Monday, May 27, 2013

Anxiety and How It Effects Sexual Function and Performance

  •  This was just written for a final paper for a bio-psychology classes I just finished. I am touching on sexual anxiety and how it is formed in the brain and manifests in your bedroom. Enjoy!

Anxiety and How It Effects Sexual Function and Performance
  • Sex starts in the mind. As much as it is considered a purely physical entity in the human experience, the researcher has found supporting evidence that sexual function is a mental function. There are neurons and neurotransmitters in the brain that supports every function in the human body. Because it is a bio-psychological entity in the opinion of the researcher, then it is possible for people to suffer from sexual dysfunction, especially when it stems from anxiety. Anxiety, being a very broad and general area of mental illness, can range from simple fears to a serious traumatic experience and has been a proven common denominator of sexual dysfunction and disorders. One thing that is for sure about anxiety is that it effects sexual function that must be addressed further to understand, educate, and discover possible treatments in regards to its bio-psychological process in individuals who seek to have satisfying and fulfilled relationships.
  • Anxiety is a fear-based disorder that expands from the simplest phobias to the most pivotal mental illnesses. In fact, fear is the main cause of anxiety even though it can be as simple as mild trepidation and to be as extreme as acute terror (Lefrancois, 2011). Fear is a negative emotion as everyone should know considering everyone has experienced it in some capacity. In fact, William James and Carl Lange discussed emotion in what has become known as the James-Lange Theory of Emotion which states that “a stimulus produces a psychological response and a physiological response produces an emotion” (Wilson, 2012). Sexually, this could mean that a person could have a particular negative experience that would cause them to be sexually dysfunctional. A stimulus to a man or woman could be that they are sexually assaulted which could produce anxiety causing them to not be able to perform sexually due to the fear of being raped again. Another stimulus would be hearing from a partner that they are not adequate in bed which could lead to lack of confidence and out of fear of inadequacy would not be able to perform sexually as they could.
  • People naturally will fear many things and there are many ways people develop anxiety because of this. In regards to a sexual relationship, a person could have what they consider to be a poor performance due to their past relationships that may have gone wrong. For example, a man may under-perform or even over-perform because he is insecure about his size based on hearing from previous partners the same complaints that continue to playback in his mind over and over again creating a pattern in the brain. It has been determined that there are specific brain waves that create undesirable results when it comes to functioning from the brain as a whole (Cleary, 2011). This is how having anxiety creates the possibility that people will develop sexual dysfunction. Sexual anxiety disorder, for example, develops in a man or woman due to fear which causes them to completely avoid sexual experiences as a whole (Brotto, 2009).
  • The brain is a major part of the nervous system in the human body and it contains neurons which are cells that transport communication throughout the nervous system (Wilson, 2012). Neurons create neurotransmitters which are chemicals that communicate through a junction between at least two neurons- a process also known as a synapse (Wilson, 2012). It is synonymous to a car battery in a car that provides electricity for all the electrical functions of the car (lights, stereo, etc.). To understand further how the brain functions when it comes to sexuality there needs to be an understanding of what neurotransmitters operate specifically for sexual function.
  • Nitric oxide (NO) has been discovered to be the main neurotransmitter that is in charge of sexual function although anxiety affects the entire brain chemistry in many different ways that can lead to sexual dysfunctions and disorders. First discovered in 1987 while acetylcholine, another prevalent neurotransmitter that produced dilation of blood vessels when this neurotransmitter was present, nitric oxide (NO) is also involved in our ability to eat, learning, memory, and aggressive behaviors along with sexual function (Wilson, 2012). The interesting thing behind this neurotransmitter is that it is involved in areas outside of just the physical aspect of sex which can lead to possible hypothesis and theories on how diet, exercise, traumatic experiences, and cognition can all relate to our sexual experiences.
  • It seems as if nitric oxide is available when acetylcholine is present at least when blood vessels are being dilated. Acetylcholine is a neurotransmitter found throughout the entire central nervous system and is also responsible for several functions in the body- one function including reducing anxiety in an individual (Wilson, 2012). Considering acetylcholine is involved with several functions in the body, perhaps a lack of it can also effect nitric oxide levels or even the use of it which can potentially effect sexual function. Low levels of nitric oxide causes sexual dysfunction while low levels of acetylcholine causes an increase of anxiety.
  • While sex is something that everyone will encounter directly and indirectly, anxiety is becoming more common causing many different disorders that are being untreated. Because of this, even sexual functioning is becoming more and more difficult among the general population as a result of poor self-esteem leading to having a much stronger anxiety in individuals (Nelson & Purdon, 2011). There is no clear indication of a specific group or sex that suffers from sexual dysfunction as a result of anxiety, but it has been proven that it effects the general population regardless of status, race, gender or sex. In fact, the initial research that was considered for this paper was dependent on studies unrelated to sexual function specifically but dealt with sexual dysfunction as a symptom that effects the general population.
  • The researcher believes that many of our relationship issues, even sexual ones, can come from experiences from childhood. In fact, a study claims that children with extreme shyness can actually grow up to have extreme anxiety disorders, including social anxiety disorder (Burstein, 2012). Due to the fact that many people grow up with a poor self-image of themselves and low self-esteem, it is effecting their adult relationships that includes how they make love to their mate. This can be commonly seen with people who have been victims of childhood sexual abuse, but it is not limited to just that. A man who is made fun of for being too short may grow up to feel inadequate to his lover. Likewise, a woman could have been teased as a child and become very promiscuous or lack in her libido.
  • Additionally, the researcher believes that sexual disorders and dysfunctions result from anxiety which can be considered an environmental factor because it stems from what people experience rather than genetics. Many people grow up with fears and never let them go and in many cases the fears will become either very serious or minute depending on what they do in regards to their mental health. Unfortunately, anxiety disorders often go undetected and untreated even in primary care settings (McGrandles & Duffy, 2012). Because anxiety is so broad, it is difficult to diagnose a person with a particular anxiety disorder until it develops into a more prevalent disorder. For many sexual dysfunctions, it would start symptomatic and eventually form into a disorder, just as a synapse can create brain wave activity that may create unhealthy patterns in the brain.
  • So, in essence, every bodily function relies on the brain and the entire nervous system to operate. The brain, being the motherboard of the body, holds memories, thoughts, thinking patterns and other biological processes that is effected by the psychological processes. Sexual performance relies on a person’s mental capacity rather than their physical ability. Anything can be the cause of a person’s sexual dysfunction when anxiety is involved. However, the trauma is nothing physical directly. Following a penile fracture, one study proved that there has been no evidence proving that something this traumatic has caused anxiety or depression after repair even though there needs to be more observation to prove this (Penbegul, et al., 2012). It doesn’t mean it couldn’t cause depression, however it doesn’t directly cause it unless it was tied to something else. Further study is needed, however the participants in this study went back to having normal sexual lives as if nothing happened (Penbegul, et al., 2012).
  • No matter what causes the anxiety in a person, it has to manifest in the brain first even when it comes to a person’s sexual performance. A study was performed to understand the metacognition of patients with erectile dysfunction and premature ejaculation proving how anxiety is what causes both disorders (Bagcioglu, et al., 2011). This study showed how participants think about how they “think” and even how they were able to improve their sexual performance when they changed how they thought about themselves and their performance. So even before a neuron can do its job in the brain, a thought has to be created and even accepted. Considering fear has to be present for a long period of time to create anxiety and even longer before a disorder can be diagnosed, the thought has to begin the process. The thought can be produced as a result of a negative experience that could include abuse, being teased, being cut from the football team, losing a loved one, contracting a disease among other things.
  • So even with the knowledge of nitric oxide being the main neurotransmitter that allows a person to perform sexually, a person would still have to maintain a positive, non-fearful mindset to curb anxiety in the bedroom. It was stated in the article on erectile dysfunction, premature ejaculation, and how it is effected by metacognition the following: “We suggest that patients who have higher cognitive self-consciousness scores may have an elevated focus of self and might display intensified responses to threatening stimuli” (Bagcioglu, et al., 2011). People who had higher self-esteem and more of an awareness of themselves as an individual was able to pinpoint any anxieties and issues they may have and be able to cope and heal from them. In other words, self-knowledge is key and being honest about the emotions, especially fear, is a way to allow a person to heal or even avoid anxiety. In fact, self-knowledge and self-esteem is important to be able to maintain a healthy mind, even during and after a negative experience that could potentially cause fear leading to anxiety.
  • Unfortunately, sexual disorders among men and women develop due to extensive fear caused by various experiences that are often unnoticed until it’s too late. Erectile dysfunction & premature ejaculation in men is caused by anxiety as discovered within the last two decades and anxiety has been considered a coping mechanism for them (Bagcioglu, et al., 2012). Anxiety was a way to cope so that they would not have to experience the stimuli that caused the anxiety anymore at the expense of their sex life. So there are men who would either avoid sex or would even stop dating to not have sex because they don’t want to risk the disappointment or the past negative experience that caused their fear ever again.
  • Interestingly, in this particular study it was also noted that men already with premature ejaculation eventually would form anxiety (if they weren’t anxious initially) which lead to erectile dysfunction (Bagcioglu, et al., 2012). There were several times when men who suffered from premature ejaculation for other various reasons developed anxiety because of their performance. Because it was not treated or handled in a healthy way they suffered further and eventually was diagnosed with erectile dysfunction. This is why the researcher believes that treatment should include cognitive therapy so that not only are they receiving the proper medications, diet, and other treatments that might be needed, they can also retrain their brain on how to think so that they may be able to optimize their sexual performance.
  • It seems to be the same with women when it comes to the orgasm. It is noted in another study that women who do not have an orgasm have feelings of inadequacy and distress; in fact, distress is what caused the lack of orgasm (Laan & Rellini, 2011). The issue with this was not the orgasm itself, but whether or not an orgasm is important. The female orgasm ideals varies among cultures- some cultures praise it while others condemn it (Laan & Rellini, 2011).
  • It seems that the cause of a woman’s orgasm, or the lack thereof, as well as her performance is based on fear considering what is deemed as acceptable or unacceptable. However, a woman’s ability to orgasm at some time in their life span is usually the determining factor of their sexual satisfaction (Laan & Rellini, 2011). One of the main issues with how a woman thinks about herself is dependent on her body image and how she genuinely feels about herself. The more a woman is open to the idea with self-confidence within and maintains a healthy mental process in her brain, the more likely she will achieve climax and have a healthy sex life. Whether man or woman, a person’s sexual satisfaction stems from the positive and negative dimensions of their sexual experiences and variables that include relationship satisfaction and even self-esteem (Stephenson & Meston, 2011).
  • Regardless of how fear is implemented in a person’s mind that leads to anxiety, in order to treat sexual dysfunction, the patient will have to be treated for anxiety to pinpoint the exact underline cause of it. There are a range of treatment options that span between pharmacological, psychological, dietary, and self-help therapies (Mcgrandles & Duffy, 2012). In fact, based on the evidence presented in this paper, the researcher supports all of these therapies when it comes to treatment critically with pharmacological methods being the last resort. Because anxiety is fear based, psychological and self-help therapies would help to transform a person cognitively and have a much healthier thought process about themselves. Fear of failure and inadequacy to control an orgasm can develop a more serious cycle of failure with an individual (Bagcioglu, et al., 2012). So it is important to focus on a person’s mental health to help them to hopefully regain their sexual confidence back. In fact, it is suggested that cognitive behavioral therapy should be implemented to treat sexual disorders to reduce anxiety that is causing it (Lofrisco, 2011).
  • Also, sexual dysfunctions are commonly coupled with another psychological disorder (Hoyer, et al., 2009). The main cause of sexual dysfunction is usually tied to something else whether it is morbid and tied to a physical illness such as diabetes or a psychological disorder such as schizophrenia and depression. As mentioned earlier, sexual dysfunction usually starts as a symptom of something else, even if it is just a fear of flying or being in the dark (this is the bare minimum of anxiety). However, a person must pay attention to their sexual responses when there is an unfortunate experience in their life regardless of the severity. This is proof that sexual performance is not based on physical performance alone, but it is based on how a person thinks even before, during, and after sex.
  • More studies are necessary to discover any form of anxiety disorders that are related to sexuality that would provide information & solutions for treatment, counseling, and education. Although there aren’t any cases reported in the one study that penile fractures causes anxiety, there is still a possibility that it can cause anxiety and erectile dysfunction, another bio-psychological condition (Penbegul, et al., 2012). Because sexual dysfunction is a recently studied area by scientists and psychologists, it is hard to tell what exactly are the causes and concerns of anxiety when it comes to sexuality. Even a more unfortunate circumstance is that epidemiological studies rarely include measures of the importance of sexual well-being (Stephenson & Meston, 2011). Some of the most important studies that cover bodily and psychological functions do not cover sexuality because it is seen as a secondary issue even though it has been proven that anxiety’s effects on sexuality has become a very prevalent topic.
  • Since it is now known that nitric oxide is important for sexual function from the brain and it is tied to eating, aggression, memory, & learning, the researcher would suggest that there are many ways to maintain a healthy and balanced sex life. This would include eating healthy and doing activities that would support a healthy sexual lifestyle that would cause aggression to dwindle and bad memories to serve as learning opportunities. Considering that it has already been proven that anxiety is the major cause of sexual dysfunctions and disorders, a healthy mind is just as important as a healthy body. Having a healthy mind will maintain the necessary nitric oxide levels needed to be able to have optimum performance during intercourse.
  • Physiologically everything starts in the brain. Neurotransmitters determine when we are hungry, sleepy, and even horny. Just as there are disorders in eating and sleeping, there are also disorders that directly affect our sex lives that are caused to anxiety. Anxiety is developed from over-extensive and under-treated fears can lead to sexual dysfunction, whether it is diagnosed or not. The harsh reality is that individuals, whether single or in a relationship, are suffering in this area because there is a lack of information and study. Understanding what fear does to the mind, how it leads to anxiety & eventually anxiety disorders, and how it can affect sexual function & performance is necessary for further study, treatment options, and dialogue for the sake and benefit of our sexual and mental health. The fact remains that anxiety is the major cause of sexual dysfunction in men and women requiring further consideration for study as well as a major part of diagnosis & treatment for people who suffer from it, in the bedroom, in the closet, and beyond.

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