Most people have heard of bipolar disorder, a mental health condition that affects about 3 percent of all adults. Still, few actually know much about it—including how deeply it can affect people’s relationships and sex lives.
There are several distinct types of bipolar disorder, but they all involve extreme mood shifts and episodes of depression and/or mania. During episodes of depression, people often experience a loss of libido, of the motivation to pursue sex even if they still desire it, and of the ability to get aroused, feel pleasure, and orgasm. Conversely, during episodes of mania, people often want more sex than usual, for longer than usual, and may experiment with sex acts or take risks they usually wouldn’t consider—but few ever feel fully satisfied. Once they come down, many people with bipolar disorder end up regretting the sexual decisions that they made.
The frequency, duration, and severity of symptoms vary substantially between types of bipolar disorder and between individuals, and often one’s symptoms will change over time. Most people’s mood swings don’t follow predictable rhythms—for example, they might have multiple episodes of depression before one of mania, with each episode a different length—and some people return to a baseline between episodes, while others do not. It’s possible to have mixed episodes, too, involving elements of both depression and mania, like a sense of emptiness alongside high energy. All of this makes it hard for most people to predict or account for bipolar disorder’s effects—and often to maintain intimate relationships of any kind—on their own.
Mental health experts can generally help people learn what, if anything, seems to trigger their mood shifts, recognize swings early, and respond to them quickly and effectively. However, experts have done surprisingly little research on the intersection between bipolar disorder and sex, which limits the tools available to practitioners trying to help people navigate this specific area of their lives. On top of that, many care providers are still hesitant to talk about sex with their patients.
Medication often plays a major role in helping people to limit their symptoms. But many of these drugs may affect a person’s sex life as well—often by limiting their libido or their ability to feel pleasure or orgasm. The sexual side effects of these meds, though well known, are also not well studied, so care providers may not be able to offer much support in dealing with them either.
In recent years, a few people with bipolar disorder have started to share their experiences of sex with the public to raise awareness and spur conversations. However, these accounts are still relatively rare and limited, and almost none include partners' perspectives and experiences. So, VICE reached out to Cassie, who has lived with type one bipolar disorder since she was a teenager, and her partner Cameron to talk about their sex life.
VICE has omitted Cassie and Cameron’s last names at their request to protect their privacy. This interview has been edited for length and clarity.
Cassie: Looking back, I had symptoms from an extremely young age, but my mother and I first noticed something was going on when I was in high school. I now know that I was experiencing periods of hypomania, a mild form of mania. I’d go weeks without sleeping much, have flights of ideas, and start projects but never finish them. When my mania ran out, I’d lose all my energy and crash. I wouldn’t want to talk to people, and I’d go from getting straight As to Ds and Fs.
We grew up poor and uneducated, so my family decided I was just being a hormonal teenager, although my behavior was clearly beyond normal teenager stuff. Then I went to college and started to manifest more symptoms. One day, while walking to class, I started to experience a major episode of mania. I knew where I was, but the buildings didn’t look right. It seemed like the world was melting. My mind was bouncing from one idea to the next, and I started talking nonsense. People thought I was high. Some of my friends found me and took me to a therapist. That’s when I started the treatment process that led to my bipolar disorder diagnosis.
I’m currently on really effective medication, and I’ve been in therapy for years. I've had experience with medications that destroyed my sex drive to the point that I literally couldn't feel anything, but I don't have those issues with this current prescription. I do still have hypomanic and depressive episodes, though. My therapist says I may experience those for the rest of my life because when we’ve tried to increase my dosages, I’ve had no emotions whatsoever.
My family was great about treating my bipolar disorder just like any other health issue that we needed to address, just like having asthma or something like that. So, early on, I never worried about telling people about my condition—I was actually very vocal about it—and I didn’t think much about how it could affect relationships. Then I dated a guy who wound up being abusive.
He made me feel shame around my bipolar disorder, like, you are defective, and no one will ever really love you. He used my depression and mania to his advantage, too. When I was hypomanic, he knew I was willing to do things and take risks I otherwise wouldn’t, so he got me to have a lot of sex with him that I otherwise wouldn’t have consented to. And when I was depressed, he’d use that to get me to feel terrible and then guilt me into having sex that I didn’t want to have.
Therapists rarely talk about sex with their patients with bipolar disorder, and when they do, they usually just stress the risks: If you’re hypomanic and not on your medicine, you’re more likely to not use a condom, to get an STI, to put yourself in dangerous situations, to be assaulted. It’s like a scare tactic: Get on your medication and stay on it, or else you’re probably going to get an STI. They almost never talk about consent or how to have healthy relationships with bipolar disorder.
So, while I was in that relationship, I didn’t recognize how abusive that situation actually was. Really, I didn’t fully recognize it until I got together with Cameron and experienced a healthy relationship with someone who respects my boundaries and approaches consent thoughtfully.
Cameron: We met on Bumble and talked for a while before we were able to meet up because I work irregular hours. We went to a game arcade bar that we both really liked and just hit it off.
Cassie: Our first date was the day before everything in our area closed down due to the start of the COVID-19 pandemic. The organization I work for lost most of its funding and furloughed me, and Cameron’s industry shut down completely. I lived by myself, and I knew that being alone during all of that wouldn’t be good for my mental health. Cameron lived with a roommate whose partner was coming over all the time. So, three weeks into the pandemic, we decided to try quarantining together. But when I moved in, I still hadn’t told Cameron about my bipolar disorder. The shame from my abusive relationship left me scared to tell partners about it.
It was also more nerve-wracking than usual with Cameron because I’ve mostly dated social workers who’ve studied psychology and who know about bipolar disorder.
Cameron: I have known people who’ve gone through long periods of depression, and I’ve learned a bit about how to talk to people about what they need for their mental health and how to give them space. But I didn’t know much about bipolar disorder before I met Cassie.
Cassie: I worried that he’d just say, “Oh, this is enough with this girl,” and leave.
Cameron: It’s not the same, but I have genital herpes, and in the past I worried about disclosing that to partners, too. But I think it’s important to disclose—and I’ve found that disclosing is a good filtering system. Hey, if you can’t accept this, then things aren’t going to work between us. So, I told Cassie about my herpes before we first had sex and before we moved in together.
Cassie: The fact that he shared this intimate health thing with me helped me feel like I could share something intimate and health-related with him too. So, about two or three weeks after he told me about his herpes, I told him about my bipolar disorder. I don’t remember much about that conversation because I was so nervous, and I felt guilty for not telling him before we moved in together. I think I just blurted out, “I have bipolar disorder!” and ran out of the room.
Cameron: My recollection is a little different. To me, it seemed like you just casually said, “Oh, by the way, I’m bipolar,” in passing one day, then went on with whatever else you were doing. I asked a few follow-up questions—when she was diagnosed, if she was on medication, and if there were any signs I should be aware of, either to ask what’s going on or to give her space. I decided that if this was going to be a part of our lives, I wanted to become better educated about bipolar disorder as well, but I didn’t push for a lot more information in that initial conversation.
Cassie: This might sound silly, but around that time, one of my cats passed away unexpectedly and quickly, at a young age. So, I went into a period of depression, which gave Cameron a chance to see what that looked like for me early on in our relationship. It was a rough one.
Cameron: Cassie also told me about her abusive relationship early on. So, from the first days of our relationship, I knew external things might affect her, and there might be times when pursuing intimacy isn’t possible—and that those times don’t necessarily reflect on me or our relationship. Sometimes we all just need time and space without sexual intimacy. And sex is more fun when everyone’s fully comfortable. I never want anyone to feel like they’ve been forced into it.
Cassie: About six months in, I realized that I wasn’t having as much sex as I usually do in relationships. I had an internal conversation with myself about why that might be. I thought my new birth control might have affected my libido or that it might be due to pandemic stress. But eventually, I realized this is just what feels right to me when a partner respects my boundaries.
Being in a healthy relationship also gave me the space to realize that both my experience in an abusive relationship and the general pressure I feel to be ‘the good bipolar person’ who doesn’t seem crazy or depressed all the time leads me to hide my emotions. That makes it difficult to give up some control during sex and intimacy—to be really vulnerable and open with a partner. I don’t think I’ve ever fully vocalized that realization to Cameron before this moment.
Cameron: I’m not here to pry information out of Cassie. I ask questions and try to be here for her, to create a space where she feels comfortable opening up, and to accept what she tells me.
Cassie: Cameron has always been good at noticing when I have my perfection mask on, though. He’s learned to read my body language and to know when he should push back on that or leave it alone. In my own head as well, sometimes I’ll notice that I’m not fully open or present during sex, and I’ll just reaffirm to myself, “I want to enjoy this; come back to this moment.” The more we have sex together, the better I get about catching myself and about letting go and opening up.
Cameron: I try to attend to Cassie’s body language to pick up on how she’s doing—and when she might or might not be open to having sex. I also like to use comedy to broach things in a lighthearted way. So, I might suggest we get intimate by saying something like [puts on a faux-suave voice], “Hey, how you doin’? Feelin’ like a little sexy time tonight?”
Cameron: It’s usually pretty clear if she’s open to sex or not. She’ll either respond or she won’t.
Cassie: It helps that I’m generally pretty open about sex and when I am or am not in the mood.
Cameron: I have been more sexually assertive and spontaneous in the past, with partners who wanted me to do things like randomly push them up against the wall and start kissing them. But I’ve taken that more sudden physical intimacy out of my repertoire in this relationship.
Cassie: I’m not a big fan of sudden physical contact. Like, my friend group knows that I am not a hugger. Unlike Cameron, who comes from a big family of huggers. But Cameron is very good about asking, “Is it okay for me to hug you right now?” Or, “Can I put my foot up on your leg?”
I also have a strong support group of friends, who are mostly social workers. They’re very good about helping me recognize when I’m hypomanic and helping me question, Does Cassie want this much sex, or does the bipolar mania that’s driving her brain right now want it? My friends and I often have those conversations when Cameron is around. I think that helps us, too. He also knows that if he’s ever in doubt about anything, he can call my close friends and tell them, like, “Hey, Cassie’s been really energetic and jumping all over me. I don’t know if it’s appropriate to be sexual with her right now.” And they’ll have an honest and informed conversation with him.
Cameron: We don’t talk to other people about our sex life all the time. But just having a close circle of friends who know what’s going on, and being able to call them, helps in general.
Cassie: If I am a little hypomanic and not fully sure whether I really want to have as much sex as I feel like I want in the moment, or if I am depressed, then Cameron and I just decide to go a few weeks without sexual intimacy. But we still kiss and hold each other to maintain wider intimacy.
I always try to let Cameron know when I’m not feeling well as soon as possible. He makes little jokes that he knows will make me feel more comfortable about opening up about that. And I know he’ll respect whatever boundaries I set, which gives me the space to focus on my episodes. Cameron also knows how to support me and how to help ground me when I’m in an episode.
I’ve started to slowly regain my sense of control over sex in general through our relationship. Like, if I realize that I’m not really feeling it during sex, I used to push through. But now I know I can just say, “We need to wrap this up,” and we will. That’s really helpful when I’m depressed and I may still want to have sex, but I can’t do it for a long time. Lately, I’ve started to use jokes during sex to communicate things I might otherwise struggle to say, too—much to Cameron’s chagrin.
Cameron: I’m only chagrined because I feel bad we can’t share those moments with the world!
Cassie: [Laughs] I should note that Cameron’s never seen me in a full manic episode. The hope is that he never will, since my meds work really well for me and I have a good relationship with my therapist. But if I’m in a full manic episode, nine times out of ten, I’ll need to be hospitalized because I’ll need a lot more supervision and specialized support than he can give me.
Cameron: We do have a game plan for if I ever notice that something is really off: What hospital I’ll take her to. Who I’ll call for support. How long it’d take to get there.
Cassie: But in general, at this point my bipolar disorder isn’t really a big deal in our relationship. It’s just a part of our life. Like Cameron’s herpes. Or like our cat.
Cameron: It’s just about a lot of communication, which is good in general.