Bipolar disorder causes a person to experience intense shifts in mood. These shifts can also occur with changes in sexual desire, confidence, or function.
However, it is important to note that everyone is different. Not all people with bipolar disorder have symptoms that affect their sexuality.
In this article, we discuss how bipolar disorder can affect sex.
Depending on the type of bipolar a person has, they may experience periods of mania, depression, or both. These mood changes can affect someone’s sexuality.
The exact effects will vary from person to person, but generally, mania has associations with increased interest in sex, while depression has links to a low desire for sex.
For some, these changes only occur during episodes, but a 2021 review notes that there is evidence that they can also persist in between episodes.
There are also links between bipolar disorder and sexual dysfunction. For example, a
However, bipolar treatments may be able to reduce sexual symptoms. There are also additional approaches that may address specific symptoms, such as erectile dysfunction.
In bipolar disorder, depressive episodes cause a person to feel down, empty, or hopeless. In an individual with bipolar disorder, they may also lead to hyposexuality, which refers to a low sex drive.
Someone with hyposexuality may experience:
- a lack of interest in sex
- feeling vulnerable or worthless, which may keep them from engaging in sex
- feeling physically unattractive or undesirable
- a disinterest in personal hygiene or grooming
- physical exhaustion, which may make sex more difficult
The person may also feel guilty about their lack of sexual desire, which could feed the cycle of self-doubt and low libido.
A manic episode of bipolar disorder can cause a person to feel unrealistically confident. They can be prone to making rash decisions, overestimate their capabilities, or feel invincible.
People experiencing mania can also exhibit hypersexuality, or a very high sex drive. In combination with the other symptoms of mania, this may result in harmful or unusual sexual behavior.
A 2024 study notes that while hypersexuality is a key bipolar disorder symptom, people often do not discuss it, and there is little research on the topic.
However, some potential examples of hypersexuality in those with bipolar disorder might include:
- atypically heightened sexual confidence
- more willingness to experiment sexually
- sex with more partners
- infidelity, if they are monogamous
- constantly thinking about sex
- increased pornography consumption
- frequent or prolonged masturbation
- visiting sexually-oriented establishments frequently
Another factor that can affect sexuality for those with bipolar disorder is medication.
For example, lithium has been a common drug for bipolar disorder for decades. However, according to a 2022 review, several studies have linked lithium to sexual dysfunction.
Anyone who believes that medication may be affecting their sex drive can speak with a doctor about their options.
Additionally, people should not stop taking medications before talking with a doctor. Doing so may increase the risk of triggering a manic or depressive episode.
Even with effective medical treatment, people with bipolar disorder may still experience hyposexuality and hypersexuality during episodes of depression and mania. This could affect their relationships, either with others or themselves.
The following strategies may help.
Seeking help early
Recognizing the early symptoms of a mood change can help people know when to seek help from their doctor.
People can also take steps to avoid exposure to potential triggers. For instance, when high levels of stress contribute to depressive episodes, a person may benefit from practicing techniques to help manage stress.
Minimizing the risks
Sex without using a barrier method can put a person and any partners at risk of sexually transmitted infections (STIs). In some situations, it could also result in pregnancy.
If a person is likely to have sex, particularly with new partners, they need to carry condoms or other barrier methods of contraception with them. These are the only forms of birth control that also reduce the risk of STIs.
It is also important to undergo regular testing for STIs. Symptoms alone are not a reliable indicator, as these infections do not always cause symptoms.
Another way to prevent certain STIs, such as human papillomavirus, is to get vaccinations.
Keeping track of side effects
People who begin a new medication or change the dosage of a medication may find it helpful to keep a diary of any side effects. This may help them track how their sexuality changes over time and whether this relates to a new drug or mood episode.
If a person has concerns their medication is affecting their sex drive, they can speak with a doctor.
Considering sex therapy
Psychotherapy may already be a component of a person’s treatment plan. However, sex therapy specifically focuses on sexual health and well-being and may offer additional support for those with specific concerns in this area.
A sex or relationship therapist may be able to help with managing sexual symptoms, either individually or by speaking to all partners together. They may be able to:
- help partners communicate
- help them understand sexual or emotional problems
- discuss ways to strengthen relationships and intimacy
Bipolar disorder affects many aspects of life, including a person’s sexuality. During manic episodes, a person may become highly sexual but then have little or no sex drive during a depressive episode.
Each of these can be challenging. An effective treatment plan should include ways to manage these sexual symptoms without putting the person or their sexual partners at risk.
For people in relationships, it is important to include partners in the process and keep the lines of communication open. This can help them better understand the symptoms a person is facing.
Working with a physician and a mental health specialist can help with developing a combination of medication and therapy that manages symptoms. Some may benefit from additional support from a sex and relationship therapist, group therapy, or support groups.