Sex and Anxiety

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.

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What is the difference between sexual performance anxiety and erectile dysfunction (ED)?

Sexual performance anxiety and erectile dysfunction (ED) are both troublesome issues, and it’s possible for a man to have both. But they do have some clear differences.

A man with sexual performance anxiety has worries about his sexual function or his ability to please his partner sexually. He might have questions like these:

  • Will I be able to get a firm erection?
  • Will I ejaculate too quickly?
  • Will I have an orgasm?
  • Does my partner find me attractive?
  • Is my penis big enough?
  • Am I sexually skilled enough?
  • Will my partner reach orgasm?
  • What will happen if my partner is not sexually satisfied?
Men who use pornography can develop sexual performance anxiety if they compare their real-life experiences to what they see in adult films and videos. Usually, such depictions are not realistic, but men may feel nervous or inadequate if they don’t perform the same way.
Sometimes, a man may become so concerned about his performance that he develops erectile dysfunction (ED). The anxiety triggers the production of stress hormones (such as epinephrine and norepinephrine) which can narrow blood vessels in the penis and make it difficult for blood to flow in and form an erection.
Erectile dysfunction (ED) occurs when a man cannot get and maintain an erection firm enough for sex. As noted earlier, ED can be a result of performance anxiety.

But health situations can affect erections, too. Here are some examples:

  • Diabetes
  • Heart disease
  • High cholesterol
  • High blood pressure
  • Smoking
  • Nerve damage
  • Cancer treatment (such as prostatectomy – removal of the prostate gland)
  • Thyroid disorders
  • Low testosterone
  • Medication side effects
  • Attention deficit (especially in young men)
Sometimes, ED leads to performance anxiety. A man who has had trouble with erections in the past may become anxious about his ability to perform sexually in the future.
While it’s possible to have both sexual performance anxiety and ED, it doesn’t always happen this way. Men who feel confident in the bedroom and in their relationships can still develop ED.
Fortunately, both ED and sexual performance anxiety can be treated.
Men with performance anxiety may consider sex therapy. A therapist can help men work through their concerns, adjust their expectations, and become more focused on the pleasure of sex. For example, a man who is concerned about a small penis might be relieved to learn that his length is in the average range. Or a man who worries about his partner’s orgasm may learn ways to ask his partner what he or she likes.
If the man is in a relationship, it’s often a good idea for his partner to come to therapy with him. Sometimes, partners are the source of pressure and anxiety due to their own worries, sexual problems, or lack of knowledge. Attending therapy together can help a couple with relationship tension, too.
 
Men with ED have a variety of treatment options, including medications, self-injections, vacuum devices, and penile implants.

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