Many women are stuck in a not-so-pleasurable Catch-22.
Liz Lazzara doesn’t always feel lost in the moment during sex, overcome with the sensations of her own pleasure.
Instead, she feels pressure internally to orgasm quickly in order to avoid irritating her partner, which often makes it difficult for her to climax.
“Even though most of my partners haven’t gotten irritable or impatient about how quickly I come, some have. Those memories stick out clearly in my mind, causing my anxiety around climaxing to persist,” she says.
Lazzara, who’s 30 years old, has generalized anxiety disorder (GAD) — a condition that’s colored many of her sexual experiences.
Experts say those with GAD might find it hard to relax, have difficulty telling their partner what they like, or focus so much on pleasing their partner that they don’t enjoy themselves.
Although Lazzara’s sex life has been affected by anxiety, many women who treat their anxiety with medication also find it challenging to maintain satisfying sex lives.
While racing thoughts or feeling selfish still impact Lazzara’s sex life, she also notes that anti-anxiety medications have lowered her sex drive and made it even more difficult for her to climax.
Since anti-anxiety medications also inhibit people’s sex lives as a side effect, it’s a problem that can seem to have no good solution.
With twice as many women as men affected by anxiety, many women out there could be experiencing a problem that rarely gets talked about.
Psychiatrist Laura F. Dabney, MD says that one reason people with anxiety might struggle to have satisfying sex lives is due to communication issues with their partner.
Dabney says the core of anxiety is often excessive, unwarranted guilt about experiencing normal emotions, such as anger or neediness. People with GAD unconsciously feel as though they should be punished for having these emotions.
“This guilt causes them to not be able to express their feelings well — or at all — so they often aren’t able to tell their partners what does and doesn’t work for them which, naturally, doesn’t help intimacy,” Dabney says.
In addition, she says many people with anxiety focus so much on pleasing others that they fail to prioritize their own happiness.
“An ideal sex life, and relationship in general, is securing your happiness and then helping your partner to be happy — put your own oxygen mask on first,” Dabney says.
In addition, the racing thoughts often associated with anxiety can inhibit sexual pleasure. Lazzara has anxiety, as well as post-traumatic stress disorder (PTSD). She says both of these conditions have made it difficult for her to orgasm during sex.
Instead of feeling lost in the moment with her significant other — overcome with lust and excitement as she comes closer to orgasm — Lazzara has to fight off intrusive thoughts, each one a libido-killing bullet.
“I tend to have racing thoughts while trying to climax, which distracts me from feeling pleasure or letting go,” she says. “These thoughts can be about everyday matters, like things I need to get done or issues of money. Or they can be more intrusive, like sexual images of me with abusive or unhealthy exes.”
Sandra*, 55 years old, has struggled with GAD her entire life. She says that despite her anxiety, she’s always had a healthy, active sex life with her husband of 25 years.
Until she began taking Valium five years ago.
The medication makes it much more difficult for Sandra to have an orgasm. And it left her almost never in the mood for sex.
“It was like some part of me stopped yearning for sex,” she says.
Nicole Prause, PhD, is a licensed psychologist and the founder of the Liberos Center, a sex research institute in Los Angeles. She says people with anxiety often find it difficult to relax at the very beginning of sex, during the arousal stage.
During this stage, being able to concentrate on sex is crucial for enjoyment. But Prause says that people with super high anxiety might find it challenging to get lost in the moment, and will overthink instead.
An inability to relax can lead to spectatoring, Prause says, which happens when people feel as though they’re watching themselves having sex instead of being immersed in the moment.
Sandra has had to make a conscious effort to overcome her low libido, as she knows sex is important for her health and the health of her marriage.
Although she struggles to feel aroused, she says that once things start heating up with her husband in bed, she always enjoys herself.
It’s a matter of giving herself that mental reminder that even though she doesn’t feel turned on now, she will once she and her husband begin touching each other.
“I still have a sex life because I intellectually choose to,” Sandra says. “And once you get going, it’s all good and fine. It’s just that I’m not drawn to it like I used to be.”
Many women with GAD, like Cohen, are stuck in a Catch-22. They have anxiety, which can negatively impact their lives — sex included — and are put on medication that helps them.
But that medication can lower their libido and give them anorgasmia, the inability to reach orgasm.
But going off of the medication isn’t always an option, as its benefits outweigh the low libido or anorgasmia.
Without medicine, women might start experiencing anxiety symptoms that previously kept them from achieving an orgasm in the first place.
There are two primary forms of medication prescribed to treat GAD. The first is benzodiazepines like Xanax or Valium, which are medications that are typically taken on an as-needed basis to acutely treat anxiety.
Then there are SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors), classes of drugs sometimes called antidepressants — like Prozac and Effexor — that are also prescribed to treat anxiety long term.
“There’s no class of medications that’s better at getting rid of orgasms,” Prause says of SSRIs.
Sandra began taking an antidepressant three weeks ago because doctors don’t advise taking Valium long term. But medication has been so integral to management of Sandra’s anxiety that she thinks it will be difficult to ever go off of it.
“I think absolutely I have to be on medication,” she says. “I could not be on it, but I’m a different person without it. I’m a sadder person. So I have to be on it.”
For people who can’t orgasm as a side effect of these medications, Prause says the only fix is to switch medications or go off of the medication and try therapy.
There’s no medication that you can take, in addition to an antidepressant, that makes it easier to orgasm, she says.
Lazzara has felt the effects of a lowered libido due to Effexor, the antidepressant she takes. “Effexor does make it more difficult for me to orgasm, both from clitoral stimulation and penetration, and it reduces my sex drive,” she says.
She says that the SSRI she was previously on had the same effects.
But like Cohen, medication has been crucial for Lazzara’s management of her anxiety.
Lazzara has learned to cope with the problems she faces in her sex life as a result of living with GAD. For example, she has discovered that nipple stimulation, vibrators, and occasionally watching porn with her partner help her reach clitoral orgasm. And she reminds herself that anxiety isn’t a problem to be solved — but rather a part of her sexual life the same way fetishes, toys, or preferred positions might be a part of another person’s sex life.
“If you’re living with anxiety, trust, comfort, and empowerment are key when it comes to your sex life,” Lazzara says. “You have to be able to let go with your partner in order to prevent the tension, restless thoughts, and mental discomfort that can be associated with anxious sex.”
*Name has been changed
Jamie Friedlander is a freelance writer and editor with a passion for health. Her work has appeared in The Cut, Chicago Tribune, Racked, Business Insider, and Success Magazine. When she’s not writing, she can usually be found traveling, drinking copious amounts of green tea, or surfing Etsy. You can see more samples of her work on her website. Follow her on Twitter.