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Sex and Anxiety: Get Out of Your Head in Bed


A woman thinks about how to manage sex and anxiety.

Sex isn’t the ideal time for rumination but anxiety often shows up uninvited. If you’re thinking about how the sheets are getting dirty, you’re surely not thinking about pleasure and having enjoyable sex.

How Does Anxiety Impact Sex?

Anxiety is an emotion that traps the mind in worrying about the past or catastrophizing about the future.  Some people experience extreme anxiety disorders that can cause panic attacks and others’ might be more situational. Regardless of the severity, anxiety can have an impact on your sexual function and mental health. When you feel anxiety, the brain fires the amygdala into fight or flight and is preparing you for action, but not the kind of action you’re seeking.

This activation can become debilitating when trying to have sex. Who wants to be worried about tomorrow night’s dinner plans when you’re trying to experience connection. If you find yourself stuck in your thoughts rather than in your body, you might start getting curious about how you can decrease anxiety and improve your sex life.

Orgasm doesn’t need to be the culmination of a sexual experience but there tends to be a cultural script at play that says sex isn’t good without it. Yet, cortisol levels rise during the stress response and can interfere with hormones responsible for sexual arousal. If you’re having sex with the end in mind, it will be difficult to enjoy the ride. Only 8% of individuals with a vagina have reliable orgasms from penile-vagina intercourse. Instead, try thinking about what you would like to experience from your sexual encounters. Is it pleasure? Closeness? Stress reduction? Something else?

There’s no right way to have sex. Anxiety can quickly turn desire into distraction, leaving you feeling overwhelmed and alone. Unaddressed anxiety has been linked to sexual problems such as erectile dysfunction, premature ejaculation, as well as other physical symptoms and side effects. The moment you start stepping into the thinking mind and out of your feels, anxiety has won. Remind yourself, there is no place like home (in your body), step back from engaging with your thoughts and focus on feeling. If you need extra support, consider online sex therapy and medical advice from a professional to go deeper with your thoughts and feelings.

Emotional Safety can Decrease Anxiety

Sadly there’s no off switch for the brain. What you can do is learn to practice regulating your nervous system to remain in the social engagement system. This system allows engagement with others and a felt experience of safety and connection. Emotional safety is equally as important as physical safety in creating hot, healthy sex. Ask yourself, what do I need to feel safe before, during, and after sexual activity?

If you notice your sexual partner seems distracted, check in. It’s okay to take a pause during sex. Contrary to pop culture movies and television, sex doesn’t happen in a 5 minute window and end in jaw dropping orgasms. What isn’t helpful is connecting to the story you’re creating in the mind.

If you’re anxious about the state of your relationship, sex can exacerbate these concerns. An unresolved fight about finances at 2pm can make it unlikely to be interested in sex later on. Make-up sex has the allure of fixing things, but rarely results in true resolution. Create new habits with your partner around communication and honesty including not having obligatory sex.

Sexual Performance Anxiety

Performance anxiety can cause you to worry about your level of attractiveness, your skill, what the other person is thinking, etc. The focus then becomes on performing and an expectation for your genitals. Likely your body parts are doing just fine, it’s anxiety taking you away from experiencing and engaging with the erotic. Consider what narrative your attitudes and beliefs about sex are creating and ask yourself, “is there space for change?”

For women, performance anxiety plays a central role in the development of sexual dysfunction.  Learning how to manage this anxiety can be a protective factor for great sex throughout your lifetime.

Sexual avoidance is a consequence of anxiety. If you have experienced sexual trauma your body might turn away from physical intimacy when your trauma response is triggered. It is absolutely possible to return to hot healthy sex after trauma. Don’t have sex if your body is signaling you to run, instead ask for help.

Managing Anxiety for Better Sex

Sex is some of the most intimate moments you can share with another human being. It’s not fair for anxiety to take that away from you.

Try some of these strategies to get you started:

  • Take a few deep breaths, and if you’re comfortable, ask your partner to do it with you.
  • Focus on the sensations in each part of your body, move all the way from your head to your toes.
  • Give yourself a mantra to repeat in your head, “be here”, “I’m present”, “I want to feel”, whatever feels good to you.
  • Ask to stop for a moment or slow down, perhaps things aren’t feeling quite right, remember you can say no to sex at anytime.

Give yourself permission to focus on what’s happening in your body and take a step back from the inner dialogue of the mind. Enjoy.

Modern Intimacy is a group therapy practice, founded by renowned Psychologist and Sex Therapist, Dr. Kate Balestrieri. This inclusive blog is designed to provide a wealth of information and resources for mental health, relationships, and sexuality. Subscribe today to get the latest information from our expert contributors from all around the world.


Author Bio

Heather "Lulu" Mazzei is a Clinical Associate at Modern Intimacy, in Los Angeles, an Associate Clinical Social Worker, supervised by Dr. Kate Balestrieri, Heather is passionate about healthy relationships and helping the people she works with to develop relationships that thrive.



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