Talking Sexual Anxiety with Shadeen Francis, LMFT

We’re in an anxious moment, historically and culturally. Anxiety about work, health, politics, and the overall future for us, our loved ones and the world can feel overwhelming. In the midst of worrying about how we’re going to manage our lives, sexual anxiety might not seem like such a big deal – but it might be more important than you think.

Connection is essential to happiness, and human beings need intimacy, with our partners and ourselves. Sexual anxiety affects people of all genders, and inhibits our ability to feel present and well-resourced in countless ways. It can affect our physical wellbeing. It can make us feel bad about ourselves when we most need to be confident and strong. And because of cultural stigmas surrounding open discussion of sex and sexual health, sexual anxiety can sometimes feel very lonely.

To get some answers, we spoke to Shadeen Francis, LMFT – one of our favorite sex and relationships therapists. She’s sought internationally to speak on topics such as sexual self-esteem, building intimacy, and boundary negotiation, and all of her work is inspired by her commitment to helping people live lives full of peace and pleasure. 

What is sexual anxiety?

Sexual anxiety isn’t a clinical diagnosis, it’s a label used to describe the experience of having anxiety about sex. When someone is sexually anxious, they are vigilant about the risk of potential sexual pain, about sexual health risks like infections, or most commonly, about their sexual performance.

What are some of the signs that someone might be experiencing sexual anxiety?

Sexual anxiety makes it hard for you to be present because you are preoccupied with critical self-judgements or worries about the future. This ends up creating a self-fulfilling cycle; worrying about sex actually distracts you from being in the moment, which negatively impacts your performance, limits your ability to make proactive health-conscious decisions, and makes pleasure more difficult. Arousal difficulties like erectile dysfunction and sexual pain often accompany sexual anxiety as the muscles throughout the body tighten and bloodflow to the genitals is restricted.

It might not be difficult to tell you are feeling anxious; anxiety is often very physical so people tend to feel uneasy, jittery, have knots in their stomach. However, some of the internal signs may be less obvious. Pay attention if you experience any of the following regularly in your sex life:

  • Dissociating (“spacing out”)
  • Feeling “trapped in your head”
  • Avoiding sex 
  • Overcompensating or faking confidence
  • Hyper-focusing on minor details
  • Perfectionism around sexual experiences or body image
  • Catastrophic thinking about potential negative outcomes
  • Compulsively seeking reassurance of what sexual partners think
  • Anxiety attacks or panic attacks

What are some of the root causes you see with your clients?

The biggest source of anxiety for folks is a lack of education, specifically comprehensive sex education that is medically-accurate, sex-positive, and pleasure-centered. People learn very little about pleasure and how bodies work in traditional sex ed, so most folks start their sexual lives feeling under-prepared and self-conscious. 

To fill the education gaps, people turn to where sex is prevalent: messages from the media, stories from friends, and pornography. While none of these are inherently bad sources, they are poor educational resources. Most are filled with unrealistic portrayals of sex, sexual stereotypes, and misinformation, like most people orgasm from penetration or that skilled lovers just know what people like (both are untrue). 

There can be a lot of pressure to like up to these unhelpful messages around what counts as sex, how long you are supposed to have sex, how often you’re supposed to have sex, and who you are supposed to have sex with. Instead of learning how to communicate, be vulnerable, seek consent, or be curious, people learn to compare their sexual experiences to sexual performances.

Are some people more likely to experience sexual anxiety than others?

Sexual anxiety is more likely for people who regularly experience other kinds of anxiety in their lives (including people with medical anxiety, social anxiety, or general anxiety). People with sexual trauma histories or that experience pain during sex are also likely to experience sexual anxiety, as our bodies are wired to protect us from danger, so it will respond with vigilant. Self-critical people can experience sexual anxiety too; depression, poor body image, and perfectionism will all make it hard for you to be present and live in the moment.

What tools and techniques can people use to overcome sexual anxiety?

Be Mindful: Allow yourself to focus on the present moment. Pay attention to how your body feels. Are you relaxed or tense? Are you ready or is there an urgency? Are you having sex to prove something or please someone else, or are you doing it because you are wanting to be sexual? Learning to act on your “yes” requires you to slow down enough to listen to yourself. This is a key to lowering anxiety. Focusing on pleasure rather than performance helps disrupt the anxious cycle.

Counter the Thoughts: Interrupt critical self-talk with affirmations, and challenge cognitive distortions (like black and white thinking) that cause you to spiral into anxiety. Sometimes writing down the worries can help us be more objective and realize which are reasonable things to address, and what can be ignored. Sometimes it is hard to soothe ourselves or reflect on our thoughts when we are anxious. This is a skill that we can develop overtime. If you can, seek the support of a therapist to help you.

Learn More: Learning is empowering. Get more information about the things that bring you doubt or uncertainty. That could be through formal sex education in person or on blogs, it could mean learning more about yourself and what you like through sex therapy or self-help books. Communication is also a way to settle sexual anxiety; learning about your partner and what they want and need sexually gives you an opportunity to work on things together.

Be Vulnerable: Give yourself permission to advocate for your needs. Practice asking for clarity and having honest conversations about what works and doesn’t work with your partners. It is easy to feel alone in your fear; allow your partners to participate in your soothing. Anxiety alerts us to danger, so it can be helpful to make joint plans for avoiding or minimizing risks. Reassurance can be helpful for the performance features of anxiety, but try not to over-rely on external validation and instead work on seeing yourself positively. This can also be worked on in therapy.

See Your Doctor: Please see a physician or a psychiatrist if your anxiety feels unmanageable or interferes with your ability to live comfortably.

If you could let people know one thing about sexual anxiety that is not widely known, what would it be? (Or more than one!)

Anxiety is not a character trait, it is a physiological response to perceived danger. When the signal doesn’t go away or gets in the way of our day-to-day functioning, it becomes a disorder. Don’t dismiss your discomfort. Anxiety disorders are currently the most common mental health issue in the United States, affecting over 40 million adults. If you are feeling anxious about sex (or anything else) you are not alone, and you deserve support.

Visit Shadeen at her website, or on Instagram @shadeenfrancislmft



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