How Do Anxiety and Intrusive Thoughts Affect Sex?
By Allison Danish, MPH
Imagine with me for a moment—it’s a situation that’s all too familiar. Things are getting steamy, absolutely groovy, baby when *record scratch* all of a sudden you’re thinking about a true crime case you heard about last week. An embarrassing thing you did 10 years ago. The probability that a tree will fall on your house and crush you and your family at this very moment. The reality that anything could be a weapon if you really think about it and you could do bodily harm to someone you love if you wanted to (but of course you don’t want to) and—oh my god, why am I thinking these thoughts right now? I’m supposed to be making out!
Or maybe those thoughts are about sex itself—will it hurt when I pee afterwards? Am I in pain right now? Am I hurting my partner? Am I close to orgasm? Am I going to come at all? Is my partner having a good time? Is my partner looking at my butthole right now and does it look weird?
Well! Those are called intrusive thoughts, and they affect up to 94% of people according to a 2013 study ominously titled “You can run but you can’t hide: Intrusive thoughts on 6 continents.” So you’re in good company, my friend. A very special brand of anxiety, intrusive thoughts are “unwanted thoughts, images, impulses, or urges.” And while it would be wonderful if thoughts could just be thoughts, those anxieties can change our state of mind and disrupt all that good sexy stuff that’s happening in our bodies.
How do anxiety and intrusive thoughts affect sex?
These thoughts and feelings can show up in a few different ways while you’re trying to do the deed:
1. They can be really distracting.
Nordstrom says, “Anxiety and intrusive thinking during the sexual experience can, at minimum, distract from the sexual experience. This can look like dissociation, boredom, or disinterest, even though the person experiencing these thoughts would not choose them over the sexual experience.” If you experience intrusive thoughts and anxiety when you’re trying to get jiggy with it, you know firsthand that you’d really rather not be having those thoughts and feelings. And because those thoughts and feelings are demanding your attention, you might feel removed from the situation or your bodily sensations. When that happens, it might appear like you’re not into it even if you are or really want to be.
2. They can make it harder to get aroused.
Research tells us anxiety and sexual arousal have a complicated relationship. In cis-men, anxiety-inducing stimuli have resulted in arousal changes all across the board. Some studies have shown being anxious results in more arousal, others have shown no change, while some have reported less sexual arousal. Similarly, research on anxiety-inducing stimuli in cis-women resulted in either no change or less sexual arousal.
When it comes to anxiety disorders, anxiety is a risk factor for low desire, difficulty reaching orgasm, and pain during sex among cis-women; and erectile dysfunction is more common among cis-men with an anxiety disorder. Unfortunately, no studies to date (to our knowledge) discuss the relationship between anxiety or anxiety disorders and sexual dysfunction among trans and nonbinary people.
Sooo TLDR; people’s experiences with anxiety and sexual function are diverse, but anxiety probably has a role in desire or arousal difficulties for a lot of people. This is because, as Dr. Marchand says, anxiety and intrusive thoughts can “serve as distractions and can "hit the brakes" on sexual functioning, making it harder to get aroused or experience pleasure.”
3. They might cause some anxiety for your partner too.
“At their worst,” Nordstrom says, “anxiety and intrusive thoughts can actively be harmful to the individuals in a sexual encounter, as they can communicate a lack of trust, safety, or pleasure.” This essentially means that if anxieties that come up during sex haven’t been talked about and it’s causing one of you to pull away physically or emotionally from sexual encounters—the other partner could get the wrong idea. They might think “they are not good enough, that they are scary, or that they are not meeting their partner’s needs,” Nordstrom explains further.
Which is a big bummer, because it’s probably not what you’re thinking and not your intention if you’re experiencing anxiety and/or intrusive thoughts.
Enlightening as this may be, what can you do about it? Turns out, there's a lot you can do! Check out part 2, How to Shut Down Anxiety + Intrusive Thoughts During Sex for tips for both you and your partner(s).