Mental Health In Bed: Sex and Anxiety

How Anxiety Can Get in the Way

There are a number of ways anxiety can turn into the unwanted third wheel between the sheets, both physically and emotionally.

As we know, the common symptoms of anxiety, like panic, fear, restlessness, shortness of breath, tense muscles, increased heart rate, and sweating, among others, make it hard to stay calm during a regular moment, let alone when we are baring our body and soul to another human. And if we look closely, there’s some overlap between the symptoms of anxiety and what happens when you jump in bed.

“The act of intimacy raises your heart rate, induces heavier breathing, and makes you sweat,” according to The Center for Treatment of Anxiety and Mood Disorders. “These bodily reactions mimic the physical ‘fight or flight’ responses people experience during a panic attack, so much so that some individuals will go to great lengths to avoid feeling them at all.”

Not only does this have an emotional impact — a desire to avoid intimacy altogether — but the resulting anxiety symptoms also have physical side effects that make having sex difficult on a functional level.

“When we experience anxiety, blood flows away from our extremities and genitals to protect our vital organs. We need that blood flow for sex,” says Marissa Nelson, a certified sex therapist and founder of IntimacyMoons Retreats. “When we are fearful and anticipating anxiety, we constrict our body and tense up, tightening the muscles. A tight pelvic floor can cause premature ejaculation…or vaginismus, for example, where the vaginal muscles will constrict and spasm in such a way that it is hard for penetration to occur.”

Anxiety can also make sex difficult emotionally because we’re more likely to worry or have obsessive thoughts about our appearance, performance, or any other number of factors that can be so consuming they diminish sexual desire before it even starts.

“People who already suffer anxiety may choose to forego sexual encounters so they don’t have to add more fears to their list of concerns,” according to The Center for Treatment of Anxiety and Mood Disorders. “Engaging in sexual activity can bring up worries about their attractiveness, their ability to perform, or may increase feelings of shame or guilt.”

A Note About Medication

For many people, mental health medications, especially SSRIs, help manage anxiety on a daily basis, providing powerful relief from many of its overwhelming symptoms. However, these same medications also come with a list of side effects that can include decreased libido for some people.

“Some people are more sensitive to the effects of these medications than others, and some people metabolize medications differently,” said Dr. Madeleine Castellanos. “So you might not experience any side effects — or you might on one drug but not another. Plus, some people who had low libido when they were depressed or anxious might do better on medication.”

If you are on medication, make sure to address your concerns about sex with your doctor. The cost of getting relief from medication shouldn’t be a healthy sex life. Work together with both your doctor and partners to find a solution that will work for you.

What You Can Do

The good news is that anxiety doesn’t have to rule your sex life. If you’re really struggling, consider finding professional support to help manage the anxiety symptoms. A therapist can address underlying issues and teach you coping skills that will come in handy when it’s time to get down to business with your partner.

Nelson also has a few at-home suggestions to help combat anxiety and get your game back, starting with self-care. Reduce stress and anxiety symptoms by eating a balanced diet, sleeping at least five to seven hours each night, and participating in hobbies and activities that boost your mood.

If you feel yourself start to get anxious and tense up around a sexual encounter, try “conscious breathing” exercises. Breathe from your belly slowly, inhaling for seven counts and then exhaling all of that energy.

“Put your hand on your belly and breathe into it with every exhalation until you see your stomach rise and fall,” advises Nelson. “Do this when there is an intrusive thought and use the mantra — ‘I am safe, I am present, I give myself permission for pleasure.’”

If you’re prone to pre-sex jitters, try re-focusing your intimate time on pleasure as opposed to “performing” the act of sex. This could mean spicing things up with a little fun and getting out of your regular routine. And it could mean going slow and exploring your partner through sensuous bathing, kissing, and touching across the entire body. The simple experience of intimately exploring each other may bring out a natural, relaxed desire for sex.

“The goal is to make each other feel good, and many times when there is no pressure or demand for sex, desire and arousal can surface,” says Nelson.

Finally, we need to be responsible for our own sexual pleasure. While this may seem counterintuitive, we’re the ones who know best when we are struggling, how we can feel more comfortable, and what we need to keep anxiety at bay. Taking charge of our own experience can help us feel empowered and in control. Plus, we might just have better sex.

“Often people relinquish their sexual wants and needs to a partner,” says Nelson. “When difficulties come up, don’t sweep it under the rug, have open and honest dialogue (no blaming or shaming) about what you want more of, and what you can adjust and modify to have a better time with each other.”

If you struggle with anxiety in bed, don’t be afraid to reach out for the support you need, whether it’s from therapists, doctors, or partners. And most of all, know you’re not alone.