What Does Asthma Mean for Your Reproductive, Mental and Sexual Health?

Asthma is a breathing condition caused by inflammation in the airways. It results in coughing, wheezing, difficulty breathing and many other issues that may seem unrelated.

According to the Asthma and Allergy Foundation of America (AAFA), 1 in 13 people will suffer from asthma at some point. Asthma is more common in children, but adult-onset asthma exists, too.

Outside factors such as air quality, allergies, certain chemicals and substances, activity level, and other illnesses can cause asthma in just about anyone. And asthma and sex are connected, especially if the condition is poorly managed.

The effects of asthma on overall health

"The physical effects of asthma can range from the occasional cough to being potentially life-threatening," said Daniel Atkinson, M.B.B.S., a U.K.-based general practitioner and the clinical lead at Treated, an online health clinic. "If your asthma bothers you at night, it can affect your quality of sleep and leave you feeling tired and restless during the day. And if your asthma gets worse when you exercise, it can impact your level of physical activity."

Atkinson noted that asthma symptoms affect everyone differently, but if your asthma is well controlled, it shouldn't stop you from doing everyday activities.

The constant symptoms, especially during periods when they are worse, can lead to fatigue and difficulty breathing, which can interfere with daily activities, according to Flora Sadri, D.O., the medical director at Psyclarity Health Massachusetts, an in-patient addiction treatment center in Saugus.

"In addition, long-term, uncontrolled asthma can lead to permanent damage to the airways, resulting in more severe and harder-to-manage symptoms," she said. "It is important to understand that proper management and treatment of the condition are essential to avoid long-term health complications."

You can think of the physical and mental effects of asthma like a snowball rolling down a hill, getting larger as it moves. Asthma can impact your sleep. Lack of sleep can impact your productivity at work and home. Low productivity can negatively impact your mental health. Poor mental health can exacerbate your original asthma symptoms, especially if you also have anxiety or experience panic attacks.

However, most of these negative effects are often due to undiagnosed or uncontrolled asthma. There is no cure for asthma, but the condition can be managed using one of two primary types of inhalers, according to the World Health Organization (WHO): a bronchodilator or a steroid inhaler.

A bronchodilator opens the airways and relieves asthma symptoms. A steroid inhaler reduces inflammation in the air passages, improves asthma symptoms, and reduces the likelihood of a severe asthma attack or even death.

Are hormones and asthma connected?

"When the level of estrogen in a woman's body changes, such as throughout the menstrual cycle, the severity of their asthma can change, too," Atkinson said. "Estrogen levels can affect your asthma as much as allergies do."

When the level of estrogen in your body is low, your asthma can be exacerbated. When it comes to pregnancy, though, the effects are variable.

"Some [pregnant people] report that their asthma improves while pregnant, some say their asthma gets worse and others claim it stays the same," Atkinson said.

The good news is that if asthma is well-managed during pregnancy, it won't increase the chance of any complications with your pregnancy or baby.

"This is why it's really important to make sure your asthma is controlled well if you're planning on having a baby," Atkinson said. "If your asthma is poorly controlled during your pregnancy, this can affect the placenta and increase your child's chance of developing asthma."

Studies have also shown how hormonal contraceptives may play a part in asthma exacerbations and symptoms. One 2015 study, published in the Journal of the Royal Society of Medicine, indicated that the use of hormonal contraceptives may reduce asthma exacerbations and the number of care episodes. The study also suggested that overweight and obese women who don't use contraception may be at increased risk of asthma. The reason for this correlation may be because estrogen and progesterone can stimulate smooth airway muscle function.

The report called for further studies to confirm its findings, but study authors indicated that the use of any hormonal contraceptive was associated with decreased risk of current physician-diagnosed asthma and reduction in asthma or wheeze care episodes.

The links between asthma, anxiety and depression

Evidence is growing of a link between asthma and mental health conditions such as depression and anxiety, Atkinson noted. This link is more prevalent in those whose condition is severe.

"Managing a potentially serious condition such as asthma can induce depression and panic attacks in some people, and this can make keeping their asthma under control even more difficult," he said.

According to the Asthma and Allergy Foundation of America, strong emotions and stress are well-known triggers of asthma. When you feel strong emotions, your breathing changes, even if you don't have asthma. The emotion doesn't cause these symptoms, but it can cause muscles to tighten up or your breathing rate to increase.

AAFA listed some examples of strong emotions that may trigger symptoms of asthma:

• Anger
• Crying
• Excitement
• Fear
• Laughter
• Yelling

The AAFA noted that stress and anxiety can trigger asthma symptoms. Still, by properly managing your stress, you can reduce your risk of having a stress-induced asthma attack or episode.

People who go through puberty and develop asthma are three times more likely to develop internalizing disorders, particularly anxiety and depression, according to a 2021 study. Other factors, such as your sex and any exposure to air pollution, are also associated with an increase in asthma and internalizing disorder diagnoses.

The reason for the correlation, according to the study's authors, is due to cytokines, which are substances secreted by various cells of the immune system, including dendritic cells, that affect other cells in the body.

The study noted that lung inflammation is a hallmark characteristic of asthma and that dendritic cells in the airway stimulated by antigens promote a [certain] immune response featuring critical cytokines. Specifically related to mental health, elevated cytokine levels have been associated with anxiety and depression disorders.

Put plainly, asthma symptoms cause cells to release a substance in excess, potentially leading to mental health disorders such as anxiety and depression.

Leading a normal, healthy sex life with asthma

In 2017, Asthma.org released the results of a survey of asthma sufferers. Almost 70 percent of those surveyed said their sex lives have been directly affected by the breathing condition. Additionally, more than 70 percent of respondents admitted they felt embarrassed about using an inhaler during a romantic evening.

Almost half of the respondents said they'd be more sexually confident if they didn't have asthma. Less than 15 percent of those surveyed said they thought asthma had something to do with their relationship ending.

"The good news is, if your asthma is well-managed, you should be able to have sex without symptoms getting in your way," Atkinson said. "However, sex can have a similar impact on asthma to exercise. As your heart rate and breathing speed up, it can trigger asthma symptoms."

Atkinson recommended that you talk to your partner about how your asthma affects sex and make sure you have your inhaler nearby to treat any symptoms when they start. There's no need to feel embarrassed. Shedding embarrassment will instantly minimize the negative impact asthma has on the fun you're having.