What is Sexual Anxiety? Signs, Causes, and How Sex Therapy Can Help

By Josephine Ferraro, LCSW
Clinical Insights from a Certified Sex Therapist in Greenwich Village, NYC

Sexual anxiety is an incredibly common problem that affects people across all stages of life. It can surface while navigating the dating world, within long-term established relationships, in casual dynamics, or during any intimate encounter.

Reclaiming a natural path to physical and emotional connection. Josephine Ferraro, LCSW provides sex-positive, specialized therapy for sexual anxiety at her private practice in Greenwich Village.

Whether your anxiety occurs occasionally or manifests as a chronic issue that consistently blocks your intimacy, you do not have to navigate it alone. Understanding the root causes of this distress is the first step toward reclaiming your sexual health.

As a licensed psychotherapist and certified sex therapist with over 25 years of experience, I work daily with individuals and couples to unpack these complex emotional patterns. 

In this article, we will identify the most common situations and psychological triggers behind sexual anxiety.

What Exactly is Sexual Anxiety?

At its core, sexual anxiety is any form of nervousness, apprehension, or fear experienced before, during, or after sexual activity.

Because sex is a highly vulnerable physical and emotional experience, anxiety can quickly flood the nervous system. When left unaddressed, this anxiety often triggers a cycle of avoidance. Individuals may begin avoiding sexual activities entirely, avoiding conversations about intimacy, or withdrawing from physical connection to protect themselves from distress.

10 Common Causes of Sexual Anxiety

Sexual anxiety rarely occurs in a vacuum. In my private practice, I find that it usually stems from a combination of psychological, relational, or cultural factors:

1. Body Image Insecurities

Body dysmorphia and general insecurities affect people of all genders. Modern mainstream pornography often skews expectations, causing men to feel insecure about penis size and women to worry about weight or breast size. When you feel shame regarding your body, your nervous system interprets intimacy as a threat, making it incredibly difficult to become or stay sexually aroused.

2. Physical Sexual Dysfunction

Anxiety and physical symptoms frequently feed into one another. Sexual anxiety is a primary psychological contributor to issues like erectile dysfunction (ED), premature ejaculation, low libido, difficulty achieving orgasm, and painful intercourse (vaginismus or dyspareunia).

3. Cultural, Religious, or Family Shame

Deeply ingrained messages from our upbringing can attach immense guilt to sex. Even when you are with a partner you love and trust, subconscious sexual shame can trigger intense anxiety before, during, or after intimacy.

4. Unresolved Relationship Conflict

Sexual intimacy reflects relational health. When a couple experiences chronic arguments, unaddressed stress, or emotional distance, that tension directly translates into the bedroom as performance anxiety or an inability to relax.

5. Past Sexual Trauma

A history of sexual abuse or boundary violations can cause current sexual activity to trigger past trauma responses. Even in a completely safe environment, the body’s nervous system may remember past threats, causing a sudden spike in panic or dissociation.

6. Infidelity and Broken Trust

Discovering a partner's cheating shatters emotional safety. Betrayal introduces complex layers of anxiety, including fears around sexually transmitted infections (STIs), intense insecurity, anger, and deep-seated sadness that completely block sexual pleasure.

7. Explicit or Implicit Pressure to Perform

Sex should always be fully consensual and pleasurable. When someone feels spoken or unspoken pressure to engage in sexual acts to appease a partner, it ceases to be truly consensual. This pressure creates deep stress, resentment, and systemic performance anxiety.

8. Lack of Experience and "Spectatoring"

A lack of comprehensive sex education or limited sexual experience often makes people hyper-focused on how they are "performing." This triggers a psychological phenomenon known as "spectatoring"—where you become a self-conscious observer inside your own head, analyzing your performance rather than feeling the physical sensations of pleasure.

9. Chronic Stress and Daily Worries

While mild sexual anticipation can enhance arousal, high levels of external stress (from work, finances, or family) prevent the body from entering the relaxed state necessary for sexual satisfaction.

10. Co-occurring Mental Health Conditions

Generalized anxiety disorder (GAD), panic disorder, and clinical depression significantly impact hormonal balance, focus, and overall libido, naturally intersecting with sexual anxiety.

The Role of Sex Therapy in Reclaiming Intimacy

Without professional support, sexual anxiety tends to solidify over time as the brain learns to associate intimacy with stress. However, these patterns are highly treatable.

Working with a specialized sex therapist allows you to untangle the emotional, physical, and psychological roots of your anxiety in a completely confidential, non-judgmental environment. You deserve to experience a fulfilling, vibrant, and peaceful sex life.

Connect with a Sex Therapist in Greenwich Village & Online

If you are ready to break free from performance anxiety and rediscover pleasure, I invite you to reach out. I am a sex-positive therapist providing specialized care for individual adults and couples.

My clinical framework integrates advanced modalities tailored to your unique healing journey, including EMDR, AEDP, Emotionally Focused Therapy (EFT), Somatic Experiencing, and clinical hypnotherapy.

Connect with a Certified Sex Therapist in Greenwich Village & Online

If you are ready to break free from performance anxiety and rediscover pleasure, I invite you to reach out. 

I am a sex-positive therapist providing specialized care for individual adults and couples.

I see clients in person in my Greenwich Village, NYC (10011) office or online.

My clinical framework integrates advanced modalities tailored to your unique healing journey, including EMDR, AEDP, IFS Emotionally Focused Therapy (EFT), Somatic Experiencing, and clinical hypnotherapy.

Take Your Next Step Toward Healing

• 👉 Schedule a Complimentary 15 Minute Call: (917) 742-2624
• 📩 Contact My Greenwich Village Office: josephineferraro@iCloud.com
• 📍 Explore My Specialized Sex Therapy Services: Josephine Ferraro, LCSW - NYC Psychotherapist

Josephine Ferraro, LCSW provides in-person therapy sessions in Greenwich Village, Manhattan, as well as secure online virtual therapy for residents across New York State.

Overcoming Problems With Anxiety-Related Erectile Dysfunction (ED)

Anxiety-related erectile dysfunction is a common problem for men regardless of sexual orientation, age or race (see my article: What is Sexual Anxiety?).

What is the Link Between Anxiety and Erectile Dysfunction?

Most men experience occasional problems with maintaining an erection and most of the time these occasional problems aren't a cause for concern.

Anxiety-Related Problems With ED

Occasional problems can be related to not getting enough sleep, drinking too much or other factors.

Occasional problems are different from ongoing problems with erectile dysfunction.  

Assuming medical problems have been ruled out by a urologist or a sexual health doctor, erectile dysfunction (ED) is often caused by stress and anxiety, especially when men worry about their ability to please their partner (see my article: The 5 Most Common Male Sexual Insecurities).

Anxiety and stress-related ED can include one or more of the following problems:

• Problems with Body Image: For many men body image problems involve worrying that their penis is too small.  There can be a lot of variation in penis size, however, the average size of a flaccid penis is 3.5 inches and 5.1 inches for an erect penis.  Men who compare the size of their penis to male actors in pornography can develop a distorted view of what an average penis looks like, especially if they don't realize that male actors in porn are chosen for their unusually large penises.  

• Shame and Guilt About Sex: Shame and guilt can be related to many factors, including personal shame about sex, cultural shame or interpersonal issues with a partner.

Anxiety-Related Problems With ED

• Relationship Conflict: Stress and anxiety related to relationship conflict can be a contributing factor to ED and an inability to experience sexual pleasure. Relationship conflict can include frequent arguments, a history of emotional and/or sexual infidelity, financial infidelity, child-rearing disagreements, problems with one's own family or with in-laws, and so on.

• Unresolved Sexual Trauma: When there is unresolved sexual trauma, partnered sex can trigger trauma-related guilt and shame which often has nothing to do with the current sexual partner.  Trauma-related triggers occur in an instant without a person's conscious awareness.  Since trauma-related triggers often occur outside a person's awareness, a man might not understand why he feels so emotionally overwhelmed in the moment because he doesn't realize he is triggered and that the trigger has nothing to do with his current partner.  Anything can act as a trigger including a scent, a word, a gesture, a movement, a particular sexual position and hundreds of other things that were related to the original trauma (see my article: How Unresolved Trauma Can Affect Your Relationship and Overcoming a History of Sexual Abuse).

• Sexual Libido Differences in a Relationship: This is the #1 problem that brings couples into sex therapy.  Even though they can accept that they have differences when it comes to food or entertainment, most people find it difficult to accept that they experience sexual libido differences with their partner. This can create sexual pressure for a man or feelings of sexual rejection which, in turn, can lead to ED or sexual avoidance (see my article: Relationships and Mismatched Sex Drives: What is Discrepant Sexual Desire?).

• Lack of Sexual Experience: When a man worries he won't be able to "perform" sexually or that he won't be able to satisfy his partner, this can lead to "spectatoring" where a man becomes so self conscious that he becomes a so-called "spectator." Rather that enjoying sex with his partner, he is  "spectatoring" which takes him out of the sexual experience and can create a problem ED (see my article: What is Performative Sex?).

• Stress and Worry Unrelated to Sex: A little stress in the form of sexual anticipation can enhance sexual pleasure, but too much stress can lead to ED.  

• Other Mental Health Problems: Generalized anxiety, depression and other mental health problems that are not directly related to sex can also contribute to ED.

How Does Sex Therapy Help Men to Overcome Erectile Dysfunction?

Sex therapy is a form of talk therapy for individual adults and couples (see my article: What is Sex Therapy?)

Sex therapy is an effective treatment for sexual anxiety and other sexual problems.

During a sex therapy session, there is no sex, nudity or physical exams (see my article: What Are Common Misconceptions About Sex Therapy?).

Individuals and couples seek help in sex therapy for many reasons (see my article: What Are Common Issues Discussed in Sex Therapy?).

Regardless of the sexual problem, sex therapy usually begins with an assessment, including taking a family history, relationship history and sexual history to determine how the current problem might be related to the client's history.  This usually takes several sessions.

Sex therapy is an effective form of treatment for ED and other sexual problems (see my article: How Sex Therapy Can Help With Sexual Anxiety).

The underlying issues of erectile dysfunction are different for each person, so there is no one-size-fits all approach to overcoming ED.  

If a man is able to maintain an erection when he masturbates and if he experiences normal erections during sleep and upon waking up (also known as "morning wood"), ED is usually related to an underlying issue that he might have no awareness about before beginning sex therapy.

A sex therapist is a trained mental health professional who has special training in sexual-related problems, including erectile dysfunction.

Sex therapists give sex therapy clients assignments to do at home either alone or with a partner.  This can include (but is not limited to):

• Practicing Sensate Focus or other forms of touch exercises (see my article: What is Sensate Focus?)

• Reading assignments 

• Keeping a journal related to the sexual problem (see my article: Keeping an Erotic Journal)

• Practicing sexual communication with a partner (see my article: How to Talk to Your Partner About Sex)

• Other assignments between sex therapy sessions

If the ED occurs within the context of a relationship, it's considered a relationship problem and sex therapy is more effective if both partners are attending sex therapy sessions together.

In future articles, I'll explore, among other topics, how the penis is often a barometer of physical, emotional and sexual health.

Also, see my article: Is It True That "Real Men" Are Always Ready to Get It Up?

Getting Help in Sex Therapy

In addition to whatever underlying issues there might be, men often feel too ashamed to seek help in sex therapy.  This is often due to distorted stereotypes of what it means to "be a man" or to "be strong."

Getting Help in Sex Therapy

Sexual shame is often reduced or eliminated when men learn how common erectile dysfunction is for men regardless of age, sexual orientation, race and other identifying factors.

If you're experiencing ED, rather than struggling on your own or ignoring the problem, seek help from a licensed mental health professional who is a trained sex therapist.

Getting Help in Sex Therapy

Overcoming anxiety-related ED can lead to more satisfying sex and a more meaningful life.

About Me

I am a licensed psychotherapist, sex therapist, couples therapist, hypnotherapist and trauma therapist (EMDR, AEDP, Somatic Experiencing and other forms of trauma therapy) with more than 20 years of experience.

I work with individual adults and couples and I have helped many clients to overcome sexual problems.

My office is conveniently located in Greenwich Village, Manhattan where I provide in-person and virtual sessions.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

The 5 Most Common Sexual Insecurities That Heterosexual Women Have

Sexual insecurity is a common problem for both men and women.   In my prior article, The 5 Most Common Sexual Insecurities that Heterosexual Men Have , I focused on men's sexual insecurities.  

The Sexual Insecurities of Women

In the current article, I'm focusing on women's most common sexual insecurities.

The 5 Most Common Sexual Insecurities That Women Have

Women often seek help in sex therapy for many of the following issues:

• Insecurity About Weight: More than ever, women are bombarded in the media with culturally idealized images of women--specifically, white women. Based on these images, women should be white, young, thin, tall and beautiful. This creates a lot of insecurity and anxiety for most women who don't fit this image.  It creates so much stress that many women are undereating, over-exercising and spending too much time worrying about their appearance and whether they'll be sexually appealing for the male gaze (see my article: How Mindfulness and Self Compassion Can Help With Body Acceptance).

Body Image Insecurity

• Insecurity About Breast Size: Insecurity about breast size is part of problems with body image, but it's such a big problem that it deserves its own category. Most heterosexual women assume they will be more desirable with large breasts and, rather than being happy with their breasts, they worry about whether they should have surgery for breast augmentation. In reality, just like anything else, beauty is in the eye of the beholder so it's a fallacy that all men prefer large breasts. Also, focusing externally, rather than appreciating your body as is, is a psychological trap. In addition, bodies change over time as people age, so learning to accept your body will give you greater peace of mind.

• Insecurity About Their Vulva and Vagina: Also related to body image is the specific anxiety that many women have about their vulva and vagina. The vulva is the external female genital area. It includes the labia, clitoris, vaginal opening and the urethra. The vagina is the internal female genital area. It includes is a muscular canal that extends from the vulva to the neck of the uterus. Specifically, women worry about whether their labia are the right size and color and whether labia are uneven. In reality, labia come in all sizes, shapes, colors, evenness and unevenness.  And all of them are normal. Similar to male insecurities about penis size, pornography usually portrays culturally idealized images of vulvas. This sends the wrong message to women that if they don't have vulvas that look like the cultural ideal, they're not normal. This could result in women seeking unnecessary plastic surgery to get their vulvas to look like the cultural ideal, which has been happening more often in recent years.Women also worry that they smell during oral sex (cunnilingus), which can create stress during sexual activities if they're preoccupied with their scent instead of focusing on their pleasure. For many women this has been exacerbated by experiences with men who want to receive fellatio (oral stimulation to a man's penis) but who are unwilling to reciprocate.  Other women won't allow men to engage in cunnilingus because they have so much shame about their scent. Each woman has her own unique scent, which is normal. Women who are concerned about a strong scent that persists despite showering should consult with her gynecologist to rule out an infection.

Sexual Insecurities of Women

• Insecurity About Taking Too Long to Orgasm: Rather than focusing on overall sexual pleasure, many heterosexual women tell their sex therapist that they worry they're taking too long to orgasm during partnered sex. They worry that men will get impatient or frustrated with them. The more they worry, the more difficult it is to have an orgasm. Many women are especially worried that men will get impatient with them during cunnilingus (oral stimulation of the vulva). This problem can be overcome during solo sex (masturbation) with either digital stimulation or stimulation with a vibrator or other sex toy. This allows women to know what they like and how they like it,which they can then communicate this to their partner. Also, getting comfortable with being more embodied, instead of being stuck in your head, can help a lot. In addition, although it can be great to have an orgasm, focusing on overall sexual pleasure, instead of orgasms, can take a lot of pressure off women (see my articles: Closing the Orgasm Gap Between Men and Women and Why You Shouldn't Fake Orgasms).

• Insecurity About "Low Libido": In their book, Desire: An Inclusive Guide to Navigating Libido Differences, the authors Dr. Lauren Fogel Mersey and Dr. Jennifer A. Vencill, make the point that desire discrepancy is relative to who you are having sex with. You can be in a relationship with someone where you're the higher desire partner and in another relationship where you're the lower desire partner. Also, many women who are falsely labeled as having a low libido aren't having sex that turns them on. They don't have low libido--sex with a particular partner just might not be satisfying for them.  So, as mentioned before, it's important to get to know what you like and don't like during solo sex so you can communicate this to your partner. In addition, TV, movies and other media tend to portray spontaneous sexual desire as being the norm. During spontaneous sexual desire, people are turned on immediately.  But, in reality, many men and women experience responsive sexual desire where they don't get sexually turned on until they have already begun sexual activities. So, if you experience responsive desire, it's often a matter of having the willingness to get started because you know you will get turned on. In addition, if there is a sexual desire discrepancy, just like any other difference in a relationship, it's normal for there to be one person who desires sex more than another. Desire discrepancy is the #1 issue that brings couples into sex therapy where they learn to negotiate these differences so both partners are satisfied.

Overcome Sexual Insecurity in Sex Therapy

Sex therapy is a form of talk therapy that focuses on sexual issues (see my article: What is Sex Therapy?).

Getting Help in Sex Therapy

There is no physical exam, nudity or sex during sex therapy sessions (see my article: What Are the Most Common Misconceptions About Sex Therapy?).

Many individual adults and couples seek help in sex therapy for a variety of reasons (see my article: What Are Common Issues Discussed in Sex Therapy?).

Rather than struggling on your own, seek help from a licensed mental health professional who is a sex therapist so you can lead a more fulfilling life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I am a sex-positive therapist who works with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

The 5 Most Common Sexual Insecurities That Heterosexual Men Have

As a sex therapist in New York City, I have seen many clients struggle with sexual insecurity. In fact, sexual insecurity is a common experience for many people at some point in their lives.  

The current article focuses on heterosexual men's sexual insecurities (see my article: Overcoming Feelings of Sexual Shame and Guilt).

The Sexual Insecurities of Men

What Are the 5 Most Common Sexual Insecurities of Men?

• Fear of Rejection: Despite many positive changes in gender roles in the past few decades, unfortunately, the cultural expectation is still that men are the pursuers and women are the pursued, especially among traditional men and women. This places the burden on men to make the first move and risk rejection, which can create stress and anxiety. It also creates anxiety and frustration for women when they're in the passive role of waiting for men. With dating experience, over time, many men learn to deal with rejection, but many others never overcome this fear. They hope they'll be able to pick up on social cues from women who are interested, but these cues might be confusing or nonexistent in certain situations. If a man is especially fearful of rejection, he might feel his whole sense of self is on the line. Due to his fear, he might avoid taking the initiative--only to feel bad about himself later (see my article: Coping With Fear of Rejection).

• Fear of Not Pleasing Their Partner in Bed: There's an unfair stereotype of men being mostly focused on their own sexual gratification. This stereotype is amplified in most male-oriented pornography which focuses primarily on men's pleasure (the exception to this is ethical porn).  Although this might be true for some men, especially in hookup situations, many men worry about whether they're pleasing women in bed. And, while it's important not to be selfish in bed, the misconception that men are responsible for "giving" women orgasms puts a lot of pressure on both men and women. It also casts women in a passive role as if they're only the recipients of sexual pleasure and not capable of generating their own pleasure.  Unfortunately, many men also base their sense of masculinity and sexual self esteem on whether or not their female partner has an orgasm instead of whether she enjoyed sex.  If their partner doesn't have an orgasm, they feel inadequate.  In some cases, due to a man's existing feelings of inadequacy, he can become so worried about his partner's pleasure that he loses sight of his own pleasure,. This can lead to other problems, including erectile dysfunction (see my articles: What is Sexual Anxiety? and What is Sexual Self Esteem?).

The Sexual Insecurities of Men

• Fear of Having a Small Penis: Another common male insecurity is fear having a small penis. This is especially true of men who watch a lot of pornography and who compare their penis to the penises they see in porn. What many men don't know is that male porn actors are specifically chosen because they have unusually large penises as compared to the average penis, which is about 5.1-5.25 inches long. Fear of having a small penis also creates a lot of shame, which can affect a man's ability to initiate sex or create anxiety about maintaining an erection.  In reality, size doesn't matter with regard to sexual pleasure, and most women don't care about penis size. Also, even a man with a micropenis, which is about 3.67 inches or less, can be give and receive pleasure.

• Fear Related to Overall Body Image: Body image issues are usually associated with women. But, even though women are mostly the ones who are negatively impacted by unrealistic body images portrayed in the media, men are also affected by unrealistic images of having "six pack" abs or a muscular build, which often creates anxiety about taking off their clothes during sex.  Other body image insecurities can include hair loss, weight, height and so on.

• Fear of Erectile Dysfunction (ED): All of the above fears can result in problems with erectile dysfunction, which most men dread. The cause of ED is often psychological due to stress, anxiety, lack of sleep, alcohol consumption, smoking cigarettes, drugs and so on. There are also some medical problems, like diabetes, high blood pressure, prostate problems that can cause ED.  If ED, premature ejaculation (PE) or delayed ejaculation (DE) is a problem, a man should see a urologist to rule out any medical problems first and then see a sex therapist to deal with psychological issues. Erectile problems can also be a combination of physical and psychological problems so that a urologist and sex therapist would collaborate in treatment.

See my article: The 5 Most Common Sexual Insecurities That Heterosexual Women Have

Overcoming Sexual Insecurities in Sex Therapy

Sex therapy is a form of talk therapy that focuses on sexual issues (see my article: What is Sex Therapy?)

Getting Help in Sex Therapy

There is no physical exam, nudity or sex during sex therapy sessions (see my article: What Are Common Misconceptions About Sex Therapy?).

Many individual adults and couples seek help in sex therapy for a variety of reasons (see my article: What Are Common Issues Discussed in Sex Therapy?).

Rather than struggling on your own, seek help from a licensed mental health professional who is a sex therapist so you can lead a more fulfilling life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I am a sex-positive therapist who works with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.