Asexuality and Mental Health: Why Ace Recognition By Clinicians Matters

Each October, Ace Week, formerly known as Asexuality Awareness Week, offers an opportunity to reflect on the lives, challenges, and resilience of individuals who identify along the asexual spectrum. Asexuality is broadly defined as experiencing little to no sexual attraction, and represents a spectrum of low, limited, or situational sexual attraction. Approximately 1% of the population is on the asexual spectrum. Despite representing millions of individuals worldwide, asexuality remains underrecognized in many settings, including psychiatry and broader healthcare. This invisibility has direct consequences for mental health. For psychiatrists and other mental health professionals, Ace Week provides an invitation to learn, listen, and integrate nonjudgemental and open-minded asexual-affirming practices into clinical care.

Historically, asexuality has been used to refer to those who are not engaged in sexual activity. By using this term as a sexual orientation, we are able to differentiate the lack of or limited sexual attraction from behaviors such as celibacy, sexual drives or libido, and the after-effects of various traumas. It is important to differentiate asexuality from aromanticism, a limited or lack of romantic attraction. It is the difference between a “crush,” or romantic attraction, and the sexual attraction. This differentiation in terminology emphasizes that sexual and romantic attractions are a dichotomy rather than a unilateral experience. Asexual individuals may or may not engage in sexual activities, masturbate, participate in sex work, date, and desire romantic relationships. The asexual community has built a vocabulary to further express these differing experiences including demisexual (lack of sexual attraction until a close emotional bond forms) and gray-asexual (very limited and rare experiences of sexual attraction). Recognizing this complexity, even if not all the terminology, helps clinicians avoid reductionist assumptions that conflate asexuality with dysfunction, which have hurt the community for years.

Unfortunately, the pathologization of asexuality is not rare. Research suggests that asexual individuals are disproportionately misdiagnosed with sexual dysfunction disorders or subjected to unnecessary medical interventions aimed at “restoring” a nonexistent sexual drive.¹ This clinical misrecognition can compound minority stress and erode trust in the healthcare system, leading to chronic psychosocial stress due to stigma, invisibility, and discrimination.

Beyond the office setting, the concept of compulsory sexuality (or the expectation that all individuals experience sexual attraction and desires sexual relationships) permeates most relationships. From the expectation one most get married and have a child, to young people going to bars with some expectation of flirting and sexual encounters, and even advertisements highlight this concept. For asexual individuals, this assumption often translates into invalidation from peers and family. Common experiences include being told “it’s just a phase,” being pressured into sexual activity to supposedly fix themselves, or excluded from LGBTQ+ spaces due to misconceptions that asexuality is not a legitimate orientation.

More specific to our typical setting, literature suggests that up to 14.6% of asexual individuals experience healthcare discrimination due to their sexual orientation.² Some recent studies also indicate that asexual individuals are at elevated risk for depression, anxiety, and social isolation.^3,4 For psychiatrists, the first step in providing affirming care is simple: validate asexuality as a legitimate orientation. When patients disclose asexual identities, clinicians should resist the urge to reframe it as pathology unless clear evidence of distress exists that is independent of orientation. As with other aspects of sexual orientation, the question to ask is whether the individual is comfortable with and accepting of their identity, not whether it conforms to societal norms.

So, how can mental health practitioners reduce such stigma and be better advocates to the asexual community? We propose some guidelines bellow:

• Inclusive intake: Incorporate questions about sexual orientation that include asexuality “are you attracted to men, women, neither, or both?”
• Avoid assumptions: Do not equate absence of sexual attraction with trauma, hormonal imbalance, or psychiatric illness without evidence. “When did this start? Has this always been the way? Are you bothered by this?”
• Affirm romantic diversity: Recognize that patients may distinguish between sexual and romantic attraction, and validate varied relationship desires.
• Address minority stress: Explore experiences of stigma, invisibility, or pressure to conform that may contribute to depression or anxiety. These factors play into estimates that up to a third of asexual individuals experience suicidal ideation, with about a tenth making plans.²
• Support community connection: Encourage patients to engage with communities, both in-person and online, which can provide vital affirmation and reduce isolation.
  

Overall, asexuality challenges cultural narratives about sexuality and relationships, but it should not challenge our commitment as psychiatrists to affirm and support all identities. This Ace Week, clinicians have an opportunity to increase awareness, dismantle stigma, and foster clinical environments where asexual patients feel seen and respected.

Dr Noureddine is apsychiatry resident at the Icahn School of Medicine at Mount Sinai and an APA Foundation Leadership Fellow.

Dr Hayes is a child and adolescent psychiatrist who fast-tracked from general psychiatry training at Maimonides in 2023 and completed child and adolescent psychiatry fellowship at Zucker Hillside Hospital in 2025. They are currently working at Project Renewal and per diem at the Cohen Children's Hospital child psychiatry emergency department.

References

1. Bradshaw J, Brown N, Kingstone A, et al. Asexuality vs. sexual interest/arousal disorder: examining group differences in initial attention to sexual stimuli. PLoS One. 2021;16(12):e0261434.

2. Chan RCH, Leung JSY. Experiences of minority stress and their impact on suicidality among asexual individuals.J Affect Disord. 2023;325:794-803.

3. Lech S, Köppe M, Berger M, et al. Depressive symptoms among individuals identifying as asexual: a cross-sectional study. Sci Rep. 2024;14(1):16120.

4. Xu Y, Ma Y, Rahman Q. Comparing asexual with heterosexual, bisexual, and gay/lesbian individuals in common mental health problems: a multivariate meta-analysis. Clin Psychol Rev. 2023;105:102334.