in-person therapy or a specialist for bipolar disorder is not available.

Another avenue to consider is sex therapy, especially for those in committed relationships as sex therapy can help reduce and remove some of the stigma about discussing sexuality.

Consider Pelvic Floor Physical Therapy

Pelvic floor physical therapy is another great option to help treat the sexual side effects and symptoms of the medications for bipolar disorder. Pelvic floor dysfunction can manifest psychosomatically as a result of other trauma and can be part of why sexual drive is impacted so negatively. It is important to remain open to the possible treatment options and understand that pelvic floor physical therapy can yield positive results in as little as one session. This therapy is covered by medical insurance and is administered by a physical therapist who has specialized training.

Interventions provided with pelvic floor physical therapy can improve ability to reach orgasm, feel pleasure and learn new ways you can access pleasure points in your body. It is a great way to keep your sexual health functioning well.^3,4

In My Experience

In my experience, treating the sexual issues that come along with bipolar disorder can be tricky at first as many people feel in denial about these issues, but once you understand that this is a byproduct of the disorder, it can become easier to accept and learn to manage. Once accepted, treating these issues can be much easier with medications and therapy. It is important to seek help for these issues instead of experiencing this alone, as you are worthy of feeling fulfilled in all ways in your life.

Having an open mind, giving yourself grace and understanding others perspectives is important to make sure that relationships and friendships can still thrive. Outlook for those with bipolar disorder who are experiencing sexual drive issues is favorable as long as they are following their treatment plan and having open communication with their partner. Remember that you have come very far already and don’t quit on yourself now.