What You Need to Know About Sex and Bipolar Disorder

Here’s something bipolar people talk about amongst themselves but not so much with the world outside: Sex.

The two poles of bipolar disorder — depression and mania — govern a person’s appetite for sex. A lot of other factors determine whether the sex will be any good, or good for the participants.

• What is Bipolar disorder?

Of course, the above is true for neurotypical people as well. Moods and emotions — things in the brain — have as much or more to do with sex than stuff in the body. Thinking about sex and wanting sex, for example, start in the brain and without them, nothing else is likely to happen anywhere else.

The depression side of bipolar sex is easy enough to map out. After all, some of the hallmarks of depression are numbness, inability to enjoy things that once gave pleasure, and a tendency to isolate. It’s hard to get your motor revving with all that going on.

Still, the depressed person may want to have sex, or at least want to want to. That’s the way it’s been with me. When I’m in a thoroughly depressed state, sex doesn’t even cross my mind. When I’m not quite as depressed, I think I might like to have sex but don’t have the energy for it. And when I’m relatively stable, there’s the meds.

It’s well-known that medications for bipolar disorder can kill the sex drive and in men, the ability to achieve or maintain an erection. Some drugs supposedly have less effect on sex, but I’ve never found the magic combination. Or the supposed sex-friendly drug has had side effects I can’t tolerate.

So if bipolar depression is largely a big zero for bipolar sex, how about mania?

Overactive sex drive, combined with a lack of impulse control, can lead to sexual excess. The tendency to minimize risk-taking behaviors means some of that sex can be detrimental to one’s health, relationships and self-esteem. Riding that wave is exhilarating, but then, inevitably, comes the crash and the need to pick up the pieces.

Full disclosure, here: Since I have bipolar 2 and my hypomania tends to turn sideways and come out as anxiety, I don’t experience that manic sex high. On the whole, I think I am grateful for this. Sex has never been such an important part of my life that I would risk everything for it.

Once, though, I did experience what you might call a hypomanic sex drive. It smoldered for a long time, requited but unconsummated until the right set of circumstances presented themselves. It was a restlessness, an obsessive thought, a longing for connection, rather than an ungovernable rush of need. It gave me, perhaps, a glimpse of what it might be like to be manic and sexually stimulated. But I’ll never really know.

I do know I am glad I had the experience, whatever it was. I’m glad it was safe sex. I’m glad it didn’t destroy relationships. But just to feel that desire again, even if only for a brief time, even with the anxiety it provoked – and there was lots of anxiety – it was a kind of affirmation that my body and brain are still connected in some vital way.

Most of the time, I limp along with only thoughts of sex too fleeting to act upon. And maybe this is not the best way to live, but I have made my peace with it. And once in a great while, every now and then, I still am reminded that I can have a sexual existence.

Even though I have bipolar.

Of course, as always, your mileage may vary.