Living with anxiety often means it’s present wherever you go ― including between the sheets.
“Anxiety and sex are not happy bedfellows,” said Jassy Casella Timberlake, a Massachusetts-based licensed marriage and family therapist and board-certified sex therapist, aptly summing up a complex issue.
Whether it’s anxiety/stress itself or the medication you use to treat it, the issue can have wide-ranging effects on a person’s sex life. While no two people will experience mental health conditions in exactly the same way, you should be aware of some general truths about anxiety and sex.
Below, experts share what you might expect, plus some strategies to cope:
How anxiety might impact your sex drive
The most ubiquitous effect of anxiety on your sex life is a lowered libido, or desire to have sex, according to Abby Altman, a New York-based psychiatrist. Higher levels of cortisol are associated with anxiety and stress emotions, and high cortisol can suppress sex hormones that impact desire.
Having sex when you’re feeling anxious is also basically like asking your mind to multitask, which is hard to do.
“It’s almost as though you have two competing interests for the same neurological system,” Altman said. “You have the anxiety, which uses the pathway of the autonomic nervous system, and you also have the sexual activity, which employs the very same system.”
So it’s not surprising why that doesn’t exactly put you in the mood.
But it’s worth noting that not everyone will experience a decreased libido. “There are some who may use sex as an anxiety reliever, or who will masturbate compulsively, for instance,” Altman added.
Data also supports that some people may have an increased sex drive when they’re feeling anxious. All this to say: there’s really no “normal” way to react to stressors.
How anxiety might alter intimacy
Anxiety can also affect the sex you do have. For one, anxiety can delay or impede your ability to orgasm, and make it harder to maintain an erection, Altman said.
Additionally, some of the physical symptoms of anxiety can throw a wrench in your plans. Those symptoms include tensed or clenched muscles, rapid breathing and lightheadedness — all of which can be pretty distracting if they’re coming from a feeling of panic and dread and not, say, an orgasm.
Casella Timberlake added that the distraction that anxiety can bring into the bedroom certainly doesn’t help you stay connected to your partner in the moment.
“People take that anxiety personally. They think it’s got something to do with them when their partner’s libido has dropped,” she said. “Anxiety can be picked up by the partner, and then they just bat that ball back and forth between them.”
Then, of course, there’s anxiety about sex, which can complicate things even further. Whether there’s a history of sexual trauma, performance anxiety or fallout from a shame-based upbringing, Casella Timberlake said that issues surrounding intimacy can greatly impact the sex you have.
For example, some people may experience vaginismus, where the vaginal muscles will clench so tightly during penetration that intercourse becomes incredibly painful. In many cases, the root of vaginismus is anxiety about sex that was brought about by past trauma or shame-based education surrounding sex, according to experts.
How medication can affect your sex life
In an unfortunate Catch-22, the very same medications that treat anxiety can also lower your sex drive. Altman said that doctors will often prescribe SSRIs ― selective serotonin reuptake inhibitors ― to treat anxiety. However, too much serotonin can decrease your libido and make it harder to orgasm.
What you can do to achieve better, more satisfying sex with anxiety
All of this doesn’t mean you’re relegated to a subpar sex life.
If it’s anxiety medication that’s causing you concern, Altman advised talking to your doctor. Your dose could be adjusted or you could switch to a different medication, although it’s worth noting a different drug might bring about other equally undesirable side effects.
Your doctor might try adding an antidepressant medication like Wellbutrin to your existing regimen, as it’s been shown to mitigate some of the negative sexual side effects of other medications, Altman said. If your anxiety is severe enough to be impacting your daily life, it’s understandable that doctors will prioritize that and the medicine that helps you instead of sex, Altman said. That being said, don’t let it deter you from advocating for yourself. A satisfying sex life is also important for your mental health, she added.
If your anxiety is unrelated to medication, you also have strategies to get more out of your intimate life. Talking to a sex therapist could be a great place to start, especially if you think that past trauma could be at play.
“One of the things that’s beneficial about having a sex therapist is that we’re trained to gently help people develop more comfort talking about sex,” Casella Timberlake said.
A sex therapist can help you work through concerns and facilitate communication with your partner if anxiety has caused a breakdown in your intimacy. However, therapy is often expensive and inaccessible. You could try a more affordable option, like text therapy, group therapy or finding someone who can provide sliding scale session rates based on your income.
Additionally, Casella Timberlake recommended trying stress-relieving techniques like meditation or mindfulness exercises. Given the many physical ways in which anxiety manifests, it can be useful to really focus on where you feel that anxiety in your body, she noted. Does it make you take shallow breaths? Tense up your muscles? If you can better understand the ways you experience anxiety, you can work on developing specific coping skills for your particular body. If you’re new to meditation, you might start with one of these apps.
Even a little self-exploration on your own might also help. While it might be difficult at first to manage your anxiety with a partner, figuring out what turns you on (and finishing in the process) can help ease your stress and know what to communicate to someone else when the time comes.
While it’s true anxiety and sex might not be “happy bedfellows,” exploring your options for treatment can make your bed cozier for you and whatever else you’re bringing along for the ride.
“Living With” is a guide to navigating conditions that affect your mind and body. Each month, HuffPost Life will tackle very real issues people live with by offering different stories, advice and ways to connect with others who understand what it’s like. In May, we’re covering anxiety in honor of Mental Health Awareness Month. Got an experience you’d like to share? Email firstname.lastname@example.org.