Vinamra (name changed on request), has recently completed his Class 10 examinations. While all his friends are having a relaxed, fun-filled summer, Vinamra is deeply distressed.
He's worried about regular nightfalls (the occurrence of spontaneous orgasm and ejaculation usually during sleep) during his sleep that he's been experiencing for the last few months.
The internet tells him that a loss of semen indicates a loss of ‘vitality’. He's apprehensive that he is ‘losing’ his libido. He's worried he won’t look masculine anymore, he won’t have girlfriends and that he will be lonely throughout his life.
He's so anxious that he sets multiple alarms every night to check whether there has been a discharge. This has resulted in him losing weight, losing sleep, feeling tired most of the time, a vanishing appetite, and his mood hitting rock bottom.
Yet, Vinamra firmly believes that an normal seminal loss from a young male at night is the root cause of all his physical problems.
Meghna (name changed) has just celebrated stepping into adulthood — her 18th birthday. But this celebration was different from the others.
She feels she has been overeating due to stress over the last few months and has put on a few kilos. People comment on her ‘changing looks’ and she is morbidly afraid of being fat-shamed.
She doesn’t feel ‘sexy’ enough, and while the 18th year of her life was supposed to allow her to explore her consensual sexual fantasies – she rather feels asexual and losing her libido fast.
She feels ashamed to see herself in front of the mirror and hates even the sight of meals. She has started to exercise vigorously to the point of exhaustion and chest pain – but no, she won’t stop anytime soon.
The First Bloom: Adolescence and Sexual Development
Anna Freud, daughter of the legendary Sigmund Freud once said, "Sexuality is a part of one’s identity."
Adolescence means 'to grow up' in Latin and these are the crucial years when the bio-psycho-social development of sexuality takes place.
Puberty forms the landmark point of sexual development in adolescents that slowly transits into the sexual preferences, orientation and fantasies of adulthood.
Besides developing logical thinking and reasoning capabilities, adolescence marks the development of a ‘sense of identity’ of which sexual awareness is a part.
Social involvement, behavioural experimentation and peer interaction – form the pillars of sexual knowledge.
Ask any adolescent whether they are curious about sex – the answer will most likely be a resounding, yes. Now ask them how they seek that knowledge – most would reply, from peers and the internet.
Besides identity development, adolescents also develop cognitive and psychological/emotional blooming during these years. And these facets are highly interlinked.
Link Between Mental Wellness and Sexual Health
The prevailing misconception that sexual health exists in isolation from mental well-being disregards the intricate interplay between the two.
However, a closer look reveals that mental health and sexual health are not only intertwined but also deeply influential on each other.
How a person thinks, feels, acts and perceives influences his/her intimacy, arousal, ability to reciprocate sexually and orgasm.
Often, when people face sexual problems in their growing years – they tend to experiment on Viagra, alcohol and other drugs.
Even, as physicians, we rarely look beyond the lens of sex drive, genital organs and medical factors to understand sexuality.
The influence of emotional state on sexual well-being is most profound during adolescence and continues to be so throughout life.
Misconceptions about sex and sexuality being rampant can depress the mind and increase health anxiety. Just like Vinamra thinks he is ‘losing his masculinity’ due to nightfalls which is one of the most normal expressions of sexuality after puberty, often accompanied by wet dreams (dreams of sexual content).
A prevalent belief that semen is made out of blood and is ‘vital’ for male strength leads to misinterpreting nightfalls as pathological.
'Two Sides of the Same Coin'
A sound state of mental wellness fosters a positive sexual experience. Individuals with good mental health often exhibit higher levels of self-esteem, confidence, and body image satisfaction, which are crucial elements in intimate relationships.
Moreover, mental wellness enables effective communication, emotional intimacy, heightened libido and the ability to navigate sexual desires and boundaries respectfully.
Conversely, poor mental health can significantly impair sexual health. Conditions such as depression, anxiety, trauma, and stress can manifest as decreased libido, sexual dysfunction, and difficulties in arousal or orgasm.
Additionally, negative body image, low self-esteem, and relationship conflicts stemming from mental health challenges can disrupt sexual satisfaction and intimacy.
Like in Meghna's case, who could not perceive herself as “attractive” and started hating food. Eventually, she started losing weight so aggressively that it affected both her menstrual and sexual health. She lost her libido.
A usual sexual response cycle in humans has four phases:
Plateau (sustained arousal)
Orgasm (height of pleasure)
Resolution (returning back to pre-excited state).
Each of these responses are related not only to sex hormones but also to stress hormones like adrenaline and cortisol.
Especially in adolescents physical, mental and social turmoil – the constant need to fit in, exam and career anxiety, risk of sexual abuse, substance abuse, adverse childhood experiences and trauma – can often affect sexuality and sexual preferences.
Certain individuals with neurodevelopmental disorders like ADHD or behavioral problems such as conduct disorder, and oppositional defiant disorder can engage in impulsive and high-risk taking sexual behaviour, aggressive sexual exploration and risky sexual experimentation.
These can impinge on sexual rights of others, and increase the risk of sexually transmitted diseases.
Furthermore, trauma-related disorders such as adjustment reactions and post-traumatic stress disorder (PTSD) can lead to sexual avoidance, hypervigilance, or dissociation during sexual encounters, hindering the ability to engage in pleasurable and consensual intimacy.
This can lead to hypoactive arousal and vaginismus (pain during intercourse) in females. Sex becomes an object of ‘fear’ and relationships turn repulsive.
How Can Parents and Teachers Help?
The pervasive stigma surrounding mental health and sexuality often deters individuals, especially adolescents, from seeking support.
However, it is essential to recognize that experiencing mental health challenges or disorders does not diminish one's worth or ability to engage in fulfilling sexual relationships.
Open dialogue, education, and destigmatization efforts are crucial in fostering an environment where individuals feel comfortable seeking help for both mental health and sexual concerns.
Make efforts to build a trusting and supportive relationship with your kids
Foster open communication, not only with you but also with their partners
Explore sex and sexuality as an open book for your younger one, free from taboo, stigma and misconceptions
Teach them to form personal values and boundaries that are essential in nurturing healthy and fulfilling intimate connections.
Seek professional help for mental health conditions beyond any stigma, shame or myth.
Parents can also help by encouraging self-care practices that promote mental wellness and enhance sexual health.
Lifestyle changes, digital detox, social connections, ‘me’ time and support system – foster both emotional and sexual wellness.
Engaging in regular exercise, practicing mindfulness and relaxation techniques, and maintaining a balanced diet contribute to overall well-being, reducing stress and promoting emotional resilience.
Comprehensive sex education is a must in schools and colleges – not only for understanding sexuality and safe sex practices but also to foster respect towards the other gender and awareness about sexual and reproductive rights.
As they venture into the ‘big feet’ of adult lives, remember that they will adopt what they see and practice what they learn.
(Dr Debanjan Banerjee is a Consultant Psychiatrist, APOLLO Multispecialty Hospitals, Kolkata.)