How Your Mental Health Affects Your Sex Life

"The biggest sex organ is the brain," Gronski said.

Feeling worried, stressed, anxious or scared about something, like pain or feeling pressured to please and perform, ramps up the sympathetic nervous system, she said.

"This means increased arterial constriction, blood flow changes to urogenital organs and digestive system, muscular guarding and tension, and diminished sexual appetite," Gronski continued.

Gronski explained the sexual response cycle in five stages:

Desire

• The need to fulfill a sexual appetite.
• Intellectual and emotional openness to engaging sexually.
• Desire can be spontaneous or responsive.

Arousal

• Heart rate increases.
• Respiratory rate increases.
• Blood flow to genitals increases.
• The parasympathetic nervous system is modulated. (The parasympathetic nervous system helps your body relax after periods of stress and helps run other life-sustaining processes, such as digestion.)
• Release of dopamine.
• Facilitates an increase in sex drive and orgasm.
• Arousal can wax and wane throughout a sexual encounter.

Plateau

• Breathing becomes more rapid.
• Muscles continue to tense.

Orgasm

• There is no formal definition of orgasm. One description is that the orgasm represents peak pleasure in the moment.
• Orgasm may or may not involve ejaculation.
• Rhythmic, involuntary contraction of pelvic floor muscles, anal sphincter and prostate/uterus.
• The sympathetic nervous system—the "fight, flight, freeze" part of the central nervous system—is modulated.
• "Feel good" chemicals, such as dopamine and oxytocin, are released from the brain.
• Research indicates brain activity during orgasm is the same for women and men.

Resolution

All systems involve a "slowdown back to baseline," and engorged/swollen erectile tissue returns to its normal size and color.

"The brain has the power to inhibit or facilitate any of the above processes, which is why it is important to view sexuality in relation to the whole person, [including] biological, psychological, sociocultural and interpersonal influences on their sexuality," Gronski noted.

For example, she said if a person experiences sexual pain, fear or any other potential threat to the person or their body, identity, relationships, work, hobbies and so on, the brain ramps up protective mechanisms.

"The brain is always predicting the next step ahead and weighing the world for us moment by moment," Gronski explained. "These predictions produce outputs like motor responses, such as muscle activation or inhibition, feelings [and] emotions, and influence behavior."

Getting in the mood

"Sex for many of us is one of the most joyous activities in our lives," said Alex Dimitriu, M.D., who is double board-certified in psychiatry and sleep medicine and the founder of Menlo Park Psychiatry & Sleep Medicine in California and BrainfoodMD.

"Whenever I work with patients and see that there's something off about sleep, sex or drugs, it always compels me to investigate further as these are often the tips of the iceberg," he explained.

Dimitriu noted many factors can contribute to issues in these three key areas. Most fundamentally, sex requires energy, desire and an ability to relax and enjoy.

"Sex, I believe, is the ultimate mindfulness practice," he added. "As anyone knows, trying to have sex while worried about a meeting the next day often does not go well. So, indeed, sex requires presence to be good."

If you feel your mental health is affecting your sex life or your sex life is affecting your mental health, Gronski advised seeking support from a qualified sex therapist. She encouraged people to find a sex therapist who is a licensed mental health professional specializing in treating people with sexual issues and concerns, and can provide in-depth psychotherapy.

Regarding what you can do personally, Gronski recommended talking to your partner.

"If a person feels safe in their relationship, I would empower them to turn toward their partner[s]—if partnered—as an erotic friend and share their sexual and mental vulnerabilities," she said.

This communication can help your partner understand how these sexual and/or mental health challenges have been affecting you.

"Sometimes just naming out loud what we are holding inside is very therapeutic," Gronski said.

Additionally, she encouraged people to stay connected to their sexual selves even when not "in the mood" for sex.

"I often ask my clients, how can you expand your sexual portfolio to connect with your sexual/sensual self or whatever kind of intimacy the person feels comfortable [with] and has the capacity to engage in at that time?" she noted.

Examples of expanding your sexual portfolio might include massage, cuddling, holding hands, exercise like walking, yoga or hiking, watching a funny movie, eating your favorite food or simply carving out time for conversation.

Of course, there are lots of other ways to make sure your sexual health and mental health are positively working together to form a desirable sexual experience.

According to Dimitriu, the biological foundation for sex must be present.

"Being tired, depressed, stressed, hungry, underslept or in pain is not a good starting point to be frisky," he said. "So certainly make sure your inner animal needs are met first before assessing your sex drive.

"Psychologically, desire for a partner is essential, but also the ability to want and experience joy or pleasure," he continued. "People who are depressed or tired will often feel anhedonia, which is a loss of joy, with a decrease in the desire for pleasurable things, like sex."

To get into the right frame of mind for sex and to feel desire, Dimitriu emphasized that you must meet your basic human needs. Get good sleep, exercise and time outdoors, and have some unscheduled time by day to relax and unwind—and not by scrolling through your phone.

"Sex likes space," he said. "Cramming it into a packed schedule can easily become another task on the to-do list. Couples have more sex on vacation because they have more time, more sleep and less stress. To whatever extent you can bring 'microvacations' home, the better. A date night, a lazy morning without kids or a weekend escape can all be helpful."

Gronski added that the ingredients for a positive sexual experience and relationship include consent, honesty, respect, shared values and communication.

"It's having compassion toward one another when leaning into potentially vulnerable situations like sexual and mental health concerns," she said. "It is vital to establish trust; to know that your partner has your back even in the most vulnerable and difficult situations, sexually and otherwise."

Gronski provided her top five tips for maintaining a sexual relationship that positively impacts your mental health.

1. Remember, a healthy sexual relationship—or any relationship for that matter—is free from coercion. It is a consensual and mutually shared experience of pleasure.
2. Understand that sexuality is fluid. It's constantly growing and evolving throughout your—and your partner's—life as well as your relationship.
3. Embrace the "good enough sex" mindset, where you value flexibility and variability in your sexual experiences. Accept that not every sexual experience is "perfect." Some sexual experiences may be so-so, some amazing and some everything in between. Acceptance of each other, the situation and the experience for what it is without blame or shame is imperative for a healthy sexual relationship.
4. Shift away from performative-based sex and redirect your expectations toward pleasure-oriented sex. Give yourself (and your partner) permission to immerse yourself in your own pleasure experience without feeling responsible for your partner's experience. You each are responsible for your own pleasure.
5. Communicate your sexual needs to your partner in an open, respectful and honest way. Explore your own sexual menu to discover what you find pleasurable and erotic. Verbally and nonverbally, guide your partner in ways you like to receive pleasure and touch positively.