Looking at the other side of the picture, sexual difficulties are common in patients affected by anxiety disorders. Often, in fact, a sexual symptom is the first reason for consulting a physician.

Kaplan1 suggested a prevalence of SD of 75% in patients with panic disorder.1 These data were confirmed by Figueira and colleagues,40 who retrospectively evaluated the sexual function and the sexual history of 30 patients with panic disorder and social phobia. They found that sexual aversion disorder is the most common SD in patients with panic disorder, and that its prevalence in this population is greater than in the general population. Furthermore, they found that in their series, sexual aversion was secondary to panic disorder: patients said that they avoided sex because they feared having a panic attack during intercourse. These results were found in both men and women and suggest that sexual aversion may be part of the agoraphobic spectrum.40

Sexual avoidance may also be caused by ED in males affected with panic disorder. An analysis of 60,949 patients with ED showed that men with panic disorder have an increased risk (odds ratio) of ED in the range of 1.33 to 2.29.41

Studies on sexuality in patients with social phobia show a comorbidity of about 30%. Arousal disorders (loss of desire during sexual intercourse)42 and orgasm-ejaculation disorders are most common in males with social phobia. Some studies that have analyzed social phobia in male populations found a high prevalence of PE (47%),40 while others found a link with retarded ejaculation (33%).42 The correlation between PE and social phobia is accepted, but there is also a relationship between retarded ejaculation and social phobia, which underlines that the specific role of anxiety is still unclear.

Pleasure and sexual satisfaction are impaired in persons with social phobia.40,42-44 Women with social phobia are more likely to have concomitant desire disorders (46%), pain during sex (42%), and less frequency of sexual thoughts and sexual intercourse.42

SDs have a prevalence of 39% in females with OCD.45Patients may report sexual disgust, the absence of sexual desire, very low sexual arousal, anorgasmia, and high avoidance of sexual intercourse.46,47 Patients with OCD show severe impairment in both interpersonal and sexual relationships48 and they tend to perceive themselves as less sensual in comparison to patients with other anxiety disorders.46 The results are a poor level of sexual pleasure47 and a strong dissatisfaction with their sexuality (73%).45

PTSD affects emotional, social, professional, and sexual life.49,50 It is still unclear whether populations with PTSD have normal levels of sexual desire.51,52 Certainly, these patients have ED (prevalence of about 69% in combat veterans with PTSD) and problems with orgasm, and thus report a poor level of $exual satisfaction.41,51,52

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