First off, this is really embarrassing to even ask this question, but here goes. Where does one go to deal with psychological issues related to sex phobia?
I had a blow to the head about 5 years ago, which apparently damaged my pituitary. My T was probably super low for years before I had it checked out. I just thought I was going crazy. During this time, sex was not impossible, but pretty close. If I didn't take some sort of PDE5 drug it wasn't going to happen, and even then it was definitely not 100%. After 3+ years of that, I'm now on T injections and my T levels are normal. I do not have erection problems now, libido is good, I get morning wood basically every night, and everything seems A-OK on the physical side of things. Happy ending to the story, right? Nope.
While I was going through the low T nightmare, I was a nervous wreck regarding sex. Just my wife rolling over in bed to hug me would literally give me a full-on panic attack because I thought she might want to have sex, and I knew I couldn't make it happen. The thing is, even though I have fully functioning equipment now, I still have the same panic reaction as I did then. It's much less now, to be sure, but definitely there. And it's not just performance anxiety either (though it is that too). I get the same feeling when I'm all alone just thinking about sex, seeing a nice-looking woman walk by, or a happy couple walk by. Basically any random thought about sex or about other people having sex and I feel like I've been punched in the gut. The killer is that now that my T is at a healthy level, I think about sex all the time like a normal guy. So I feel sick to my stomach ALL THE FREAKING TIME. It's my first thought in the morning and my last thought before going to bed, and definitely my constant thought when I lie awake in the middle of the night. Unless I distract myself with some activity, I feel like this 24/7.
So obviously I have some learned response that needs to be unlearned somehow. I thought just having normal sex for a while would do the trick, but I've been "healed" for almost a year now, and no dice. Paradoxically, it's actually gotten worse over the last couple of months. This is ruining my life almost as much as the low T did.
I don't think there is any physical cause for this. I'm quite fit for my age, my marriage is very strong, my T is normal (trough is 800ish), I meditate when I can and really try to avoid any stress whenever I can, and I don't use porn whatsoever. Porn would probably give me a heart attack! Before all this started, my sex life was really really good for well over a decade, so it's not like this has always been the case. It all started with the low T five years ago.
What professional can I see to help me with this? How do I know they can help with this particular issue?
Is there something I can do myself without the help of a professional?
Check out the "depression and anxiety guide" in my signature to make sure you're optimal with other hormones. Hypothyroidism, for example, can cause anxiety through increased norepinephrine. There's no point in putting in the hours needs for slow psychological change if your anxiety can be more quickly ameliorated.
For the best chance to get a good result, go to a PhD psychologist who specializes in sex-related issues. I'm a MA-level therapist (mental health counselor) with a lot of contempt for the lackadaisical learning requirements of my MA-level peers, so I recommend clients I refer out to PhD folks who are more likely to be more intelligent and backed in research given their level of education. If you can't find a psychologist who specializes in sex, that's fine, because your issue is pretty straightforward as a phobia -- you nailed it hard by describing it as a sex phobia. Bibliotherapy is an option, particularly books that deal with anxiety disorders. Unfortunately because the field as a whole is so split along classic CBT and mindfulness traditions (rather than fusing them like a good therapist would), I can't make high recommendations. The Anxiety and Phobia Workbook is a good, albeit thick, volume to consider. A personal favorite that doesn't focus exclusively on anxiety (but does have chapters on panic and flooding, etc.) is Thoughts and Feelings by McKay et al.
Note that there are technical differences that need to be considered. Anxiety is the expectation of danger with the concurrent belief in your inability to adequately handle it. Panic is extreme anxiety that happens because your mind and body get caught in a positive feedback loop: you have an anxiety-arousing thought or image, leading to anxiety, leading to the negative evaluation of your body being anxious (e.g., "oh shit! I'm anxious! This will be really bad!", etc. etc.), which causes more anxiety, ad infinitum; panic attacks can last tens of minutes, and even an hour or more in some cases because of this feedback loop. A phobia is basically anxiety associated with a specific trigger, although stimulus generalization usually occurs (e.g., needle phobia generalizes to an extreme anxiety about bee stings).
What a good therapist will do is two things: 1) help you realize that the basis if your anxiety is cognitive (i.e., having to do with thoughts, images, and/or beliefs) and that a good deal of treatment (in some cases all) has to do with challenging negative cognitions underlying the anxiety; and 2) help you gradually expose yourself to the feared stimulus of sex -- or alternatively not so gradually -- until you gain a sense of confidence or courage that usually but not always results in the reduction of anxiety. We call this latter part exposure therapy, and the gradual part systematic desensitization, the more immediate type (which is definitely harder but works much better faster) called flooding; basically in either case you're "convincing" your more primitive fear center of the brain, the amygdala, that the stimulus you immediately interpret as anxiety-arousing is actually okay. Which leads to the next point that's part and parcel of anxiety disorders: avoidance. The most natural response toward something we have anxiety toward is to avoid the anxiety-arousing stimulus (really mediated by thoughts, beliefs, and/or images) is to avoid it, but this avoidance prevents us from developing coping strategies for dealing with the stimulus, doesn't allow us to "apply" challenged thoughts or beliefs underlying our anxiety, and ultimately keeps the monster under the bed as it is -- when in reality there isn't a monster there at all. This sheet
does a good job summarizing this idea.
Some of this will probably need your partner to be part of the therapy process. There's a technique called dereflection that's sometimes used for people with sexual problems where they learn to stop thinking about their sex-related (or whatever), which make it impossible to perform sexually or even be aroused, by basically lying side by side naked next to each other until the urge for sex naturally takes hold -- rather than forcing it, which usually results in failure. This could be part of your desensitiztion training, e.g., you learn to lay next to your partner fully clothed, wait until your anxiety reduces (scaling is helpful, anxiety on a 1-10 for example) a few points, then maybe moving to partly clothed until anxiety reduces, then naked, etc. A good therapist will help create this desensitization hierarchy, and the best therapist will help you practice it with imagery, literally having you close your eyes in the therapy session and practice any cognitive disputations (challenges to your original anxiety-arousing cognitions) while also utilizing emotion regulation techniques (deep breathing, progressive muscle relaxation, mindfulness, etc.), and most importantly imagining the worst-case scenario in full or broken down ways via a hierarchy.
You basically have to give your brain time to convince itself that things are okay. You do this through exposure and through challenging and replacing anxiety-arousing cognitions. There are multiple ways of doing exposure (imaginal exposure, flooding, systematic desensitization, etc. mentioned above). You also need to learn emotion regulation techniques, staring with deep breathing, to help your body begin to learn when to relax when needed.
To get started you should ask yourself what's the worse-case fear scenario that goes with your anxiety. Is it the belief that you won't be able to perform? That your partner will be disappointed, etc., with you? Ask yourself "what does this mean to me?" or "what's so bad about this?" to help you get to the deeper beliefs that might be pushing the anxiety on a cognitive level.
Most importantly, though, you have to learn the paradox of leaning into your anxiety
. This obviously easier said than done, and approaches like mindfulness meditation can be helpful in learning to tolerate and even welcome (which isn't the same as agreeing with) your anxiety. This is because, especially in panic disorder
where the body sort of learns to fear its own anxiety response, lots if not all of anxiety also is anxiety about your anxiety happening
, i.e., metaanxiety. You can even pinpoint this metaanxiety cognitively, and it's usually something along the lines of (in panic disorder), "my body is doing something awful," "I'm going to die," etc. -- these being examples of anxiety-inspiring cognitions that are about anxiety itself.
I know this is a lot of stuff. Feel free to ask here or PM me for more detail. Your problem is definitely treatable. A general treatment program (please do not take this as therapy, because it isn't) goes something like:
1) Learn emotion regulation techniques to manage anxiety: controlled/diaphragmatic breathing, progressive muscle relaxation, mindfulness, stretching, etc.
2) List anxiety-related triggers and underlying thoughts, beliefs, and images (e.g., worst-case fears)
3) Create a list of rational, realistic responses to each anxiety-related cognition (e.g., "I can handle this", "if I can't perform, that's okay," etc.), and practice these with another person if possible (to "feel them out")
4) Create a hierarchy of anxiety-arousing situations, real or imagined, rating them on a 1-10 and trying as much as possible to keep anxiety-arousing situations close in anxiety scaling (e.g., a 2/10 involving the image of your partner smiling at you with a 3/10 of your partner making a sexually suggestive behavior, as opposed to keeping this 2/10 next to a 6/10)
5) With the help of a therapist, utilize imaginal exposure, involving emotion regulation and cognitive responses paired with one or multiple anxiety-arousing images or worst-case fears.
5b) Alternatively, you can record yourself going through these fears, narrating very slowly, which allows you as a listener to imagine the situation in detail and develop responses discussed above, as you practice listening to the tape in 20- or 30- or 60- minute trials, which should see a gradual reduction in anxiety as you practice in the long run.
6) Put the last point into practice in the real world again in a broken down way if possible.
6b) Alternatively, utilize flooding, which can cause a lot of anxiety but if persevered can result in big improvements in much faster periods of time. You can also utilize a recording to help with flooding (I recommend the book Thoughts and Feelings book chapter if you're interested in trying this).
This is just an example. You can get a lot of this stuff from the books I've recommended, but again the best course is to find a good therapist -- PhD psychologist if possible, but an MA counselor can be very good as well, but you're just taking more of a gamble because many of my MA-level colleagues are, er, let's say, not very good.