Why This Doctor Cares About Your Sex Life
If your mood is better but your sex life is gone, are you actually well—or just functioning?
Many patients are surprised—or uncomfortable—when a psychiatrist asks about their sex life. Some wonder if it’s intrusive or irrelevant. One of the main reasons I ask is simple: I care whether my patients are optimal, not just “getting by.” Sexual health is one of the clearest indicators that the brain, body, hormones, mood, and motivation systems are working together the way they should.
From a psychiatric perspective, sexual desire and function are tightly linked to neurotransmitters such as dopamine, serotonin, and norepinephrine. Depression often lowers libido. Anxiety can interfere with arousal. Chronic stress raises cortisol, which suppresses sexual interest entirely. When a patient’s sex life disappears, it’s rarely “just relationship issues”—it’s often a sign the nervous system is under strain and not operating at full capacity.
Psychiatric medications can also affect sexual functioning, which matters deeply if the goal is optimal mental health. Many antidepressants—particularly SSRIs and SNRIs—can reduce libido, delay orgasm, or cause erectile difficulties. Mood stabilizers and antipsychotics may influence prolactin or testosterone levels. If sexual side effects aren’t discussed openly, patients may tolerate suboptimal functioning or quietly stop medications that are otherwise helping.
Sexual health questions also help psychiatrists detect risk. Changes in sexual behavior can signal emerging hypomania or mania, especially in patients with bipolar spectrum conditions. Hormonal contraception, pregnancy, and postpartum changes can further influence mood stability. Asking about sex, birth control, and reproductive plans isn’t about moral judgment—it’s about preventing destabilization and protecting long-term mental health.
Ultimately, I care about my patients’ sex lives because I care about whether they’re thriving. When mood, motivation, sleep, cognition, and sexual health are aligned, people aren’t just surviving—they’re functioning optimally. And that’s the goal.
