It may not seem likely because it’s not widely discussed, but a majority of people will be affected by symptoms of depression, anxiety and sexual dysfunction at some point in their lives. This fact is at odds with the shame and discomfort surrounding these symptoms in our society.
Sexual dysfunction covers issues such as a lack of sexual desire, an inability to become aroused or achieve orgasm, premature ejaculation and erectile dysfunction. These problems are often not picked up by doctors, and people hesitate to raise the issues themselves, maybe because they feel embarrassed.
While depression, anxiety and sexual dysfunction can each have a profound effect on quality of life, their impact is much worse when the symptoms co-occur.
In these combined cases, symptoms tend to be more severe and last longer, and when not dealt with together, treatments tend to be less effective. Indeed, people using ineffective approaches end up having worse long-term outcomes, tend to drop out of treatment, and are less likely to return.
We know depression, anxiety and sexual problems are related, but there’s very little research on how or why. Some studies show the disorders tend to appear at the same time, or that sexual dysfunction develops as a symptom of depression and anxiety.
Others suggest sexual dysfunction creates a vulnerability to anxiety and depression. But when we look at the body of research as a whole, the relationships appear to go deeper than this.
We know depression, anxiety and sexual problems co-occur at very high rates, and that they share multiple cognitive and emotional characteristics. We also know they can all be treated effectively using mindfulness and cognitive behavioural therapy.
These commonalities suggest they might all be part of a family of disorders called “internalising disorders”; one isn’t causing another but they all share an underlying vulnerability. Preliminary research has supported this idea.
Lack of awareness
Given this close relationships between the disorders, and the negative impact of not treating them together, it’s concerning that they’re consistently treated separately. And that the manuals used by mental health professionals and clinicians to diagnose disorders (the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases) don’t recognise the relationships between them.
Indeed, the separation in the way we diagnose and treat these disorders is likely contributing to the low recognition rates of sexual problems in primary care.
Studies have shown that most people with sexual problems consider it appropriate to discuss their symptoms with their doctor, but very few actively seek out help. People tend to expect their doctor to ask, and will not bring it up themselves.
Only 6% of participants in a study of Australian adults aged between 40 and 80 had been asked about their sexual function during a routine medical exam in the last three years. And those who were asked were more likely to seek help and enter treatment.
Clearly, doctors should be screening for sexual problems, as people aren’t actively seeking the help they require.
Moving forward together
If assessment of sexual problems were part of the initial evaluation of depression and anxiety, and vice versa, the low recognition rates of sexual dysfunction could be improved, and all symptoms could be treated concurrently. This would improve effectiveness and be better for patients.
Effective new treatment programs that target the common elements of multiple disorders have already been developed for the shared aspects of depression and anxiety disorders. The same types of programs could be developed using mindfulness and cognitive behavioural therapy to treat sexual dysfunction, along with depression and anxiety.
Taken together, what research we have suggests this would improve the quality of life of people suffering from combinations of these disorders.
At the very least, doctors should be aware of the co-occurrence of the symptoms of these disorders, and the fact that if a person is experiencing depression or anxiety, that should act as a red flag to screen for sexual dysfunction.