Sexual difficulties are common among people experiencing post-traumatic stress disorder (PTSD) or anxiety disorders. If you're dealing with changes in your sexual health alongside these mental health conditions, you're not alone—and there are effective ways to address these concerns.

The Connection Between Mental Health and Sexual Function

Trauma can profoundly affect a person's sense of safety, self-efficacy, and ability to trust and connect with others—all features that are fundamental to healthy sexual functioning. Research shows that PTSD is related to an increased risk of developing sexual difficulties, with the association being most evident in overall sexual function, sexual satisfaction, sexual desire, and sexual distress. Similarly, anxiety disorders have been identified as having a high prevalence of erectile dysfunction, with a median value of 20%, though this varies widely among individuals.

How PTSD Affects Sexual Health

The psychobiology of PTSD may result in an association of arousal with threat, an impaired ability to downregulate the fear response, and difficulty engaging the inhibitory neurobiological processes associated with sexual activity. In simpler terms, the body's alarm system stays "on," making it hard to relax and feel safe during intimate moments. People with PTSD may actively avoid sexual activity to minimize feelings of physical arousal or vulnerability that could trigger flashbacks or intrusive memories. This avoidance is a natural protective response, but it can create challenges in relationships and personal wellbeing.

Common Sexual Concerns with PTSD

Research indicates that PTSD impairs sexual functioning across multiple domains: desire, arousal, orgasm, activity, and satisfaction. The most reported problems include erectile dysfunction, premature ejaculation, and overall sexual disinterest. Experts theorise that PTSD symptoms may contribute to sexual difficulties if distressing thoughts or flashbacks occur during sexual activity, the person feels emotionally or physically vulnerable during sex, sexual activity reminds the person of the traumatic event, or negative beliefs make it difficult to be present during the experience.

How Anxiety Affects Sexual Health

The brain filters our emotional and psychological responses to sex, analysing questions about desire, safety, performance, and connection. When anxiety is present, it can interfere with this natural process. An abnormal anxiety response causes an increase in sympathetic tone, resulting in a distraction from erotic stimuli leading to impaired arousal. This means anxiety activates the body's "fight or flight" response, which works against the relaxation needed for sexual arousal.

Common Ways Anxiety Affects Sexual Function

Anxiety's effects on sexual function can take many forms, including:

• Low desire: Anxiety can make us less interested in sex
• Performance concerns: Worrying about pleasing a partner can interfere with natural responses
• Pain: The expectation of pain can become so intense that it blocks pleasure
• Difficulty with orgasm: Anxiety can have a cumulative effect, making it harder to reach orgasm
• Avoidance: Some people may avoid dating, relationships, and sex entirely

Sexual performance anxiety can become a difficult cycle in which worries contribute to sexual difficulties like erectile dysfunction or premature ejaculation, which then causes more worry about future performance.

Stellate Ganglion Block: A Novel Approach to Nervous System Regulation

An emerging treatment option that addresses the underlying nervous system dysregulation in PTSD and anxiety is the Stellate Ganglion Block (SGB). This procedure may be particularly helpful when sexual dysfunction is related to sympathetic nervous system overactivity.

What is a Stellate Ganglion Block?

The stellate ganglion is a collection of nerves located at the base of your neck that plays a key role in your body's "fight or flight" response. When you experience PTSD or severe anxiety, your sympathetic nervous system can become stuck in an overactive state, constantly signalling danger even when you're safe. An SGB is an outpatient procedure where a local anaesthetic is injected near these nerves under ultrasound guidance. The procedure takes less than 30 minutes and works by temporarily blocking the overactive sympathetic signals, allowing your nervous system to "reset" to a more balanced state.

How SGB Relates to Sexual Function

Sexual function is regulated by the autonomic nervous system, which includes both the sympathetic ("fight or flight") and parasympathetic ("rest and digest") branches. For healthy sexual response, your body needs to be able to shift into the parasympathetic state - you need to feel safe, relaxed, and present. When the sympathetic nervous system is chronically overactive due to PTSD or anxiety, it can override the parasympathetic responses needed for sexual arousal and satisfaction. By reducing excessive sympathetic tone, SGB may help restore the natural balance needed for sexual function. Research has shown improvements in heart rate, digestion, and sexual function following SGB treatment.

Evidence for SGB

Research on SGB has shown promising results. A randomized clinical trial published in JAMA Psychiatry in 2020 demonstrated that SGB was twice as effective as a sham procedure for reducing PTSD symptoms. Additionally, a study of 285 patients showed that anxiety scores dropped significantly following SGB treatment, with approximately 80% of patients demonstrating clinically meaningful improvement that lasted at least one month. The procedure has been used successfully for over a decade to treat thousands of military service members, veterans, and civilians with PTSD and anxiety. Many patients report rapid improvements—often within minutes to days—in symptoms including hyperarousal, sleep difficulties, and overall quality of life.

Important Considerations

While SGB is new/novel and shows promise in this space, it's important to understand that: • Results can vary from person to person • Some patients may benefit from repeat treatments • SGB works best as part of comprehensive care that may include therapy and other treatments • The procedure should only be performed by specially trained physicians using image  guidance

Positive steps. Start here

The good news is that both PTSD/anxiety and sexual difficulties are treatable.

1. Talk to your Healthcare Provider:
   The increasing documentation of the comorbidity of PTSD and sexual dysfunction warrants a call for training for providers and screening for patients presenting with trauma exposure or sexual dysfunction. Don't hesitate to bring up sexual health concerns with your doctor - it's an important part of your overall well-being.
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2. Communicate with your Partner:
   If you are in a relationship, try to speak with your partner about how you are feeling. Encouraging understanding between you and your partner will be helpful for working through sexual issues.
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3. Seek Specialised Support:
   In addition to consideration new and novel treatments, you can also consider seeing specialist who focuses on couples therapy where you and your partner can learn to work through issues constructively.
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4. Practice Self-Compassion:
   Remember that sexual difficulties related to PTSD or anxiety are not your fault. They're a common response to stress and trauma, and with appropriate support, improvement is possible.

Points to Remember

• Sexual difficulties are very common among people with PTSD and anxiety disorders
• These issues affect all genders and can involve desire, arousal, orgasm, and satisfaction
• The connection between mental health and sexual health is bidirectional treating one often helps the other
• Effective treatments are available
• Open communication with healthcare providers and partners is essential
• You deserve comprehensive care that addresses all aspects of your health and wellbeing

Key Medical References:

1. Yehuda, R., Lehrner, A., & Rosenbaum, T. Y. (2015). PTSD and sexual dysfunction in men and women. The Journal of Sexual Medicine, 12(5), 1107-1119. https://www.sciencedirect.com/science/article/abs/pii/S1743609515310249
2. Nunnink, S. E., Goldwaser, G., Heppner, P. S., Pittman, J. O., Nievergelt, C. M., & Baker, D. G. (2010). Female veterans of the OEF/OIF conflict: Concordance of PTSD symptoms and substance misuse. Journal of the American Psychiatric Nurses Association, 16(4), 243-254.
3. Atlantis, E., & Sullivan, T. (2012). Bidirectional association between depression and sexual dysfunction: a systematic review and meta-analysis. The Journal of Sexual Medicine, 9(6), 1497-1507.
4. Psychiatric Times. (2020). The Relationship Between Anxiety Disorders and Sexual Dysfunction. https://www.psychiatrictimes.com/view/relationship-between-anxietydisorders-and-sexual-dysfunction
5. Annals of General Psychiatry. (2021). Posttraumatic stress disorder and the risk of erectile dysfunction: a nationwide cohort study. https://annals-generalpsychiatry.biomedcentral.com/articles/10.1186/s12991-021-00368-w
6. PMC. (2022). Erectile dysfunction in patients with anxiety disorders: a systematic review. https://pmc.ncbi.nlm.nih.gov/articles/PMC8964411/
7. Heiman, J. R. (2002). Sexual dysfunction: Overview of prevalence, etiological factors, and treatments. The Journal of Sex Research, 39(1), 73-78.
8. VA Research. (2015). Sexual dysfunction a common problem in Veterans with PTSD. https://www.research.va.gov/currents/spring2015/spring2015-3.cfm
9. Hanling, S. R., Hickey, A., Lesnik, I., et al. (2016). Stellate ganglion block for the treatment of posttraumatic stress disorder: A randomized, double-blind, controlled trial. Regional Anesthesia & Pain Medicine, 41(4), 494-500. https://journals.lww.com/rapm/Abstract/2016/07000/Stellate_Ganglion_Block_for_ the_Treatment_of.14.aspx
10. Lynch, J. H., Mulvaney, S. W., & Bryan, C. J. (2023). Stellate ganglion block reduces anxiety symptoms by half: A case series of 285 patients. Journal of Personalized Medicine, 13(6), 958. https://www.mdpi.com/2075-4426/13/6/958
11. Peterson, K., Bourne, D., Anderson, J., Mackey, K., & Helfand, M. (2017). Effectiveness of stellate ganglion block for treatment of posttraumatic stress disorder (PTSD). VA Evidence Synthesis Program. https://www.ncbi.nlm.nih.gov/books/NBK442253/
12. Blakey, S. M., et al. (2024). Differential posttraumatic stress disorder symptom cluster response to stellate ganglion block: Secondary analysis of a randomized controlled trial. Translational Psychiatry, 14, 223. https://www.nature.com/articles/s41398-024-02926-8

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This information is for educational purposes and should not replace professional medical advice.