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Sex Phobias Case Study

If you suffer with social anxiety disorder (SAD), you may also experience problems with sexual dysfunction.

Sexual dysfunction may include things such as avoiding sex, erectile dysfunction, and decreased enjoyment. In addition, some medications used in treating SAD, such as selective serotonin reuptake inhibitors (SSRIs) can sometimes cause sexual dysfunction.

Research is still in the early stages about the relationship between social anxiety disorder and sexual dysfunction.

This relationship makes sense when you think about the fact that people with SAD are afraid of performance and social situations: sex can draw out both of these fears.

However, while there is some evidence that social anxiety disorder and sexual dysfunction are both present in some people, studies do not show that this is always the case.

How Do Men and Women With SAD Experience Sex?

Initial small studies suggest that there may be a link between SAD and sex.

  • In a study of 40 people with social anxiety disorder and 40 without, men with the disorder were found to have moderate impairment in sexual arousal, orgasm, enjoyment and satisfaction.

    Women with SAD were found to have severe impairment in sexual desire, arousal, activity and satisfaction. In addition, men with social anxiety disorder were more likely to have paid for sex and women with SAD had fewer sexual partners.

  • Researchers compared 30 people with SAD and 28 people with panic disorder, and found that 75% of those with panic disorder, versus 33% of those with social anxiety disorder, had sexual problems. The most frequent problem in males with SAD was premature ejaculation.
  • In a study comparing 106 individuals with social anxiety disorder, 164 people with sexual dysfunction, and 111 normal controls, men with SAD were found to be less sexually active but just as satisfied as male normal controls. Women with social anxiety disorder were not found to differ from female normal controls.
  • In a 2015 study, a history of childhood sexual abuse or comorbid depression were predictive of problems with sexual functioning in those with social anxiety disorder.

What Does This Mean for You?

If you have been diagnosed with social anxiety disorder and are also experiencing problems with sexual functioning, it is important (although probably nerve-wracking) to tell your doctor or therapist. Remember that this person is a professional and has probably heard it all before.

Issues such as sexual performance anxiety can be treated along with SAD in therapy (after medical causes have been ruled out for problems such as erectile dysfunction), so it is important to talk about problems you are having.

In addition to addressing sexual problems in therapy, medications can be tailored to your particular situation. For example, SSRIs may be a good option if you suffer with premature ejaculation as they can help to delay orgasm.


Bodinger L, Hermesh H, Aizenberg D, et al. Sexual function and behavior in social phobia. Journal of Clinical Psychiatry. 2002;63(10):874-879.

Figueira I, Possidente E, Marques C, Hayes K. Sexual dysfunction: a neglected complication of panic disorder and social phobia. Archives of Sexual Behavior. 2001;30(4):369-377.

Munoz V, Stravynski A. Social phobia and sexual problems: A comparison of social phobic, sexually dysfunctional and normal individuals. British Journal of Clinical Psychology. 2010;49(1):53-66.

Tekin A, Meriç C, Sağbilge E et al. The relationship between childhood sexual/physical abuse and sexual dysfunction in patients with social anxiety disorder. Nord J Psychiatry. 2015 Jun 25:1-5. Epub ahead of print.

The specific phobias, such as animal phobias, or the fear of lightning, are easier, in general, to treat than agoraphobia. Agoraphobia spreads from place to place because the basic fear is not of that place or set of circumstances, but of the feeling the phobic person has in those situations. If agoraphobics are afraid of getting panicky and losing control of themselves, as they are, they will have that fear in any place from which they cannot quickly, and easily, extricate themselves. On the other hand, the fear of dogs, for example, is not likely to spread to other places and things. Just avoiding dogs will usually be enough to allow people afraid of dogs to live their lives comfortably. But not always.

A woman who had a singularly disruptive fear of snakes came for treatment to our Anxiety and Phobia Center. Usually, avoiding snakes is much easier than avoiding dogs. I live in Westchester County, as she did, and I haven’t seen a snake outside of a nature center or pet store in the last forty years. She was so afraid of snakes, however, that she had not left her house alone for over ten years—on the odd chance that she would encounter a snake. That was her only fear. She felt at ease in those places—elevators, theaters, restaurants, and so on—that agoraphobics typically avoid. She entered an eight week treatment program along with other more typical phobics and, of course, the trained Phobia Aides we use, almost all of whom had been phobic, themselves, in the past.

During out first group session, she asked me if she would be able to recover completely.

“Sure,” I told her. “But to recover completely, you will have to confront snakes closely. In the end, you will have to hold them in your hands.”

She began to cry.

After the meeting, the Aides complained to me that I should not have, in this very first meeting, confronted her with what she obviously thought was impossible. I think they were right. If I had scared her too much, she might have left treatment. I wish I were sensitive and adroit enough to say the right thing reliably; but I cannot. I tend to say what I think. I can no more pretend to be circumspect than I can pretend to be neat, rather than messy. I would not be able to pull it off. On the other hand, there are some advantages to being outspoken. The patients always know exactly what I think. In any case, this particular patient was not dissuaded from continuing in treatment.

Besides the weekly group meetings, where progress and difficulties are reported, treatment involves the patient exposing herself, with the help of the Aides, to snakes—the idea of snakes, the fact of snakes--in a series of experiences of graduated difficulty, starting with:

  1. Reading about snakes. I like phobics to become very knowledgeable, if possible an expert, about whatever they fear, in the case of snakes, their habits and habitats, whether they are poisonous or not, what they like to eat, how they have evolved. The more the patient knows, the better.
  2. Looking at pictures of snakes. Not easy. Even a drawing of a snake could elicit a gut-wrenching feeling at first. But with more pictures and photographs, this became less and less upsetting.
  3. Holding a toy snake. Still difficult. The patient had to get used to a stuffed snake first, then a toy snake that squiggled at the end of a stick.
  4. Getting a snake skin, and keeping it in different places around the house.
  5. Looking at a snake in a pet store, first from a distance, then closer and closer. It turns out a snake in a glass cage is very boring. It doesn’t snap or snarl. It sleeps most of the time.
  6. Going to a nature center where non-poisonous snakes slither around the floor.
  7. Holding a snake.

By the end of eight weeks, this patient was holding, and demonstrating, snakes in the nature center. One of the unexpected things she discovered, she told me, was that the snake always slithered away from her when she inadvertently dropped it.

 Months later she was still fine. Her husband, however, was complaining about all the snake skins he found around the house. (c) Fredric Neuman 2012    Follow Dr. Neuman's blog on