East Toronto Therapy

Anxiety and Sex

In my previous post, I discussed anxiety in general. In this post, I’ll discuss anxiety specifically in relation to sex.

Anxiety and sexual dysfunction go hand in hand. Whatever the sexual difficulty (low desire, erectile dysfunction, premature ejaculation, delayed ejaculation, pelvic pain, or inability to orgasm) anxiety is usually involved to some degree. In some cases, the anxiety is present at the start of a sexual encounter, as performance anxiety or self-consciousness about one’s appearance. Even in cases where anxiety is not present at the outset, once a sexual encounter begins to go differently from the way one had hoped, anxiety can set in. This anxiety then results in the person being up in their head with thoughts and worries. Thoughts might include: This isn’t working. Why am I not turned on yet? Can my partner tell that I’m not into this? Is my erection strong enough? Will it hurt? My partner will be disappointed if we don’t have sex.

These thoughts increase the anxiety, and also take the person away from being in the moment in the sexual experience. Focusing on the thoughts means that the person is less likely to notice the pleasurable sensations that would normally facilitate the sexual response (desire, arousal, and orgasm). This increases the chances that the sexual encounter will not go the way they want it to, and in turn, increases the anxiety for the next time, and the cycle continues.

As with anxiety related to non-sexual situations, treatment for sexual anxiety involves two different approaches: challenging negative thoughts and relaxation. Included in the relaxation approach is the cultivation of a low-pressure approach to sex. Individual sex therapy can help develop these skills, and in some cases, couple sex therapy is also helpful to re-integrate a focus on pleasure rather than anxiety.