science of us

Treating My Anxiety Made My Sex Life Worse

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I was at Target on a mission. I'd never bought a sex toy before, but there I was, standing between shelves of pregnancy tests and shelves of condoms, where the store stocked a variety of tiny vibrators and lube. Here, I hoped, was where I'd find the tools to help me recover my orgasm, which I'd recently lost.

Several months earlier, I had started taking Lexapro for my anxiety, which was frequently so bad that I felt physically ill. The Lexapro worked for me: Once it was in my system, I could send emails without wanting to barf, and I could go to work without feeling lightheaded. I could sleep at night.

But I also could no longer orgasm. As everything else in my life began to feel better, sex had gotten worse.

Lexapro belongs to a group of drugs called selective serotonin reuptake inhibitors. SSRIs help correct an imbalance of the brain chemical serotonin, a lack of which can contribute to anxiety, depression, and other mental illnesses; the drugs work by blocking the reabsorption of serotonin in your brain and allowing it to build up. (My doctor has described it to me as feeling like a constant low dose of Xanax, which honestly sounds pretty great). SSRIs are among the most widely prescribed anti-anxiety and anti-depression medications because they tend to have fewer side effects than other types of medication.

Unfortunately, the side effects they do have are often related to sex, and those side effects are common and can have serious consequences. In one 2003 study, 62.5 percent of men and 38.5 percent of women said they felt their medication was causing sexual side effects, and 41.7 percent of men and 15.4 percent of women said they stopped taking their medication at some point because of it. This study included SSRIs along with other types of medication, but of those taking SSRIs, 70 percent reported sexual side effects.

"Sexual side effects" can refer to a wide variety of issues.
It can mean low libido, or it can mean problems with erections and lubrication, experiencing less pleasure, or taking longer to orgasm than it used to. Sometimes it means that you still have desire to have sex, but you don't have the ability to orgasm at all.

That was me. Not to brag, but before Lexapro, I orgasmed pretty regularly. I'd been with my partner for years, and sex was great — we mixed things up and played around, and genuinely cared about and paid attention to what felt good for each other. And after years of practice, we had gotten pretty good at it. According to another study, the ability to orgasm from intercourse alone is relatively rare for women, with only 18.4 percent of women saying that they could. But it wasn't rare for me. In fact, it was the only thing that worked for me, besides masturbating on my own.

But after Lexapro, nothing seemed to work. It's not that sex didn't feel good. It did feel good, which was part of why it was so frustrating — I would get close to an orgasm and just not be able to go over the edge. And I didn't feel like my desire was muted, either. I wanted to, and did, have sex regularly. It just wasn't getting me the same results.

"When doctors ask about sex, often their question is, 'So how's your sex life?' And people say 'fine.' And that's sort of like asking 'How's school?' to your kids, and they tell you it's fine. That's nothing," says psychiatrist Kenneth Paul Rosenberg, author of the 2003 study. "There's all parts of sex: There's desire, there's orgasm, there's how you feel about it. So it's not something that's dissected and talked about fully."

And many women can end up feeling like they have to choose between good sex and medication. "A message that seems to come out with women that I've spoken to is that [doctors'] response tends to be, well, you can either have good mental health or good sexual health, but you can't have both," says Cathy O'Mullan, a professor of public health at Central Queensland University in Australia and the author of a study on how women cope with sexual side effects of SSRIs. In some cases, doctors are unwilling or unable to address these side affects; in others, women are unwilling or unable to talk about them in the first place, because of embarrassment or lack of understanding of what's happening. In either situation, sexual side effects become a problem that goes undiscussed and untreated.

And that's only exacerbated when women are too uncomfortable to tell their partners that anything had changed. I told mine — honestly, it would have been difficult to hide the frustration I was feeling. Thankfully, he cared more about my health and pleasure than about his own ego over making me orgasm. (Nothing kills it faster for me than a man demanding I come to prove how good he is at sex.)

In our case, being open about what was going on with me and my medication made it clear that my lack of orgasm wasn't because of an issue in our relationship, or the result of something he was doing. Talking about it ended up easing some of the anxiety that I'd had about the situation — which, in turn, ended up making sex more fun. Talking about it also opened up a discussion to try new things to see what might feel good. After years of having sex with each other, it was almost like learning how to do it all over again. It forced me to really pay attention to my body and speak up for what I wanted.

Which is what led me to the sex aisle at Target. I thought maybe a fancy lube would help, or some kind of toy that could make things feel more intense. I ended up grabbing lube and two different kinds of small personal massagers. I stuck them in the bottom of my basket under some other random items I grabbed to justify my trip to Target and rushed to the self-checkout.

We tried it all, with varying levels of success. It was fun to try new things, but none of them by themselves brought my orgasm back. What did help, more than any vibrator could, was changing my view of what sex should be. When I went into sex without putting pressure on myself to come, it was more enjoyable. And taking the time to focus on me and what felt good — and allowing myself to be okay with taking that time, which was difficult — had better results than just using KY Jelly.

In her study, this is what O'Mullan described as acceptance.
She found that many women coped with their sexual side effects this way: by accepting that sex didn't have to look like it used to, or like how society says it should.

"I kind of refer to it as the new normal. Not even just with people who are on medication, but at different life stages, your body changes," said clinical psychologist and sex therapist Elizabeth Perri. "Sex is not going to look like it did in your 20s. So a lot of sex therapy is about acceptance and about sex maybe not looking the way you thought it would, and that's okay."

By accepting that orgasms would be more difficult and maybe not happen at all, I let myself be more in the moment during sex, and found myself more attuned to the sensations I was experiencing. Experimenting also made me more comfortable with speaking up for what I wanted and spending time on my own pleasure. And sure enough, after a while, I had an orgasm.

And the new normal felt great.

Treating My Anxiety Made My Sex Life Worse