How to Navigate Sex with Anxiety—Q&A with Sex Therapist Casey Tanner

The impact of anxiety on sexuality, and vice versa, is by far the most prevalent concern amongst my clients. Anxiety about sex is an experience that pervades individuals and relationships regardless of gender, age, sexual orientation, or body type. Ironically, the relationship between stress and sexuality is a catch-22; research shows anxiety often interferes with our ability to fully enjoy sex, while also demonstrating that sex can help decrease anxiety. 

Ever Had Sex So Good You Felt Bad

The question becomes, then, how do we lower our anxiety just enough to engage sexually so that we can benefit from the healing power of sex? We asked LELO fans to share their biggest concerns about anxiety and sex, with hopes of shedding some light on this very question.

Q: Can sex help release anxiety?

Sex is not a cure to any mental illness, however studies consistently demonstrate the mental and physiological benefits of sexual wellness. First, sex releases neurotransmitters, or brain chemicals, that promote feelings of euphoria and relaxation. This can be true whether or not one experiences orgasm. 

Furthermore, many experience sex as a mindful or meditative activity, or a time when they can get out of their brains and into their bodies. When we focus on our five senses during sex—what we see, hear, smell, taste, and feel—our brains get a break from racing thoughts, negative cognitive patterns, or concerns about performance.  

Sex has also been shown to help move our bodies through the stress response cycle, a nervous system response to stress that moves us into that fight, flight, freeze state. When we’re caught up in the stress response cycle, we are in “survival mode” where we may experience shortness of breath, a racing heart, anxious thoughts or urges to act out in ways that aren’t helpful. 

We often get stuck in this space, feeling unable to ride the wave of intense emotion and calm ourselves down. Engaging in sex is one way to complete that stress response cycle and can help bring our bodies back to a state of connection and homeostasis.

Sex can help release anxiety whether you’re engaging in pleasure solo or with a partner or partners. During masturbation, you are engaging in self-care, showing yourself through action that you matter, you’re deserving of pleasure, and that you can make space for you. When engaging in partnered sex, the experience of attachment and bonding can also lower anxiety by creating a sense of connection, belonging, and security.

Q: How can you tell if you’re experiencing anxiety or anticipation?

Anxiety and anticipation are often two different ways of labeling very similar experiences in the body. The difference is often in how we were taught to interpret the signals our bodies give us. For example, one person might notice an increased heartbeat and think, “I’m excited!”, while another person may feel that same heartbeat and think, “I must be so anxious.” 

The great news here is that we do have some control over our interpretation of these sensations, as there is power in the stories we tell ourselves about what our bodies are doing. If you’re someone that tends to interpret symptoms as anxiety, it may be worthwhile to experiment with a different narrative, such as one of excitement or anticipation. Even love, desire, and high libido can feel like anxiety if we choose to label it as such.

Another way to distinguish anxiety and anticipation is to get curious with our bodies about what they are trying to tell us. Often stress-related symptoms are our body’s ways of showing us what we need; perhaps we need more security, physical safety, validation, or even just a good night’s sleep. Sometimes these symptoms tell us we are fearing rejection, while other times they show up because we drank too much the night before. 

Rather than jump to conclusions about what you’re sensing, take a few deep breaths, and run through a list of possible reasons why you may be feeling the way you’re feeling. Do you have a big date coming up? Are you and your partner planning on trying something new? Likely these are signs of anticipation. However, if your body’s reactions seem more connected to a traumatic experience or feeling unsafe in a relationship, chances are the experience is more akin to anxiety or stress.

Q: Does being anxious make it hard to orgasm during sex?

The majority of people experience anxiety as a barrier to pleasureful sex, while a select few actually find that anxiety may increase or positively impact their sex drive. For those who struggle to orgasm, once biological causes (I.e. pain, vaginismus) are ruled out, anxiety is the primary cause of this concern. 

The way that anxiety operates in the body—turning on fight, flight, freeze responses, constricting blood flow, causing racing thoughts—is quite opposite of what the body needs in order to have an orgasm. Orgasms require immense amounts of blood flow to the genitals, relaxation, and a sense of letting go. When we feel anxious and unsafe, the last thing we want to do is let go.

Orgasm, for many, requires something called “erotic focus”, or the ability to stay present with the pleasure of the experience. Anxiety is often described as the opposite of presence; instead of being in-the-moment, we are anywhere but. We may be in the past, depending on previous experiences of sexual trauma. We may be in the future, wondering if our partner will still be there for us if something goes wrong. We may be in our heads, concerned with “performing” or doing things “right”.

Especially for people socialized as women, anxiety teaches us not to take up space and make ourselves smaller to decrease the likelihood we will be attacked or criticized. Orgasming, however, requires expansiveness and taking up space. Many of my clients are perfectly capable of orgasming, but stop themselves or their partners in the middle of a sexual experience because they worry they are “taking too long”. They tell themselves that they are being inconvenient or difficult. Furthermore, they feel that something is wrong with them if they are unable to orgasm, or they don’t want to hurt their partner’s feelings. All of these narratives put an immense amount of pressure on orgasm, just increasing anxiety and actually making orgasm more difficult to achieve.

Q: How does anxiety usually affect men when it comes to sex?

Whereas women are socialized to take up less space, quiet their voice, be convenient, and ask for less, men are socialized to do quite the opposite. It’s no surprise, then, that men feel pressure to be ultra-physical, high-performing, effective, physically large, and long-lasting. For people with penises, anxiety often centers around the size/shape of their body and the way their body performs. I often hear questions such as, “Will I last long enough?”, “Is my penis large enough?”, or “Am I muscular enough?”. I also hear the opposite questions; “Am I too big?  Do I last too long?” For many, it feels that there’s no way to win.

And here enters yet another catch-22 about sex and anxiety: the more one focuses on the performance of their penis, the more likely it is that their penis will have difficulty performing. There’s a negative correlation between performance pressure and pleasure. The answer to this sounds simple, yet is so much easier said than done. We must redefine successful sex to be less about performance and more about pleasure, less about impressing someone and more about connecting with them, less about the destination and more about the journey.  

Q: Why does it only seem like I can orgasm if I’m high?

Many folks utilize marijuana as a way to decrease their anxiety, so it’s not uncommon that smoking, using a tincture or taking an edible prior to sex would increase one’s ability to orgasm. There’s nothing intrinsically wrong with substances aiding your sexual relationship, especially if that substance isn’t creating social, biological, or professional consequences for you. If you notice, however, that incorporating a substance in your sex life is leading to overdependence, decreased connection, or is getting in the way of recovery, it may be worth inquiring into this with a therapist or professional.

Q: I have no problem orgasming on my own, but I struggle so much with a partner; why?

For folks who have no issues orgasming during masturbation, but struggle during partnered sex, the good news is that the issue is likely not physiological. In other words, your body is capable of having an orgasm in the right set of circumstances. 

There are several differences in the context of solo sex compared to partnered sex that can provide insight into what happens for folks who can’t orgasm with a partner. First, solo sex eliminates the third-party pressure; there is likely no one gazing upon you as you pleasure yourself and no one to perform for except yourself. Second, many make allowances for their pleasure during masturbation that they don’t make with a partner. They put on the music they like, dim the lights to their comfort level and use a toy they know works for them. Often, when that same person gets in front of a partner, they worry that asking for a similar ambience or use of a toy will be too “high maintenance”, and so they settle for less.

Thus, if you’d like to orgasm with your partner, don’t settle for less. Don’t settle for less time spent on you. Don’t settle for a technique that doesn’t work for your body. Don’t settle for the sex position they like that doesn’t actually do much for you. Of course, there is always room for compromise, but you are the biggest effort and highest advocate for what you need in order to orgasm. All you need is to recognize what is getting in the way of asking for that in a partnered context.

It’s important to note, once again, that the answer may be a bit different for trauma survivors. Masturbation may feel safer because one feels more control over their body. Partnered sex may introduce triggers, reminders, or sensations that bring back memories of traumatic experience. These trauma-related reactions should not be taken lightly, and often it’s helpful to consult with a mental health professional to get support with the next steps.

Q: How do I know when to initiate sex? I never know if my partner is in the mood.

When people ask me when to initiate sex, I often hear them asking, “How do I initiate sex such that I won’t be rejected?” No one likes to be turned away, and so we all long for the formula that ensures we will be received with open arms when initiating sex. This makes total sense and is simply self-protective. The challenge here is that it is almost impossible to predict our partner’s sex drive enough to ensure that we will always initiate at the “right” time.  Couples with robust sex lives are those who know how to ask for sex without fear of being turned away every once in a while, and who know how to say “no” to sex in a way that is still connective and not rejecting.

When our partners say no to sex, we often create a narrative that the “no” is about us, when far more often it is about the other person. Rather than taking “no’s” personally, we can develop initiative resilience by re-writing the script. Instead of telling ourselves, “wow they must not be attracted to me”, we might try saying “you know, they had a long day at work, they probably just don’t have the energy.” Those two different scripts elicit two very different emotions and judgments about ourselves.

When we are saying no to sex, it’s helpful to express appreciation to the initiator and provide a reason for our no. Rather than slapping our partner’s hand away, or simply saying “no”, try offering thanks to your partner for being vulnerable, and sharing why you’re not in a place for sex at the moment. If you’re open to it, let them know that you’d love to circle back the next day or when you’re in a more open headspace.

Q: How do I keep a high libido when on anxiety medication?

Anxiety medications, especially SSRI’s (selective serotonin reuptake inhibitors) are known to have the side effect of decreasing libido. It’s not at all uncommon that your desire for sex would go down after beginning such a medication. The good news, though, is that there are ways to find your sex drive even while responsibly treating your mental health. For many, being on medications means that they will need a more specific context in order to desire sex. Perhaps prior to taking the medication, you experienced desire out of the blue or were ready for sex any time anywhere. Now, sex seems to be the last thing on your mind.  

Post-medication, you may need more preparation in order to experience the kind of desire you did pre-medication.  You may take longer to orgasm. You may need more foreplay, whatever that means to you. You may benefit from incorporating a toy. In other words, your body chemistry has shifted, and your sexual needs along with it. Give yourself permission to ask for contexts that help you get there, and try to be patient with yourself as you do.

Q: I always need lube to make sex work. What can I do to stop worrying so much?

Especially if you’re someone who struggles with anxiety, becoming naturally lubricated may come less easily. Rather than judging oneself for requiring lube or becoming anxious about the anxiety, it’s helpful to validate that needing lube is an absolutely normal experience. The lube industry is so successful because so many people benefit greatly from the extra wetness and enjoy sex far more because of it. Rather than worrying that something is wrong with you for needing lube, honor that you’ve found a tool that works for you. You are deserving of whatever products and aides necessary to help you enjoy sex.

Q: How do I overcome anxiety about being inexperienced sexually with a same-gender partner?

Our culture places so much emphasis on sexual experience and being “good in bed” that we often lose sight of the other factors that make people great sexual partners. Experience only gets you so far, because every body is so different; what worked on one partner might do absolutely nothing for the next. In fact, many get stuck in a rut of using only one technique, only to find that their next partner prefers something totally different. 

In working with many individuals and relationships on having great sex, experience is far less important than passion, attitude, consent and non-judgment. You are perfectly capable of bringing those strengths into your next sexual experience with a same-gender partner, even as you can’t control the previous experience you’ve had.  

Written by: Donna Turner

Donna Turner
Donna is a Volonté contributor and freelancer who lives in San Francisco with her understanding husband and not-so-understanding teenage sons. Her work has been published in The Journal of Sexology and she is currently writing a book on love languages.

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