Stress and anxiety are an unavoidable part of life, something we are constantly inundated with on a daily basis. Stress has been especially pervasive in recent months, perhaps because many of us have been isolated from our loved ones during the coronavirus pandemic or caught up in all of the sociopolitical upheaval that dominates our daily news feeds. Whatever the source, stress can have harmful effects on much of the way we interact in the world. It can influence everything from our mood to our appetite to our sex lives.
When we encounter stress, a biological response is triggered. Our bodies release chemicals and hormones in reaction to a perceived threat or challenge. And all of this is carried out largely without our control. Usually, after this stress response occurs, our bodies return to a relaxed state. But in times of constant stress, this does not always happen and we can start to experience negative consequences to our health.
As a sexual health specialist, I have seen the various ways increased stress can have a detrimental impact on sexual function. This has become even more obvious recently with many patients reporting new onset erectile dysfunction, increased sexual pain, and dramatically declining libido. Previously stable, longstanding patients are coming in suddenly incapable of performing or insisting that something feels off in their sex lives.
What follows is an overview of stress and its relationship to your health. You may not be able to avoid stress, but understanding more about it will hopefully help you manage your response and minimize how it might upend your sex life.
Types of Stress
Acute stress happens to everyone. Your body reacts suddenly to a fleeting new and challenging situation. It’s that feeling you get when you’re about to give a presentation in front of a large crowd or nearing the top of a roller coaster or narrowly avoid a car accident. Your heart begins racing and your blood pressure starts rising. Other symptoms include irritability, chest or back pain, headache, and gut issues. Acute stress is an amalgam of fear and thrill and it’s typically momentary. Once the danger ceases, your body typically returns to normal. If the acute stress is particularly severe, some people may develop post-traumatic stress disorder (PTSD) or other longstanding consequences.
Episodic acute stress is a recurring type of stress characterized by regularly occurring mini-crises that result in symptoms that occur more often and tend to accumulate. People with episodic stress live in a state of tension. This can occur in a variety of life situations but is especially prevalent in professions constantly exposed to frequent high-stress situations like firefighters or law enforcement. Over time, a pattern of episodic acute stress can start to affect your self-esteem, relationships, and work. People with episodic acute stress sometimes turn to unhealthy coping strategies like overeating, binge drinking or drug use, or clinging to bad relationships. Some even give up pursuing pleasurable activities or worthwhile goals altogether. If mismanaged, episodic acute stress can affect your physical and mental health and lead to issues like heart disease and depression.
Chronic stress is the constant wearing down of our best coping mechanisms over months to years. It typically arises from more serious issues that seem beyond our control, like childhood trauma, poverty, or systemic racism. Sometimes these problems can feel so overwhelming that people accommodate rather than fight the source of chronic stress. This almost always has a negative impact on our health. Chronic stress may contribute to anxiety, depression, high blood pressure, cardiovascular disease, weight gain, insomnia, a weakened immune system, abdominal pain and gut problems, and even memory or cognitive dysfunction.
Sources of Stress
Physical stress is a type of stress that occurs in the body. Some examples include infection, surgery, environmental pollution, chronic illness, malnutrition, dehydration, and hormonal deficiencies. Psychological stress occurs outside the body. It can involve emotional factors, a sense of feeling out of control, guilt, shame, jealousy, and certain misguided beliefs, attitudes, and perceptions. Social stress can entail difficulty in relationships, a lack of social support and resources, a loss of a loved one, and isolation. Spiritual stress may involve misalignment of one’s core beliefs, values, meaning, and purpose.
The Biological Response to and Physical Manifestations of Stress
No matter the source, stress can have real-life, physiological consequences. When you sense danger, the hypothalamus—the hormone-regulating center in your brain—reacts by sending signals to several parts of your body. In the short term, epinephrine (or adrenaline) is secreted and causes various changes including increased heart and respiratory rate, contraction of blood vessels, sweating, decreased insulin production, and increased glucose metabolism in your muscles. These adrenaline-induced changes can be helpful in the moment but over time can lead to hypertension, peripheral vascular disease, and even stroke and heart attacks.
Chronic stress results in elevated cortisol levels, the primary stress hormone. Cortisol serves many functions including increasing blood glucose, improving glucose metabolism in the brain, altering the immune response, dampening the reproductive system, and generally restraining non-essential bodily functions. Again, this can be helpful in the short term but chronically elevated cortisol levels can lead to weight gain, fatigue, diabetes, osteoporosis, low libido, erectile dysfunction, brain fog, and a weak immune system.
Stress and Sexual Function
When your mind and body are overwhelmed by stress, it’s often hard (no pun intended) to function sexually. Think of it this way: when you are stressed, your body tends to focus on managing the issue at hand and other functions like sex take a back seat. How our bodies carry out sexual functions is largely regulated by the hypothalamus-pituitary-adrenal (HPA) system. Long-term stress can lead to dysregulation of this system with abnormal basal and stress levels of the HPA hormones cortisol and dehydroepiandrosterone (Basson). Chronic stress can also affect normal production of testosterone, which can result in a decline in sex drive or libido and can even lead to erectile dysfunction.
Blood cortisol and adrenaline levels tend to increase together as part of the HPA and sympathetic nervous systems when stress is encountered. Cortisol and sympathetic nervous activity is thought to have a restraining effect on arousal and has been shown to negatively affect erectile function (Kobori). In one study, serum cortisol levels in healthy volunteers significantly decreased in the systemic circulation and the erectile tissue with increasing sexual arousal (Ückert). This seems to suggest that as we become aroused, cortisol tends to decrease thereby allowing erection. But if you are chronically stressed and in a constant elevated cortisol state that erection may not happen.
Similar findings have been reported in female sexual function as well. One study found that high levels of chronic stress were related to lower levels of genital sexual arousal in women watching erotic films. The authors reported both psychological (distraction) and hormonal (increased cortisol) factors were related to the lower levels of sexual arousal seen in women under chronic stress (Hamilton). Another study looking at the effects of burnout and occupational stress on sexual function in both male and female participants found that burnout was associated with sexual dysfunction in men (erectile dysfunction and reduced sexual satisfaction) whereas job stress correlated with female sexual problems, including lubrication and orgasm.
The bottom line: too much stress is bad for sex.
Stress and Reproductive Function
Chronic stress can also negatively impact reproductive function, including sperm production and maturation. As previously mentioned, stress results in abnormally low testosterone production, and testosterone is crucial for normal sperm making. Some research suggests that men under regular stress may have a lower percentage of sperm motility (how they swim) and a lower percentage of normal sperm morphology (how they look), compared with men who report low stress. Abnormal sperm production and maturation can cause fertility issues in couples trying to conceive.
Stress can also play an important role in normal menstruation and reproductive function in women. High levels of stress may be associated with absent or irregular periods, more painful periods, and even changes in the length of menstrual cycles. In women with premenstrual symptoms like cramping, bloating, negative mood (including depression), and mood swings, stress may make their symptoms considerably worse. Stress can also negatively influence a woman’s ability to conceive, compromise the health of her pregnancy, and impact the postpartum period. Excess stress increases the likelihood of developing depression and anxiety during and after pregnancy. Furthermore, maternal stress can negatively affect fetal and ongoing childhood development.
With all the potential havoc that stress can wreak, it is important to highlight how you can combat its effects and avoid compromising your sexual and reproductive function. Exercise is a great way to help reduce the impacts of stress. Eating a healthy diet and getting 7-8 hours of sleep each night helps to regulate your cortisol and hormonal levels. Meditation and mindfulness are also great tools to calm your nerves. Minimize your intake of caffeine and alcohol. Foster a strong social network and stay connected with those who support you (even if that means virtually). Practice deep breathing, get a massage, listen to your favorite relaxing music—all of these can help curb stress, keep cortisol at bay, and help increase your sexual and reproductive potential.
Like we said from the beginning, stress is inescapable. But how you respond to it is what matters most. The goal of stress management is not to rid you of stress altogether. It’s about recognizing the cause of your stress and doing your best to avoid similar situations or finding ways to cope with those situations in a healthy way. It takes practice.
If you find it difficult to manage stress on your own, especially if you are experiencing overwhelming depression or anxiety, ask for help and consider talking to your doctor or other mental health professional. You’d be surprised at how many people may be struggling with stress just like you.
Over time, stress management will help you maximize your sexual and reproductive health and reduce your risk of other stress-related diseases. And it’ll also help you feel better on a daily basis. As the Irish playwright George Bernard Shaw once said, “People become attached to their burdens sometimes more than the burdens are attached to them.” So for the sake of your mental, sexual, reproductive, and overall health, do your best to let go of your burdens.
Basson R, O’Loughlin JI, Weinberg J, Young AH, Bodnar T, Brotto LA. Dehydroepiandrosterone and cortisol as markers of HPA axis dysregulation in women with low sexual desire. Psychoneuroendocrinology. 2019 Jun;104:259-268. doi: 10.1016/j.psyneuen.2019.03.001.
Kobori Y, Koh E, Sugimoto K, et al. The relationship of serum and salivary cortisol levels to male sexual dysfunction as measured by the International Index of Erectile Function. Int J Impot Res. 2009;21(4):207-212. doi:10.1038/ijir.2009.14
Uckert S, Fuhlenriede MH, Becker AJ, Stief CG, Scheller F, Knapp WH, Jonas U. Is there an inhibitory role of cortisol in the mechanism of male sexual arousal and penile erection? Urol Res. 2003 Dec;31(6):402-6. doi: 10.1007/s00240-003-0359-5.
Hamilton LD, Meston CM. Chronic stress and sexual function in women. J Sex Med. 2013;10(10):2443-2454. doi:10.1111/jsm.12249
Papaefstathiou, E., Apostolopoulou, A., Papaefstathiou, E. et al. The impact of burnout and occupational stress on sexual function in both male and female individuals: a cross-sectional study. Int J Impot Res 32, 510–519 (2020). https://doi.org/10.1038/s41443-019-0170-7