Ask a Therapist: Sex, Masturbation & Mental Health

Enjoy our Q&A with sex therapist, Casey Tanner.

sex masturbation mental health

How can sex help our mental health?

There is so much evidence that sex, masturbation, and orgasm can all have amazing benefits on your health and mental health.

This is mainly because the same system that is responsible for sex and arousal is also connected to the stress system and the sleep system. This means that you’re likely going to see a lot of benefits as it relates to your ability to fall asleep and stay asleep as well as your ability to regulate stress and anxiety.

This is because you get all sorts of delicious neurochemicals when you have sexual experiences such as oxytocin, serotonin, and dopamine. Some of those neurochemicals have even been associated with lower rates of pain and decreased period cramps.

When you have a regular sexual self-care practice or a regular connective practice with a partner, that can increase body positivity and self-esteem. Sex has also been shown to increase motivation and focus.

In a sense, the better question is what can’t sex do?

I’m bisexual, but I find it more difficult hitting on women than men. Why?

We are taught how to pursue, flirt with, and be in intimate relationships with people of the “opposite sex”, but we are not taught how to do that with people who are the same gender as us.

When traditional gender roles go out the window, it can be incredibly confusing to navigate roles in the relationship such as who is supposed to text first, pay for the meal on a date, or initiate sex.

It makes sense that being in a new territory – a territory you were never taught to be in before – is more anxiety-provoking and feels like there’s more at stake. 

What’s the difference between sex therapy and “regular” therapy?

When a professional labels themselves as a sex therapist, typically that means they have the same training and credentials as a “regular therapist” with the added benefit of additional training in sexuality and/or gender.

A lot of sex therapists also have additional training in couples therapy and relationship dynamics. It is a myth that if you go to sex therapy you’ll only talk about sex.

As a sex therapist myself, I spend a lot of time talking with clients about all the types of things you would talk about in “regular” therapy such as anxiety, depression, and trauma.

What sets sex therapists apart is that they do this through the lens of believing that sexuality is a key part of our development and the way that we move through the world.

As a sex therapist, I may ask more questions about sex than the average therapist, and will probably display more comfort and competence around sexuality than someone who doesn’t have that extra training.

If you’re seeking therapy for a problem related to sexuality or if you’re looking for an affirming therapist in regards to your gender or sexual orientation, it’s a great option to pursue someone who has that extra training. 

How do I deal with intrusive thoughts during sex or masturbation?

Begin by asking yourself if there is a particular topic or subject that those thoughts center around.

If those thoughts are related to performance anxiety, for example, that gives you some guidance of what type of help you should seek out.

There are some people who may experience intrusive thoughts during sex as a result of Obsessive Compulsive Disorder (OCD), which is a different genre of intrusive sexual thoughts.

Experiencing intrusive thoughts that are getting in the way of your sexual pleasure or performance is a great reason to seek out a therapist or sex therapist so that they can help you pinpoint the origin of those thoughts.

Whether you’re someone experiencing OCD or performance anxiety, a lot of the work you’re going to do will be related to feeling less afraid of those thoughts and giving them less power.

People often approach intrusive thoughts by trying to push them away with a lot of shame, but self-compassion is often the antidote to these thoughts. When we are able to find compassion for ourselves for where those thoughts are coming from, we can sit with those thoughts and not find them so threatening.

Once you go through that process, intrusive thoughts will often show up less and are less distressing when they do show up.

I come from a religious background. I’m no longer in it, but I feel a lot of leftover sexual shame.

In any part of life, we might find ourselves logically thinking one thing and emotionally thinking something totally different.

In the case of this particular question, logically you might be far past that time in your life where you held those harmful religious beliefs and religious trauma, yet emotionally you are still waiting for your brain and body to catch up to the new knowledge that you have that you’re now safe and no longer believe those things.

It is not at all uncommon that shame might be the last thing to go as you move through the healing process.

Trauma does not just live in our logical thoughts; it lives in our memories and our bodies. Often it takes a lot of exposure to pleasure-positive people, accepting partners, and communities that don’t have harmful beliefs for our bodies to fully relax into our new identities and feel safe – even if, logically, we have been there for a while.  

How do I deal with perfectionism, anxiety, and nervousness keeping me from doing something sexy?

Ask yourself, “what is the risk of trying that thing that you find really sexy?” The way that you answer that question is going to tell yourself what you’re most afraid of.

For example, is the risk feeling rejected? Is the risk that it won’t be as sexy as you thought it would be?

Your answer to that question will tell you the negative belief that you need to work on challenging yourself to move through some of that perfectionism and anxiety. 

If your fear is being rejected, then sit with that for a moment. If you do try something sexy and a partner doesn’t enjoy it, what does that mean about you?

At the end of the day, it actually doesn’t mean anything about you. We all try things every so often that someone doesn’t enjoy or reciprocate, and that doesn’t mean that there’s something bad about us or wrong with us.

As long as we’re approaching it consensually, we’re not harming someone by trying something that we find sexy. If they say no, part of the work is trying to learn not to take it personally. If growing up you were rejected and shamed because of your sexuality it can be incredibly difficult not to take this personally.

But now that you’re a grown adult who’s in charge of their own life, at the end of the day the risk is an awkward moment that you might have to laugh off or some difficult feelings that you have to work through. 

What can I do about SSRIs and the loss of libido?

The struggle is real for folks on SSRIs who have experienced a decrease in their sexual drive or sexual desire because of their medication. This is such a tough place to be in because it’s not fair that you have to decide between keeping your sex drive up and taking this medication that could potentially be lifechanging for your depression and anxiety.

I know it’s hard to talk to doctors about sexuality, especially when they’re not asking you outright (and many of them don’t). Rest assured, there are options when it comes to medications for depression and anxiety that have lower sexual side effects, and there are also options for medications that you can add on top of your current SSRI that might help lessen and mitigate those sexual side effects.

There is also recent research of some plant-based products that have been associated with increasing libido, such as maca. Chat with your doctor and perhaps seek help from a therapist to help you advocate for yourself around SSRIs and loss of libido.

Can an addiction to masturbation exacerbate depression?

If you’re feeling distress about your sex life, including distress about how often you masturbate, that can certainly impact your mood and potentially lead to feelings of guilt, shame, and depression.

What I would encourage you to do is talk to a pleasure-positive sex therapist. They can help you differentiate between masturbation that is happening too often or for the wrong reasons, and healthy masturbation practice that you may feel a lot of shame about because of the way our culture talks about masturbation.

That’s a really important differentiation, because we can be really quick to judge and pathologize ourselves regarding how often we masturbate (even when it is completely normal) because we live in a sex-negative society. Seek out a professional to help you figure out what’s going on in your case.

The short answer is: yes, your mood can absolutely be impacted by guilt and shame that you’re experiencing around this element of your sexuality.