Sexual anxiety: When stress makes its way under the bed sheets

Why do some people experience stress or discomfort about sex, even when they feel safe with their partners? During sexual activity, it's not uncommon for negative emotions and thoughts about performance or physical appearance to overshadow pleasure and connection with partners. This stress, which is often constant during intimate encounters, can be a sign of sexual anxiety. It's a common reality, affecting the sexual experience of one in twenty people 1. However, this number is probably underestimated, as many choose not to talk about it.

What is sexual anxiety?

Sexual anxiety is the feeling of stress, discomfort, or concern about sexuality 2. For example, a person experiencing this anxiety might feel uncomfortable communicating their sexual preferences, while another might fear not living up to their partners' sexual expectations. Sexual anxiety can manifest itself in a variety of ways, with significant consequences for intimate life and relationship well-being. It can, for example, be expressed by worries, intrusive thoughts or physical tension before or during sexual relations. If you experience these types of discomfort, or persistent worry during sexual activity, it may be a sign of sexual anxiety.

In more severe cases, sexual anxiety can manifest itself as sexual aversion, an intense and persistent experience of fear and disgust towards sexual contexts involving genital contact with partners 3, 4. Certain situations associated with sexuality, such as nudity, sensual talk or cuddling, may be sufficient to provoke strong aversive reactions 5. Sexual aversion is thus a form of sexual phobia, leading sufferers to avoid intimate moments with their partners. In Quebec, sexual aversion affects nearly one adult in ten, and women are twice as likely as men to suffer from it 6. Nevertheless, it's important to distinguish sexual aversion from asexuality, a sexual orientation characterized by a low or absent level of sexual attraction. Unlike sexual aversion, which necessarily involves suffering, asexuality does not.

The different facets of sexual anxiety

A frequent preoccupation of people with sexual anxiety is body image, particularly when the appearance of genitalia, breasts or body mass is perceived as imperfect 7, 8, 9. This anxiety is particularly felt during sexual activity, where a fixation on body dissatisfaction sometimes leads to less satisfying sexual activity, partly due to the fear of not pleasing partners 7. In addition, these people more often report difficulties in discussing sexual topics, such as their preferences and limits, and in undertaking certain sexual practices. These difficulties could be linked to low self-esteem as a sexual partner 8, 10. A critical view of oneself, combined with feelings of shame and dissatisfaction with one's body, can also accentuate sexual anxiety 10.

Another factor frequently associated with sexual anxiety is sexual performance anxiety, which is characterized by worries about one's ability to satisfy partners during intercourse 11, 12, 13. It can lead a person to focus on the negative consequences of poor sexual performance (e.g., difficulty to maintain a satisfying erection, reaching orgasm too late), to the detriment of the pleasure they might experience 14. For example, a person might find it hard to enjoy a sexual experience, fearing that a performance deemed inadequate will make partners less keen to have sex in the future. Moreover, this anxiety is sometimes accompanied by various difficulties such as lower sexual desire, increased difficulty in reaching orgasm and more pain during intercourse 12, 15, 16. Sexual performance anxiety can affect anyone, but its manifestations are generally 50% more frequent in men, affecting around one in four men and one in ten women 13, 17.

Finally, people who have experienced childhood sexual abuse frequently report sexual anxiety 18, 19, 20. Many victims of sexual abuse, such as molestation, may experience memories related to the abuse when they find themselves in sexual contexts. This can lead to fear, tension in the body or intrusive thoughts related to what they have experienced, which can cause sexual anxiety 18, 19, 21.

Possible solutions

Sexual anxiety is a complex reality that can profoundly affect sexuality and intimate relationships. However, it is not unmanageable, and there are a number of things you can do about it:

A specialized therapist, such as a sexologist or psychologist, can help you identify the causes of sexual anxiety and suggest appropriate strategies for overcoming them. For example, Sensate Focus is an approach based on progressive sensory exploration, without performance goals or sexual expectations, which can be used without professional support 11. This method, which can be performed alone or with a partner, helps reduce sexual performance anxiety and promotes a climate of safety, relaxation and pleasure 22.

Adopting an approach with partners that focuses on pleasure, exploration and connection through mindfulness helps to relieve the pressure that can accompany sexual relations 23, 24. This can enable sexuality to be experienced in a more fulfilling way, integrating its different sensory, emotional and relational facets, while possibly alleviating sexual anxiety 23, 24, 25.

Although sexual anxiety is a reality for many people, it can feel like you're the only one going through it. Talking about it can seem difficult, intimidating or embarrassing. However, addressing it can help you normalize your experience, understand it better and come to terms with it. If you recognize yourself in what you've read, it can be helpful to discuss it with someone you trust, whether it's someone close to you or a professional.

To cite this article: Calazana, F., Dussault, É., & Lafortune, D. (2025, July 7). Sexual anxiety: When stress makes its way under the bed sheets. TRACE Blog. https://natachagodbout.com/en/blog/sexual-anxiety-when-stress-makes-its…

The publication of this article was made possible thanks to our partner, the Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse (CRIPCAS), and the Fonds de recherche du Québec. 

• 1Mitchell, K. R., Mercer, C. H., Ploubidis, G. B., Jones, K. G., Datta, J., Field, N., Copas, A. J., Tanton, C., Erens, B., Sonnenberg, P., Clifton, S., Macdowall, W., Phelps, A., Johnson, A. M., & Wellings, K. (2013). Sexual function in Britain: Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet, 382(9907), 1817–1829. https://doi.org/10.1016/S0140-6736(13)62366-1
• 2Snell, W. E., Fisher, T. D., & Walters, A. S. (1993). The Multidimensional Sexuality Questionnaire: An objective self-report measure of psychological tendencies associated with human sexuality. Annals of Sex Research, 6(1), 27–55. https://doi.org/10.1007/BF00849744
• 3Brotto, L. A. (2010). The DSM diagnostic criteria for sexual aversion disorder. Archives of Sexual Behavior, 39(2), 271–277. https://doi.org/10.1007/s10508-009-9534-2
• 4American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
• 5Lafortune, D., Dussault, É., Vaillancourt-Morel, M. P., Lapointe, V. A., Blais, M., & Godbout, N. (2024). Is sexual aversion a distinct disorder or a trans-diagnostic symptom across sexual dysfunctions? A latent class analysis. Journal of Sex & Marital Therapy, 50(1), 105–120. https://doi.org/10.1080/0092623X.2023.2261933
• 6Lafortune, D., Dussault, É., Philibert, M., & Godbout, N. (2022). Prevalence and correlates of sexual aversion: A Canadian community-based study. The Journal of Sexual Medicine, 19(8), 1269–1280. https://doi.org/10.1016/j.jsxm.2022.05.142
• 7a7bPujols, Y., Meston, C. M., & Seal, B. N. (2010). The association between sexual satisfaction and body image in women. The Journal of Sexual Medicine, 7(2), 905–916. https://doi.org/10.1111/j.1743-6109.2009.01604.x
• 8a8bFaith, M. S., & Schare, M. L. (1993). The role of body image in sexually avoidant behavior. Archives of Sexual Behavior, 22(4), 345–356. https://doi.org/10.1007/BF01542123
• 9Lafortune, D., Canivet, C., Boislard, M.-A., & Godbout, N. (2021). Validation of a brief French version of the Sexual Anxiety Scale. The Canadian Journal of Human Sexuality, 30(1), 94–105. https://doi.org/10.3138/cjhs.2020-0042
• 10a10bGillen, M. M., & Markey, C. H. (2019). A review of research linking body image and sexual well-being. Body Image, 31, 294–301. https://doi.org/10.1016/j.bodyim.2018.12.004
• 11a11bMasters, W. H., & Johnson, V. E. (1970). Human sexual inadequacy. Little and Brown.
• 12a12bMcCabe, M. P. (2005). The role of performance anxiety in the development and maintenance of sexual dysfunction in men and women. International Journal of Stress Management, 12(4), 379–388. https://doi.org/10.1037/1072-5245.12.4.379
• 13a13bPyke, R. E. (2020). Sexual performance anxiety. Sexual Medicine Reviews, 8(2), 183–190. https://doi.org/10.1016/j.sxmr.2019.07.001
• 14Barlow, D. H., Durand, V. M., Gottschalk, M., & Granger, B. (2016). Psychopathologie : une approche intégrative (3th ed.). De Boeck Supérieur.
• 15Barlow, D. H. (1986). Causes of sexual dysfunction: the role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology, 54(2), 140–148.
• 16Payne, K. A., Binik, Y. M., Amsel, R., & Khalifé, S. (2005). When sex hurts, anxiety and fear orient attention towards pain. European Journal of Pain, 9(4), 427. https://doi.org/10.1016/j.ejpain.2004.10.003
• 17Bockaj, A., Muise, M. D., Belu, C. F., Rosen, N. O., & O'Sullivan, L. F. (2024). Under pressure: Men's and women's sexual performance anxiety in the sexual interactions of adult couples. The Journal of Sex Research, 1-13.
• 18a18bBigras, N., Godbout, N., & Briere, J. (2015). Child sexual abuse, sexual anxiety, and sexual satisfaction: The role of self-capacities. Journal of Child Sexual Abuse, 24(5), 464–483. https://doi.org/10.1080/10538712.2015.1042184
• 19a19bBigras, N., Daspe, M.-È., Godbout, N., Briere, J., & Sabourin, S. (2017). Cumulative childhood trauma and adult sexual satisfaction: Mediation by affect dysregulation and sexual anxiety in men and women. Journal of Sex & Marital Therapy, 43(4), 377–396. https://doi.org/10.1080/0092623X.2016.1176609
• 20Girard, M., Dugal, C., Hébert, M., & Godbout, N. (2020). Is my sex life OK? The mediating role of sexual anxiety in the association between childhood sexual abuse and sexual coercion against women. Journal of Child Sexual Abuse, 29(6), 717–733. https://doi.org/10.1080/10538712.2020.1774697
• 21Gewirtz-Meydan, A., & Godbout, N. (2023). Between pleasure, guilt, and dissociation: How trauma unfolds in the sexuality of childhood sexual abuse survivors. Child Abuse & Neglect, 141, 106195. https://doi.org/10.1016/j.chiabu.2023.106195
• 22Avery-Clark, C., Weiner, L., & Adams-Clark, A. A. (2019). Sensate Focus for sexual concerns: An updated, critical literature review. Current Sexual Health Reports, 11(2), 84–94. https://doi.org/10.1007/s11930-019-00197-9
• 23a23bDussault, É., Fernet, M., & Godbout, N. (2020). A metasynthesis of qualitative studies on mindfulness, sexuality, and relationality. Mindfulness, 11(12), 2682–2694. https://doi.org/10.1007/s12671-020-01463-x
• 24a24bBrotto, L.A. (2018). Better sex through mindfulness : How women can cultivate desire. Greystone Books
• 25Leavitt, C. E., Lefkowitz, E. S., & Waterman, E. A. (2019). The role of sexual mindfulness in sexual wellbeing, relational wellbeing, and self-esteem. Journal of Sex & Marital Therapy, 45(6), 497–509. https://doi.org/10.1080/0092623X.2019.1572680