anxious couple holding hands
Illustration by Marta Pucci

Anxiety interfering with your sex life? You’re not alone.

Photo of Dr Katherine Hertlein
Reviewed by Dr Katherine Hertlein,
created by Blueheart
created by Josh Green
created by Sophie Browness
Photo of Dr Katherine Hertlein
Reviewed by Dr Laura Vowels,
created by Blueheart
created by Josh Green
created by Sophie Browness

TL;DR

  • Sexual anxiety is any anxiety that you experience in relation to sex, and it can affect both members of a couple in different ways, often leading to a conscious (or even unconscious) avoidance of sex.
  • 'Spectatoring', or sexual performance anxiety, is one of the most common sexual complaints, affecting up to 25% of men and up to 16% of women, and is associated with many different sexual dysfunctions, including lack of desire.
  • It’s practically impossible to become aroused, or engage fully in the moment of sexual intimacy if you’re caught up in sexual performance anxiety, and the critical thoughts that come with it.
  • One of the main techniques used in sex therapy is called Sensate Focus, which is a series of touch exercises that are designed to reduce sexual anxiety and provide opportunities for you to explore your own and your partner's body.

Is anxiety affecting your sex life? You’re not alone.

Sex can be one of life’s great gifts: a space for you and your partner(s) to be fully present, to experience pleasure and joy, to play, to connect with yourself and each other. But that’s why, when you’re experiencing sexual dysfunction, it can be so disheartening, because the sex that you used to have, or that you’d like to be having, feels so out of reach. Even though lots of other species have sex just for fun (short-nosed fruit bats, anyone?) one of the uniquely human aspects of sex is our ability to get lost in our own thoughts, worrying about what we look like, how we’re performing, or whether the other person is having a good time. In other words: sexual anxiety. And even though it’s a completely normal thing to experience, it can be incredibly stressful, so let’s have a closer look at what sexual anxiety is, the effects it can have on you and your relationship - and what you can do about it. 

What is Sexual Anxiety?

In its simplest form, sexual anxiety is any anxiety that you experience in relation to sex, including concerns about sexual dysfunction, sexual performance, or relationship issues. Maybe just the thought of sex makes you feel anxious, or it could be that the anxiety is more present during sex - like if you can’t stop worrying about how you look or whether the other person is enjoying themselves - or after sex, if you’ve had trouble becoming aroused, reaching orgasm quicker than you’d like, or not reaching it at all, and you might feel a sense of shame or guilt. It’s really common for sexual anxiety to lead to an avoidance of sex - whether consciously or unconsciously - and even to avoidance of anything that might lead to sex, like kissing, holding hands, or compliments. Over time, this avoidance might start to impact the relationship more broadly, because it can cause a problematic cycle in which anxious thoughts about sex lead to avoiding sex, and the avoidance of sex leads to more anxious thoughts and insecurity in both of you, which leads to increased avoidance and a lack of desire.

In fact, even though it might seem like sexual anxiety only affects one person in the relationship, it actually has an impact on both of you, just in different ways. For one of you, it might be more about the sex itself (concerns about performance and the way your body works, for example, or feeling like you need to look a certain way). And for the other, there might be more anxiety about initiating sex, because they’re afraid of being rejected or that their partner doesn’t find them attractive anymore, among other things.

What causes sexual anxiety?

Relationship Issues

Having unresolved issues in your relationship can contribute to a feeling of anxiety around sex, which is why sex therapy and couples therapy often go hand-in-hand. Relationship difficulties can lead to negative emotions like resentment, guilt, sadness, and anger, among many others: none of which are helpful if you’re trying to create a safe, playful, relaxed context for sex. Even for couples who feel like their relationship is rock-solid, sex can be a hard subject to talk about, especially if there are parts of your sex life that you’re not happy with, or if you grew up in a household where sex was a taboo subject. However, it’s really important to be able to talk about sex with your partner: so much so, in fact, that renowned relationship researcher, Dr John Gottman, found that 91% of couples who can’t comfortably talk about sex said that they were not sexually satisfied. In other words, being able to talk comfortably about sex is key for a healthy sex life, and having a safe space in which to express your fears, needs, and desires will go a long way towards reducing your sexual anxiety. 

Mental Health

Your general mental health can also impact sexual anxiety, particularly if you suffer from Generalized Anxiety Disorder or depression. Unfortunately, some pharmacological treatments for depression and anxiety, predominantly selective serotonin reuptake inhibitors (SSRIs) can have a wide range of side effects, including creating temporary sexual dysfunction or exacerbating existing sexual dysfunction, by reducing sexual desire, creating a vicious cycle where sexual dysfunction and the mental health condition reinforce each other. If you think your medication might be having an impact on your sex life, don't stop taking them without talking to your doctor first.

Your mental health can also include more subtle things that you might not realize, such as low self-esteem, concerns about body image, or unhelpful beliefs about sex that you learned from society, the media, or your family, and then internalized. All of these could contribute to a feeling of sexual anxiety. 

Previous traumatic experiences

If you've previously had a traumatic experience, particularly one involving sex, it's entirely normal that you might have anxiety about sex or sexual situations. If you think that there are issues from your past that might be negatively affecting you, it could be very helpful to speak to a qualified mental health professional. 

What are some of the symptoms of sexual anxiety?

Spectatoring, or Sexual Performance Anxiety

One way that sexual anxiety makes itself known during a sexual encounter is in what we call ‘spectatoring’: watching yourself as if from above, disconnected from what’s going on, trying to manage how your partner experiences you, rather than being present in the moment. In today’s society, most of our ideas about what sex is, or ‘should’ be, come from Hollywood or porn, so it’s probably not surprising that sexual performance anxiety (and the spectatoring that comes with it) is one of the most common sexual complaints, affecting up to 25% of men and up to 16% of women, and is associated with many different sexual dysfunctions, including lack of desire. 

Feeling self-conscious about your body or how it works, comparing yourself to other people your partner may have slept with or how you used to look, or worrying about disappointing your partner - sexual performance anxiety is completely normal, and it often comes with a sense of shame, which can be deeply uncomfortable. These kinds of thoughts are also a roadblock to sexual desire, sexual arousal, and intimacy. In fact, if you take just one message away from this article, let it be this: it’s practically impossible to become aroused, or engage fully in the moment of sexual intimacy if you’re caught up in sexual performance anxiety, and the critical thoughts that come with it. It just won’t happen, because your body and mind need safety and relaxation before they can open up to the possibility of sex. 

Sexual Dysfunction

Perhaps unsurprisingly, then, there are several types of sexual dysfunction that you are more likely to experience alongside sex anxiety. For example, premature ejaculation, delayed ejaculation, and erectile dysfunction for men, and sexual arousal difficulties, painful sex, and anorgasmia (difficulty reaching orgasm) for women. One important thing to be aware of is that, as well as being a symptom of sexual anxiety, the experience of having sexual difficulties can cause performance anxiety, which can make the sexual difficulties worse, and reinforce the anxiety. The relationship between all of these things is complex, but the fact that they are all connected is a really strong indication of just how important it is to address your sexual anxiety.

How can I overcome my sexual anxiety? 

Sensate Focus

One of the main techniques we use at Blueheart is called Sensate Focus, which is a series of touch exercises that are designed to reduce sex anxiety and provide opportunities for you to explore your own and your partner's body. By focusing only on the sensations you feel, you learn to get out of your head and into the moment, which gives your body space to respond naturally. You go entirely at your own pace, doing only what you feel comfortable with, and touch for your own curiosity, without trying to force any kind of response from yourself or from your partner. And it really works; in a 2015 study of the effectiveness of Sensate Focus as a treatment for a variety of sexual difficulties, therapists found it to be 83% effective in the treatment of sexual dysfunction.

Get therapy

Talking to a therapist about your sexual anxiety can be a big help, and they can help you understand more about your worries and where they come from, as well as providing practical exercises for you to do at home. Make sure your therapist is qualified, experienced, and comfortable talking about sexual issues; most sex therapy uses a version of cognitive-behavioral therapy, but the type of therapy that they practice doesn't really matter - the main thing is that you feel safe with them and that you have a good connection. 

Take the pressure off (No more duty sex!)

If the sex you’re having isn’t making you feel good, or if you’re not having any sex at all, and that’s making you anxious, one thing you can do is deceptively simple: take sex off the table for a while. Or, rather, take Sex-That-You-Don’t-Want-To-Be-Having off the table for a while, and only have sex when you and your partner both feel comfortable with it, without any sense of duty or expectation. Easier said than done of course, but taking the pressure away from having to have sex means you can both work on your sexual relationship with one of you having fewer anxiety-inducing experiences, and the other having fewer moments of feeling rejected, isolated, and frustrated. It’s a win-win. 

Redefine what sex means to you

Our society generally does a really terrible job of teaching people about what sex really is. The sex that we’re taught about is fraught with the risks of STIs and unwanted pregnancies, and the sex that we see in the media is either unrealistically glamorous, ending in mutual orgasm for all, or unrealistically athletic, performative, and completely centered around penetrative sex. No wonder so many of us feel insecure and anxious about our sex lives! But, in reality, sex is so much more than penetration and orgasm; it’s all about pleasure and connection, whatever those things mean to you - whether that’s connecting with and giving pleasure to yourself, or connecting with and giving pleasure to each other. What’s more, sex is a buffet, not a set menu, so if you don’t feel like having penetrative sex, but you do want to be sensual, there’s so much more you can explore: only you get to define what sex means to you. 

For a healthy sex life, reduce your stress generally

This one is much easier said than done! Stress is so detrimental to our lives, and especially to our sex lives because it has such a big impact on every aspect of sex: desire, arousal, orgasm - all of them are negatively affected by stress. So if there’s anything in your life that’s causing you stress, and it’s possible to reduce or remove that stress, it might be worth giving it a try. Stress also has a big impact on our sleep, and if you’re not sleeping well, you’re probably not feeling a huge amount of sexual desire generally, and it gets much harder to regulate our emotions, which could well be contributing to your sexual anxiety. Above all, be kind to yourself! It can be hard for some people to connect to the idea of being kind to themselves because society so actively discourages it, but see if you can do just one thing today that brings you pleasure: it could be as small as going for a walk in your favorite park with a cup of coffee; watching an episode of that show you’ve been meaning to catch up on; taking a long, hot bath in peace; or spending some time expressing yourself through drawing, painting, writing, singing, or anything else. Whatever it is, make sure it’s just for you.


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