Mental Health and Sex

Written by Sex Debbie
Sex Debbie is a sex educator based in the South West of the UK. Her focus is on sex re-education for people of all ages. She encourages people to re-evaluate their knowledge, be open to learning something new, and ensure personal growth by celebrating and looking at the impact of changes through each of life’s chapters. Sex and relationships have a complicated place in our society, and Debbie aims to help normalise these conversations and break some taboos in the process!

Our mental health is intertwined with our sex lives on several levels. It can make us feel alone in a world that keeps turning. Sex and mental health are two taboos that can be hard to express. 

Without good mental wellbeing, the chances of desire and possible arousal are lowered. Mentally we are connected to sex whether it’s being present in the moment, emotionally connected to our partner or having a positive sense of self. All these factors can improve sexual pleasure and strengthen relationships. As well as mental health affecting our sex lives, sex itself can also improve our mental health. Sexual enjoyment can cause the release of endorphins, and hormones that make you relax, feel good and emotionally connect.

Those struggling with their mental health may be doing so for a variety of reasons.

To simplify, history shows us that Western society has been heavily influenced by patriarchal and Christian ways of talking about sex that have shaped heteronormative scripts. This is often framed as ‘banter’ or conservative opinions. Women who talk about sex and have sex for pleasure have often been seen as promiscuous prompting others not to follow suit for fear of retribution. This could increase the anxiety of those with sexual problems relating to pleasure.

Contrasting this, a man who has a sexual problem and talks about this could feel emasculated due to these sexual scripts at play. This in turn could create huge anxiety and prevent open discussion or seeking help.

We are surrounded by external & internal pressures when it comes to sex. This could be how we are viewed publicly, by a partner or judgments of ‘normal’. Previous trauma may result in anxiety responses from sexual contact. Depression, mood and other mental health concerns.

The more society normalises people talking about sex publicly, increases the status of psychosexual therapy and shows sex as a pleasurable, safe experience the easier it will be to talk about sex. And in turn the easier it will become to talk about sex and its links to our mental health.

Many things can impact our mental health when it comes to sex.


The word stress usually conjures negative images. However, it’s important to recognise that there can be healthy and unhealthy forms of stress.

Stress and the pressure it places on our lives is a motivation, to pay a bill on time, learn a new skill, or perform well. Adrenaline and other endorphins are produced as a reaction to stress. These often benefit our reactions and behaviour. These can all be positive or ‘healthy stress’.

Unhealthy stress on the other hand is when these feelings become a constant. Causing depression or anxiety. A reduction in immunity can often be seen accompanying unhealthy stress. Those suffering from this ‘unhealthy stress’ are often unable to face even small everyday tasks or goals like bills, interaction, cleaning and sex.


Anxiety is a response to stress. It can manifest itself with both mental and physical reactions. Feeling worry or fear as a natural reaction to a stressful experience is normal but it can become a problem when these anxious thoughts become more constant. Those suffering from anxiety may find it affects their daily lives. It may be a symptom of a further condition or a generalised anxiety disorder.

Anxiety can also result in intrusive thoughts. These can spiral out of control, causing a loss of self-identity as it becomes clouded with false representations. These thoughts are like seeds planted in your mind that grow into weeds, suffocating you. Often intrusive thoughts can become sexual. Because sex is a taboo and associated deeply with shame. This then worsens anxiety.

Anxiety can affect sex in a variety of ways manifesting in several sexual problems.

Sexual Problems & Mental Health


When muscles around the vagina spasm during penetration, then making penetrative sex painful. Arousal and desire are often still present making the condition even more frustrating and upsetting. Sexual enjoyment can be still gained from non-penetrative acts, however in order to improve their condition treatment should be sought. 

Thought to be caused by subconscious anxiety, vaginismus cannot be controlled when it occurs. It can, however, be treated using psychosexual therapy, often combined with other methods, in order to alter the thought process of the sufferers when it comes to penetration.

How could you help improve sex for sufferers of vaginismus?

Tackling the anxiety – a fear or concern about painful sex can create anxiety and cause someone to tense up, making vaginismus worse. By working on reducing the anxiety trying different techniques to find which one works for the individual.

Make a doctor’s appointment – in order to check whether there is any physical cause of the perceived vaginismus, a medical professional should be consulted to check whether there is anything that can be identified.

Vaginal trainers/dilators could also be used by the sufferer to practice strategies discussed in therapy in an environment they are able to control at home for example.

Psychosexual Therapy – to understand perhaps the cause of the anxiety and work on facing this in order to rebuild sexual enjoyment.


A term used to describe pain during or after sex. More commonly experienced in women rather than men, it can be caused by a number of both physiological and psychological triggers and should not be ignored. The diagnosis of dyspareunia can be quite confusing as it is an umbrella term. As is often found with these broad labels, once given people perhaps walk away with a name but no path for how to improve it. Someone experiencing pain during or after sex should first speak to a doctor to rule out any causes such as an infection before looking at psychosexual therapy. If no physiological concern is found, then therapy can be used to help treat any causes of anxiety or stress that could be resulting in dyspareunia.

Once dyspareunia occurs, anxiety around sexual activity increases making it more common. Using relaxation techniques and becoming more in tune with the body’s tensions can help reduce these effects. Therapy could also address any anxieties that caused the start of the dyspareunia. Perhaps an education or upbringing that surrounded sex with shame, or hidden sexuality. Once the root of the anxiety is unearthed, it can be improved.

Premature Ejaculation

Ejaculating too quickly during sexual activity. Sufferers with PE find that when they ejaculate, they are unlikely to feel in control of that climax. 

It is often unhelpfully seen as a sexual failure and can have a heavy impact on both sexual partners, yet most men experience PE at some point. This is due to misinformed sexual scripts that place male ejaculation as the pinnacle of sexual engagement, rather than sexual enjoyment and arousal. This is usually perceived as less of a problem for women, wrongly due to this patriarchal concentration on the male orgasm. Although women may be able to orgasm more than once during sexual play, ejaculating or orgasming too early can be an issue. However, sex through the ages focusses on sex ending when the male ejaculates. If focus was shifted on the mutual pleasure and sexual play for both partners, premature ejaculation wouldn’t carry such a huge weight and stigma leading to a performance anxiety in men.

Erectile Dysfunction

Struggling to get or maintain an erection. Sufferers of premature ejaculation may find they then suffer from erectile dysfunction due to the immense anxiety felt about their ‘performance’ preventing them from creating that physical arrival to start with. Make a doctor’s appointment to check there are no physical concerns relating to blood pressure, hormones or medication for example.

Reduce stress at work, and aim to maintain a healthy work-life balance. If our mind is preoccupied it can subconsciously affect our potential to become aroused. Stressors prevent the mind from being present during a sexual encounter and therefore inhibit arousal and can cause erectile dysfunction.

Tackle any anxiety, as once ED occurs it can cause a build-up of anxiety. The concern will reoccur and may result in being unable to perform sexually.

The pressure put on by society to prioritise penis in vagina sex, which requires an erect penis, does nothing to help this. Sexual scripts that use poor sexual performance to emasculate a man can cause anxiety which then, in turn, results in erectile dysfunction. The worry about 'what if I am not good?' Tackling these anxieties as well as others relating to erectile dysfunction can be done.

Look at lifestyle. Smoking and drugs can cause erectile dysfunction. By living an active and healthy lifestyle you can help prevent regular erectile dysfunction.

In order to understand the cause of erectile dysfunction and its effect on the individual and/or couples’ sexual relationship, psychosexual therapy can be sought. By doing an assessment of the individual a better understanding can be gained of their sexual motivators and feedback from partners can encourage working towards a solution.

Orgasmic Dysfunction

When a male or female finds difficulty in reaching orgasm and this situation becomes frequent, they could be described as suffering from Orgasmic Dysfunction. It is important to understand that orgasm should not always be considered to be the main objective of a sexual encounter. To be able to be in a state of arousal and sexual enjoyment is more of a priority in order to ensure a stronger sexual relationship as well as individual sexual empowerment.

Many people may find difficulty reaching orgasm for a variety of reasons. In order to reduce the effects of orgasmic dysfunction several things could be addressed. Psychosexual therapy could be used to address any trauma, anxiety or stress causing the problem.

Understanding that in order to have pleasurable sexual activity we need an awareness of our own psychical and psychological stimulus, be it negative or positive, as well as an ability to be present to enjoy the sexual encounter. Only when we know our own sexual stimuli can we then communicate effectively with a sexual partner and make the experience more pleasurable.

As with any sexual dysfunction, once it occurs, anxiety increases anytime sexual activity is approached. This anxiety then needs addressing via therapy or at least controlling with a coping mechanism.

Sexual Desire

Concern over loss of desire is often misunderstood and causes should be identified, looking at issues that contribute towards or manifest as a reduction of desire.

If someone is unable to be present in the moment due to stress at work, bearing the mental load in the relationship or housework for example, then loss of desire may be experienced as sex becomes lower down the priority list. Those unable to be present all have less of an emotional experience during sex and may find arousal limited and resentment for their sexual partner building up.  A lack of focus reduces the desirability of initiating the sexual scenario.

Psychological arousal is key. The build-up of sexual engagement. Anticipation, preparation, attention and connection all contribute to desire. Almost like mental foreplay.

Desire is also contributed to by physical arousal. Senses and body confidence are some of the things that can link to physical arousal. The menstrual cycle and other hormonal changes can contribute to desire when the body feels and reacts when aroused. Conditions such as erectile dysfunction or vaginismus can also cause great anxiety relating to a loss of desire or can be hiding behind the loss of desire. Loss of desire is then decided or seen as the sexual problem, and it must be unpicked, to find the cause or underlying problem. Lack of desire is often used as an excuse in this way to protect a sexual partner from exposing a weakness or engaging in a personal conversation that may result in further conflict.

Understanding a sexual partner’s ‘turn-ons’ and ‘turn-offs’ as well as an awareness of their sexuality contributes to their desire. These could be as simple as a date night, time for emotional connection, helping with the mental load, engaging in some touching or play that activates the senses or changing the type of sexual engagement to list just a few examples.


If raised within this culture those who are not virgins, especially girls, could be judged as dirty or no longer desirable. Such are the religious ideals lived by. This can contribute to anxiety surrounding sexual behaviour and perhaps act as a permission to others to treat those who are not virgins differently. Sexual experience first or last is for enjoyment, pleasure and exploration. Rather than something to be lost or endured. 

Homosexuality is also challenged by religious teachings. Seen by some religions as sinful or wrong, those raised with these teachings often repress any homosexual thoughts or feelings and carry out a heteronormative script at the detriment of their wants or desires, and ultimately their mental health. 

Society’s expectations of sexual behaviour when dominated by religion are a large contributor to poor sexual acceptance and result in sexual difficulties due to the anxiety and conflict caused by going against the perceived ‘right way’ to do things.

Even now in modern times with religion having less control over society, we are still dictated to by these judgments of what is right or wrong or normal or not. All stemming from religious roots.

Hormonal Contraception

A dose of a hormone that would affect female reproductive organs and their menstrual cycle freeing them from the burden of unplanned and unwanted pregnancy. But it also can be accompanied by side-effects on their mental health, as well as hormones, skin and bodies. These hormones can affect arousal, desire, body confidence and a number of factors that could be considered when it comes to sex and mental health.

Sexual Phobias

There is a wide variety of sexual phobias that are related to mental health. Here are some examples:

Performance Anxiety

The NHS categorise Performance Anxiety as a sexual phobia. Often linked with Erectile Dysfunction in men but can also affect women, Performance Anxiety is caused usually by negative thoughts either about oneself and one’s physical and sexual ability eg. body image, sexual inadequacy etc; or external factors such as relationship security, financial worries, use of porn etc.


The fear of engaging in sexual contact. This can result in panic or fear from either a physical or psychological stimulus. Often sufferers of Genophobia are victims of sexual assault, however this isn’t the sole cause.


The fear of contracting a disease is called Nosophobia. This is relevant within sexual relationships due to the possibility of STIs. Those with nosophobia may refrain from sexual contact or insist on stringent testing of sexual partners alongside a variety of barrier methods of contraception or even minimal touching. This phobia in my opinion could be seen as a result of the school education many young people have been given in more recent times. Following HIV breakouts and a stark rise in chlamydia, fear was used to educate pupils in schools within biology and Personal Social and Health Education (PSHE) lessons. This same tactic was used for to fuel a fear of pregnancy, Tokophobia is the fear of getting pregnant. No mention of pleasure from sex within education. If you suffer from Nosophobia, iPlaySafe can help, with our home STI testing kits available to order through our app.

Body Image

An individual’s body image permeated by upbringing, education and media, is frequently a concern for many, affecting sex. Undressing in front of someone, being in positions that are not 'every day', making yourself vulnerable in a naked or semi-naked state is something that many may not be confident with and could contribute to sexual performance, or anxiety surrounding it. Lights off, under covers, only certain positions, etc. 

Oral sex is a prime example of this vulnerability being up close and personal and all on show with nowhere to hide. If there is a body image concern here, it is hard to enjoy the sexual encounter taking place or even enter that engagement.

Anxiety can stem from the vulnerability that a negative body image brings. This could result in a variety of sex and relationship intimacy concerns.

Coping with Mental Health in Sex and Relationships

There are many ways of coping with stress, and what works for one individual does not always work for another. The following list and summaries are some ways to deal with stress and anxiety both in the short and long term, looking at cause and reaction.

Identify triggers – by understanding what triggers stress, it can be anticipated and if unavoidable you can at least be prepared. If the cause is something that cannot be changed, learning to accept this as well as understanding how and when is best to face these stressors is important. For self-help there is lots of information online. Charities such as Mind offer lots of signposting or advice on how to address the cause of stress from a variety of triggers.

Breathing exercises - controlling the pace and depth of breathing can positively correlate with feelings of anxiety. Taking back control both physically and mentally.

Visualisation exercises - focusing the mind on either a real or imaginary image or setting. This image is a positive place of relaxation. By bringing the focus onto this place and the thoughts and feelings that accompany it, the conscious mind is taken away from negative feelings of anxiety and fear and moves towards calm.

Muscle relaxation exercises - tensing and relaxing each muscle in turn. Feeling muscles when they are tight and the change when that is released is important to recognise tension held from anxiety and negativity. The sufferer is then able to take control of the impact anxiety has on their body.

Cued relaxation exercises - once more experienced with relaxation techniques you can set an external cue to remind you to use them in smaller ways throughout the day. This encourages regular work throughout the day to keep on top of any negative thinking.

Physical health - exercise no matter how mild has been shown to improve mental health. Changing environment, moving your body, all helps clear headspace and reduce stress. Sleep helps us rest and repair. Lack of sleep can reduce focus and heighten stress. Eating well and regularly improves mood and helps give our body energy, increases concentration and can make a big difference in how we cope with stress.

Take a break – remove yourself from your desk, home, rut or routing causing conflict. Whether it is to go for a walk, have a weekend away or even go on a holiday. ‘A change is as good as a rest’.

Support Network – ‘a problem shared is a problem halved’. Being able to communicate any sexual or mental health concerns with your partner or those close to you is vital.  Asking for help or explaining what you are finding hard could help you find more support. Using forums and resources online to talk to those experiencing similar problems to yours, or to research and understand more about your mental health are also helpful.

See a therapist – if something were causing you regular concern physically you would seek advice from a doctor. The same should be done for your mental health. Finding a therapist or speaking with your GP about how you are feeling can lead to a helpful programme of sessions that could look at improving how you cope with stress, uncovering your triggers and working on improving your overall mental health.

Cognitive Behavioural Therapy - CBT can work on steps to manage and resolve. Talking about the issue openly, barriers begin to be broken down and sex normalised. Sexual problems are often left undiscussed and kept private. Sex itself, even when not problematic, is full of unspoken negotiations and innuendo. Perhaps if intimacy became something that was discussed, sexual problems could be improved rather than relationships struggling because a partner is expected to mind-read or instinctually know what the other is not enjoying. In fact, sex is something that hugely benefits from open discussion, planning and build up yet normally in society is expected to just be a spontaneous passion-filled wonder, relying heavily on your desire being aligned with a partner’s. CBT can be used to dissect the anxiety or behaviour contributing to the sexual problem and because of it.