Anxiety depression and sex

Anxiety / Depression and Sex

  • Sexual Performance Anxiety

  • Anxiety Disorders and Sexual Function

Sexual Performance Anxiety

Sexual Performance Anxiety is a preoccupation with sexual performance that interferes with sexual pleasure and often hinders the progression of the sexual response cycle. Sexual performance anxiety  is a distraction from sexual arousal and can inhibit orgasm. Sexual performance anxiety occurs during sex, although it can also occur outside sexual activity, especially in the lead up to partnered sex or afterwards.

People experiencing Sexual Performance Anxiety often report:

  •      Mechanically going through the motions
  •      Not being able to feel any sensations
  •      A reluctance to try new things for concern that they may get it wrong
  •      Faking orgasms
  •      Irritation, frustration or anger at not being able to come.
  •      Rushing to intercourse to maintain an erection
  •      Worrying that they might lose their erection or come too quickly
  •      Needing to make their partner come to feel good about themselves
  •      Only worrying about their partners sexual needs, and not themselves
  •      Watching what they are doing during sexual activity, like a spectator, rather than experiencing it

Many people with Sexual Performance Anxiety do not feel anxious, nor do they experience the common physiological symptoms of anxiety such as a fast heart rate; sweaty hands; fast breathing; tingly fingers; nausea; dizzy; or a feeling of unreality. Most commonly they are aware of wanting to avoid perceived sexual failure, disappointing or upsetting their partner, feelings of inadequate, embarrassment, frustrated or shame.


Sexual Performance Anxiety is easily treatable. The sooner you deal with it the quicker it resolves. Cognitive Behavioural Sex Therapy is the most effective treatment, with many people responding quickly, over 3-9 sessions, whilst other over 12-18 sessions.

Anxiety Disorders and Sexual Function (GAD, SOCD, HOCD, POCD, PTSD, PANIC)

Many people with anxiety disorders have difficulty with sexual function or sexual relationships.

Both men and women with Social Phobia (Social Anxiety Disorder), Generalised Anxiety Disorder, Obsessive Compulsive Disorder, Panic Disorder & Post Traumatic Stress Disorder have increased incidence of sexual difficulties when compared with the general population. This makes sense; if you experience anxiety in other areas of your life then you may also experience anxiety about sex or sexual relationships.


Anxiety reduction strategies include reduction of physiological symptoms of anxiety, challenging faulty thinking that produces anxiety, confronting avoidance in a systematic and manageable way (exposure) and modifying or stopping behaviours that perpetuate anxiety (safety behaviours). I am experienced at treating individuals and couples with anxiety and reducing the impact of anxiety on sexual and general intimacy.

The Clinical Research Unit for Anxiety Disorders at St Vincent’s Hospital Sydney, has good resources and on line treatment for anxiety disorders.

Anxiety Disorders that may impact on sex and relationship intimacy

People with Social Anxiety Disorder are overly concerned about what others think of them and become worried that others will judge them because they are anxious. As sexual activity is one of the most personal social interactions you can have, it stands to reason that people with social anxiety will be concerned about dating and sexual performance. High levels of anxiety during sex can interfere with sexual arousal resulting in: lack of sensation; difficulty getting or maintaining an erection; poor control of ejaculation; trouble reaching orgasm; or pain during sex. People with social anxiety may also avoid sex and sexual relationships.

People with Generalised Anxiety Disorder (GAD) are generally anxious and worry about things going wrong, particularly about important people or aspect of their  lives. People with GAD may also worry unnecessarily or in an exaggerated way about relationships security, stability or their partner’s safety. This high level of worry can impact on sexual intimacy, general relationship intimacy and arousal during sexual activity.

People with Obsessive Compulsive Disorder (OCD) who experience unpleasant, unwanted or intrusive sexual thoughts may avoid sexual activity as a way of managing their obsessions. Alternatively, rituals or routines used to manage anxiety may interfere with couple sexual intimacy and arousal.  Perfectionism can also inhibit personal arousal; if a personal standard is not met it may create internal or relationship conflict and reduce sexual intimacy. Many people with OCD have sexual obsessions (SOCD). That is they are disturbed and preoccupied by intrusive thoughts of a sexual nature. Common sexual obsessions are: Homosexual obsessions (HOCD) “I was looking at that guys, does that mean I’m gay?” “I thought that girl was attractive am I lesbian?”; Paedophile Obsessions (POCD)”What if I get sexually aroused when I have children?” Beastiality obsessions “I can’t get a dog in case I get sexually aroused” necrophilia obsessions: “what if I become aroused at the funeral”; Sexual Violence obsession: “I think about hurting my partner during sex”. These obsessions are often followed by lengthy mental rituals where the person will debate with themselves the likelihood of this, avoidance of sexual triggers, checking arousal to see if obsession is true. Further reading.

People with Panic Disorder fear the reoccurrence of a Panic Attack. A panic attack involves intense physical symptoms such as:

  • heart pounding, palpitations, fast heart rate
  • sweating
  • shaking or trembling
  • tingling,
  • hot or cold flushes
  • chest pain or discomfort
  • nausea or stomach upset
  • dizzy unsteady, light headed or faint
  • shortness of breath,
  • feelings of unreality or being detached from oneself,

People with Panic Disorder fear that these anxiety symptoms are signs that they are going to die, go crazy, or lose control. Often the physical arousal that occurs during sex triggers fear of a panic attack leading to avoidance of sex or sexual aversion. Some women who persist with sex with panic disorder can experience vaginismus, which is painful or impossible vaginal penetration. 

Post Traumatic Stress Disorder, from either general trauma or sexual trauma impacts on sexual and general intimacy and can cause sexual dysfunction. The feelings that are required for good sex are: pleasure, intimacy, trust and safety, which are blunted or absent with PTSD.

Educational movies on sex and sexuality

The Perfect Vagina: A documentary of cosmetic surgery to the genitals.

My Penis and Everyone Else’s: A documentary on masculine stereotype

Depression and Sex

Depression is when the emotional system becomes overloaded and it becomes stuck in sadness and the body collapses. Symptoms include pervasive low mood, low energy, fatigue, low motivation, poor concentration, lack of sexual desire, interference with sleep and appetite and loss of enjoyment or pleasure in things you once enjoyed. Guilt, irritability, worthlessness and punishment feelings can also be involved. There is a tendency to withdraw and shut out loved ones.

As you can see this is not the environment for sexual opening or comfortable moving towards. It is not the environment for curiosity and play, for relaxation and pleasure for giving and receiving. 

The body is not designed to shut down and shut out when we are in this collapsed state. Our sexual system is functionally turned off. For people who have had a positive sexual history, the loss of sex as a comforter can be an additional loss. For our partner who crave our attention and touch, this rejection can feel like a physical pain. Sometimes sexual dysfunction can cause depression. Men with erectile dysfunction, progressively lose interest in sex and can become depressed by their lack of sexuality. Equally women who have pain with penetration or impossible penetration can become depressed at lack of ability to have intercourse. Both situations can impact on self worth. 

Medications to treat sexual desire also impact on sexual function, delaying orgasm and ejaculation, causing vaginal dryness, impacting on erection function and ability to get aroused. However this is usually an additive effect and once depression is reduced the impact of medications are not as severe. 

Treating depression is required before sexual desire and sexual function returns. The first steps is to move towards touch, without demanding the sexual performance, without intrusive intercourse. Intercourse is a high desire sexual activity and if performed in low desire sate reinforce sexual aversion. 

Depression and the impact on sexual relationships is a very manageable and treatable situation.