by Carol Boulware, Ph.D., Certified Sex Therapist

Sex should be a very enjoyable experience, but anxiety can interfere with your or your partner’s ability to feel confident and sexy.  Arousal involves more than just physical stimulation – the mind and body work together during sex.  If you are overly worried about how you look, preoccupied with your performance, or experiencing on-going anxiety or high stress, it can negatively affect your sexual arousal and satisfaction.

Studies show that individuals with anxiety disorders are also likely to have problems with their sexual responsiveness and satisfaction.  Long-term stress and anxiety disorders, such as panic attacks, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD) can contribute to low sexual desire, sex avoidance, sex aversion, or erection and orgasm problems.

How Anxiety Affects Sexuality

There are several ways anxiety can affect sexuality.  Anxiety triggers stress chemicals, such as adrenaline, which can preoccupy, or divert, a person’s attention away from erotic stimuli and reduce their sexual arousal. This can result in erection difficulties for men, and reduce a woman’s lubrication and ability to orgasm.

Someone with an anxiety disorder will usually focus on their fears, rather than on other aspects of their lives, such as relationships and sexual intimacy.  High stress and worry consumes energy.  A person may be “too tired” or not “in the mood” for sex or intimacy because they feel emotionally drained, or are distracted by their anxiety symptoms.

Research also revealed that a high percentage of individuals with OCD see themselves as being less sensual than other people, have a low level of sexual satisfaction, and are very dissatisfied with their sexuality.

Anxiety and Male Sexuality

Anxiety releases stress hormones that, among other things, constrict blood vessels.  This can lessen the flow of blood to the penis and make it difficult for a man to get or maintain an erection. Men with anxiety disorders primarily have problems of erectile dysfunction and premature ejaculation.

Their anxiety causes them to have an exaggerated fear of not satisfying their partner, which then becomes a “self-fulfilling prophecy.”  The fear of failing to meet a partner’s expectations is a common cause of premature ejaculation.

During sex, preoccupation with thoughts like ‘What if I can’t get an erection,’ ‘I’ve got to keep my erection long enough to satisfy her,’ ‘What if she thinks I’m a bad lover,’ ‘I hope I don’t come too soon,’ or ‘Will my penis measure up,’ distract attention from the pleasurable sensations that precede erection and ejaculation.

Anxiety and Female Sexuality

Women with anxiety disorders tend to have more intense concerns and more self-doubt with regard to their sexuality.  Overly anxious thoughts like ‘I probably won’t be able to climax,’ ‘I’m not sexy enough,’ ‘I’ll bet he thinks my breasts are too small,’ ‘I hope it doesn’t hurt,’ or ‘Do I look fat,’ can undermine their sexual pleasure and satisfaction.

In females, brain chemicals triggered by their anxiety disorders can contribute to a variety of sexual dysfunctions, including vaginal tightness, painful intercourse, sex aversion, sex avoidance, and hinder their ability to be aroused or achieve orgasm.

Avoidance of Sex and Intimacy

Research shows that patients with anxiety disorders, phobias (irrational fears) and OCD had higher rates of avoidance of sex.  Panic disorder, for instance, is frequently a factor in sexual avoidance in men and substantially increased their risk of erectile dysfunction.

Being unavailable, physically or emotionally, for intimacy and sex is a psychological “defense” designed to “protect” oneself from emotional pain.  However, avoidant behavior also prevents the person from experiencing emotional balance and deeply satisfying intimate relationships.

Other Causes of Sexual Anxiety

Inexperience can result in temporary sexual problems, such as premature ejaculation or not getting aroused enough to reach orgasm. However, early problems can cause feelings of shame or inadequacy, which can lead to future performance anxiety and dysfunction.

Social pressure is a common cause of performance anxiety.  Both men and women can be affected by the impossibly high “standards” of sexuality promoted in the media, movies and pornography. These pressures create unrealistic expectations of physicality and sexual performance that can result in self-loathing, shame or guilt, and in some cases, the complete avoidance of sex.

Past negative experiences such as violence, being ridiculed, humiliated or abused before or during sex can result in strong feelings of shame, low sexual desire, or aversion to sex, due to the emotional, psychological link created between the two events.

Treatment Options

In addition to being a component of anxiety disorders, sexual problems can also play a role in substance and alcohol abuse, addiction, and issues resulting from childhood or adult abuse.  As a psychotherapist and certified sex therapist, I have extensive experience helping clients relieve, and even eliminate, long-standing problems that have kept them from emotional health and greater sexual satisfaction.

Whatever your immediate concerns, I can offer you an effective therapy plan to reduce your anxiety, such as psychotherapy, sex therapy, EMDR, Somatic Experiencing, EFT and de-stressing techniques to reduce your anxiety and make your sex life much more enjoyable.


Dr. Carol Boulware is a psychotherapist, Certified Sex Therapist, Certified EMDR Therapist, and a Somatic Experiencing Practitioner practicing in Santa Monica and Redondo Beach.  She is a member of the Independent Psychotherapy Network.  You can contact Dr. Boulware at (310) 365-8717 or via email to