From Matthew Tiemeyer,
Your Guide to Eating Disorders.
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About.com Health's Disease and Condition content is reviewed by Steven Gans, MD

For many people with anorexia, sex becomes a forgotten subject. Anorexia has a powerfully negative effect on sexuality for a variety of reasons.

Biological Changes Affect Sexuality

The most obvious reason those with anorexia are limited in their ability to experience sex is their lack of physical development. When a person who has not yet reached puberty does not take in sufficient calories, sexual development slows down and may stop completely. Some may experience a delay in the onset of puberty for years. Women who have already started their period and who are now anorexic may even stop menstruating.

Much of this results in hormonal imbalances that change the way the person with anorexia even thinks about sex.

Why a Person With Anorexia Doesn't "Need" Sex

Anorexia is tied to a mindset that makes sex seem unattractive. The person with anorexia does not allow anything to affect her. She has decided that she doesn't need food -- and she certainly doesn't need sex. In her mind, a healthy desire for sex would be a sign of weakness. It would mean that she is not entirely self-sufficient.

Anorexia is also often associated with a fear of growing up and taking on the role, body and challenges of being a sexual adult.

Anorexia and Avoiding the Pleasure of Sex

Pleasure can seem very threatening to someone with anorexia, as she instead derives satisfaction from avoiding pleasure. The pleasure centers of the brain do not receive stimulation from consumption of food. The same dynamic is active when it comes to sex: Pleasure is to be avoided, so sex is not an option. Avoiding sex, like avoiding food, means taking nothing into the body.

Most important to someone with anorexia is the desire to keep the body from being affected by others. It is often the only thing that seems to be in her control, and that may be why she started restricting in the first place: So many things felt out of control that she had to look hard to find one that wasn't.

Restricting food is a way to exercise exclusive control. Restricting sex does the same thing. The body becomes, in a way, sacred. Nothing gets "in" without passing through the "security gate" of the eating disorder.

Sex Requires Intimacy

While it's true that many can engage in sex without the deepest levels of intimacy, sex involves intimacy by definition: Barring the unusual, it occurs between two persons at one time, making sexual moments exclusive moments. An exclusive experience is intimate, whether the experience is good or bad.

The person with anorexia fears intimacy, though she often wants it very much at her hidden core. But since sex creates intimacy, it becomes a frightening challenge that just seems easier to do without.

Letting Others In

The road to healthy sex for someone with anorexia has little to do with sex, at least initially. It involves trust of something or someone outside one's self. Many times, the first person someone with anorexia trusts is a therapist or other professional. When trust begins, it can expand to include acceptance of food and relationships with other people.

Sources:

Carnes, Patrick. Sexual anorexia: Overcoming sexual self-hatred. Center City, Minnesota: Hazelden, 1997.

Zraly, K. and Swift, D. Overcoming eating disorders: Recovery from anorexia, bulimia, and compulsive overeating. New York: Crossroad, 1990.