How do stress and anxiety affect sexual performance and erectile dysfunction?

Stress is the body’s reaction to any change that requires an adjustment or response to maintain normal function. The body may react to changes with physical, emotional or mental responses. Anxiety can be described as feelings of worry, nervousness or unease about something with an uncertain outcome. Anxiety is the most common mental health condition in Australia, and 20% of men will experience anxiety at some stage in their life.

Feeling stressed is usually connected to your circumstances, and it is usually temporary (like an upcoming project deadline, exams, a new baby on the way, relationship struggles or retirement). Anxiety, on the other hand, is more than feeling stressed, nervous or worried. Anxiety is continuing to feel stressed or worried after the source of this stress and/or worry has passed (like ongoing health anxiety, financial anxiety and social anxiety).

So, how does stress and anxiety affect sex drive?

Stress and anxiety may cause your sex drive to spike, or it may cause your sex drive to dip.

From a psychological (mental) perspective, stress and anxiety may increase your sex drive because:

• When you are stressed or anxious, you may crave feelings of care and safety that come with physical intimacy;
• When you are stressed or anxious about whether or not you are allowed to have sex during this time, the 'wanting what you can’t have' logic might make you want to have sex more;
• When you are feeling stressed or anxious, you welcome a distraction, with more available time with your partner in the home, you may feel that your sex drive has increased; and
• When you have fears about mortality or the future, you may begin to forge a more intimate connection with your partner and therefore you may feel that your sex drive is higher.

On the other hand, stress and anxiety may cause a dip in your sex drive, and there are two reasons for this.

From a psychological (mental) perspective, your sex drive may dip because:

• You are feeling upset and you are consumed with worry. Understandably, you may not want to get physical.
• You are experiencing a busy brain or brain fog. It may surprise you to hear that your genitals are not your main sex organ, your brain is. Your brain plays a huge role in your ability to feel aroused. If you are finding it difficult to relax, it will be difficult to get aroused or reach orgasm.

From a biological (physical) perspective, your sex drive may dip because:

When we get a sudden fright our ‘fight or flight’ response kicks in so that we can cope with the immediate threat. This response is due to the activation of our sympathetic nervous system and is an unconscious way that our brain helps to protect us. The response includes a quicker heart rate and deeper breathing, which can help us to meet the threat head-on or outrun the danger. It also includes inhibition of bodily functions that aren’t needed to fight or flee, like digestion or having an erection. Once the threat has gone, and you’ve beaten it or out-run it, things go back to normal.

If threats continue, or a whole lot of problems keep coming up, our hypothalamic-pituitary-adrenal axis (HPA axis) gets activated to try and help us cope with the ongoing stress. Activation of the HPA axis results in an increase in cortisol (our main stress hormone), which raises our blood sugar levels and blood pressure, and inhibits our immune system. High cortisol levels are linked with anxiety. Cortisol also inhibits testosterone, the primary male sex hormone, which is responsible for sex drive (libido) and might contribute to the blood flow changes that cause an erection.

How do stress and anxiety affect erectile dysfunction?

Men of all ages may experience erectile dysfunction in some shape or form caused by stress.

• Men under the age of 30 are most likely to experience erectile dysfunction due to nervousness and anxiety. This form of psychological erectile dysfunction is generally short-lived.
• Men over the age of 30 are more likely to be dealing with personal and professional stress which may lead to erectile dysfunction.
• Men over the age of 50 are more likely to experience erectile dysfunction because of ageing. Life circumstances, such as losing a partner or adjusting to retirement, may also cause stress and anxiety in men, which can, in turn, cause erectile dysfunction.

You might be wondering how something that you experience in your mind may affect your erectile dysfunction.

There are a few key factors that play a part when it comes to achieving an erection. The nervous system, blood vessels, muscles, hormones, and emotions all play a role in your erection.

• Stress and anxiety may trigger an increased production or stress hormones and a lower level of testosterone which plays a role in your sex drive.
• Stress and anxiety may trigger the way your brain sends signals to the penis to allow for better blood flow.
• Stress and anxiety may impact your self-esteem and feelings of desire.

Stress and anxiety are a natural part of life, and most of us will experience one or both throughout our lifetimes. 

What is performance anxiety?

Sexual performance anxiety is a term used to describe feelings of worry or fear related to sexual activity, but it's not recognised as a diagnosis. Anxiety about sexual performance can become a hard-to-break cycle in which your worries contribute to sexual difficulties like erectile dysfunction or premature ejaculation, which then causes you to worry more about future performance. 

What should you do if you are having issues?

Whether you are in a relationship or you are single, changes in sex drive and your ability to achieve an erection can both be confronting issues.

If you are in a relationship, try to speak with your partner about how you are feeling. Encouraging understanding between you and your partner will be helpful for working through the sexual issues you are having.

If you are single, consider talking to a person you trust, like your doctor or a friend, about changes in your sex drive or your erectile function. Talking through your source of stress and anxiety may help you to better understand the next best steps you can take.

Remember that it is completely normal to feel stressed or anxious during this time. It is normal to not feel like having sex all of the time.

If your sex drive remains low and you are having issues with erectile function for a couple of weeks, you should visit your doctor. Your doctor can carry out a physical examination to help understand the causes of your erectile dysfunction and set up a treatment plan for the next steps.

For more information about erectile dysfunction, watch our short video:

You can also find more information and resources regarding erectile dysfunction on our Erectile Dysfunction information page.