Journal

Anxiety and sex

By Madeleine Castellanos, M.D.


Anxiety (or stress, nervousness, worry, or fear) is a natural part of life. Without a little anxiety, there would be little motivation to get things done or any sign to tell us that we are in danger. Anxiety is a way of alerting the body and mind that it should take some action. In order to understand just how anxiety works, it is important to explain the body's autonomic system. This is the part of the nervous system that is not under our voluntary control. It is divided into the sympathetic nervous system and the parasympathetic nervous system.

The parasympathetic nervous system is the one that is charged with our regenerative functions. It is the dominant system when we are digesting our food, sleeping, and maintaining our internal organs. It is opposed by the sympathetic nervous system, more commonly known as the "fight or flight response." When we are in danger and the sympathetic nervous system takes over, blood is diverted away from the internal organs and instead sent to the large voluntary muscles that allow us to take immediate physical action. It does this by constricting the blood vessels that supply our internal organs and raising our blood pressure. The heart beats faster to get the blood to the arms and legs, and the lungs breathe shallower and faster. These two parts of the autonomic nervous system directly oppose each other, the sympathetic system taking over quickly when danger (anxiety) is perceived. The difficulty is that our brain perceives our own anxious thoughts as signals of danger, and we respond physically with our sympathetic nervous system.

But what many people do not know is that sexual arousal is a function of the parasympathetic nervous system. It is important for the body and the mind to relax in order to have physical manifestations of sexual excitation. During arousal, blood flow to the pelvis and genitals increases when the blood vessels relax. This results in an erection for men and increased blood to the prostate, and in engorgement of the clitoris and other spongy tissue as well as lubrication in women.

With anxiety, these blood vessels constrict and sufficient blood cannot flow to the appropriate tissues. Different people are affected by anxiety at different levels. For some, a little is all it takes. It could be as simple and telling yourself "What if I don't get aroused?" Some wonder if their partner is attracted to them or if they will be pleased. Others try to will themselves to get aroused, which is counter to what the brain is trying to do.

The most important thing is to learn how to calm your own anxiety. Learning to soothe yourself and turn your negative thoughts into more positive and motivating thoughts is the way to achieve mastery over anxiety. Many people try to medicate their anxiety away or seek sexual enhancement agents to override their anxiety. This very often comes with side effects, or can result in a physical or psychological dependence. Learning how to decrease our anxiety takes effort, practice, and time.

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