I don’t know if you have ever dealt with this in your column before. I am writing to you because I have not been able to find much information about this. Unfortunately, I get really depressed after I have an orgasm. These feelings are intense enough that my partners can get concerned. Some people have decided not to be in a relationship with me because of the post-orgasm drop into the blues. One lover told me,
“After we make love, I might want to get a snack or just go to sleep or lay around and giggle for a while. But I don’t want to play therapist every single time. You need to fix this.” I told him I couldn’t fix it, it was just the way I was, and shortly after that, he left me. Now I am wondering if this is a condition that has a name or a recognizable cause, and if so, is there a treatment? I would be willing to try anything. This happens, by the way, whether I am masturbating or having sex with a partner. I rarely even bother to get off with myself because I hate having these feelings of intense depression if I am all alone.
This condition does have a name. It’s called postcoital dysphoria. There are many reasons why someone might get depressed after sex. If you are having sex with someone you don’t like, or if you feel the relationship is moving too fast, or you regret or feel shame about the decision to be sexual, that can induce depression. If you feel you had to have sex because the other person was abusive or coercive, or if you were trading sex for things you needed to survive, that difficult and scary situation can lead to depression. Sometimes negative feelings about oneself can cause depression after sex—thoughts about your body not being perfect, perhaps, or fears about whether your performance met with approval, or a rude comment an inconsiderate partner made. Fear of being alone after sex can trigger sadness. If having sex contradicted your moral values, feeling bad about that can lead to a lowered mood. Looking at this list, it is easy to see that most people will have experienced postcoital dysphoria during their lifetime.
But if this is something that happens consistently, as you report, then it becomes a real problem. Is the pleasure of an orgasm or the intimacy of a sexual experience worth it if it will be followed by a steep drop into despair? Especially if that despair leads to rejection from someone you’d like to have an ongoing relationship with! People can easily begin to avoid sexual opportunities, but this becomes yet another trigger for depression.
This is an under-researched problem. Here are some of the hypotheses about it. One thought is that having a history of sexual abuse may predispose women to experience depression after sex. (I don’t know why the only research was done on female respondents, since men are also victims of sexual abuse and men, too, can have postcoital dysphoria.) This hypothesis seems to be partially confirmed, but research samples were small. More work needs to be done to understand this fully. Another thought is that perhaps there is a biological reason for this drop in mood, that there is something unique about brain chemistry in the people who have postcoital dysphoria. This, too, seems to have some validity. A physician attempted to treat this by administering Prozac to his patients with this issue. His reasoning was that Prozac mutes the intensity of sexual experience. His patients did report that as their orgasms became less intense, the depression also decreased. But they didn’t like having orgasms that were not as strong, of course. So this is not a satisfactory treatment for the condition.
One thing I would suggest is finding a therapist who works with cognitive-behavioral techniques (CBT). Cognitive-behavioral therapy can be very useful in addressing depressive states and other moods like anxiety. By changing what you think or feel, CBT can also change what is going on regarding brain chemistry. The body is constantly shifting this way, with brain chemistry affecting thoughts and feelings, and vice versa. There is no research on this and no guarantee it would help. But this is a drug-free treatment that will have no side-effects. It has worked with post-traumatic stress disorder, panic disorder, and other severe mood problems that do not seem to be under the individual’s conscious control. Even if you can obtain a little relief, it would be helpful to you. And you may be able to make more improvement than that.
CBT doesn’t require you to go into your childhood or investigate the unconscious. It is usually time-limited. But it is also empathic and CBT therapists care quite a bit about how you feel and how you are functioning in your life. They want you to do well. But they go about helping you a little differently than psychoanalysts. I hope this suggestion will be useful. If not, you will still be free to seek out other options.