The taboo and restrictive conversation around sexual and mental health makes it difficult for people to talk about these issues and seek help when needed since be it low libido, lack of orgasms, erectile dysfunction or premature ejaculation, these issues aren’t dealt with in a holistic manner. A lot of times, poor sexual health like vaginismus, endometriosis in women is caused due to trauma and abuse while men with poor semen health can experience low libido and premature ejaculation etc.

All this works in tandem with the mental health of an individual since if they are unable to satisfy their partner male or female, it causes various mental health issues like depression, anxiety leading to hopelessness and suicidal ideations due to low self-esteem and shame. The mind and body are connected through the vagus nervous system hence, it is imperative that one is not only focused on the physical wellbeing but sexual and mental wellbeing as well as both are closely intertwined.

Infertility in the Indian context is a medical condition with societal consequences and as such, couples and individuals experiencing infertility exhibit mental health problems. Some of the feelings that infertile individuals report include anxiety, depression, feelings related to loss of control in their lives and a dip in self-confidence and self-esteem while they can also feel isolated and alienated because of their condition.

These feelings have been reported by both men and women however, there is a silent shame imposed by society on men with questions being raised directly on their masculinity. The fear of being infertile is so deep rooted that they might deter from getting themselves tested and thus, the female in most cases, face the brunt of the situation.

In a study published in Fertility and Sterility (2016) with 352 women and 274 men opting for infertility treatments found that depression is as widespread as in 56% women and 32% in men. As many as 76% women and 61% men reported experiencing anxiety. These symptoms in women afflicted with infertility have been compared with patients that are diagnosed with hypertension and cancer.

In an interview with HT Lifestyle, Dr Roshan Jain, Consultant Psychiatrist at Bangalore’s Apollo Hospitals, shared, “Sexuality and sexual health is an important aspect in the quality of our life and relationships. Any mental health ailments or psychological issues remain the most important risk factor for sexual dysfunction or disorder. The neurobiology and symptoms of many ailments such as anxiety and depression can drive many a features of sexual dysfunction. Loss of libido or interest in sexual activity is strongly linked with depression. Likewise, premature ejaculation, erectile dysfunction, lack of arousal as well as fear of intimacy can be underpinned by an anxiety disorder.”

He added, “Physical or sexual abuse and trauma can be linked with a wide array of interpersonal emotional and psychological problems, consequently impacting on the intimacy and sexual contact. Finally, many medicines used for mental problems such as antidepressants and antipsychotic medication can adversely impact sexual function. As per the definition of World Health Organization (WHO), health is nothing but an overall physical, psychological, social as well as spiritual well-being. I think we can add that good sexual health is equally important for one’s emotional and interpersonal well-being. The mind and the body are eternally in the link. And likewise, the biology and psychology are too. Investment in one is likely to effect a positive impact on the other.”

Echoing the same, Dr Kersi Chavda, Psychiatrist at PD Hinduja Hospital in Mumbai’s Khar, explained, “When we talk about mental health and sexual disorders, it goes bi-directional. Sexual problems can lead to depression and mental health and the reverse is true as well. Mental illness like depression, anxiety, bipolar disorder etc affects sexual health for a lot of individuals. Further, sexual health has various components and each needs attention. Depression can lead to lack of desire to have sex. This can be a concern in the long run as the individual feels that he/she starts feeling a kind of numbness and a feeling of not enjoying sex anymore.”

According to him, “In some cases, performance anxiety leads to delayed or premature ejaculation, wherein an individual can dread or have a fear that there might be a performance failure. Another psychiatric condition (not as reported as it probably should be) is Fetishism where an individual is excited to have sex in response to an object or clothing that his/her partner is wearing like shoes, thongs, leather blouse, locket etc. If one is psychotic or has bipolar disorder, he/she can have either a diminished desire for sex or over increased desire for sex during both of which can cause issues. Secondly, medications especially for hypertension, anti-diabetes, and some psychiatric medication can also affect sexual health as it might reduce the libido.”

Talking about what does one do in such scenarios, Dr Kersi Chavda recommended, “In such scenarios, it is always advisable to visit your doctor. During the medical examination, the doctor will try to evaluate and understand the primary cause of the condition. The evaluation will help conclude if the condition is due to medications or if it is related to the basic condition itself. During diagnosis, if found that the medicines are leading to less sexual desire, then the doctor will gradually change the medicine dosage to suit the patient. Also, in many cases, doctors opt for combination of medications and psychological methods (like fantasy techniques/squeeze method etc) to treat the disorder. A combination of both, medication and therapy, helps in improvement of the overall sexual health.”

Adding to the list of tips on what can be done, Dr Ajith Partha, MBBS, DPM (Diploma in psychiatric medicine) at Kindly, said, “A trend that I have seen is that post Covid-19, a lot of men have started talking about these issues and consulting a doctor. It is important to create safe spaces and communities where children as well as adults learn about unsafe sex, fertility issues etc. The most important step is to seek help and get regular check-ups done. For eg, regular semen analysis, fertility tests and consulting a specialist recommended by the physician is a must and there should be a collaborative effort between the patient, doctor and a mental health professional.”

He pointed out, “A lot of times with poor sexual health, it can cause low energy, fatigue and stress leading to serious physiological disorders like hormone imbalance, infertility, tumours, infections, sexually transmitted diseases and immunity disorders. So, if you think, sexual, physiological and mental disorders are all closely connected with each other and require equal attention. Ignoring the issue will further jeopardize one’s health.”

Asserting the flipside that sexual disorders may be caused due to challenges one faces with their mental health, Dr Kshitiz Murdia, CEO and Co-Founder of Indira IVF, said, “This can be traced to the existence of mental illness or mental distress that manifests itself as social behaviour, leading to sexual dysfunction in the individual. Furthermore, the therapy or medication one takes can also impact their sexual function. It has also been observed that there is a co-relation between adoption of an unhealthy lifestyle and the presence of mental health disorders. In individuals facing complications with their infertility due to mental disorders and vice-versa, a few proactive initiatives can help limit their consequences.”

He advised, “Maintain a scientific and medical mind-set while addressing both mental and sexual disorders. One must pay heed to the symptoms associated with both and not neglect them as this would only escalate the extent of the condition. With this understanding, one must approach a relevant medical practitioner in order to take remedial measures. One must speak with an infertility specialist, psychologist or psychiatrist for the same, as the case may be. It is advised that individuals incorporate healthy habits in their daily life, as well as following an engaging schedule. This includes inculcating a balanced diet, physical activities, and including activities that one enjoys. Ceasing unhealthy habits such as consumption of alcohol and tobacco can help. There are many therapies available that assist people to quit tobacco and alcohol consumption that contribute to sexual disorders.”