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Let's Talk About Sex....and Anxiety!

Trauma, Sexual Avoidance, and Sex as Coping

There are lots of reasons we might feel anxiety when it comes to sex. Some common reasons include:

-Anxiety about our bodies, body shame, or low self-confidence

-Anxiety related to Sexual Abuse or Trauma

-Performance Anxiety or anxiety about bodily function such as Erectile Dysfunction, Premature Ejaculation or Vaginismus

-Anxiety about your ability to reach orgasm

-Sexual Anxiety related to aging, menopause, or decreased mobility

-Anxiety related to low libido or arousal discrepancy with our partner

-Anxiety from lack of education about sex or limited sexual experience

-Anxiety from growing up in sex-negative environments

-Anxiety from religious or shame-based sexual education

Anxiety and excitement can exist on a sort of continuum. If you think about it, the sensations of excitement and anxiety aren’t very different, except that one tends to be viewed as positive and the other we tend to view as negative.

To a certain point, anxiety can be helpful. Think about the early stages of a dating relationship when you have some anxiety built up about how an encounter might go. This low-level anxiety can enhance our experience. It can make us more attentive and attuned to small details that signal mutual interest or hint at a sexual encounter. This kind of anxiety can be exciting and pleasure-enhancing. However, once anxiety gets to a more moderate or severe level, the results can be devastating.

Sexual Anxiety often appears as difficulty getting interested in sex, difficulty attaining or maintaining arousal, or difficulty reaching orgasm. It might lead us to avoid initiating sex or to decline sexual advances (even if we don’t want to). We might even experience other body-based symptoms such as feeling nauseous, shaky, or like our hearts are racing when our partner initiates sex. Anxiety can also lead us to tense or clench our muscles, which makes it extremely difficult to feel pleasure. Moderate to severe anxiety is the antithesis of pleasure; we have a really hard time feeling pleasure if we can’t relax.

Often, anxiety can change our relationship to sex. This can result in:

1. Avoiding Sex

2. Sex as Coping (using sex as a way to cope or find relief from anxiety)

1. Avoiding sex

Avoiding sex can happen for a lot of reasons. Many people who have experienced sexual abuse, violation, or any type of body trauma experience anxiety (and lots of other feelings) about being touched. If you have ever experienced a flashback, intense emotions, or dissociation during sex, you might want to avoid it in the future. If you have never felt safety or pleasure during a sexual encounter, it makes a lot of sense that you wouldn’t feel great about engaging in sex.

For some survivors, sexual anxiety can actually increase as a relationship becomes more intimate. For example, you might find that sex with a stranger or a casual partner is “easier” or more comfortable than with a long-term partner. This is especially true for survivors of intimate partner abuse, domestic violence, or incest.

We can also experience anxiety about sex when our relationship with our partner has been damaged. This can include experiences of infidelity or other trust violations such as compulsive pornography use. For partners of individuals struggling with pornography addiction, there can be anxiety related to feeling like you can’t “measure up” to the actors or exciting situations presented in the pornography. Other relationship factors that can damage sexual interest include hurtful relationship dynamics such as when our partners are critical or we don’t feel supported. If we don’t feel safe with our partner, it can be hard to experience arousal.

Issues with body confidence and body shame can wreak havoc on our sexual interest. If we are focused on how we look in our bodies during sex, it’s pretty hard to pay attention to how our bodies feel. We might find ourselves experiencing anxiety about certain movements that jiggle or angles that “don’t flatter.” This moves our thoughts away from pleasure and what feels good, and toward self-doubt and self-objectification. This can be made even worse if our partner has made critical comments about our body.

Mismatched Libido & Arousal Discrepancy: This is when our partner wants more or less sex than we do. It’s a very common issue that can create a lot of anxiety! We might start to get anxious that our partner won’t want to be sexual with us. If they are the higher -libido partner, we might feel pressure to engage in sexual activity when we aren’t really feeling it, or even “force ourselves” to participate. When this happens, anyone can experience increased anxiety, but for individuals who have experienced sexual abuse, it can also can re-traumatize.

2. Sex as Coping

Sex as coping is when we use sex, dating, hook-ups, flirting, masturbation, or pornography as a way to manage our emotions. This can lead to drastic changes in our sexual lives. For example. you may notice increasingly risky sexual behaviors such as cheating, paying for sex, or looking at pornography at work.

Lots of people use sex or masturbation as coping on occasion and it doesn’t necessarily mean something is wrong. However, if your sexual behavior is becoming more about trying to cope with or avoid anxiety, and less about feeling good, therapy can help.

Here are some quick self-check questions to explore if you think you may be using sex as a way to cope:

Have you noticed:

-increased interest in sex when you are experiencing periods of stress?

-spending less energy on sex with your partner and more time masturbating?

-looking at more pornography, or more unusual pornography over time?

-orgasms are more frequently for self-medicating than for pleasure?

-secrecy around your sexual behaviors?

-defensiveness about your sexual behavior?

-feeling “out of control” of your sexual behavior?

-masturbating when it doesn’t feel good, or to the point of irritation/injury?

-spending more than you’d like on sexually-based sites such as OnlyFans?

-trying unsuccessfully to change or stop your sexual behaviors?

-sex is taking you away from things you value like spending time with family or hobbies?

If you think you might be experiencing Sexual Avoidance or Sex as Coping, know that relief is possible.


If you are located in Pennsylvania, please visit www.embodiedexpressionstherapy.com/sex-help to learn more. If you are looking for support outside of Pennsylvania, try searching for some of the following terms to locate a licensed therapist in your area:

“Sex Therapy Near Me”

“Sex Abuse Therapy”

“Sexual Abuse Therapy”

“Sex Addiction Therapy”

“Sex and Love Addiction Therapy”

“Sexual Anorexia Therapy”

“Sex Avoidance Therapy”

“Pornography Addiction Therapy”

“Compulsive Sexual Behavior Therapy”

“Betrayal Trauma Therapy”

“PTSD Therapy”

“CPTSD Therapy”

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is an online-only therapy service serving clients throughout the state of Pennsylvania. 

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Sahra Riccardi, ATR-BC, LPC

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