Sex, intimacy, and your mental health
Reviewed by therapist.com team
Written bytherapist.com team
Last updated: 10/13/2022
Sex is a normal, healthy part of life that affects and interacts with other parts of your life, including your sexual identity, physical health, relationships, family planning, and mental health. It offers both physical and mental health benefits.
When we talk about sex, we’re also talking about consent—the free, voluntary agreement to engage in sexual activity. Consent is the key to a healthy sexual experience. Whether you choose to engage in or abstain from sex should be entirely your choice.
Consent is often defined as an “enthusiastic yes” to any type of sexual activity. It involves both verbal agreement to engage in sexual activity as well as nonverbal cues that correspond with this agreement, such as body language. However, nonverbal cues alone are not enough to indicate consent; explicit verbal communication is also important.
For example, someone who expresses sexual interest through their body language has not given consent until they verbally affirm their intention to engage in sexual activity. Similarly, someone who feels pressured or coerced into having sex—and who doesn’t explicitly say no but clearly communicates through body language that they do not want to have sex—has not given consent.
Consent is also not a one-time event. Consenting to sex once with someone does not mean you consent to sex with them forever. Similarly, consent to one kind of sexual activity does not mean consent to all sexual activities. Consent can be revoked at any time before or during sex.
Shame, pressure, expectation, or threats should play no part in influencing your decision to engage in sexual activity. Similarly, you should never employ such tactics to influence someone else’s decision to engage in sexual activity with you.
Only adults who are not cognitively impaired by either substances or other health conditions can consent to sex. Minors categorically cannot consent to sex. People who are incapacited or overly intoxicated as a result of alcohol or drug use are also unable to give consent, as well as people who are cognitively impaired due to injury, illness, or certain disabilities.
The rule of consent also applies to sex by yourself. Private self-exploration through masturbation is a normal, healthy step in sexual development. However, no one should ever feel pressured to engage in any sexual activity, including masturbation. People who identify as asexual or who freely choose to be abstinent or celibate, whether for a season or a lifetime, can live full, healthy lives without sex.
Most mental health experts take a sex-positive approach in their work. Sex-positive frameworks define healthy, safe, consensual sex between adults as a generally positive thing.
Sex positivity rejects narratives that suggest that sex (particularly “too much” sex or certain kinds of sex acts) is inherently negative, unhealthy, morally bad, indicative of some kind of pathology, or “dirty.” It also avoids prescribing specific types of sex as suprerior to others, such as heteronormative penile-vaginal intercourse (PVI), sex for reproductive purposes, or sex that always ends with orgasm.
With a sex-positive framework, mental health professionals can help individuals of all sexualities learn how to have a healthy relationship with sex, their sexual identity, and any potential or committed sexual partners. They can also help individuals protect and prioritize their physical and mental health as they engage in sexual activity.
Healthy, consensual sex protects and prioritizes both your physical and mental health. There are many physical benefits of having sex, including:
- Better heart health: Having sex is considered a light form of cardiovascular exercise. It lowers blood pressure and reduces your risk for heart disease.
- Pain relief: Sex can relieve headaches, migraines, period cramps, and other types of pain.
- Better sleep: If you orgasm during sex, your body will release a hormone known as prolactin, which is linked to better sleep.
The mental health benefits of having sex include:
- Stress relief: Having sex lowers stress hormones like cortisol.
- Happiness: Sex releases hormones that make us feel good, including dopamine, endorphins, and oxytocin. This may temporarily relieve or reduce symptoms of anxiety or depression.
- Increased self-esteem: Sex and masturbation allow us to explore our bodies in ways that may increase self-confidence.
- Better communication: Communication is important during sex to ensure everyone feels safe and enjoys the experience. Sex can help you learn how to better communicate with your partner(s) both inside and outside of the bedroom.
- Increased intimacy: Sex can be an intimate experience, especially if engaged in regularly with the same partner(s). Sex can make you feel both physically and emotionally closer to your partner(s).
Safety is key in protecting and promoting your sexual health as well as your mental health. A lack of physical, mental, and emotional safety in sexual health may result in negative mental health outcomes, including:
- Increased anxiety: Engaging in unsafe or compulsive sexual behavior increases your risk for sexually transmitted infections or diseases. This threat to your physical health may result in increased levels of anxiety.
- Hypersexual disorder: Excessive preoccupation with sex can threaten both your physical and mental health. You may be diagnosed with hypersexual disorder, a mental health condition in which a seemingly uncontrollable desire for sex causes emotional distress, threatens your physical health, and harms your ability to live your life.
- Lack of acceptance: LGBTQIA+ individuals often face higher rates of depression due to discrimination and lack of acceptance of their sexuality and/or gender identity. If you are exploring or questioning your sexuality, you may struggle with guilt, shame, or depression due to lack of support from your family or community or your own internalized homophobia. Remember, your identity is not an inherent risk factor for depression; rather, it is discrimination and bigotry that increase your risk.
Your mental health may also affect your relationship to sex. Certain mental health conditions (as well as resulting treatments for these conditions) can affect sexual desire and performance, such as anxiety, depression, insomnia, stress, grief, and some antidepressants.
Unresolved or untreated trauma can have a huge impact on your experience of and relationship with sex, particularly trauma that is rooted in sexual abuse or assault. Symptoms of posttraumatic stress disorder (PTSD) may be triggered by sexual activity, especially if the trauma you experienced was sexual in nature. Traumatic birthing experiences can also change or decrease your sexual desire.
If you’re struggling with your mental health in the bedroom, you are not alone. A trauma-informed therapist, sex therapist, and/or couples counselor can help you start your journey toward healing. Click here to find a therapist near you.
Intimacy is another part of life that intersects with sex and mental health. It refers to a closeness that often characterizes committed sexual relationships. However, not all sex is intimate, and not all intimacy is sexual. Examples of intimacy include:
- Physical intimacy: Holding hands, hugging, sharing physical space with someone, sitting next to someone
- Emotional intimacy: Confiding in someone, asking for advice, offering encouragement, expressing feelings verbally
- Sexual intimacy: Being naked with your partner, holding each other, massaging one another, engaging in sexual activity
Both sexual and nonsexual intimacy are associated with various mental health benefits, including decreased stress, a stronger sense of belonging, and the joy of connecting with another person. Making time for nonsexual intimacy can also increase your enjoyment of sexual intimacy.
Sex, intimacy, and mental health are intersecting aspects of the human experience. Your relationship with one may affect or change your experience of another. Here are some tips for how to navigate these complex yet ultimately positive parts of your life in ways that prioritize and protect your health and safety.
Self-exploration is one of the best ways to learn about sex, your own sexual preferences, and your sexual identity. Masturbation is a safe, healthy part of sexual development. Age-appropriate sex education and self-exploration destigmatize sex and protect both minors and adults from sexual abuse or exploitation.
Having sex can be a vulnerable experience. You may experience a strong desire to do it “right” in order to avoid embarrassment. Statistics about sex, Hollywood portrayals of sex, pornography, and anecdotal sexual stories from friends can all seem to prescribe certain ideals about sex that may feel impossible to achieve.
However, real, healthy sex is all about learning, making mistakes, and trying new things. Sex is rarely “cool” or “perfect”—more often than not, it’s silly, funny, vulnerable, confusing, intimate, creative, and enjoyable. Instead of comparing yourself to others, trying to impress your partner, or striving to meet to certain ideas about sex, try being present instead. You and your partner will likely have a more enjoyable experience if you focus on what’s happening instead of what “should” be happening.
Some people believe that sex only “counts” if it ends in orgasm or involves PVI. Such strict definitions can limit your sexual experiences and make you feel pressured to perform in a certain way. Instead of defining sex so narrowly, embrace a broader definition that includes sensuality and different types of intimacy.
Some people choose to pursue sex and intimacy together, often in the form of a committed relationship to a single sexual partner. Others choose to pursue them separately. It’s important to ask yourself how you feel about sex and intimacy and whether you want to pursue them together or in different ways.
There is no right answer, and your answer may change over time. What’s important is that you know what you’re looking for in a sexual partner or an intimate relationship so you have the best chance of finding it.
The best way to protect your sexual health is to practice safe sex. Safe sex means:
- Not having sex until you are of legal age
- Having the freedom to say no or stop at any time
- Only having sex if your partner is a consenting adult
- Using contraceptives to prevent unwanted pregnancy and sexually transmitted diseases/infections
- Knowing and understanding your options if contraceptives fail
Your relationship with sex and intimacy is informed and affected by your mental health. Therapy can help you learn how to set boundaries, communicate more effectively, trust those closest to you, challenge unhelpful thoughts and emotions, and be fully present.
Prioritizing your mental health benefits you physically, mentally, emotionally, spiritually, and yes, even sexually. Click here to find a therapist near you.
Sex addiction is not a medical diagnosis. However, mental health professionals have identified hypersexual disorder as a condition in which an excessive preoccupation with sex threatens your physical, mental, and emotional health and inhibits daily functioning. If you think your sexual behavior may be compulsive or you feel out of control, seek help from a sex therapist.
It is not inherently unhealthy, bad, or wrong to have multiple sexual partners. However, you need to take intentional steps to protect both your sexual health and your mental health.
Make sure that your sexual activity is motivated by pleasure, curiosity, and/or experimentation. It is unhealthy to engage in sexual behavior as a way to avoid difficult emotions or to intentionally harm yourself or others. If you’re worried your sexual behavior may be unhealthy, click here to find a sex therapist near you.
About the author
The editorial team at therapist.com works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends.