Let's Talk About Sex and Depression

Photo by A is for Angle via Creative Commons.

Imagine for a moment that I took away your ability to enjoy sex. It’s just gone. Now in order to get it back, you would have to declare that you belong to two categories of people who are regularly stigmatized in pop culture. While you are dealing with this, you may also be experiencing feelings of worthlessness, guilt, hopelessness, lethargy, anxiety, and the inability to concentrate. If you can get past all that and reach out for help, there’s a big chance no one will do anything. They may not even believe you.

Welcome to the world of a woman dealing with the sexual side effects of depression and its treatment.

According to the World Health Organization, depression impacts 350 million people worldwide. The National Institute of Mental Health reports that women are particularly at risk for depression, with a 70 percent greater likelihood of depression than men. Since Prozac launched in the 1980s, antidepressant medications have become a blockbuster business. But a study conducted by Johns Hopkins found that 30-70 percent of those being treated with antidepressant medications will experience some form of sexual side effects.

I report often on sexual health issues and was interested in how treatment for depression impacts our sex lives. So in 2014, I conducted an informal online survey focusing exclusively on sex and depression. Of the survey’s 1,100 respondents, more than 65 percent of people who were medicated for their depression said they experience sexual side effects. But many people suffering from side effects like decreased libido and difficulty having orgasms hadn’t talked about it much. Of the people I surveyed who experienced sexual side effects of their medication, only 45 percent had talked to their doctors about the problem.  

This is clearly a big issue in the lives of many people. So why don’t we talk about it more?

Well, people have plenty of reasons to not want to talk about their depression and its impact on their sexuality. Pop culture often portrays people dealing with mental illness as unreliable individuals, violent criminals, or—in the case of women—“crazy” bitches. None of those sound like appealing clubs to join. As for women who talk about their sexuality? They don’t fare much better. Amber Rose’s recent speech at Slut Walk in LA addressed the humiliation she had faced at the hands of high-profile lovers. When even the most intimate companions are quick to distance themselves from sexually confident women, it’s no surprise that women are hesitant to openly discuss their sex lives. The intersection of two taboo subjects—sex and depression— make discussing these serious health problems difficult.

Survey respondents often listed embarrassment and awkwardness as reasons for not bringing up the issue of sex with their doctors. There was something else though too: the idea that doctors would not be willing to help.  “They didn’t care and it wouldn’t matter,” wrote one respondent.  “My psychiatrist gives no shits,” wrote another.

In theory, a doctor’s office should be a safe space for people to talk about their symptoms and experiences without fear of judgement. Why do so many feel that they can’t?

The recent attacks on Planned Parenthood give us some indication. The years-long relentless assault on an organization devoted to women’s health has sent one message to women: “Your sexual health is not important.” Reproductive and sexual healthcare is cut off from other aspects of healthcare in some destructive ways.

So what happens when patients do speak up? Over half of the people I surveyed braved the stigma and the awkwardness to ask their doctors for help. But nearly 40 percent of them reported that their doctors didn’t address their concerns addressed at all. When asked to elaborate, four women provided the following quotes:

“He kept telling me the drug I was on 'doesn't do that.’”

“He suggested I just needed more 'me time.'”

“I was shamed for being too sexual and shallow.”

“I was told to 'suck it up.’”

Here we see some familiar tropes played out: the assurance that the silly woman doesn’t know what is happening to her body, the reminder to “calm down,” and, of course, the idea that having a fulfilling sex life isn’t important—instead of working to improve your quality of life, you should just “suck it up.”

Stories like these serve to reinforce the image of the brusque doctors for whom sex is an off-limits topic. It can add another layer of fear and shame and prevent people from speaking up. Stories like these keep people quiet, which allows the stigma to live on and causes people struggle alone, rather than getting the help and support they need.

Changing this stigmatizing culture in our healthcare is huge work, since it means addressing attitudes around both sex and depression. A huge first step is talking openly about mental health. This year has seen two social media campaigns devoted to mental health go viral. In January, sex writer Crista Anne launched the hashtag #OrgasmQuest to chronicle her quest to reclaim the sexual pleasure she lost when her life-long depression was successfully treated. Another hashtag,  #MedicatedAndMighty, came from Erin Jones, the woman behind the site Mother Lovin’ Autism who encouraged the destigmatization of medicating for mental illness. These are just two examples of individuals doing what they can to create a more open conversation around mental illness and sexuality. Conversations like these are opening the doors for people to discuss their issues, relate to one another and let go of the fear and shame that can come with mental illness.

Talking openly, letting go of the stigma, and valuing sexual health amongst ourselves is one thing, but what will it take to bring the change to the doctor’s office? Currently the average amount of time medical schools spend on clinical sexual health education is eight hours—when it is required at all. Only certain specialities such as gynecology, obstetrics, and family medicine feature individual components devoted to sexual health. The message sent to doctors here is that sex is not something that pertains to the whole person, only to the part that makes the babies. Consequently, these conversations about happy sex lives can be challenging for doctors as well. Patients need to know that they are entitled to a doctor who listens to them, who values their health as whole person—sex and all— and whose office is a safe space. We are hearing some rumblings from within the field, too. Last August saw the publication of an article in the Journal of the American Medical Association that addressed the need to recognize sexual health beyond just talking about sexually transmitted diseases. Instead of just getting doctors trained on deadly diseases, the article authors recommend an “integrated, health-promoting approach to sexual health.” It may sound like a small step, but for many doctors talking about the social and cultural dynamics of sex is a big leap.

There’s a long way to go in the conversation on sex and depression—the world has a lot of opinions on both sex and mental illness. But we’re talking now. If we keep the conversation going, the world will catch up with us.

Related Reading: Don't We Hurt Like You? Examining the Lack of Portrayals of African American Women and Mental Health