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How Bipolar Disorder Affects Sexual Health

Medically Reviewed by Smitha Bhandari, MD on September 01, 2020

If you have bipolar disorder and notice changes in your sexual health, you're not alone. Both your condition and some medications used to treat it can alter your sexual behavior and experience.

Knowing how to spot key symptoms and side effects will allow you to work with your doctor to find ways to improve your sexual health.

Effects From Bipolar Disorder

The defining feature of this mental illness is wide mood swings. But shifts in sexual attitudes and risk-taking also can be common signs of bipolar disorder. A few ways it can affect your sex life may include:

Hypersexuality. It’s also called compulsive sexual behavior. It’s when sex becomes a main focus of your life. You may not be able to control it even if it harms you or other people. This usually happens during the manic or hypomanic phase of your illness. That’s when you’re most likely to do something pleasurable without thinking about potential harms.

Risky behavior. It’s not only people who have bipolar disorder who engage in dangerous sex. But the condition can lead you to take chances more often. Those risks can include sex with strangers, sex without condoms and other protection, or mixing sex with drugs.

Lower sex satisfaction. You may find that you enjoy sex less than you used to. Or your sex drive may drop when you’re in the depressive phase of your illness, which can leave you feeling indifferent or tired.

Sexual dysfunction. You can have problems in four areas: desire, arousal, orgasm, and pain during sex. This can be a lingering symptom of bipolar disorder and typically happens when you're in a "normal" mood, and not feeling manic or depressed.

Effects From Bipolar Medications

Treatment with drugs can help you manage mania and depression. But some medications can have side effects that can cause sexual problems.

Lithium. About three in 10 people who take this common drug report sex issues. Lithium may lower testosterone levels, which is linked to low sex drive. It also may block a chemical that helps men get and keep an erection. That can lead to erectile dysfunction. Chances of problems get worse when you combine lithium with benzodiazepines, fast-acting sedatives.

Other side effects from lithium may include:

  • Less sex
  • Fewer sexual fantasies
  • Lower sex satisfaction

Antipsychotic medications. Your doctor may prescribe olanzapine (Zyprexa), aripiprazole (Abilify), or other antipsychotic drugs to treat regular manic episodes or if you lose touch with reality. They work by blocking dopamine receptors in your brain. But that, in turn, raises your level of prolactin, a hormone that controls sexual functions such as menstrual periods and sperm production. The result can dampen your libido or make it harder for you to get aroused or reach orgasm.

Anticonvulsants. These can help with mania and mood swings, especially if lithium doesn't work well for you. Some anticonvulsants can interfere with your periods or disrupt your hormones. They may also lower your libido and make it harder to get and keep an erection.

What You Can Do

One of the best things you can do is be vocal and honest with your doctor or therapist about any symptoms or side effects you're feeling so they can fine-tune your treatment.

It may help to track any sexual symptoms of your bipolar disorder so you and your doctor can look for solutions. This is particularly important during the time when you may be trying different medications to find the right type and dosage. Be sure not to change or skip your medication without your doctor’s OK.

Show Sources

SOURCES:

American Society for Reproductive Medicine: "Hyperprolactinemia (High Prolactin Levels)."

BMC Psychiatry: "Risky sexual behavior and associated factors among patients with bipolar disorders in Ethiopia."

Cleveland Clinic: "Medications that Affect Sexual Function."

HelpGuide: "Living with Bipolar Disorder," "Bipolar Medication Guide."

Human Psychopharmacology: Clinical and Experimental: "Lithium and sexual dysfunction: an under-researched area."

Journal of Affective Disorders: "Hypersexuality and couple relationships in bipolar disorder: A review," "High-risk behaviour in hypomanic states."

Mayo Clinic: "Compulsive sexual behavior."

National Institute of Mental Health: "Bipolar Disorder."

NeuroRx: "How antipsychotics work -- from receptors to reality."

Psychiatry Journal: "Comparison of Sexual Experience and Behavior between Bipolar Outpatients and Outpatients without Mood Disorders."

The World Journal of Men's Health: "Antipsychotic-Induced Sexual Dysfunction and Its Management."

Urology Care Foundation: "What is Low Testosterone?"

World Psychiatry: "The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management."

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