Here on SexHealthMatters we often talk about the role of the brain during sexual activity. While the genitals may seem more involved with the “action,” the brain is a great coordinator. It takes in sexual stimuli (like a provocative smile or a touch), processes them, and sends messages to the genitals to start getting ready, either through erection or vaginal lubrication.
But there’s more to the brain and sex than these physiological processes. The brain also filters our emotional and psychological responses to sex. It analyzes questions like:
- Do I trust my partner?
- Will my partner or I become pregnant?
- Does my partner have a sexually-transmitted infection?
- Is this a safe place to have sex?
- If I can’t perform sexually, what will my partner think?
- Will sex hurt?
- Will my spouse find out I’m having an affair?
- Do I really want to have sex with this person right now?
The list could go on. Such anxieties – and more formally diagnosed anxiety disorders - can have an impact on our sexual function. That’s what we’ll be talking about today.
What is anxiety?
We’ve all felt anxious at times. Life events like starting a new job, getting married, or having a baby can all be anxiety-inducing. But so can smaller-scale events like asking for a raise at work or handling a dispute with your neighbor.
Sometimes, these feelings of apprehension occur in situations that wouldn’t make the average person anxious. The feelings can start to interfere with daily life.
In that case, a person might be diagnosed with an anxiety disorder, such as generalized anxiety disorder (excessive anxiety), panic disorder (episodes of great fear), social anxiety (fear of social situations and judgement by others), or posttraumatic stress disorder (PTSD – anxiety triggered by a traumatic event).
The relationship between anxiety and sex, however, can be circular.
Feeling anxious can impair your sexual function. For example, if you’re concerned about your partner’s fidelity, you might find yourself focused on that during sex, making it more difficult to relax and stay in the moment.
Conversely, if you have a medical condition that can make sex uncomfortable, such as endometriosis, the anticipation of pain can dampen your sexual desire or lead you to avoid sex altogether.
How can anxiety impact sex?
The brain works in many mysterious ways and anxiety’s effects on sexual function can take many forms. Here are some of the more common ones:
- Low desire. Anxiety can make us less interested in sex. For example, if a woman suspects that her partner is unfaithful, she may feel inadequate, angry, and less inclined to have sex.
- Performance. Sometimes people are so worried about pleasing their partner that their performance suffers. Men might have trouble getting an erection or might ejaculate before they want to. Women might have trouble relaxing enough to allow penetration.
- Pain. Pain is a common sexual problem, especially for women. Unfortunately, the expectation of pain can become so intense that it blocks out any pleasure.
- Trouble with orgasm. The effects of anxiety can have a cumulative effect, making it more difficult to reach orgasm.
- Avoidance. People may be so anxious about sex that they shy away from dating, relationships, and sex.
What can people do?
If you think anxiety is interfering with your sex life, there are several steps you can take:
- See your doctor. Sometimes, people feel awkward about seeing a professional for anxiety and try to manage it on their own. But there’s nothing wrong with asking for help. Your doctor can refer you to a mental health specialist who will come up with a treatment plan tailored just for you.
- Consider couples counseling. If you feel anxious about some aspect of your relationship, you might see a specialist who focuses on couples therapy. You and your partner can learn to work through your issues constructively and come up with strategies to improve life at home. You can also learn better communication skills.
- Try sex therapy.Sex therapy is another type of counseling, but it focuses more on sex itself. It can be a helpful option for people with performance anxiety or sexual fears.
- Be up front with your partner. Lots of couples have trouble discussing sex. Sometimes, we just need to take a deep breath and start the conversation. Be honest about how you’re feeling. Your partner might be thinking about the same issues and feel relieved that you brought them up. Also, be open with your partner about what feels good to you and ask for what you want sexually.
- Focus on the intimacy. Your fears and anxieties can take a lot of your mental energy and keep you from just enjoying sex for what it is – a connection between two people at one moment in time. Try to focus on what’s happening. Use your senses – what sorts of touch, sounds, and smells are you experiencing? Are they pleasant? Put your attention there.
- Say “no” if you want to. If you don’t want to have sex with a certain person or at a certain time, you do not have to. You have every right to say “no.” This is also true if you and your partner disagree on sexual practices, like condom use. (Click here to learn more about sexual consent.)
Florio, Gina M.
“7 Ways Sex Is Different When You Have Anxiety”
(July 29, 2016)
National Institute of Mental Health
(Last revised: March 2016)
Corretti, Giorgio, MD and Irene Baldi, MD
“The Relationship Between Anxiety Disorders and Sexual Dysfunction”
(August 1, 2007)