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Bulimia Nervosa & Sexual Health Challenges

Dr. Lisa Lawless

Dr. Lisa Lawless, CEO of Holistic Wisdom
Clinical Psychotherapist: Relationship & Sexual Health Expert

Flowers in shape of heart

What Is Bulimia Nervosa?

Many people know about bulimia (bulimia nervosa), which is an eating disorder primarily centered around binge eating and purging. However, some side effects may not be as commonly known. In this article, we will explore a bit about bulimia and, more specifically, how it can impact sexual health.

Eating disorders can impact people of any body weight, gender, age, racial or ethnic background. They often manifest during adolescence but can develop in childhood as well as later in life. Bulimia typically involves self-inducing vomiting and may include using laxatives, diuretics, and excessive exercise, which can physically damage the digestive system and cause electrolyte imbalances.

Common contributors to developing bulimia nervosa are psychological and genetic factors, trauma or abuse, social and environmental pressures, and medical conditions. In addition, there are often co-occurring conditions such as depression, anxiety, OCD, ADHD, body dysmorphia, borderline personality disorder (BPD), and more. It is vital to explore if one has a co-occurring condition because it may be the underlying cause of developing an eating disorder in the first place. 

Bulimia Nervosa is a serious mental health disorder, and those challenged by it can suffer mentally, emotionally, and physically. However, there are many helpful resources and support systems for those who are affected by bulimia as well as those who are recovering from it.

Bulimia Nervosa & Sexual Health

Approaching bulimia holistically by addressing its mental, emotional and physical challenges is essential. This means including the component of sexual health. Bulimia can impact sexual functioning and satisfaction in various ways such as:

  • Nutritional deficiencies that are caused by bulimia can lead to a decrease in energy and cause fatigue. This can contribute to a loss of libido and decreased sexual performance.

  • Bulimia can cause hormonal imbalances in any gender, affecting sexual functioning. Estrogen, progesterone, and testosterone levels can drop, which can cause a decrease in sexual desire. Hormonal changes can also contribute to rectal and vaginal dryness, which can cause pain during penetration and cause problems achieving an erection of the penis and clitoris. This can lead to erectile dysfunction (ED) or female sexual dysfunction.

  • Vaginal and rectal dryness can be of concern for those with bulimia because the constant purging of food and fluids can lead to dehydration. This can also cause the mucus membranes to dry out, including areas of the body such as the mouth, tongue, esophagus, stomach, eyelids, intestines, urethra, rectum, and vagina. Penetration when the mucous membrane of the rectum or vagina is dry can cause pain and increase the risk of tearing. This can, in turn, increase the risk of infections. 

  • Bulimia can cause damage to the entire digestive system (esophagus, stomach, intestines). This can lead to painful heartburn, nausea, and constipation, making sexual stimulation uncomfortable and, in some cases, painful.

  • Because people with bulimia often struggle with low self-esteem and body image issues, this can contribute to inhibitions around sexual contact with a partner.

  • Bulimia can cause long-term anxiety and stress, impacting sexual functioning through decreased libido and functioning. In addition, depression or anxiety alone can cause a loss of sexual desire and contribute to sexual performance issues, so the added stress that bulimia can cause can compound the effects. 

  • Those with bulimia who have experienced trauma or have a history of abuse may find that they struggle with establishing physical and emotional intimacy with a sexual partner.

  • Bulimia can cause menstrual irregularities, including absent periods (amenorrhea) or infrequent or light periods (oligomenorrhea). This occurs because the body has to put more energy toward maintaining vital functions such as balancing heart rate and blood pressure over ovulation.

  • Vomiting from bulimia can cause damage to the lining of reproductive organs from repeated exposure to stomach acid.

  • Bulimia is a form of starvation because the body is deprived of nutrients. This can cause high cortisol levels (hypercortisolism). When this occurs for an extended time, it can dramatically impact sexual health. This can occur in various ways; for example, it can lower testosterone which can cause a decrease in sexual desire and functioning. This can also reduce blood flow to the genitals, causing challenges in achieving orgasm.

  • Bulimia can contribute to vaginal atrophy, which is the shrinking and thinning of the lining of the vaginal walls (epithelium). It can lead to discomfort and pain through dryness, itching, and burning. Vaginal atrophy is a common cause of painful sex and may require using a vaginal dilator to help slowly stretch the vagina tissue allowing for more comfortable penetration. 

Bulimia & Pelvic Floor Dysfunction

Those who struggle with bulimia may find that purging has caused an increase in intra-abdominal pressure over time. This can weaken and damage pelvic floor muscles (Kegel muscles) and contribute to stress urinary incontinence (SUI). This is where urine can come out of the urethra unintentionally, especially during physical activities, coughing, sneezing, laughing, and while purging.

Studies in the International Urogynecology Journal and the Journal of Sexual Medicine found that many women with bulimia nervosa struggle with urinary issues. If you experience stress urinary incontinence, it is critical to meet with a healthcare provider to review the best recovery options, including pelvic floor exercises (also known as Kegel exercises), lifestyle changes, surgery, and mental health assistance to ensure the treatment of bulimia is addressed as well.

You may work with a pelvic floor therapist, OBGYN, urologist, or other related healthcare providers, and if they suggest using Kegel weights to help address strengthening your pelvic floor muscles, make sure to read our helpful guide How To Use Kegel Weights and to ensure that you buy a kegel weight set that is phthalate-free and body safe.

Seek The Help You Deserve

Finding healthcare providers that approach disordered eating with compassion and sensitivity is essential for building trust and being able to have open communication. This will help provide the best treatment options and possibilities. After all, those who struggle with eating disorders deserve to have a safe and supportive environment for their healing and recovery.

What To Look For In A Therapist

Make sure that when you look for a therapist to help with any eating disorder, you find someone who specializes in them, as they will be better equipped to provide effective treatment for this complex mental health condition. Someone who is trained in areas of nutrition, trauma, anxiety, and depression and provides a supportive and nonjudgemental attitude is also essential. A therapist who specializes in eating disorders should have other healthcare practitioners they work with as a team. Therapists who work with medical practitioners, nutritionists, and other healthcare professionals are better able to provide comprehensive mental, emotional, and physical care.

Sexual Health Products

If you or someone you love is struggling with pelvic floor issues or other related sexual health struggles and you need assistance choosing a product that can help, such as moisturizing lubricants, vaginal dilators, Kegel exercisers, vibrators for increasing blood circulation or sex toys for erectile dysfunction, please feel free to contact us as our compassionate and well-trained staff will be more than happy to help.

If you are working with a mental health therapist, pelvic floor therapist, OBGYN, urologist, or other healthcare provider, please don't hesitate to have them get in touch with us. We love working with healthcare professionals and are happy to help them find the best sexual products available for their patients.

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