Mental health plays a significant role in sexual function, and experiencing stress, anxiety and depression can affect our sex lives in various ways. Here's what you need to know about the relationship between mental health and sexual health. 


Sex and stress

Stress is our body’s response to pressure — a bit of it can be tolerable or even helpful. But when there’s an imbalance between the demands we face and our ability to cope with them, it can become a problem. 

When we experience stress our sympathetic nervous system kicks into gear and our bodies get ready to either fight the challenge or run from it. However, once the stress or threat is gone, our parasympathetic nervous system takes over to help restore our body back to its normal state. When we are exposed to prolonged stress — be it a life event like the death of a loved one, major health concerns, or living in an unpredictable global pandemic — our sympathetic nervous system is activated for much longer than usual1,2. Normally when the sympathetic nervous system is activated, our bodies release cortisol, which helps with our fight or flight response. Prolonged release of cortisol can reduce testosterone production, which impacts sex drive3 and can exacerbate any pre-existing mental health issues such as anxiety, which can affect erectile performance2,3,4.

Think about how you feel when you’re stressed — irritable, grumpy, anxious, sad, or frightened. While these feelings are normal they don’t often encourage desire, intimacy and romance. So how do you manage stress (and support a healthy sex life) while navigating your way out of a pandemic? Self-care is an important factor for resilience during difficult times.

Sometimes, we think of self-care as selfish or indulgent, but it helps us persevere and become better parents, partners, and lovers.


1. Move more

Movement is great not just for physical health, but also for mental health, as exercise reduces levels of stress hormones, like cortisol, and stimulates the production of endorphins, promoting feelings of relaxation and optimism.


2. Date night

If you’re still working from home, you may be seeing a lot of your partner. However, creating quality time for romance and relationships is still important. Try to do something together each week, like making a special meal together, going for a walk or watching a movie.


3. Communicate

If you’re having a bad day, rather than lashing out or projecting it onto your partner, communicate how you’re feeling. Often when couples are having issues (both in and out of the bedroom) one of the biggest factors is a lack of communication, which can lead to one or both partners feeling rejected or undesired.


Sex and anxiety

Anxiety can have a significant impact on erections and ejaculation. When we experience anxiety we get physiological symptoms — such as increased heart rate, gastrointestinal upset or sweaty palms — and anxious thoughts interrupt how your brain communicates with your penis. This can lead to a loss of erections5, which can create more anxiety. This cycle of erectile dysfunction (ED) can lead some people to withdraw from their partners both sexually and non-sexually out of fear that if they engage, it will lead to sexual activity that may lead to ED, disappointment and rejection.


By yourself

It’s important to understand that sensuality and relaxation are important components of the sexual experience. Try practising what is called “wax and wane”, which is when you masturbate and allow yourself to go soft, then get hard again, and repeat. This exercise helps you to remain calm and not to panic when you do lose your erection, knowing it will come back6.


With your partner

Sex is so much more than just penetration and performance — it’s about pleasure. By its very nature, sexual performance is stressful, and this can become a major preoccupation for most men at some point in their life. This can include thoughts such as, ‘Are they enjoying it?’, ‘I can’t come too quick!’, ‘Why aren’t I like those porn stars?’, ‘Is my dick too small?’, ‘What do they think of me?’. It’s important that men work with their partners to increase their enjoyment of sensual pleasure, which includes all of the activities that are possible during sex, such as touch and affection as well as other sexual acts.


Quiet your mind

Often it can be difficult to quiet your brain when you’re in the midst of sex. The following tools are circuit breakers that allow you to reduce the impact of anxious thoughts and return to being present with your partner when pesky thoughts pop up.

  • Activities: Use positive activities such as sex in the shower, going down on your partner, or using a toy
  • Emotions: Before sex try things that change your emotional state, like watching funny online videos, or listening to upbeat music
  • Push away: Use mindfulness techniques to push away anxious thoughts
  • Thoughts: Actively engage your mind to think about something else
  • Sensations: Focus on sensations (such as the feeling of your partner’s skin under your hand) to ground your thoughts.


Sex and depression

Depression can be characterised by a marked decrease in activities that were previously a source of pleasure, such as sex. Mood changes and fatigue can prevent your body from responding physically, contributing to low libido difficulties with arousal, erectile dysfunction and delayed orgasm. Having issues with your sexual health can cause shame, guilt and low self-esteem, and worsen symptoms of depression. This can become a vicious cycle of worsening depression and sexual dysfunction.


Talk to your doctor

If you have signs of depression that last for more than two weeks, or you are concerned that you may be depressed, speak with a doctor. There's a lot of stigma around using medication but it may help you get your head above the waterline to engage more effectively with psychological treatment. Some antidepressants can contribute to sexual dysfunction, including delayed ejaculation. If this is a concern for you, talk to your prescribing doctor as there may be alternative medications available for you. Do not stop medication without seeking professional advice. With the right treatments, you can focus on managing depression, and then improving sexual function.


Communicate with your partner

Be honest with your partner about what you're experiencing and how it's impacting your sexual health. Communicating how you're feeling can help take the pressure off and a partner's support can lessen feelings of guilt and worthlessness. 


Christopher Brett-Renes
Christopher Brett-Renes

Christopher Brett-Renes is an experienced psychosexual therapist who specialises in treating anxiety and depression, PTSD and trauma, grief and loss, relationship and couples counselling, sex therapy, coming out and transitioning support, porn and sex addiction, stress management and HIV/STI counselling. 


[1] Young E, Korszun A. 2010. Sex, trauma, stress hormones and depression. Molecular psychiatry

[2] Dana, D. 2018. The polyvagal theory in therapy: engaging the rhythm of regulation (First edition.). W.W. Norton & Company.

[3] King, R. 1998. Good Loving Great Sex: Finding Balance when Your Sex Drives Differ. Random House Australia.

[4] Van der Kolk, B. A. 2014. The body keeps the score: mind, brain and body in the transformation of trauma. Allen Lane, an imprint of Penguin Books.

[5] Andrews, G., Creamer, M., Crino, R., Page, A., Hunt, C., & Lampe, L. 2003. The treatment of anxiety disorders: Clinician guides and patient manuals. Cambridge University Press.

[6] McCarthy, B. W. 2001. Relapse Prevention Strategies and Techniques with Erectile Dysfunction. Journal of Sex & Marital Therapy

[7] Metz, M. E., & McCarthy, B. W. 2010. Male Sexuality and Couple Sexual Health: A Case Illustration. Journal of Family Psychotherapy

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