Sexuality and Bipolar Disorder

Kelly Connell, PhD

As with other aspects of living with bipolar disorder, sexuality and sexual activity can swing back and forth between periods of hyper sexuality during a manic phase, and complete loss of sex drive during a depressive episode.

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This can wreak havoc on relationships and a person’s sexual self-esteem.

Sexuality During Mania

Hyper-sexuality is an increased level of interest in sex or increased amount of sexual activity that can seem out
of control. It is characterized by:

  • never feeling sexually satisfied despite engaging in a lot of sexual
    activity
  • sex drive that seems out of control
  • not having sexual gratification
  • having sex with multiple sex partners, including strangers
  • excessive masturbation
  • having continuous affairs and putting relationships at risk
  • inappropriate and risky sexual behavior
  • sex is used as a “painkiller” to avoid intimacy and other aspects of human relations that are feared
  • not having emotional satisfaction from sex
  • poor sexual impulse control
  • preoccupation with sexual thoughts
  • possible increase in use of pornography

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In persons with bipolar disorder, hyper-sexuality is often the most troubling and challenging symptom to cope with. Adolescents and younger children with bipolar disorder often act out with inappropriate sexual behavior with older persons. Adults often ruin their marriage or relationship because they are not able to control the urge to have sex with someone other than their partner. Sexual health issues are increased due to poor judgment, failing to use birth control or condoms, and having sex with unknown partners.

It is not clear why, but research indicates that more women are subject to experiencing hyper-sexuality than men.

Sexuality During Depression

When someone with bipolar disorder is at the other end of the spectrum and experiencing a depressive episode, just as the symptoms are the opposite from mania, so it is with sexuality. It is not uncommon for the person to experience low or diminished sex drive or hypo-sexuality. Hypo-sexuality and depression can be interrelated and for patients who are experiencing them, it can seem like and endless cycle.

Depression can lead to lack of interest in sex and lack of interest in sex can lead to depression, particularly when the hypo-sexuality causes relationship problems and the other partner doesn’t understand the low desire issues. This is especially true when a person with bipolar disorder goes from an extreme mania high and having hyper-sexual behavior, to crashing into depression and suddenly losing their sex drive. It can leave the partner confused, dismayed, frustrated, and often feeling rejected.

Low sex drive can also be a result of side effects of medication taken to treat the bipolar disorder. This can cause some patients to stop taking their medication, which can send them into either a manic or depressive episode. Further, the depression that accompanies bipolar disorder can also contribute to sexual dysfunction including erectile dysfunction in men.

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What You, as a Partner, Can Do

Sexuality issues that can accompany bipolar disorder have long been the forgotten aspect of the mood disorder. While changes in sexual behavior can be one of more obvious symptoms in both the manic and depressive stages, dealing with sexuality issues has been largely overlooked by health care providers.

However, there are things that health care providers, bipolar patients, and their partners can do to better understand and deal with sexuality issues when they arise. Some suggestions for positive action include:

• Become educated. Health care providers must become better educated on how illness affects human sexuality. Patients and their partners need to insist that their health care provider address sexuality issues in a proactive manner and also be assertive about educating themselves as well.

• Pay attention to symptoms and triggers. Helping to determine when extreme moods—either manic or depressive—are going to occur can alter patients and partners to watch for signs of hyper or hypo-sexuality.

• Be aware of medication side effects. Discuss possible alternatives that may not have sexual side effects. There are medications available for bipolar patients that can help them to have a healthy sex life.

• Be aware of sexual health issues. Protecting oneself and partners against unplanned pregnancy, STDs, and HIV is absolutely necessary. This is especially true when someone is experiencing hyper-sexuality and is having indiscriminant sex with multiple partners.

• Talk about it. Bipolar patients and their partners must communicate with each other about the realities of the disorder and how it may impact their relationship. Persons with bipolar disorder should make attempts at discussing any sexual issues they are experiencing before the relationship is impacted.

• Seek professional help. It may be beneficial to utilize therapy along with medical treatment to help work through tough issues for both patients and partners. Patients and partners may experience additional benefit in seeking therapy alone as well as a couple.

The Whole Truth

The truth is, sexuality issues and sexual behavior can be some of the hardest aspects of bipolar disorder to treat. When someone is in a manic stage, they often feel indestructible and are not concerned with consequences of their actions.

When someone is in a depressive stage, it is difficult to see things clearly as well, and they are often either apathetic about sex or distressed because they recognize the loss of libido and don’t know what do to about it.

Getting bipolar disorder under control is the first step at reclaiming a healthy sex life. When someone is stable with their moods addressing underlying issues is easier for both patient and provider.

If the bipolar disorder is stable, their sexuality issues should hopefully become stable as well. There are many people with bipolar disorder who are able to have healthy relationships and satisfying sex lives.

They key is to not give up, continue to work with health care professionals seeking answers to the problems, and keep the lines of communication between patients and their partners wide open.