The Complicated Relationship Between Anorexia and Sex

Forgetting and relearning how to have desires and act on them

Posted Feb 14, 2019

Sex is one of the many absences at the heart of anorexia, and one of the presences at the heart of many recoveries from it. Having recently written a post on menstruation, and having published Karen Photiou’s guest post on pregnancy and early motherhood, it felt like sex was waiting to be talked about. And even before those posts, it had been waiting in the wings a good long while, I suppose: quietly involved in things I’ve written about relationships and body confidence and learning to trust one’s appetites again. Sex is obviously one of those topics that gets way too much coverage in some respects and way too little in others, but it’s safe to say that the anorexia–sex section of the Venn diagram could do with a bit more airtime.  

As usual, I’ll draw on my personal experience and what I’ve learned from you, my blog readers, as well as the relevant scientific research. I’ll stick to a more or less chronological framework, asking how attitudes to sex and the effects of sex and abstinence from sex change from pre-illness to post-recovery. Because I’m a woman, and all the people who have had anorexia whom I know well are women, and almost all the existing research on sex and anorexia involves only women, my discussion will be fairly female-centric; because I’ve only ever had sex with men, it will also be pretty hetero-centric. But some of it may still be relevant to thinking about homosexual sexual activity and sexuality from a male perspective. 

Before the beginning (1): Sex as a trigger

Sometimes, rape, abuse including sexual abuse, or other sex-related trauma is a trigger for the onset of an eating disorder (Connors and Morse, 1993; Wonderlich et al., 2001; Chen et al., 2010; Behar et al., 2016). Sex-related trauma can also result from things that would not be traumatic if humans were more humane: the experience of gender confusion and exploration, the discovery of non-hetero sexuality, sex without marriage, and other sex-related phenomena that still attract discrimination or outright punishment, in some societies more than others.

The precise mechanisms by which sexual trauma leads to an eating disorder aren’t well understood. Indeed, given eating pathology is often just one part of a wider set of post-traumatic symptoms, it’s still an open question whether the common "pattern of pervasive dysregulation and impulsivity following childhood trauma [is] best considered an eating disorder with comorbidity, a form of PTSD, a personality disorder, an impulsive control disorder, or something else" (Wonderlich et al., 2001). The initial trauma response may involve behavioral dysregulation, changed stress response, and/or altered reward and aversion processing, and these may, in turn, make eating pathology (whether restrictive and/or binge/purge forms) more likely. There may also be direct perceived value to the individual of self-starvation or other forms of food-related behavioral manipulation: reducing one’s sexual attractiveness, rebelling against the abuser by demonstrating one’s needlessness, withdrawing emotionally from pain and shame, punishing the body for failing to protect one from the abuse, making something else more cognitively salient than the abuse, or any combination of these. 

When it comes to using (not) eating as a coping mechanism, sex-related abuse can be understood as an acute version of the many other forms of suffering involved in the strange transition from childhood to adulthood, or simply in the strange fact of being alive. Anorexia or other eating pathologies can, for some people, for some amount of time, feel like the best possible, or the least worst, response. My post on the six seductions of anorexia explores the apparent solutions anorexia offers, and their expiry dates, in more depth.

Before the beginning (2): Sexual activity and interest in sex

For most people, anorexia and other eating disorders don’t start with acute trauma; they start with dieting or some other response to food- or body-related discontent, often exacerbated by the changes involved in puberty. But some of the factors that affect susceptibility to an eating disorder—personality and attitude variables like emotional regulation, valuation of control, and body image satisfaction—may manifest in variations in levels and types of sexual interest and activity before the onset of an eating disorder. For example, there’s some evidence (based on retrospective self-report) that the average age of the first kiss and first orgasm for women with eating disorders is later than for healthy controls, though the age of first menstruation and first intercourse is similar (Mangweth-Matzek et al., 2007). There’s variation amongst the eating disorders, too: the same study found that women with anorexia are less likely to have had sex than those with bulimia. An earlier study found less sexual interest and activity (both intercourse and masturbation), and later first sex, in the phase predating the onset of anorexia than bulimia (Wiederman, 1996).

In many respects, I was a typical pre-anorexic teenager: neither thin nor fat but gradually coming to believe I was fat, and that life would be better if I were thinner and my tummy was flatter; experimenting with what felt like innocuous dieting; getting sucked in before I or anyone else realized what was happening. As regards sex, though, I was something of an outlier in the picture that emerges from the research on pre-anorexic sexual interest and activity. I had quite a lot of sex, from quite young. I had a lot of sexual confidence, and sex and alcohol and other drugs were important parts of growing up, working out who I was, and opening myself emotionally to other people. Then anorexia kicked in, and all that fell, not instantly but within a few years, by the wayside. By my early 20s, I was looking back with grandmotherly disapproval on the "recklessness" of my teenage out-till-dawn self and musing that I really should become a hermit when I grow up.

For many people, the sexualizing phase of growing up doesn’t have time to happen before anorexia begins, and then anorexia prevents it from happening in anything like a normal way. This makes it a strong example of a more general phenomenon in any prolonged illness: missing out on the ordinary developmental phases that others go through. It’s, of course, possible to "catch up" after recovery (more on this later), but not doing the things that most people do at the age they do them can create anxieties that easily become self-perpetuating: because you feel insecure about your lack of experience relative to others, you don’t dare seek it out, and so the anxieties grow. Less direct ways of gathering experience that may seem safer can, incidentally, step in to fill the gap here. One respondent to the survey I ran with the charity Beat on people’s perceptions of the links between their reading habits and their mental health commented that 

"after reading Time Traveller’s Wife, I can see my body as something that can connect with another. Reading my preferred type of fiction has had a strong effect on how I feel about my body as something sexual. As I had anorexia 11-22, I missed a large part of development and so I have learnt to view my body sexually through reading fiction."

Exploring fictional worlds with fictional companions is one way that, for some people, the anorexic closing-down of experience can be countered, in recovery or perhaps even before.

In the beginning: Starvation desexualizes

How exactly does anorexia interrupt sexuality? At the heart of it is the simple fact that when a human body is starving, its priority is survival not procreation. The resulting starvation-triggered chemical changes drive profound physical, cognitive-emotional, and behavioral changes that affect everything about sex. The cultural value of slimness may mean some people may experience a short-term increase in sexual self-confidence as a result of the early weight loss that heralds the onset of anorexia. But at some point in anorexia’s development, as malnutrition takes hold, hormone (especially ovarian steroid hormone) and neurotransmitter balances change radically (usually as part of the systemic condition known as functional hypothalamic amenorrhea), and most people’s sexual interest and activity diminishes drastically.

Research on sexual interest and activity during eating disorders suggests that people with eating disorders have less sex and masturbation than healthy controls, with the reduction greatest for those with anorexia. Loss of libido, sexual anxiety, and relationship tension have also been found to be higher in women with eating disorders, along with detached relationships, frequent relationship changes, and relationships without sex—though overall fewer women with eating disorders reported not having a partner at all than did healthy women (Pinheiro et al., 2010). A more nuanced landscape emerges from other work finding a dissociation between sexual interest or enjoyment and sexual activity (Morgan et al., 1999). This parallels the dissociation between hunger and eating in anorexia, and more generally the rift that (as I discussed in this post) opens up between liking and wanting in anorexic responses to food and other rewards.

Wellcome Collection gallery (2018-03-28), under the Creative Commons Attribution 4.0 International
Chinese ivory statue in the form of a man and woman engaged in sexual foreplay
Source: Wellcome Collection gallery (2018-03-28), under the Creative Commons Attribution 4.0 International

As for the specific mediators of change, basic physical problems are part of the story: women with anorexia who do continue to have sex often suffer from lack of vaginal lubrication or vaginal atrophy (thanks to low oestrogen) and/or other sources of pain during sex, and often have difficulty reaching orgasm (presumably often for a combination of physical and psychological reasons). And pretty much all the other anorexic symptoms you can think of—low energy, low mood, low self-confidence, persistent cold, secretive and judgemental habits, obsessive-compulsive and controlling habits, denigration of the bodily in favor of the intellectual life—make it hardly surprising that sex and sexual pleasure don’t tend to get much of a look in. Indeed, numerous other correlations have been found connecting the physical, behavioral, and psychological aspects of eating disorders with specific sex-related changes. For example, Pinheiro and colleagues (2010) report associations of:

  • caloric restriction and weight loss with loss of sexual satisfaction and enjoyment 
  • higher interoceptive awareness and higher anxiety with loss of libido
  • lower minimum lifetime BMI, harm avoidance, and feelings of ineffectiveness with sexual anxiety
  • and lower minimum lifetime BMI and lower age of disorder onset with lack of current relationship (with or without sex).

So it’s a complex picture, as ever, but the severity of starvation is, as ever, a crucial marker—whether as a correlate with other symptoms that affect sex-related factors, or as a direct driver, or (most likely) both. Bodyweight isn’t everything, by any means, but it’s a sign and symptom and contributing cause of an awful lot. 

For me, sex was simply non-existent, for years. Masturbation never occurred to me, other people had zero sexual attraction for me, and the deeper I moved into illness the less I missed or even thought about the sexual activity of my teenage years. I felt less like a woman, or a member of a sex, still less a gender, than simply like a person; indeed, my sense of womanhood returned only quite slowly, and is still more ambivalent than I imagine it might have been without that long hiatus. Even my membership of the human race felt tenuous a lot of the time: I felt an emotional connection with almost no one, shared my days and nights with almost no one, and thought of relationship stuff mostly as a difficult banality.

I met my first long-term partner after I’d first fallen ill aged 16, and before I relapsed from my first recovery effort after leaving for university. When we got together I was somewhere precarious between well and unwell, and sex was important to me as part of desiring and later loving him. For a while he was the only person I could/would eat with, and feeling connected through him to the physical realm applied to sex as much as eating: "I won’t relinquish my control for anyone else," was the declaration underlying it all. Sometimes sex would replace eating, leaving me replete in a way more exhausting but as satisfying as food; more often, each would support the other, as integral parts of our intimacy. We went out a lot, drank a lot, had sex a lot, ate quite a lot, took some drugs, and all that was an excellent counterpoint to school and exams and everything. 

But once my feelings about him stopped being strong enough to counter the resurgence of anorexia, both the eating and sex suffered—though not always neatly in tandem: sometimes there were confusing time lags where I’d start to eat more, determinedly, but my sexual desires seemed to diminish as I grew. My longing for him came and went, but more and more my longing to go out drinking and dancing with him got replaced by a longing to be early to bed with tea and a book and my own company. And in the end, the ebbs and flows of my willingness to eat and to have sex, along with those of his struggles with depression and unemployment, brought our relationship to several messy, temporary ends and finally a final one.

When we split up, anorexia would be both the stick to beat myself with and the blanket to wrap myself in. I tried to tell myself that he’d never even have fancied me if I hadn’t had anorexia and had stayed "fat," but never quite believed it, mostly torturing myself with the idea that his new partner ate and was warm and wanted sex with him and found sex with him painless with a straightforwardness I’d never had. And then I stopped eating to dull the anguish, and it worked, for a while.

A year or so into our relationship, one English lesson in my last year at school, I recorded in my diary a funny little episode tangentially about Chaucer:

In English today, a propos the Wife of Bath’s Tale as it turned out, we had to split up into pairs and disperse, and the boy had to ask the girl, "What do women most desire?" I said to Edmund the thing that first came into my head, instinctively—"Endlessly satisfying love and sex." Mr. C read it out and laughed and said "That can be arranged," and everyone else seemed very surprised by it too—called me a hedonist—as if they never thought would say the word "sex," especially not at school. I’d thought they’d all say things like that, but though sex did feature in a few, others said peace, friends, happiness, marriage, fun (some definitely mutually exclusive), "not to be badgered survey-wise," make-up(?!). I still stick by mine, having thought at greater length. Even the order’s right. Not that I’ve had love without sex, but I’ve had plenty of sex without love and it’s nothing special. Anyway, this evening I’ve been stupidly bored and miserable. I want him so much. I’m sure he won’t be endlessly satisfying but it’s been wonderful so far. I wonder what he would say about men’s desires?

That was a telling little collision of lives: Emily the school swot versus Emily the underage clubber. It was also an ironic little pivot point: in half a year I’d be starting a literature-heavy languages degree at Oxford, and clubbing Emily would die in the ascendancy of undergrad swot Emily, and the schoolgirl who let one speak through the other would turn into the student who would deny all the wisdom she’d been so pleased with. She would get sucked deeper and deeper into her obsession with language, with all its intricacies and ambiguities and the ways it constructs reality right from the ground up (or so she came to believe), and above all with the ways it fails, the ways it creates bridgeless rifts in understanding between humans trying to show each other who they are but falling back every time into incompleteness and the self-reflexive awareness of it, and she would forget about endlessly satisfying love and sex, except as a turn of phrase she’d once used, and analyzed, in service of the analysis of a long-dead man’s greater more ancient words. 

The idea of a meaningful world beyond the attempt to capture it in the structures of language grew more and more alien to me, and sex was the antithesis of that but also got sucked into it, as my romantic mode grew more and more language-centric too. More and more, I’d refuse physical proximity for linguistic dreaming, and making love less about wordless physical communion than about communion in words that seduced and intoxicated and would one day, just maybe, stop being prison gates.

In the depths: Sex is irrelevant

I think the preoccupation with abstractions of one kind or another is fairly common in anorexia, as the starved mind closes in on itself and embodied practicalities become fraught. For me, the deep years of illness were like being split into a creature of two halves: the intellectual submerged in literary criticism and the animal stuffing her hungry mouth with chocolate after gauging the size of her nightly shit in the toilet bowl. There was no embodiment that wasn’t tied to food and the size and weight and shape of my body and the effort to control all of them. There was nothing much but vague distanced repulsion, or at best uninterest, in my own body and others. There was no desire left over for anything that wasn’t food. There was no immediacy of bodily sensation that wasn’t hunger, or the things that flowed from ignoring hunger: cold, tiredness, weakness, sometimes dizziness. And there was nothing that was really about anyone else. 

So, it was all a million miles from the profound reciprocity, from the loss of self and of control, that there is in (good) sex. Light years from the heady balance of desiring and being desired. From the all-eclipsing pleasure that is as much in the knowledge and imagining of the other person’s as it is in one’s own. 

And I cynically savored the ironies of taking contraception because of my lack of sexual viability; made one attempt, in my Masters year (eight years after my illness began), at a romantic and sexual relationship that floundered most of all on the sexual part; naively failed to recognise some men’s physical attraction to me; but saw fewer and fewer people anyway, so it didn’t much matter. 

Re-emerging: Sex is scary, sex is food-like, sex is healing, sex can be taken slow

The research on how things change again after recovery is hampered, as with everything else in eating disorder research, by the fact that hardly any studies involve many participants who seem to have got actually better (for reasons I explore herehere, and here). But the few studies that do exist make clear that as you’d expect, when other stuff improves, so does the sex (Don Morgan et al., 1995). One study (Morgan et al., 1999) tracked participants’ progress through weight restoration and found that sex drive (measured in terms of sexual daydreaming rather than sexual behavior) increased in line with BMI. The same study also found a weaker association between weight restoration and depression. This finding isn’t entirely surprising (many aspects of gaining weight are uncomfortable and scary, and weight gain is accompanied by many other things which are too), but it does make one long for a study that doesn’t stop as soon as participants reach a population-average bodyweight. Changes and improvements in sexual activity and enjoyment during and after recovery need a lot more exploration, especially given that positive personal (including romantic) relationships are a commonly cited form of support in recovery (Tozzi et al., 2003) as well as a common motivator for embarking on recovery in the first place. 

The precise interplay between emotional and sexual recovery is an interesting area too. For me, falling in love happened very early on in recovery, before falling in lust, or growing otherwise interested in sex again. Both the emotional and the sexual reawakening were at once terrifying and profoundly motivating. It’s frightening realizing that you can feel emotions again—strong, unpredictable, vulnerable-making emotions like love. But it’s also exciting. And for me it was a strikingly beautiful discovery, finding that my emotional capacities were being fed as linearly as my body. Indeed, after having fallen in love, and before he and I could spend much time together, I encouraged myself to eat with the thought that I was strengthening myself for him, even specifically helping myself long for him more strongly—wanting the emotion to grow and grow even though all the standard torturing anxieties about whether he felt the same and where it was all going grew along with it. Conversely, when anticipating the first time we were to spend alone together, I longed also, simply, to eat with him. 

It went both ways, too, when we finally did spend a week together. The first night we had sex, and slept, together was also the first night when I had neither my standard low-calorie chocolate drink nor my muesli nor my chocolate before bed. With him to sleep next to I felt I no longer needed them; with him to eat dinner with I physically needed them less too. I had finally relearned that there are things far more wonderful than food—and that the wonderfulness of food makes those other things possible. In those first few heady days by the sea with him, I also started eating little sweet things in bed with tea first thing in the morning, an intimate statement of a new normal that nourished me for many months to come.

Feeling sexual desire for someone and giving yourself permission to act on it is frightening in a similar way to feeling hunger for food and giving yourself permission to act on it. Or, equally, stopping giving yourself permission never to act on it. The confusion I remember feeling at the novelty of my overwhelming hunger no longer being neatly ignorable was strong and lasted some time. The confusion was less with sexual desires, but it’s taken me a long time to work through the full implications of what it means to not automatically try to censor those desires; indeed, as I’ll come back to at the end, I’m still not at the end of that working-out process.

Experiencing new extremes of physical sensation is scary too. Hunger and cold, and conversely the ecstasies of eating and warmth, had for many years been the only intensities I’d known. This old-new sex thing was weird: it had no shape/weight/size-related implications or precursors, no "downsides," nothing to fear except the fear of wanting too much of it, which turns out to be the same old fear as the fear of food, wrapped up differently. Actually, there wasn’t much of that for me with sex, but I can imagine there might be, especially with less prior experience as a guide to how the whole system of wanting and getting and wanting and getting again really can and does self-regulate

With food, not leaping straight from severe restriction to unregulated extremes of eating makes sense, both physically (to avoid dangers like refeeding syndrome) and psychologically (to avoid freaking yourself out with the violence of a movement from barely eating anything to feeling you should be eating everything). And if a gentle movement from a strict recovery meal plan to the embrace of appetite-led spontaneities makes sense for food, maybe it does for sex too. Not that you should necessarily pin your physical intimacy plans for the week on the fridge. And not that I did anything remotely this systematic. But with the benefits of hindsight and other people’s testimony: treat it as a process and one that can be taken slow. 

Maybe start on your own: (re)learn how to give yourself pleasure. And cultivate the joys of other forms of physical intimacy, at other points on the spectrum of sexuality: with someone you trust, hugs, cuddles, kisses, massage, sexting, can all be sensuous and intimate in ways that should never be diminished by comparison with "actual sex." If you find someone you’re physically or sexually attracted to, let it go as slow as you want it to, regardless of what (s)he may want; this is a simple consent issue. My mother told me not to rush it, and even if that’s what mothers always say, she was right, and if I didn’t entirely pay attention, well, she was still right. 

Taking it slow includes being patient, and not measuring or judging your recovery against anyone else’s. Just as the variance in timing of any given physical marker like the resumption of menstruation is vast, so is almost everything else about individuals’ recovery timelines, and whether you find yourself eyeing people up in bars at month 2 or month 14, it’s fine. And if it never happens, well, it’s possible you’re naturally some variant on asexual, but it’s more likely that you’re not actually recovered yet, or you are but have other sex-related issues that still need addressing. 

One important habit here is to keep reminding yourself that how things are now is not how they will always be: don’t beat yourself up about being ridiculously teenage in your infatuations or your lusts, or indeed about still feeling grandmotherly as hell. It all passes; it all finds its balance. And, if sex was a traumatic part of the onset of your eating disorder, in any way at all, be all the more careful. Get professional help for this side of things if you can. Remind yourself that you are vulnerable, and look after yourself as you would advise a friend to.

Underlying all this is the question of how you come to be in contact with people you fancy, and more generally how relationships of all kinds have a tendency to shift as a serious illness comes to an end. You may well find that family relationships and friendships are put under interesting kinds of strain as you stop being the anorexic person and start being someone no one recognizes, including probably yourself. Some will survive the movement, others won’t; many will change, as you do, almost beyond recognition. Knowing how to let go is as crucial a skill here as anywhere else. And as existing relationships end or transform, your capacity to form new ones grows and changes too. If you’re anything like I was, you’ll be as unpractised at having friendships as at having romances, and all of them will take time and patience, from you and the other parties. In this context, some ways of meeting people will be more fitting than others: leaping straight on to hook-up-orientated dating apps possibly less so than choosing a lower-key get-to-you-know kind, or going old-school with volunteering or the pub.

Being so much in love doubtless made me leap a little too fast into a serious relationship, in a simple old-fashioned pre-Tinder way, but it probably also helped smooth over any anxieties I might otherwise have had about having sex again. The fact of my new partner being sexually less experienced than I was probably did too. Many people coming out of an eating disorder feel a distinct lack of confidence about their ability to be a good sexual partner. If you do, remember that you’re probably also overestimating the confidence of people who aren’t coming out of an eating disorder, including the person you’re attracted to or involved with.

On this note, it’s also important to remember that one’s first sexual experience, or one’s first after a long gap, is usually somewhat rubbish. (The naivety of the M-22 lyric "We can do it all night / Like it was the first time" always makes me smirk; though I guess that’s not the intended effect.) Having sex is a skillful activity that, like all others, is not instantly easy and repays practice. Anorexia and being only adequate (or even inadequate) at stuff are not the comfiest of bedfellows. So if you feel ignorant and unskilled, don’t worry: bad sex is probably as important as good sex in the whole huge learning curve that is recovery. Embrace it! Test out the observation that "sex is like pizza—even when it’s bad, it’s still good." And then enjoy it getting better—and not through manual-led determination or self-critique, but through practice of all those harder to pin down attitudes of relaxation and acceptance and jollity and being embarrassed but not caring too much. And if it doesn’t get better, say something, and do something. Oh, and remember that, as a friend currently in recovery recently confirmed: "Sex after anorexia is much better when you’re brave enough to take your clothes off."

My first sex in years was beautiful less for the physical pleasure, which was hampered a bit by having drunk and smoked and my mother being in the next room, than in the closeness it marked for us. But our joy in the sex itself grew in the nights and days after that, and we had sex as much as we ate, and ate as much as we had sex, and it was great.

The question of selflessness is an interesting one here amid food and sex. In an obvious sense, anorexia is all about self-denial: you deny yourself all the most basic life-sustaining pleasures, from food upwards. But in another sense it’s not at all: you deny yourself those things because the denial gives you something. Self-denial becomes the substance you’re addicted to; it gives you the high (or at least the temporary freedom from the lows) you think you need. The selflessness involved in good sex is of quite another kind: it isn’t the sterile selflessness of asceticism, but the fluid eroticism of self not being denied, but losing its boundaries from the other—both physically (skin touching skin, body boundaries penetrated) and sensationally and emotionally (in the shared rhythms of a progression towards orgasm, in the intensity of balanced needs and their fulfillment). So self is lost not by squashing it down out of sight (which makes it clamor all the louder) but by letting it be part of someone else for a while. It’s quite different. 

Above all, the value of sex to me in those early months of recovery was twofold: one, as a way of growing closer to the man I loved, and remembering how to love and be loved; two, as a way of learning to love my changing, rapidly growing body through his appreciation of it. I remember wondering early on why he said he loved my mouth so much, and then looking at it in the mirror and seeing little dimples between my lips and my cheeks that hadn’t been there for years, and beginning to understand, and smiling, and realizing that how he made me laugh and smile was part of it all too. In little ways like that, I learned to see myself anew. I hope I would have coped with the weight gain and the vastly increased body fat and everything else, and learned to see myself with love without him, but it might well have been a lot harder and take a lot longer.

Recovering fully: You and sex and appetite

I’m no longer with the man I fell in love with ten years ago. One of the things that brought our relationship to an end was my realization that I had sexual desires which I needed to fulfill with men who weren’t him. The strength of this realization arose in the wake of my father’s unexpected death: everything was upturned, and new clarities emerged when the ashes settled. 

We split up, painfully, and I spent a few summer months sleeping around. It was fun, and also in some respects tedious; it was not very satisfying while also profoundly satisfying. It was what I needed, and it was good and necessary to get it. It was, I think, a sort of making up for lost time. It was granted permission for the pendulum to swing a long way the other way before settling again somewhere nearer the middle—just as I’d had to do, and firstly feared and later relished doing, with food: eating really a lot of food, eating lots of animal fat and lots of sugar and lots of everything. For me, it seemed that long-refused appetites could not be adequately calmed by a direct reversion to moderation. I suspect this is true of most people when it comes to the recalibration of appetite for food; the reason many people stay semi-recovered is that they don’t let this happen. On the sexual side of things, there’s probably more variation, though perhaps less than many people might admit. 

I guess there was a kind of symmetry between the relative hedonism, not least sexual, of those few months four years after starting recovery and the teenage years before and as I became ill. If illness was a retreat from an expansive embrace of demanding, complex, emotional aspects of life including sex, then this tail end of recovery was about letting that back in again. 

That period of exploring what I wanted, or getting some lingering instincts to abstinence finally out of my system, was brought to an end by meeting two men, both of whom I fell in love within the space of a few months. This led me to a new phase of exploration of what I later learned is called polyamory, and (as I mentioned in my post on normality) exploring the possibilities and navigating the difficulties of that way of having emotional and sexual relationships is what I’ve been doing ever since. Most of the world condemns and/or misunderstands it (or my take on it, anyway), but for me it’s as important, for now, as not counting calories to make my thighs thinner: not to automatically ignore, discredit, demonise, lie about, or at best bargain with and find loopholes for, any form of attraction I feel to anyone is a fundamental tenet of my freedom. In this sense, I suppose I haven’t floated back to the pendulum’s "normal" in a societal-scale sense, but I have reached what for me feels, most of the time, like equilibrium. There are alternatives to every dogma, whether the status quo is serial monogamy or diet culture. The ways of being that are norms in a quantitative sense are fairly messed up, and the alternatives are still emerging.

So, find your own route. Reject what needs rejecting. Embrace what you value. If you know something is normal but you hate the fact that it is, don’t let it be your normality. Yes, lots of people feel shame, dissatisfaction, and endless critique in relation to their own bodies, including during sex. Yes, many people who’ve never had an eating disorder will have sex only with the light off, or only with some critical number of clothes on, or only with the bedclothes covering them, or only in some positions. (One study found that 52% of heterosexual women, versus 44% of lesbians, reported hiding at least one part of their body during sex [Peplau et al., 2009]) Yes, many people will spend most of the time they’re having sex wondering or worrying how they look: wondering in a self-detached, sometimes satisfied, always self-distancing way, or worrying in an avoidant way, or both at once or in alternation. There’s accumulating evidence linking self-objectification with higher self-consciousness during sex, with lower sexual functioning, with lower sexual self-esteem, as well as with more disordered eating; similarly, internalization of media body ideals is strongly associated with body dissatisfaction and low self-esteem. (For a review, see Yean et al., 2013). 

There are many sociocultural things driving these patterns, but it is not inevitable that you succumb to them. On the positive side of the coin, body appreciation has been linked to women’s sexual arousal, satisfaction, orgasm, and sexual desire (Woertman and Van den Brink, 2012). And given your recovery will involve cultivating things like body appreciation as a matter of urgency, you have a readymade opportunity to do better than many do: to be forced by the extent of the problem to make it no longer a problem. For you, self-objectification won’t just make sex a little less good; it will also help keep you ill. Whatever normal may look like in your part of the planet, don’t assume it’s the best you can aim for. Normality should be an observation, not an aspiration.

Jean-Pierre Dalbéra via Flickr under the Creative Commons Attribution 2.0 Generic license
Tantric carving from the Lakshmana Temple, Khajuraho, India
Source: Jean-Pierre Dalbéra via Flickr under the Creative Commons Attribution 2.0 Generic license

So, set aside what pornography and the lightly pornographic advertising of everything from gym memberships to ice cream encourage. Refuse it in bed as in the rest of your life. Get naked in broad daylight and/or blindfolded. Practice being present as a bodily subject, rather than observing your body as an aesthetic object, at other less heightened times of day, so it becomes a habit that extends naturally into sex. Change the automatically self-critical things you do with mirrors and the idea of beauty. And remember that the appreciation you desire is also yours to give—to your partner and to yourself.


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