A recent study by the Tel Aviv University, Israel, showed the impact of mental illness on sexual function. Researchers identified a number of individuals with mental disorders like depression, schizophrenia and eating and personality disturbances who also have sexual dysfunctions. The researchers found that the two were, in fact, related.

Proper sexual function is one of the most important components of quality of life and maintaining a healthy relationship. Thus, the prevalence of sexual dysfunctions is more in those with mental disorders, than in the normal population.

Here is where the chicken vs egg debate arises. Did mental illness come first, or sexual dysfunction? The answer: either.

Sexual problems are known to cause marital discord. The reverse is also the case: Marital discord has been found to lead to sexual problems. It ultimately becomes a vicious cycle that is difficult to break. These two factors are closely related mainly because sexual dysfunctions affect the core aspects of a marriage: the individual, the partner as well as the relationship.

The partner with sexual dysfunction may experience anxiety, depression, frustration, low self-esteem, avoidance tendencies, feelings of inadequacy and fault-finding. The spouse will also experience similar emotional turmoil. The relationship suffers because of this emotional turbulence. Unhappiness in the non-sexual relationship, communication gaps and manipulations and any form of violence owing to jealousy, divorce, etc, may rock the marriage. The couple also become poor role models for their children.

When marital discord is at its peak, sexual dysfunction may be close behind. Rebellious hostility and rage towards one’s partner and a fear of rejection and abandonment can lead to a sharp decline in trust and some form of power struggle. In a bid to hit back at the partner, the angry spouse may resort to tactics to deny pleasure to the partner. Sexual sabotage techniques may include pressure and tension (picking quarrels, making demands, criticism); timing (delay sex when partner is in mood and demand sex when he/she is not); making oneself repulsive (deliberately taking no care of grooming and personal hygiene); frustrating the partner’s sexual desires (withholding the partner’s turn-ons). When the anarchy and insecurities reach their crest, and sex is used as a weapon to show control, there is only one possible outcome—disaster.

The Tel Aviv study showed that the most common sexual dysfunction in women is reduced sexual desire, while it is erectile dysfunction in men. In the discord explained above, it becomes quite clear how these sexual dysfunctions fit in. When pressure, tension and negativity run wild, and sexual dysfunctions seep into the equation, it is a no-brainer that mental illness runs the risk of joining the combination, forming a deadly triad.

Another possible reason why mental illness and sexual dysfunction are strongly related is the use of medications to treat mental disorders. While the medication may manage the mental disorder, side effects cannot be ignored. In many cases, sexual desire has been found to drop, along with erection, penetration and so on.

Sexual problems that are side-effects of psycho-active medications have to be managed with other medicines like PDE5 inhibitors and hormone preparations. Concurrent psychotherapy or counselling, however, goes a long way in comprehensive management. This is because, although these medicines may counter-balance some of the side effects, should the relationship turn sour, progress becomes dim. It is very difficult to recover when the triggers, that cause or fuel the disorder, remain unaltered.

Marriage and family therapy, or couple counselling as it is commonly referred to, is a type of psycho-therapy. It does not discriminate between clientele, and focuses on helping couples in intimate relationships. It helps couples of all types recognise and resolve conflicts and improve their relationship. Marriage counselling helps one make thoughtful decisions about rebuilding the relationship.

Counselling of this nature addresses specific issues of marital discord. It not only focuses on the sexual dysfunctions, but also associated concerns like anger, financial problems, infidelity, conflict about child-rearing and communication problems.

The vicious circle, although difficult to break, can also evolve into a healthy one. The realisation that mental illnesses, relationship and sexual dysfunction are all related, and that change in one area may lead to change in another, can open up multiple opportunities for change. Mental illnesses are real issues with real symptoms, and it may be time to take steps to address them.

Dr. Reddy is a consultant in Sexual Medicine at Apollo Hospitals, Chennai. He is a Fellow of the American College of Sexologists.