Bipolar disorder and sex: It's time to talk about this emotional minefield In both cases, "up states" are usually followed by down or depressive periods, although the balance of up to down varies from each individual. Most can manage their disorder through medication and therapy. Individuals learn to watch out for triggers that may send them spinning into an exaggerated mood state. Yet, sex for those who are bipolar can prove a real minefield. Hypersexuality, a frequent urge for sexual activity, has long been touted as a symptom of bipolar, which is said to become apparent as individual descends into into a manic or hypomanic state. However, it's now the subject of much debate amongst both medical professionals and those with the condition. As Suzanne Hudson, chief executive of Bipolar UK explains, it's not so much that everyone entering an elevated mood becomes hypersexual, but that feeling "high" can lead to some individuals engaging in more "pleasure-seeking" behaviours - which include things like shopping, gambling and sex. "Someone about to go into hypomania usually becomes very productive," she tells me. From writing, to making phone calls, working to working out or having sex all night, it just depends on the individual. Along with that energy burst and increased pleasure-seeking, comes the added complication of impaired judgement. "While it won't affect someone's baseline sexuality, those with bipolar can end up indulging in behaviours they usually keep under control," explains Dr Nick Craddock, Professor of Psychiatry at Cardiff University, who specialises in the clinical research of bipolar. This could be anything from same-sex encounters to sex in public. "Given the social double standard we have around male and female sexuality, women in particular can find themselves "shamed" for what they get up to. And then there's the increased risk of STIs and pregnancy. As Tom, a 27-year-old student from Wales, who has just been diagnosed and has only just started on medication, put it: "My sex drive can be virtually insatiable. It might seem all good when you're ex is telling you they love how dirty you are, but I had a one-night-stand without using a condom that embarrasses me to this day. I can also fall in love with someone I barely know when we are having sex. A sexual carnival Reading through the Reddit threads and the internet's bipolar forums about the experience of hypersexuality - it sounds like a sexual - and emotional - carnival. Sometimes the acts of have no apparent consequences, other times there are heart-wrenching repercussions. Hours lost to masturbating; the impromptu orgies; the damage caused to marriages by extra-marital affairs or the risk of seeking out more and more extreme sexual activities in order to try and "scratch an itch which can never be scratched," as one web user puts it. You get the gist. Those with a more liberal approach to sexuality in general seem to cope better, probably because they don't worry so much about being considered promiscuous. But the notion of feeling out of control is what really seems to gnaw at sufferers" self-esteem, as well as affecting their relationships. Tina, who has bipolar disorder, has been with her current partner for six years and finds that her volatility is the real test: "He's been so supportive and patient with me. But because I can't control my actions, thoughts and feelings sometimes, I find it hard to show him how much I love and appreciate him. Which brings us on to the depressive lows. Like anyone with clinical depression, libido often evaporates as the mood plummets. As Tina puts it: "Sex never really impacts my mood; my mood impacts sex. In my past relationship, I was called a "let-down" if I didn't have sex, which made me scared of saying no. With my current partner, if I'm really low I will push him away, not letting him touch or kiss me. Yet if someone in a depressed bipolar state, or the common mixed state - where features of hypomania combine with those of depression - starts to self-medicate with sex, the result is rarely positive. One-night stands on a low mood can be awful and lead to incredible self-loathing. I self-harmed after one, head-butted a wall," Tom tells me. And then there's the impact on the other person when you just don't want to have sex at all. It's awful when someone thinks it's because of them. I go weeks without wanting sex, can't bear to be touched. As a guy, you're meant to want sex all the time. It's emasculating. Mismatched libidos The tension caused by mismatched libidos can really rock a relationship. When my former partner went from wanting sex every day to not at all for weeks, I'll admit I was pretty cut up. But as Dr Nick Craddock points out, dealing with a mismatch in sex drives is a problem for many couples, irrespective of bipolar. One in four people claimed it affected their relationship in the recent Natsal 3 survey. On the other hand: "If you have bipolar and are trying to manage an elevated mode," says Suzanne Hudson, "a highly sexed relationship might not help." Looking back, it's easy to see now why my undiagnosed ex might have thought hooking up with a sex columnist would be a good foil for his hypomanic libido. Now I know I was pretty much the worst choice he could have made. Of course, not having sex is also not the answer, says Dr Craddock. Just like everyone, people with bipolar still go through the usual fluctuations of wanting more or less sex. Instead, it's about being able to recognise when sexual behaviour - and other behaviours - are changing in tandem. Do you want sex three times a day instead of once? Did you also just go on a spending spree? We advise people create a checklist of warning signs when they are feeling balanced. Then they and the people around them can refer to the list if anyone thinks they are experiencing a significant mood change. For women, it also helps to make decisions about contraception that can't be influenced that much by a state change. The coil or contraceptive implant, for example, might be better choices than the pill," he explains. But for 23-year-old Eleanor who was diagnosed two and a half years ago, the significance of hypersexuality is exaggerated. If you are successfully supported, and taking the right medication, hypersexuality shouldn't be that much of an issue. I may have had a lot of casual sex before I was diagnosed, but it was always with people I trusted. At the end of the day, learning to make wise sexual decisions is part of growing up for everyone, bipolar or otherwise.