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Sexual Health and Bipolar Disorder

Reviewed by: HU Medical Review Board | Last reviewed: September 2023

Living with bipolar disorder may bring a rollercoaster ride of mania and depression. These mood swings can lead a person to shift between having no interest in sex and an overwhelming interest in sex.1

These mood changes often frustrate the person with the condition as well as their partner. Partners may be confused or frustrated by sudden changes in sexual desire.2

Bipolar moods affect sexuality in different ways, depending on whether a person is in a manic state or a depressed state.1,2

Mania and sexuality

During manic episodes, some people with bipolar disorder think about sex more. They may want to have more sex as well. Excessive and inappropriate flirting is also common.2

Combined with lower inhibitions and disregard for painful consequences, these desires can lead to unwise or even dangerous sexual encounters. Unplanned pregnancies or sexually transmitted infections (STIs) may result from these encounters. Manic sexual behaviors may include:2,3

  • Having sex outside established relationships
  • Multiple partners
  • Unprotected sex
  • More masturbation than what is typical for a person
  • Sexual experimentation outside one’s normal boundaries
  • Sex with people of unknown HIV or other STI status
  • High-risk sexual behaviors

Studies show that people with bipolar disorder have more STIs and unplanned pregnancies than people without the condition. They also experience more sexual violence. Children and young teens with bipolar disorder may engage in behavior inappropriate for their age, such as flirtatious touching and using sexual language.2

Depression and sexuality

Low mood and negative self-esteem in people with bipolar depression often result in feeling undesirable or uninterested in sex. These people may feel unattractive and lose interest in keeping up their grooming habits. Exhaustion also may make sex unappealing.4

Sex and bipolar medicines

The medicines that help control bipolar mood swings may cause side effects. Some of these side effects may affect a person’s desire and ability to enjoy sex. For all genders, bipolar drugs can cause loss of sexual desire, trouble having an orgasm, or painful sex. In people with a penis, bipolar drugs may make it hard to get or keep an erection (erectile dysfunction).5

Studies show the drugs most often linked to sexual problems are:6

  • Lithium – When used alone, it may lead to worse sexual arousal.
  • Benzodiazepines – When used with lithium, they may lead to less sexual desire.
  • Certain mood stabilizers with lithium – This combination may lead to problems with orgasm.

Get empowered through knowledge

It is important to feel comfortable talking about your sex life with your doctor and therapist. They can suggest easy ways to protect yourself and your partners against STIs and unwanted pregnancies. They also may be able to make changes to your medicines that keep both your moods and your sexual health stable.

Managing the manic side of sexuality can be done, but it takes work. You also can protect yourself by learning to recognize your triggers and early symptoms. Sex counseling can help people with bipolar disorder find more positive ways to handle how mania and depression impact their sexual health.2

Some people with bipolar disorder find that it helps to channel their sexual energy into creative projects. Therapy also can help people learn how unwise sexual encounters affect their disease, cause shame or embarrassment, and lead to relationship problems.2

Like other aspects of living with bipolar disorder, sexual issues can be challenging. But developing self-awareness and communicating openly with loved ones and your healthcare team can help you learn to manage this part of the condition. It is possible to find balance and overall well-being when living with bipolar disorder.

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