When you think about “sexual health,” you may think “STDs”—as in, herpes, HIV, gonorrhea, syphilis, chlamydia, and a host of other infections I won’t go into. One thing that probably doesn’t pop into your head is how having a sexually transmitted disease can affect someone mentally and emotionally. But for many, the impact beyond the physical effects of an infection—and of course sometimes there is no clear evidence that one’s infected at all—can be huge. However, since we rarely talk about the taboo subject of STDs, we often don’t talk about the mental impact of having one, either.
The two-way street of STDs and mental health is a classic chicken-and-egg situation: Are people with mental health issues like depression, ADHD, or schizophrenia more likely to contract an STD? Or is it that being diagnosed causes or worsens mental health issues that weren’t much of a problem before the infection?
At the organization I run, The STD Project, we’ve found evidence of both being true: First, finding out that you have an STD does seem to bring on or exacerbate underlying mental health issues, including severe stress and depression, in some people. “It’s really tough to explain to someone who has never had an STD why the virus can be so mentally taxing,” a 32-year-old government employee living with molluscum contagiosum (MC) told me.
In fact, the consequences of a diagnosis are, generally, much harder to handle emotionally than physically. For many, they’re devastating. “Honestly, I have found it to be the most difficult part of the process,” he added. “I retreated to the confines of my bedroom; I didn’t come out for two weeks. When I finally got in [to the doctor], I told the doctor what was going on, we discussed and agreed that I was likely suffering from significant depression from all of [it]. I was prescribed an antidepressant.”
This man’s turmoil isn’t unique. In fact, for the thousands of diverse readers who come to The STD Project website every week—sharing an incredible variety of stories—their emotional struggle is nearly identical: A 35-year-old librarian with genital herpes recently wrote, “I don’t know how to put it into words, except maybe to say that the current fabric of my existence seems to be made almost entirely of [my diagnosis]. I cannot un-believe that I am more than my herpes at this point. It has changed the way I look at and think of just about everything. I entered the deepest depression I have ever experienced in the 6 months following my diagnosis.”
"I entered the deepest depression I have ever experienced in the 6 months following my diagnosis," said one woman with herpes.
In some cases, struggling with a mental disorder can increase the risk of contracting an STD. A 2006 study in the journal Pediatrics looked at sexually active kids and teens in middle and high school and found that those who had symptoms of depression were more likely to engage in risky sexual behaviors like sex without a condom, substance abuse, and multiple sexual partners, significantly increasing their risk of contracting an STD.
The research suggested that those same students were less likely to have family support, and were more likely be socially isolated and to seek, or be pressured into, sexual activities as a substitute for meaningful intimate relationships. Finally, the researchers found that the students dealing with depression were also likely to have less self-confidence, which hurt their ability to negotiate safer-sex practices and to resist peer pressure, alcohol, and other drugs.
But that’s not the whole story. The journal Sexually Transmitted Diseases reported on a study done in a Boston health clinic that found that although lesbian patients were more likely to suffer from mental health issues prior to seeking care, they were significantly less likely to engage in risky sexual behaviors. However, those who were diagnosed with an STD were more likely to experience severe emotional trauma and require additional mental health care. In contrast, research reported in 2009 in JAMA Pediatrics found that depression was directly related to an increased risk of STDs—but only among African-American men.
The truth is, the current data presents a varied picture, so I believe it’s important to simply remember that mental health problems intersect with sexual behavior and our overall health in complex ways. If we’re going to end the American epidemic of STDs, we definitely need more research to understand the link between mental health issues and increased risk of STDs, as well as the psychological impact of a diagnosis. Our experience at The STD Project has shown that those who are diagnosed experience intense trauma, emotional distress, and often seek mental health care. “For the first time ever, I felt absolutely no hope,” the librarian told me. “I believed—and still have to fight believing—that the people around me would be better off if I was out of their lives. My life went from ‘normal’ to a nightmare in my head.” “One of the hardest parts is suffering in silence,” said the young man with MC. “You have no idea how much of an impact it is on your life until you get [MC] and support is needed."
If we took these experiences into consideration when designing targeted sexual education, and consider those who are already suffering from mental illness and the extra help they may need, I believe we could reduce transmission rates—a crucial step in lowering the astronomic rates of STDs in the U.S. If nothing else, it’s safe to say that addressing the mental health-STD link could help millions from from having to feel so isolated.
If you’ve been diagnosed with an STD, or know someone who has, how did you, or they, feel about the diagnosis?
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Jenelle Marie is the founder of The STD Project, an award-winning website and progressive movement aimed at eradicating the stigma associated with contracting an STD and living with an STD by facilitating and encouraging awareness, education, and acceptance through storytelling and resource recommendations. You can also find The STD Project on Facebook and Twitter. Look for her e-Book, “The Relationship Survival Guide to Living with an STD” available in 2013. TakePart.com