Trigger warnings: anorexia nervosa, eating disorders
There are many things we don’t discuss in relation to anorexia nervosa and the impacts that it has on our bodies. Constipation due to malnutrition, the obsessive use of laxatives, and the growth of downy hair are among the few lesser known results. Even lesser still is the impact that anorexia nervosa has on the sexual dysfunction of women.
As a gender, women are less likely to discuss sex and sexual issues than men. Speaking from personal experience, I’ve never spoken to my therapist or physician about my lack of libido and pain during intercourse. The embarrassment of admitting that I hadn’t had sex in over six months, despite being in a long-term relationship, is much too daunting. Ultimately, I fear their judgement of both my relationship and myself, therefore I’ve kept it a secret.
For a long time, I thought I was alone in this, choosing instead to blame the pituitary tumor in my skull or my upbringing wherein sex was deemed shameful. However, after I came across an article discussing sexual dysfunction and anorexia nervosa, I discovered that I wasn’t the only one.
The disturbances in sexual function come from many places, including hormonal imbalances, malnutrition, underlying and accompanying mental health conditions, poor body image, and low self-esteem. More than anything, it’s a symptom of the deep psychological and physiological hold that eating disorders can have over us.
Physiological impacts on sexual functioning.
Although sexual dysfunction in women with eating disorders is widely under-researched, the studies that are available show a clear correlation between the two, specifically with that of anorexia nervosa.
Considering the negative impacts that eating disorders have on the body and brain, it comes as no surprise that sexual dysfunction is included on the list. Research has shown that anorexia nervosa is prevalent in the majority of cases. In fact, a 2012 study of 242 found that over 66.9% of women experiencing an eating disorder reported a decrease in sexual desire. This is thought to be due to the maintenance of a low body mass index (BMI). In the general population, low body weight is considered to negatively impact our sex life due to the effects of malnutrition.
When the brain is starved of nutrition, it starts to lose function and slows down all non-essential systems within our body. This includes the reproductive system. As a way of conserving energy for priority functions, the brain will gradually begin to shut off the function of the ovaries. In turn, this causes the reduction of the sex hormones oestrogen and testosterone, which are responsible for creating sexual desire and promoting the healthy operation of the sexual reproductive system.
Sex can become unsatisfying and even painful due to reports of vaginismus, wherein sex is painful due to a lack of lubrication and unnatural tightness. It’s thought that this also contributes to the inability to reach orgasim.
With all of these physiological issues going on within the body, women with anorexia often find themselves discouraged from any sort of sexual activity.
Psychological impacts on sexual functioning;
The negative side effects of anorexia nervosa on sex are not only limited to the physical. In fact, the psychological issues preventing sexual desire can be even more prevalent, with the onset of depression, anxiety, and other mental illness. The prevalence of mental health issues is well documented for contributing to a lowered libido, and with the likelihood of medication, this lack of sexual desire can be expected to increase.
Women with anorexia nervosa often suffer from distorted body image and body dissatisfaction, which can create anxiety surrounding the act of sex. This is apparent in Pinherio’s study, wherein it was discovered that of the 242 women studied, 59.2% reported feeling sexual anxiety. Quite often, they feel embarrassed to get undressed for fear of what their sexual partner will think of them.They may also struggle with confidence and the sexual confidence that is needed to feel ‘sexy’.
The lack of sexual interest is not limited to activity with sexual partners—this also includes activity with themselves. There were lower levels of masturbation reported among women suffering from anorexia nervosa. Again, this could be deemed down to the impacts on hormones and the severe body dissatisfaction.
Sexual dysfunction among women with eating disorders is a well kept secret. We hide, preferring to keep it to ourselves than to discuss our sexual issues for a variety of reasons, stigma being one of the biggest. Talking openly about it, whether it’s online or in therapy, helps spread the word that this isn’t a unique issue.
The important thing to remember is that the majority of women who have experienced sexual dysfunction reported relatively normal sexual functioning prior to the onset of the eating disorder. It’s therefore thought that with the restoration of the body to a normal BMI, sufferers should start to see the return of normal sexual desire and functioning.
However, it’s not as simple as fixing our bodies. The mind clearly plays a big part in assisting our sexual function, and can often be a critical part of prompting sexual desire. Although the body may be restored to a regular weight, allowing for the production of hormones, the mind can take around six months to a year to follow suit. It may take work in regards to building confidence and self-esteem and letting go of past assumptions to coax our minds into healthier thinking patterns.
Finally, sex drives differs from one person to the next. Even those of a healthy BMI have differing sex drives. That’s okay. Having a naturally lower sex drive is nothing to be ashamed of in our currently hypersexual culture, and it shouldn’t be something you should ever be shamed for.