Can Stress, Anxiety, and Depression Affect Your Sex Life? Erectile Dysfunction, Low Libido, and More

If you’ve ever felt stressed, anxious, or depressed, you’re not alone. After all, these conditions affect millions of people in the U.S. every year. And here’s the hard truth: When you’re not feeling well mentally, it can affect your sex life too. 

In this article, we’ll explore the link between mental and sexual health. We’ll also discuss common reasons for sexual problems — including erectile dysfunction (ED). And we’ll share some ideas for treatment. 

How do depression, anxiety, and stress affect your sex life?

Stress, depression, and anxiety can affect your sexual health in many ways. After all, your mental, physical, and sexual health are closely connected.

If you’re struggling mentally, here are some things that you might notice:

• Low libido: You might have a low libido (sex drive), which means you’re less interested in sex. 

• Physical problems: These could be problems with erections, ejaculation, or orgasm. You might also have a hard time getting physically aroused, or “turned on.”

• Less pleasurable sex: Depression and anxiety can make you feel bad about yourself, and they can make it harder to communicate with your partner. These issues might make sex less enjoyable overall. 

• Fertility issues: Stress can affect sperm health and a woman’s ability to conceive. 

Let’s take a closer look at some specific situations. 

Can depression and anxiety cause erectile dysfunction?

Yes. Anxiety and depression can both contribute to erectile dysfunction (also known as ED, or impotence). When you’re feeling anxious, sad, or irritable, it can be hard to get in the mood for sex. These feelings can also make erections go away if you have one. 

Symptoms of ED (impotence) include:

• Difficulty having an erection

• Difficulty maintaining an erection 

• Having an erection that’s too soft for penetration

• Losing your erection too soon after penetration

• Feeling like sex is less satisfying or pleasurable

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Sometimes, the cause of ED is depression or anxiety. Other times, ED can make your mental health worse. It can be a cycle that feels hard to control. You may even start to worry ahead of time about your ability to have an erection (performance anxiety). Working with a healthcare professional is one way to end this pattern. 

Can stress cause erectile dysfunction? 

Yes. When you experience ongoing stress, your body can release cortisol. Cortisol is a hormone that constricts the blood vessels in your penis. When blood can’t flow properly to your penis, you may have difficulty achieving an erection.

Over time, chronic stress can also decrease the amount of testosterone your body makes. And low testosterone is linked to ED. Low testosterone is also common in people with mental health issues like depression and anxiety.

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Can anxiety or depression affect your orgasms?

Yes. An orgasm is often the climax of sexual excitement. For many people, orgasm happens during or at the end of a sexual activity — like penetration, masturbation, or sensual massage. To be able to have an orgasm, your body and brain usually have to work together. 

Feeling depressed, anxious, or stressed can make it harder for your brain and body to coordinate well. You may have trouble getting physically aroused. Or you might be more preoccupied during sex and feel less connected to your partner. And some people with depression and anxiety find sex less pleasurable, or even painful. 

When all of these combine, an orgasm can be harder to achieve or less enjoyable when it does happen.

Can antidepressants cause ED and other sexual problems?

Yes. Antidepressants are used to treat anxiety and depression. Unfortunately, many can also have sexual side effects, like low libido, problems with orgasm, and changes in ejaculation. 

Common medications with sexual side effects include:

• Selective serotonin reuptake inhibitors (SSRIs): like fluoxetine, sertraline, and especially paroxetine

• Serotonin and norepinephrine reuptake inhibitors (SNRIs): like venlafaxine and duloxetine

• Tricyclic antidepressants (TCAs): like amitriptyline, imipramine, and doxepin

But these antidepressants are less likely to cause sexual side effects: 

• Bupropion (Wellbutrin)

• Mirtazapine (Remeron)

• Vortioxetine (Trintellix)

• Vilazodone (Viibryd)

• Selegiline (Emsam)

• Nefazodone

If you’re taking an antidepressant and having sexual problems, talk to your healthcare team. It may be possible to lower the dose of your medication or switch to another one. Your prescriber might also suggest adding another medication to help. 

What can you do if you’re having trouble in your sex life?

One of the best things you can do if you're having trouble with sex is to talk to a healthcare professional. It can feel hard to bring up sex. But remember: They’re there to help. After all, your sexual health is an important part of you. 

Check your general physical health

First of all, it’s a good idea to get a general checkup. Many sexual problems are linked to physical (not psychological) conditions, so it’s important to make sure your body is healthy. A health problem might be affecting your sexual abilities. 

Treat your depression or anxiety

If you have depression or anxiety, getting treatment can also help with your sexual problems. Here are the two top treatments for mental health: 

• Therapy: This is a great first-choice option for both depression or anxiety. 

• Medications: Many people get help with medications. 

Both therapy and medications can make a huge difference in your quality of life — including your sex life. And keep in mind: Many antidepressant and anti-anxiety medications take about 4 to 6 weeks to really start working. So don’t get discouraged if you’re not feeling any changes in your mental health right away. 

Finally, remember that many medications for depression and anxiety can actually cause sexual side effects. Keep your healthcare team in the loop, so they can adjust (or stop) your medication if needed. 

Treat your sexual problems directly

In some cases, you may need specialized treatment for a sexual problem. Fortunately, there are a lot of great options. 

Medications can directly help with: 

• ED

• Problems related to the menopause transition

• Vaginal dryness and pain

• Premature ejaculation

• Low libido

Physical treatments can help too. This might mean working with a physical therapist, using vaginal dilators, or doing Kegel exercises. In some cases, surgery or implants can also work well for ED. And there are even sex therapists who specialize in sexual health problems. 

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Written by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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