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  • David Khalili, LMFT

When Anxiety Leads to Sexual Dysfunction


By David F Khalili, LMFT

It's no secret that anxiety can have an adverse impact on our lives. Anxiety can make us feel uneasy and on edge, cause us to avoid circumstances that make us uncomfortable, and even lead to physical symptoms like a racing heart or numbing sensations. As you probably know, anxiety can also impact sexual functioning. For some, anxiety can lead to erectile dysfunction, vaginismus, premature ejaculation, or pain during sex.

In this article, we'll explore how anxiety can impact sexual functioning and potentially lead to pain during sex. We'll also explain how for many, combining sex therapy and pelvic floor physical therapy is an excellent approach to treating pain or discomfort during sex.


Anxiety and sexual functioning


It's not uncommon for people to experience performance anxiety regarding sex. After all, we live in a culture that puts a lot of pressure to be "good in bed." For some, anxiety shows up by feeling pressure to perform sex in a certain way and not be their authentic self. Anxiety can also show up by hyper-focusing (read: heavily and horribly critiquing) your own naked body while in front of a partner or partners. Performance anxiety is often the root cause of erectile dysfunction, for example. And when we're anxious about our performance, we're more likely to rush through sex or focus too much on our pleasure, which can lead to premature ejaculation. Anxiety can also cause us to tighten up our muscles, which can lead to pain during sex. For vulva owners, it is known as dyspareunia and can sometimes lead people to feelings of shame for being “broken.”


You are not broken.

Whether you are dealing with erectile dysfunction, dyspareunia, performance anxiety, anodyspareunia, or other sexual functioning concerns, working with a sex therapist can benefit your treatment.

What is sex therapy?


Sex therapy provides a safe space to explore the entire spectrum of sex and relationships on an individual or couple level. Sex therapists include licensed therapists with extensive training in sex education, couples skills, cultural sensitivity, and psychological tools to identify and treat sex-related concerns such as:

  • Sex anxiety

  • Trauma - physical, sexual, emotional, spiritual

  • Shame

  • Self-esteem

  • Body image distortion

  • Gender identity affirmation

  • Couples communication

Working with a sex therapist can make an immense difference in sexual wellness by offering personalized ways of understanding your relationship with sex and gender, then formulating approaches based on your unique set of experiences and concerns.

Treatment can include:

  • Talk therapy

  • Somatic therapy

  • Nervous system regulation exercises

  • Solo and partnered erotic mindfulness exercises to try on your own

  • Trauma-support

  • Gender-affirming therapy

  • Coaching

  • Communication exercises

  • Values identification and boundary setting

  • Referrals to providers like pelvic floor physical therapists, psychiatrists, natural medicine doctors, coaches, etc.

Pelvic Floor Physical Therapy for Pain During Sex


If you're experiencing pain during sex, it's important to see a healthcare provider who can determine the cause of the pain. Pelvic floor physical therapists are experts in treating concerns related to your pelvic floor muscles, and would be the one to accurately diagnose this issue. They use a combination of manual therapy and exercises to release tightness and improve function. In some cases, they may also recommend the use of vaginal dilators or other devices to help stretch the pelvic floor muscles and reduce pain during sex.

Anxiety is a common issue that can have a negative impact on many areas of our lives, including our sexual functioning. If you're experiencing anxiety-related sexual dysfunction or pain during sex, don't hesitate to seek help from a healthcare provider who specializes in treating these issues. In many cases, a combination of sex therapy and pelvic floor physical therapy is an excellent approach to treating anxiety-related sexual problems.

If you’d like to learn more about receiving sex and relationship therapy services with our wonderful clinicians, please visit Rouse Relational Wellness, offering online therapy in California and in-person therapy at our office in the Castro district of San Francisco.

David Khalii, LMFT is a licensed therapist, board-certified sexologist, and founder of Rouse Relational Wellness in San Francisco, CA. He is first-generation American-born, and specializes in working with multicultural individuals and couples, poly/kinky folks, men, and approaches to sex anxiety.

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