Clearly anxiety can be an obstacle to a healthy sex life and needs to be talked about.
You’re stressed so you clench. When you clench, it cramps. It’s a cycle that starts in the mind and finds its way down into the body. And I’m not talking about your jaw, I’m talking about your genitals.
Anxiety presents itself in many ways, but one of its more clandestine manifestations takes place below the belt. For men, that can lead to erectile dysfunction, an ailment we’re all familiar with thanks to late-night ads. Far fewer of us can list the effects anxiety has on the female sexual response cycle.
After researching 5,865 adolescents and adults ages 14 to 94, researchers at the National Survey of Sexual Health and Behavior (NSSHB) found that upwards of 30 percent of women report pain during vaginal intercourse. The most common approach to the problem was to “do nothing.”
As Andrew Heartman, a certified sex surrogate based in California, has reminded us,“[Women] can engage in sexual activity, but not really be present, and not really enjoy it… they can perform sufficiently to have their partner be satisfied.”
Sometimes, it’s worse than just a lack of enjoyment.
“I would say one of the main reasons women come in to see a sex therapist is because they have painful sex,” says Houston-based sex therapist Mary Jo Rapini. “When you talk to them further, you start understanding it’s their anxiety.”
She explained that some women are so hard hit with anxiety during sex that their vaginal muscles tighten up to the point that penetration becomes impossible. “When they do try to have intercourse, they can’t,” she says.
Rapini treated one woman who had gone 12 years without having sex because it was too painful. Even on her wedding night, she was unable to consummate the marriage. In other extreme cases she’s seen women unable to undergo a procedure as simple as a pap smear. “They can’t get the speculum in,” she says. “It’s so tight.”
Unfortunately, stigmas surrounding sex, specifically sexual dysfunction, run deep, and most people shy away from addressing the issues head on. “There’s an element of shame, with anxiety and depression. We’re used to seeing it as a weakness or proof there’s something wrong with you,” says Rapini.
As opposed to the platter of pills available to help enhance male sexual performance, the FDA has approved just one pill to treat sexual dysfunction in women. It’s called flibanerin, and it was originally marketed as an antidepressant.
But just because it’s an uncomfortable topic to bring up doesn’t mean it’s uncommon. As Rapini explains, “Anxiety is growing in the population and it’s incredible… Our brains have trouble just throwing stuff out.” According to Rapini, it’s not uncommon for this kind of anxiety-induced vaginal tightening to occur in women the week before their periods. Many women are also affected during the pre-menopausal period. “Your hormones are all over the place,” she says.
But not all instances fit neatly into a timetable. Rapini explains that women can be especially sensitive to situational factors relating to sex. Women who aren’t comfortable with their partners, women in bad relationships, even women turned off by something said during sex can find themselves closing up at a moment’s notice. “As a sex therapist, my job is more finding tools for them to help them relax,” says Rapini.
Within clinical circles, the condition is known as vaginismus, which the American Congress of Obstetricians and Gynecologists defines as a “reflex contraction (tightening) of the muscles at the opening of the vagina.” Because the condition has been linked to stress and anxiety, therapy is recommended. Often, vaginal dilators are also employed. As WebMD notes, “The approach is called progressive desensitization, and the idea is to get comfortable with insertion.” For women who experience more mild symptoms, other approaches may apply such as antidepressants, warm baths, breathing exercises, and heating pads.
Of course, when it comes to arousal issues with women, you’ve also got to give a nod to lubrication. Vaginal dryness is a big issue, and according to Rapini, it often works alongside anxiety to sabotage women’s pleasure. “For an orgasm to happen, first of all, the woman has to create the scene or the excitement in her mind. You can’t do that if your mind is focused or taken over by anxiety… and especially if you’re not using lubricant,” she says.
Experiencing pain during sex may not be the easiest thing to admit to, but Rapini says it’s not as unusual as one would think. “First of all, this is not abnormal. It affects a large part of the population.” Reports hold that women are twice as likely to experience anxiety as men. But the first step to securing sexual satisfaction in women takes place in the mind. “There’s a rhythm to recovery,” says Rapini. “That rhythm starts by slowing down.”
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