The relationship between anxiety and sexual function is complex because it has been considered in 2 symmetrical directions: the primary symptom and the secondary consequence. Understanding the cause-effect link in clinical practice necessitates experience and an expanded point of view.

The relationship between anxiety and sexuality can be theoretically described as one of the following:

  • Anxiety may cause sexual failure.
  • SDs may cause anxiety.
  • SDs and anxiety are not causally related.
  • Anxiety and SDs may be different expressions of the same processes.

The analogies in neurobiology and the good response to similar treatments (psychotherapy and/or SSRIs)53-56 seem to confirm the last hypothesis, suggesting a common root of these 2 manifestations. Obtaining a complete psychopathological and sexual history represents an important step in diagnosis that can influence prognosis with either pathology.

When investigating anxiety disorders, it is important to consider the patient’s sexual life, and vice versa. When we evaluate SD, anxiety disorder should always be considered. In our practice, failure to investigate the patient’s psychological background negatively influences the treatment goal of a patient with an SD.

The clinical evaluation should not be restricted to the patient but should extend to the partner. In particular, partners of men with SDs frequently have not only an unsatisfactory sexual life but an anxiety disorder as well.57

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