The complex relationship between anxiety disorders and desire disorders is rarely clarified in the medical literature. Kaplan1 underlines a strong prevalence of panic disorder (25%) in patients affected by $exual aversion disorder. Anxiety is also relevant in sexual arousal. Induced by different stressors, anxiety can distract from erotic stimuli and impair $exual arousal, principally through an increased sympathetic tone.3,4 This may result in poor erection in males and a reduction in lubrication and clitoral tumescence in females.

Various aspects of anxiety are historically considered in arousal disorders, particularly the vicious circle of anxiety/dysfunction/performance anxiety.5 Honeymoon impotence is a specific example of this, as suggested by Shamloul,6 who studied 100 patients with this problem.

Several studies have found that the prevalence of anxiety disorders varies from 2.5% to 37% in males affected with erectile dysfunction (ED).7-9 However, these studies failed to point out a significant correlation between a sin-gular type of anxiety disorder and ED. Recently, however, a link between free-floating anxiety and ED has been suggested.10 Others report that the association between anxiety (as a feeling) and ED is strongest in patients aged 45 to 54 years.11

One study found that the presence of anxiety symptoms in patients with arousal disorders was associated with poor treatment outcomes.7 Hyperarousal syndromes, such as persistent sexual arousal, are not found in DSM-IV-TR. The specific role of anxiety in these cases is unknown. Leiblum and colleagues12 described 103 women with involuntary genital and clitoral arousal. An anxious experience represented the trigger in one third of these women. Anxiety-related symptoms such as worry, panic attacks, and obsessive thoughts or behaviors were also seen in significant numbers of these patients, as were secondary anxiety symptoms (worry and embarrassment).

In addition to desire and arousal, orgasm may also be impaired by anxiety. While it is widely accepted that anxious thoughts or feelings disrupt female orgasm, few studies have examined this relationship or tried to identify specific aspects of anxiety related to impaired orgasm.13-15

Negative emotions, including anxiety or fear of failing to meet a partner’s expectations, represent one of the most common causes of premature ejaculation (PE).16-20 This has been explained by investigators as being caused by a sympathetic hyperactivity that reduces ejaculation control.20-22 Others have pointed to the role of attention, suggesting that men who are anxious during sexual intercourse are worried about sexual performance or sexual adequacy, and that these thoughts may distract attention from the sexual sensations that precede orgasm and ejaculation.18,21,23

Hyperattention to performance and fear of inadequacy in meeting others’ expectationare typical of social phobia, in which concern about performance and judgment reflect a high sympathetic tone. This has been confirmed by Tignol and colleagues24 and Corretti and colleagues,25 who report that the prevalence of social phobia is 47% and 25.5%, respectively, in patients with PE. This link between social phobia and PE was also substantiated by reports of 2 cases in which worry about social performance led to uncontrolled ejaculation.26

Other investigators propose a significant role of free-floating anxiety in PE.10 The relationship between anxiety and retarded ejaculation is unclear, although some investigators suggest that sexual performance anxiety can contribute to retarded ejaculation.18,27

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