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13 May 2021 (Last updated 22 Jan 2024)

Our mental health and sexuality

Sexual Health 13 min read
Expert Dr. Donna Oriowo
how our mental health impacts our sex life

How our mental wellbeing impacts us sexually.

Ever wondered how anxiety and depression affects us sexually? If emotions are connected to our sex drive? Or, felt like the medication to help us feel better is diminishing our sex life? With the help of sex therapist Dr. Donna Oriowo, we connect the dots of our mental and sexual selves to explore how mental health impacts our sexuality - from an emotion-based therapy lens.

Listen to the full podcast episode on Mental Health and Sexuality with Dr Donna Oriowo.

What is emotionally focused therapy?

The first thing that comes to many people’s minds when we discuss mental health is problematic thoughts; we talk about our thoughts and then want to change our behaviors. However, oftentimes emotions can inform our thoughts and our emotions can also drive our behaviors. So, emotionally focused therapy means that we’re getting to the essence of what is that we’re feeling.

We can also use somatic work (physical body work) as emotions hold space in our bodies, even if we don’t remember things. A lot of times people can’t remember exactly what happened, but they can remember how they felt and where they felt whatever they felt within their bodies.

Emotions inform what we think and what we think informs what we do, and it becomes a beautiful cycle that keeps giving. If we start with what we’re feeling, then we’re better able to gauge how those feelings then interact with our thoughts and interact with our behaviors. Instead of an approach that is just ‘let’s change up what we think’ with cognitive behavioral therapy, or ‘let’s change up what we do’ with behavioral therapy; we can take it one step back into emotions. Emotionally focused therapy means we get a better and more full picture of what’s actually going on for a person, as opposed to just picking this or that piece.

How do we identify emotions?

Normalize that feelings are a thing and we should have them.

We have not explored our emotions enough. Beyond, ‘I’m happy, I’m sad, I’m angry’, we need to learn the spectrum of emotions. A good place to start is with a feelings check-in, looking at a feelings chart and picking off a couple of things that we could be feeling. Getting ourselves into the mindset that emotions matter, and breaking the habit that we want to just ignore them.

For example, if we meet someone in an elevator they might say ‘Hey, how are you doing?’ and we respond with ‘Hey, you alright?’ - neither of us actually care, we just want to keep going. We’re in a habit of not waiting to realise an answer, and often answer with our thoughts rather than our feelings.

‘So I get them out of that habit. And I'm like, "Hey, good morning, how are you feeling?" And I wait for an answer. And if they answer with their thoughts, I direct them back to their feelings. So what it ends up looking like is first to normalize that feelings are a thing and that they should have them. And then the other piece is sometimes there needs to be some emotive education.’

There needs to be more emotive education.

There isn’t a real understanding of what emotions are, in fact it can be so based on sexism. A woman can’t feel angry, because that means that there’s a problem. A man can’t feel sad, because that means that there’s a problem.

So, in the space of therapy, expanding the expectations for emotions and showing that they are perfectly acceptable and required normalizes emotions as part of the work. Recognising that we have emotions, and opening up discussions about them are all part of the process.We’re in a world that often talks about separating our feelings, asking us to be strong or to not be emotional. But, emotions are nothing but information. They are just informing us about how we feel about a situation, there to let us know, and then what we do with that information is ours. Time and time again, we’re told to favor logic over emotion, yet one should not be favored over the other. They are actually very equal in how they help or hurt our lives. This is what we need to unlearn, and why there’s a lot of education needed around decoding emotions.

Emotion educational exercises.

Think of a scenario and then ask...

  • How might somebody feel about it?
  • What might be the thought process with that feeling?
  • What might be the behavior they exhibit because of that feeling?
  • Think of a situation we’ve been in that is similar to that?

How does mental health impact sexuality?

Mental health goes way beyond just thoughts, and taking care of it impacts all other areas of our wellbeing too; physically, emotionally, sexually…

How can emotion decoding guide sexuality?

Society can create standards about accepted or expected emotions or behaviors, and decrypting emotions can guide us towards having a sexuality that is on our terms, and not on the ones dictated by society. By unlearning the ‘norms’ and expectations of others, we can then build an understanding of the emotion, thought and doing process to see how sexuality relates to our emotions, and trusting them. Emotions are ours, it’s about us and not about others or their values.

Emotion & sexuality exercise.

Questions to ask ourselves to help undo the emotional learnings we have already...

  • How do we feel about our sexuality in general?
  • What do people think about our sexuality?
  • How do we imagine that that changes our behavior?
  • What feels right to us?
  • What feels good to us?
  • What makes us feel happy vs what other people told us should not make us happy?

How do we breakdown emotional and sexual preconceptions?

If patriarchy can dictate logic over emotion, what else can it dictate in relation to our sex life and emotions? We may feel anxious, depressed or have low self-esteem because we can’t be completely ourselves. Because we are having to be performative. Because we are made to feel as if something is wrong with us. Breaking it back down to emotions allows us to see that we might be simply trying to survive in a patriarchal world.

With emotions, the same thing goes for people of color; there are certain things we do not have access to depending on our race. Black women can feel angry but not want to become the angry black woman, so it paints a picture that this anger is not justified. In general, we are scared of anger and especially anger from people of color; so there are limits on those of us who have true access to angry feelings. But, anger tells us that something is wrong, and that we may have been hurt. And, it is an emotion that motivates us towards change.

‘So anger is my favorite emotion. I love it when it comes up in therapy. So when my clients get angry, and I start smiling, they'd be like, Why are you always smiling? I like anger. It's my favorite, we're about to do some work, man. I can see it.’

The shift is seeing all these pieces; the access to emotions and certain aspects of their sexuality. Breaking them down to then bridge the gap between those two things, while also working on psychoeducation.

Emotional expectations & sexuality exercise.

Things to consider when trying to pull down preconceptions of sexuality...

  • Does this thing actually work for us?
  • Or, is it something that feels separate from us?
  • Is it a performance that we have to put on?
  • How do we feel when we have to put on this performance?

What emotions come up in therapy to do with sexuality?

When it comes to talking about our relationship with our sexuality, and our experience with our own bodies, shame comes up a lot. We can feel ashamed that we are not as sexual as we feel we should be; ashamed that we haven’t had certain relationships by a certain point in our lives; or, ashamed that we like the things we like. Shame makes us feel like something’s wrong, and also brings feelings of guilt and sadness. Our socially-influenced experience of sexuality can sometimes be so frustrating and detaching, the shame so heavy, that it can actually lead us to a depressed state.

Depression and sex.

Sex can affect our mental health; when our sex life isn’t what we want it to be, or our relationships aren’t what we want them to be, these can feel like disappointments. Sometimes, we internalize that and feel as if we fell short eg. instead of ‘this relationship didn’t work out’, it’s ‘we are the thing that is wrong with this relationship’. So, it goes from being that is external to something that is internal. And, when it is internalized like that it becomes shame. Shame has no real purpose, it makes us feel horrible, but it doesn’t actually help fix anything. Instead we take it on to mean that something is wrong with us, as opposed to maybe something is wrong with a situation.

This shame can make it hard to access our sexuality. Instead, we may follow what others or a partner are doing; because we think ‘there’s nothing wrong with them, there is something wrong with us’. We access our sexuality from a place of deficit, trying to fill the deficit through what other people want or require from us, which makes it less ours and more theirs. We lose a grip on our own sexuality.

How to recognise sexual shame?

To own our sexuality on our terms, we have to recognise when it isn’t on our terms. Identifying the cycles that we may find ourselves in, and what they look like. If we have a loop in our sex lives, we need to create a space to break it down through emotions - then, build it back up again using our imaginations. The significance of this recognition is practicing a pause. Taking the time to think about our sex lives, and the things that are asked or expcected of us. Rather than jumping into it, pause and reflect on the moment that creates part of the loop. We can often find ourselves on autopilot, responding automatically without taking the pause - especially during partner sex.

Sexual shame exercise.

Ways to acknowledge sexual cycles we might be in...

  • Notice that when this happens
  • What happens next?
  • What happens after that?
  • What would we want to do instead?
  • How would we want to feel instead?
  • What would we want to think instead?

Then, identify initial emotions that feed back into the loop…

  • What is the initial emotion?
  • Where does it come from?
  • What are the origins of this feeling?
  • Who or what made this possible?
  • What would we like to be feeling instead?
  • If we felt this, what would happen?

These types of cycles can in our sex life can cross into other parts of our lives too, and exploring them can provide us with the tools to readily identify how that loop shows up in those other places. It all connects!

Antidepressants & sex.

So, as we know sexual wellbeing affects other aspects of our lives - and, vice versa. Whilst our experience and emotions with sexuality can cause depression, our depression can impact our sex lives. But, does treatment for depression work together or against our sexual health?

There's a myriad of ways that these things can impact one another. Depression can strip us of our desire or want to engage sexually with ourselves or with others. For some, taking medication for depression - in the context of our sex lives - can feel like a no-win situation, as it fuels a cycle of anxiety in itself. So, considering ‘can antidepressants affect sex drive’ feels a bit like unpicking a non-stop back-and-forth of cause and effect.

How can medication affect our sex lives?

For some of us, our depression can make us feel anxious if our partner has been asking for sex. So then when it seems like they might ask for sex, our anxiety heightens and we create excuses, and then plunge deeper into a depression because now we also worry that we’re negatively affecting our relationship with our partner, if there is one. So we become more distant, and to be even harder on ourselves. More so, it is possible to lose sexual libido as a side effect of depression medication. Often, we might not feel our complete selves as the medication works with various neurotransmitters to make us feel less depressed. These changes to our body chemistry can really impact one of our biggest sex organs, the brain. Hence the no-win feeling, because lack of sexual desire can also make us feel depressed!

Yet again, we’re presented with a mental and emotional situation which leaves us in a sexual deficit - our sexuality doesn’t feel like it’s on our terms. This can be exasperated with partner sex, where feelings of anxiety and guilt arise from not wanting to engage with our partner. Consequently, we often find ourselves having sex to appease our partners, rather than pleasure ourselves. There’s a lack of desire for sexual pleasure, yet we put on a performance. Which, of course, can then make us feel resentful and as though our relationship is deteriorating.

How to overcome the negative effects of antidepressants on our sex drive?

It’s important to determine if the medication is really the main cause of the change, or lack of, sexual responses. If so, we should always address the conversation with our health professional such as a doctor or psychiatrist - whoever prescribes the medication. Perhaps it’s possible to change the dosage, try a different type of medication or add something else to help.

Otherwise, it could be an underlying cycle that needs to be identified with ourselves or our partners. Taking that pause; to consider what the medication or depression has been doing. Beyond changing treatment, can we do something to feel more sexy, more in the mood, more ready?

‘I think that sometimes people are very ready to jump into the sex, to have sex to be in the throes of the passion and all that, but there's been no work no lead up, no preparation, no anything.’

We can be mindful of the preparation that goes into sex, of the step-by-step process that we often overlook. Just like at work, there’s a lot of things we do to prepare ourselves to be there. We take a shower, we pick out clothes that are appropriate for the occasion, we do our hair, we make sure we have all the things we need for a day of work, we might check our emails on the way… there’s a process we do to make sure that our minds and bodies are fully engaged in the work process. We do not do the same thing with our sexual habits and practices, but perhaps we should. To help overcome a lack of libido, let’s ask ourselves..

  • Did we do anything with our body?
  • Did you put anything in our mind?
  • Did you interact with the other person in small ways that would also lead up to this?
  • Or did we just think that we could sex our way into sex?

Building in practices can help, it might not fully counteract the negative impacts of medication, but building systems can be helpful for depression. In the context of sex? That looks like getting into a mindset, giving ourselves our own sexual aphrodisiacs, creating a sexual space.

Dr. Donna Oriowo is a sex and relationship therapist in the United States. She focuses on working with black women especially, on issues related to mental health and sexuality because the two go hand-in-hand.

Looking for an emotion chart? We love this wheel my Lindsay Braman.

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