How Depression Can Affect Your Sex Life by Betty Butch

For many of us, sex is an integral part of our relationships and self-expression. I value sex for how it allows me to express affection and wonder towards my partner, how it provides an avenue for playfulness and creativity, and how it benefits me physically and emotionally. Having sex regularly helps keep me connected to my partner and helps improve my mood and sleeping schedule. 

But having sex when you have depression is hard. 

“Dealing with depression can be tough in so many ways,” writes Ashley Mateo for Healthline, “The devastating effect it can have on sex makes the condition even worse. Researchers have definitively linked this mental health diagnosis to a number of intimacy challenges: difficulties with sexual self-esteem, feeling sexually distant from a partner, trouble communicating about sex, being unsure how to initiate sex, and a flatlining interest in sex in general, according to a new study in the Journal of Social and Personal Relationships.” 

For me, the exhaustion and disinterest that come with depression are some of the biggest barriers to maintaining my sex life. I’m so tired it’s difficult to function, let alone get it on, and in the depths of my depression fog I can barely remember why I enjoy and appreciate sex. Depression also erodes my hard-won self-esteem, making it difficult to consider my body – which is not the mainstream ideal – worthy of physical appreciation. 

Detailing her own experiences with depression for the Hot Octopuss blog, Amy Norton of Coffee & Kink writes, “Where my sex drive – my ability to connect with my body and with my partners’ bodies – had been, there was just this gaping black hole of nothing. [...] Pleasure felt like this alien thing that had existed in a former life, but was now as inaccessible to me as the moon.” She goes on to describe her instinct to pull away when a partner showed interest “because the idea of any kind of sexual touch [...] or even any sexual feelings coming from me just made me want to crawl into a cave and die.”

And mental health isn’t the only struggle that can impact one’s sexuality. “When my chronic illnesses are whipping me about like an untethered sail, I tend to feel like I’ve lost every aspect of who I once was, and that often includes my normal desire for intimacy. I feel unattractive and, at times, unlovable. I don’t want to be touched,” writes Barbara Leech for Chronic Sex, “Intimacy can feel like just one more obstacle course I must navigate when it hurts to move.”

Illness – both mental and physical – can have a profound impact on every aspect of someone’s life, so it’s no surprise that sex becomes complicated and sometimes unwanted. When I’m in the worst pits of my depression, my partner has to remind me to eat and shower. My illness convinces me it’s not worth the trouble to get out of bed, and my exhaustion makes it impossible to bother anyway. That deeply discouraging combination is common for people coping with mental and physical illnesses. Consider the addition of physical complications – such as painful sensory sensitivities, gastrointestinal problems, or painful and/or limited mobility – and the negative side effects of the medications often necessary to manage illnesses both mental and physical, and you have an entirely new set of hurdles in the way of sexual intimacy. “The pain that comes with your body working against you can be unbearable at times. So much so that sex isn’t on your mind,” writes Cordelia Michaelson for the Peepshow Toys blog, “But it’s not just the pain itself, it’s the lack of comfort and the lack of arousal that can be [...] a side effect of opioid medications.”

Coping with illness is often like dealing with a Rubik’s Cube where there is no satisfactory solution, and sex is just one box among a dozen other colors that don’t match up.

A few things to remember about illness and sex:

You cannot “reason” someone out of their illness or their illness’s effects. If a partner is suffering from depression and feels unsexy, even the most sincere reassurance of their desirability will not magically cure their self-esteem. Depression is a powerful liar. While it’s important to offer genuine reminders of love and even want, these shouldn’t be given with the expectation of “fixing things.” Similarly, if someone with a chronic illness says they cannot do something, they can’t be cajoled into it by a motivational speech. If they’re in too much pain or can’t focus, you can’t seduce them into feeling differently. 

Patience and understanding are key, and if those are conditional – ie, I’ll only be patient and understanding as long as you “try” to “do more” – then they’re just expectations masquerading as compassion. 

Sex can be whatever you need (and want) it to be. If I had the opportunity I would walk around Times Square banging pots and pans while yelling ‘there is so much more to sex than penetration!’ Because it’s not just true, it’s important. Too often when I hear couples’ dissatisfaction around their sex lives, it’s because penetration is currently out of the question. Who cares! Take turns having oral sex (or settle into a comfortable 69 on your sides)! Use sex toys! Mutually masturbate with wand vibrators and see who can hold off the longest! Don’t worry about orgasms at all and just touch everywhere that feels good! You can customize your sex life to suit your needs. There are no rules except for the ones you set for yourselves. 

Physicality is not the only avenue for intimacy. While it can be easy to point to a stagnated sex life as the cause of loneliness in a relationship, it’s often a lack of emotional intimacy that creates a wedge, not a lack of tail. For someone struggling with an illness that saps their self-esteem, interest, and ability to parse emotions or focus, emotionally engaging a partner can sometimes be just as difficult as having sex. It’s important for everyone involved to consider their intimacy needs, and decide how best to exchange caring and affection – sometimes in new or abbreviated ways. When I’m depressed, my interest in cuddling (already complicated by my autism) is almost zero… but doing it doesn’t bother me either. I’ll often cuddle my partner to let them know that somewhere in the fog I still care for them, and even if my heart isn’t in it the way it is when I’m feeling better, the message I’m communicating is the same: hi, you feel nice in my arms, and I love you. 

But that’s my choice. Just as it’s their choice to receive my affection in an altered form. 

Sex isn’t the only way to feel pleasure. While writing about celibacy and pleasure here on the Peepshow Toys blog, I pointed out that not having sex doesn’t have to “close someone off from experiencing and exploring pleasure and sensuality. You don’t need sex to feel good – or to indulge in the erotic. Depending on your interests and boundaries, there are numerous ways to experience pleasure, from the obvious (getting to know those wand attachments a little better) to the obscure (paper crumpling, anyone?)”

If sex becomes a possibility again, don’t put too much pressure on it. “The most important thing to remember is that a sexless relationship is not a crisis; in fact, for some folks, it’s an ideal relationship structure,” I emphasized in Reintroducing Sex to Your Relationship, “A lack of sex isn’t a lack of love or intimacy, and it’s important not to conflate the two and put undue pressure on yourself and your partner(s).” It’s easy to rob sex of fun, curiosity, and in-the-moment connection by building it up to be a Big Deal. Yes, sex can be beautiful, intense, and full of feeling – but that comes as a result of having it, not because you decided it should be ahead of time. Sex after a long break, or sex while coping with an illness, can be an emotionally complicated endeavor, and piling it with expectations is a recipe for frustration. 

Start slow, expect nothing, and embrace new ideas about pleasure and sexual intimacy. You might not feel all right, but it’s all right to feel that way – and it’s okay to seek out good feelings in whatever capacity you’re ready and capable of, or to keep those adventures on the bench for later. 

I love sex. I’m frustrated that it feels so far away from me when I’m depressed. But talking about it – yes, even on the internet – helps. 

So, how are you feeling about sex?

Betty Butch is a queer, sex-positive blogger who reviews pleasure products and writes about identity and kink at bettybutch.com. You can find her on Twitter via @betty_butch.