Anxiety disorders are common mental health conditions that affect an estimated 7 percent of adults worldwide. (1) Anxiety disorders fall into several categories: Generalized anxiety disorder (GAD) in which people experience intense worry that interferes with daily life, panic disorder, in which people repeatedly experience panic attacks, and phobia-related disorders, in which people have intense fears about certain situations or objects. (2)
Anxiety can also be a normal part of life and doesn’t always indicate a mental health condition. It’s common to feel occasional anxiety about health, work, relationships, and world events. Even for those whose experience of anxiety doesn’t fit the criteria for a mental health diagnosis, however, anxiety can affect daily life, including sex.
4 ways anxiety may impact your sex life
Anxiety can have physical, psychological, and emotional effects, including intense worry, fear, or distraction, muscle tension, shortness of breath, and sleep problems like insomnia. (2) All these symptoms can make it more difficult to relax and be present during sex. Here are a few ways anxiety can impact your sex life.
1. It can impact your desire for sex
Sex and relationship expert and author of forthcoming book Chasing Clouds Annabelle Knight, Bsc., tells O.school, “When a person is suffering from anxiety they have higher levels of the stress hormone, cortisol. High levels of cortisol acts as a sexual suppressant.” She adds that anxiety can also take an emotional toll, which can in turn impact your desire for sex. “You may not want to be physically or emotionally close to your partner when you're overwhelmed by anxiety.”
Dr. Gail Saltz, a therapist and professor of psychiatry, adds that, “High anxiety may decrease libido (desire) because much of one's thinking is taken up with anxious thoughts. Even if libido is there, the ability to achieve arousal and orgasm is inhibited. […] People with anxiety often report feeling out of body, and more like they are self-observing sex.”
2. It can make it difficult to perform
Anxious thoughts can get in the way of sexual arousal and impact someone’s ability to get hard or wet, or to reach orgasm. Focusing on a stressor or a source of anxiety can make it difficult to relax enough to become sexually aroused. (3) Insecurity about your body, anxiety about intimacy, or repetitive thoughts that distract you from the sensations in your body can all contribute to challenges with sexual performance. (3)
You may also experience sexual performance anxiety, which is a specific type of anxiety that makes it hard to enjoy sex with a partner. A person who experiences this type of anxiety may find the pressure to please their partner, to become erect or wet, or to have an orgasm overwhelming.
3. It may cause physiological changes that impact your ability to enjoy sex
Kate Moyle, psychosexual and relationship therapist and host of The Sexual Wellness Sessions Podcast, tells O.school, “On the physical side of things, anxiety can interrupt normal sexual functioning and cause [...] vaginismus [vaginal pain], rapid ejaculation or erectile dysfunction.” For some people, pain during sex can be the result of a feedback loop between anxious thoughts and vaginal muscles spasms. (4) Research has suggested that cortisol, which may be elevated in people with anxiety, can make it more difficult to get or maintain an erection.
4. Certain medications used to treat anxiety may also cause sexual changes
Molye tells O.school that “some medications used to treat conditions like anxiety and depression can impact people's sexual responses and experience.” If you’re taking medication for anxiety and experiencing sexual changes that bother you, it’s a good idea to check in with your healthcare provider to see if the dosage can be adjusted to minimize side effects, or if there’s another treatment that may work for you. It’s important to work with a healthcare provider if you’re thinking about making changes to your medication; stopping medications or trying to adjust the dose on your own can be dangerous.
How can anxiety impact relationships?
Relationships often present challenges that require communication and compromise. If you’re struggling with anxiety, these challenges can be amplified, and may feel harder to manage.
Relationship expert Laurel Steinberg, PhD, tells O.school that people who have anxiety may “struggle to handle new stressors that come their way, [which] can result in couples arguing much more than they otherwise would, or could cause people to shut down and withdraw from their partners.”
Knight agrees that anxiety can lead to withdrawal and a lack of connection: “Anxiety causes avoidance, which in turn can place a strain on your relationship.”
If anxiety is impacting your relationship, it may be helpful to keep in mind that it’s totally normal to experience challenges in partnership. Acknowledging that all relationships have ups and downs and giving yourself permission to take care of your mental health can help you to move forward without blaming your partner or yourself.
5 tips for navigating sex when you have anxiety
Addressing your anxiety directly can be helpful for your sex life and for your general wellbeing. Here are some tips for navigating sex if you have anxiety.
1. Address your anxiety. Dr. Saltz emphasizes that “anxiety is treatable and [treatment] can help the patient and overall relationship.” Psychotherapy and medication have both been shown to be effective treatments for anxiety. (5; 6) Even if you don’t choose to pursue therapy or medication, it may be worthwhile to try other strategies to manage anxiety: Dr. Steinberg tells O.school that, in addition to seeking help from a mental health professional, “People with anxiety that interferes with their enjoyment of life [can] read books to learn new thinking skills to better respond to and handle life stressors.” In addition to therapy and medication, some people may find that physical exercise helps to relieve anxiety symptoms. (7)
2. Talk with your partner. Being open about your anxiety and how it affects your sexuality can help to reassure your partner that sexual challenges aren’t their fault and creates an opportunity to find solutions together. Knight recommends that people with anxiety “Have an open and honest conversation with your partner about how your anxiety is affecting you. […] It clears the air and allows them the opportunity to work through any issues with you. [These conversations] can also help to bring a couple closer together and help to build bonds of emotional intimacy and trust.”
3. Take the pressure off. Moyle tells O.school: “You may find taking intercourse off the table for a period of time if that's the source of the anxiety and focusing on just connecting, enjoying each other and being close again can be really helpful.” Other kinds of closeness like kissing, holding hands or cuddling can help to counteract stress and maintain a sense of connection in your relationship.
4. Be mindful. The American Psychological Association defines mindfulness as “a moment-to-moment awareness of one's experience without judgment.” Moyle tells O.school that bringing mindfulness to sex can help people struggling with anxiety: “Mindful sex is a great resource for getting out of your head and into your body. Basic mindfulness exercises such as running through the five senses to keep you in the moment and lean into sensuality can help to encourage both desire and arousal.” For those who want to learn more about mindfulness and sex, she recommends this interview with sex therapist and researcher Dr. Lori Brotto.
5. Breathe. Breathing exercises have been shown to be an effective treatment for anxiety. (8) You can use breathing exercises to help relax your body and mind before or during sex, or any time you feel anxious. The University of Michigan has a guide to breathing techniques that may be helpful for managing anxiety symptoms.
The Bottom Line
Anxiety is a common mental health condition that can affect sex and relationships. If you find that anxiety is impacting your sex life, communicating openly with your partner about your experience, seeking support from a mental health professional, and finding other ways to manage anxiety symptoms can help.