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Sex, Intimacy, and Mental Health

It's no secret Hollywood has a habit of glossing over the less "sexy" details of daily life, especially in the bedroom.

When it comes to intimacy and sex, movies typically show an experience executed smoothly, filled with passion, and somehow includes no sweat or cleanup.

What they don't typically show is someone fumbling around awkwardly for a condom, a dog that starts getting a little too nosy, or having to constantly readjust positions because your knees just don't bend the way they used to.

More importantly, though, movies rarely nod to one of intimacy's most common bedfellows: Mental health.

For millions of people (myself included), sexual intimacy isn't always this blissful explosion of passion and romance. It can be messy, uncomfortable, daunting, and complex in many ways.

I'm currently in recovery from anorexia nervosa and have witnessed firsthand the intersectionality between mental health and intimacy.

From body image distress to medication regimens and chronic depression, my eating disorder has added an extra layer of complexity to sexual intimacy. But that doesn't mean it has ruined the experience for me.

Over time, I've learned to identify potential scenarios or triggers that could lead to increased anxiety during sex and can now be proactive in my intimate experiences.

I can't say that it will always be smooth sailing, but enjoying intimacy is attainable once you understand what might be hindering your experience and how to manage it.

Eating disorder or not, feeling completely comfortable in our body is not something many people have mastered - this is perfectly natural.

Society has not created an atmosphere to love our bodies wholeheartedly. From an early age, we're constantly inundated with messages that if we lose more weight, gain more muscle, or put on a sexy outfit, then we'll be more desirable to others.

We see this in movies and pornography, where the stars of the scene are perfectly chiseled, have curves in all the right places, and not one single hair moves out of place. The cameras conveniently leave out the view of the smudged makeup, natural body rolls, and sweat-matted hair.

So, when we're in the situation where we are exposed completely to our partners, we feel inadequate because this isn't what we've been told is sexy.

We think, "My stomach doesn't look like theirs," or "Do I look saggy from this angle?" or "I need to start working out more."

These thoughts then begin to take over your experience. Instead of being in the moment with your partner, you're preoccupied with thoughts of shame, inadequacy, or guilt over your physical appearance.

For me, I find myself shutting down intimate advances from my partner when I'm feeling particularly body-conscious. I hardly feel comfortable when clothes are touching my body, let alone when someone else is touching it.

Not only does feeling guilty impact my sex drive and comfort being completely exposed, but it also further prevents me from truly enjoying intimacy with my partner. This makes achieving orgasm more difficult, staying self-lubricated nearly impossible, or it just genuinely creates a feeling of disgust or discomfort in myself.

While there is, unfortunately, no cure-all when it comes to eliminating body image distress in the bedroom, there are ways to help assuage these negative feelings and start enjoying your time tangled up in the sheets.

Anticipate the triggers ahead of time

Consider experimenting with morning sex, pre-meal sex, or waiting until an hour after eating to get physical.

Sex, Intimacy, and Mental Health

My issues with sexual intimacy happen more frequently in the evenings following a bigger meal or one that's deemed "unhealthy" by society's standards or those set by my eating disorder.

To help avoid this, I try to work sex into the schedule before a large meal or at least an hour after to let the anxiety pass. This allows me to stay present in the moment without hyper-fixating on how my body looks in the moment.

This strategy may seem perfect in theory, but trust me - it isn't. Body image issues are deep-rooted, so sticking to a schedule isn't going to automatically solve all my problems or cure my insecurities.

What the strategy can do, though, is alleviate the stress associated with certain triggers and allow me to take a large step toward being present with my partner.

Communicate with your partner

Communication is another major key to setting yourself up for success in the bedroom, especially regarding body image concerns.

Vocalizing your mindset or triggers to your partner can help strengthen your bond, improve your experience, and take power away from the voice in your head that says you don't have a body that deserves to be touched.

Get comfortable with yourself

Try sitting in your bra and underwear when you're alone to get used to feeling exposed. This can help raise your comfort level when the time comes to undress with your partner.

Get hype

Hype yourself up before doing the deed. Turn on your favorite pump-up song, get dolled up (if you want), dance around, and don't take yourself too seriously.

Following my anorexia diagnosis, I was put on an antidepressant, which I'm still taking today. Since then, I've noticed a stark difference in my libido.

Like millions of other people, I take a selective serotonin reuptake inhibitor (SSRI) - an antidepressant that works by increasing serotonin levels in the brain. Serotonin helps to regulate mood, appetite, sleep, and sexual desire.

SSRIs can be an incredible method for alleviating symptoms of anxiety and depression, but they're also known for their sexual side effects. Some common ones include:

  • decreased or lack of desire for sex
  • delayed lubrication
  • blocked or delayed orgasms
  • erectile dysfunction

For a long time, I didn't know this about antidepressants and felt embarrassed in sexual situations. I even noticed that it made my partners feel self-conscious, as if they were doing something wrong when I wasn't "wet" or couldn't achieve an orgasm.

Finally, I discussed it with my psychiatrist, who quickly assured me that nothing was wrong with me and that it was a common side effect of SSRIs. We adjusted my dosage and temporarily tried a different prescription; however, I ultimately preferred my initial prescription regimen.

Instead of giving up on the prospect of enjoying sex, I decided to add some new tools - and toys - to my toolbelt. (Look... I'm not saying that buying my first bottle of lube was life-changing, but it was pretty damn close.)

Instead of being embarrassed to address the lack of self-lubrication, I became comfortable with casually mentioning that it's very natural with my medication and that lube will sometimes do the trick.

It can feel frustrating or embarrassing for both men and women when your body doesn't react the way you want it to in sexual situations. Being able to understand and convey why it's happening is a great way to break down that barrier.

If you or your partner experience a shift in your sex drive or performance due to your antidepressant or another medication, here are a few tips that may help spice up your sex life and get you back in the saddle:

  • Try the wait-and-see approach: It can take up to 4 to 6 weeks for your body to adjust to a new medication, so the side effects may go away on their own. However, while suggests this may be the most-widely used method among physicians, it's also the least effective one, with only some people seeing some improvement within a few weeks or months.
  • Consider a new medication or lower dosage: Try talking with your healthcare professional about switching your medication or lowering your dosage. shows that this is one of the most common ways to treat unwanted sexual side effects. There are some antidepressants that cause fewer sexual side effects that may work for you.
  • Try lubricant: Invest in a good lube! I promise you won't regret it. Using over-the-counter lubricants may be helpful if you're experiencing vaginal dryness during sex.
  • Increase time spent on foreplay: SSRI or not, we should never neglect foreplay.
  • Plan intimacy around medication regimen: For example, if you take your SSRI at 10 a.m., try to initiate morning sex before taking your next dosage.
  • Educate yourself and become comfortable talking about your situation: If you're comfortable and don't make it seem awkward, your partner will follow your lead.

If your partner lives with a mental health condition that impacts their sexual intimacy experience, you can play a significant role in helping them feel comfortable.

Here are a few things to keep in mind in supporting your partner:

  • It might be a good idea to educate yourself on the matter and try to be open to hearing about their experience.
  • Try to avoid gaslighting them or making them feel guilty over a decreased sex drive.
  • Try to avoid making physically focused comments, especially in intimate settings. (You never know if your partner has been restricting that day and will assume they look good only because of this.)
  • Personality compliments like "it's so sexy seeing you so confident," "you're glowing," "you have such a great energy," or "I love feeling close and connected to you" can be a great way to make your partner feel comfortable.
  • Try to be patient. Remember that it's probably more frustrating for your partner.
  • Encouraging open communication and asking how you can provide support can go a long way in showing your partner you care and support them.

While I'm navigating my personal journey with managing my eating disorder and finding ways to embrace intimacy, I'm sure many others out there can relate to the overall theme of navigating the interconnectedness of mental health and sexual intimacy.

Whether body image distress, medications, past traumas, or anything else impacts your ability to be fully present and enjoy sexual experiences, remember that you are not alone.

You don't have to settle for going through the motions or avoiding physicality altogether. You can find ways to help enhance your intimacy and your sexual experience.

You can feel sexy. You can enjoy sex and intimacy. Once you accept that truth, you can begin taking back your sexuality - in and out of the bedroom.

Alex Carroll is a creative communications aficionado with a knack for storytelling. Now in recovery from anorexia, Alex uses her experience and passion for mental health to educate people about eating disorders, and edify those managing ED. She speaks at universities, conferences, and events in the Virginia area, and counsels young adults coming to terms with eating disorders.