Here are five reasons anorexia nervosa can impact your sex drive.

In the fall of 2017, as I set out to conduct interviews on sexuality in women with anorexia nervosa for my dissertation research, I did so knowing that women would express experiences with low sex drive. After all, research shows that this population tends to have avoidant, immature, and averse feelings toward sexual activity.

What I did not expect, however, was how often women worried that this experience was unique.

Over and over again, feelings of abnormality would come up in these conversations. One woman called herself “really awkward and atypical,” and even went as far as to say her lack of interest in sex makes her “a crazy person.” Another, after explaining her experience, backtracked, stating, “I don’t even know how that makes sense or how that works.”

Weird was the word women most often used to describe themselves.

But here’s the thing: If you have anorexia and experience low sex drive, you are not weird. You’re not abnormal, atypical, or crazy. If anything, you’re actually average.

A 2016 literature review noted that, though research exploring sexuality in women with anorexia is, minimal, nearly all studies found those women had lower sexual functioning.

In short: For women with anorexia, a low sex drive is very, very common.

So if you have been diagnosed with anorexia nervosa and find your sex drive to be low, here are five reasons why this might be the case and what you can do about it.

Let’s start from a physiological explanation. What makes anorexia especially dangerous is that starvation leads to malnutrition — and a malnourished brain loses function. When you’re not consuming enough calories to maintain appropriate levels of energy, your body starts to shut down systems to conserve.

Starvation’s effect on physiological health includes hypogonadism, or the failure of the ovaries to function properly. Reduced levels of hormones related to sexual functioning — including estrogen and progesterone, which the ovaries produce — can affect your sex drive. We often think of this in relation to aging and menopause, but anorexia can create this effect, too.

What to know
there’s a way forward if you’re struggling with, or recovering from, anorexia
nervosa. Studies show that recovery — specifically weight restoration, if this was an issue for you —
is linked to increased sexual functioning. As your body heals, so too can your

Reasons for a decrease in sex drive don’t necessarily have to do with the eating disorder itself, but rather other factors that accompany said eating disorder. Depression, for example, in and of itself, can have a negative impact on sexual functioning.

And because approximately 33 to 50 percent of people with anorexia nervosa have mood disorders — such as depression — at some time in their lives, it can also be an underlying factor as to why your sex drive might be low.

The treatment for depression can also play a role as well. Selective serotonin reuptake inhibitors (SSRIs) — a class of drugs often used as antidepressants and in the treatment of eating disorders — are known to have adverse effects on sexual function. In fact, common side effects can include reduced sexual desire and difficulty reaching orgasm.

What you can do
medical and mental health professionals are well aware of the sexual side
effects of SSRIs. They should be willing to work with you to find treatment
options, including medication — either an alternative SSRI or an accompanying
medication — that can help to improve your quality of life. And remember, if your doctor
doesn’t take your sexual satisfaction seriously, you are perfectly within your
right to find a different
healthcare provider

When conducting my own dissertation research, more than half of participants with anorexia nervosa mentioned experiences with abuse in their lives — whether sexual, physical, or emotional, be it in childhood or adulthood. (And this rang true for me too, as I developed an eating disorder in response to a relationship with an abusive partner.)

Moreover, the same participants talked about how these experiences had a significant impact on their sexuality.

And this is unsurprising.

Many women with eating disorders have had past experiences with trauma, specifically sexual trauma. In fact, rape survivors may be more likely to meet eating disorder diagnostic criteria. One small 2004 study found that 53 percent of 32 female sexual trauma survivors experienced eating disorders, as compared to just 6 percent of 32 women with no sexual trauma history.

What you can do
If you
struggle with sexuality after trauma, you’re not alone – and there is hope. An
exploration of sensate focus, a practice involving slowly
(re)introducing sensual touch into a person’s life in a deliberate manner, can
be helpful. This, however, should ideally be done with the help of a sex

For many women with anorexia, their aversion to sex is less of a physiological barrier, and much more a psychological one. It’s hard to engage in sex when you’re not comfortable with your body! That’s true even for women who don’t have eating disorders.

In fact, one 2001 study found that, compared to women with positive perceptions of their bodies, those who experience bodily dissatisfaction report less frequent sex and orgasm. Women with negative body image also report less comfort in:

  • initiating sexual activity
  • undressing in front of their partner
  • having sex with the lights on
  • exploring new sexual activities

Even a Cosmopolitan survey noted that approximately one-third of women report inability to orgasm because they’re too focused on how they look.

But the opposite is also true: Women with positive body image report greater sexual confidence, more assertiveness, and higher sex drive.

What you can do
If your
body image is getting in the way of a satisfying sex life, focusing on healing
that relationship can lead to improvements. Whether you’re working on body image and self-esteem
issues in a therapeutic environment, going the self-help route with books to
help you break down body hate (I recommend Sonya Renee Taylor’s The Body Is Not an
), or starting slowly by diversifying your
Instagram feed
, a happier relationship with your body
can lead to a healthier relationship with sex.

Personality is a contested topic: Is it nature? Is it nurture? How do we become who we are — and does it even really matter? In this conversation, it does. Because the same personality traits that are commonly associated with anorexia diagnoses might also be connected to a disinterest in sex.

In one 2004 study, researchers asked a sample of clinicians to describe their patients with eating disorders. Women with anorexia were described as “prim/proper” and “constricted/overcontrolled” — and this personality predicted sexual immaturity. Obsessionality (preoccupation with thoughts and behaviors), restraint, and perfectionism are three personality traits often associated with anorexia, and they can get in the way of interest in sex. Sex might feel too messy. It might feel out of control. It might feel indulgent. And this can lead to sex feeling uninviting.

That said, the thing to remember about sex drive is that it naturally differs person to person. Some people have a high capacity for sexual interest, and some people have a low capacity. But we’re convinced in our hypersexual culture that being on the lower end is wrong or abnormal — it’s vital to remember, however, that it’s not.

Asexuality is a legitimate experience
some, low sex drive might be due to falling on the asexuality

which can include everything from little to no to specific interest in sex.
It’s important to remember that this is a legitimate experience of sexuality.
There isn’t inherently something wrong
with you because you’re disinterested in sex. It might just be your preference.
What’s important is communicating this to your partners, expecting them to
respect your needs, and developing comfort with ending relationships that
aren’t sexually compatible.

The most important thing to remember about “sexual dysfunction” ­— a troubling term in and of itself ­— is that it’s only a problem if it’s a problem for you. It doesn’t matter how society views “normal” sexuality. It doesn’t matter what your partners want. It doesn’t matter what your friends are doing. What matters is you. If you’re distressed about your level of interest in sex, you deserve to investigate it and find solutions. And hopefully, this article gives you a place to start.

Melissa A. Fabello, PhD, is a feminist educator whose work focuses on body politics, beauty culture, and eating disorders. Follow her on Twitter and Instagram.