Different faces of anxiety in sexual dysfunction: key features, effective interventions, and critical implications for health care professionals—ESSM position statements

Introduction: In the field of sexual health research, anxiety stands out as a pivotal element recognized by both researchers and clinicians for its potential to disrupt multiple phases of the sexual response cycle. While research on anxiety and sexual dysfunctions has typically focused on studying various manifestations of anxiety separately, clinical practice often reveals a different reality, with patients frequently experiencing multiple types of anxiety simultaneously. Aims: The objectives of this paper are to provide a comprehensive understanding of the diverse manifestations of sex-related anxiety and their clinical implications, and to identify and highlight existing scientific gaps that require further investigation. Methods: This statement paper is an expert opinion-based proposal developed under the auspices of the European Society for Sexual Medicine (ESSM). A group of experts designed a conceptual framework on anxiety related to sexual dysfunctions and reviewed the literature from 2005 to 2023 across various databases focusing on five anxiety domains, sexual performance anxiety, sexual phobia, sexual distress, attachment anxiety, and somatic symptom disorder, leading to consensus on position statements. The process included revisions approved by the ESSM Executive Committee and affiliate societies. Results: Eighteen statements on anxiety in individuals with sexual dysfunctions were developed, including three general statements on anxiety, three on sexual performance anxiety, three on sexual phobias, three on sexual distress, three on attachment anxiety, and three on somatic symptom disorder. Each type of anxiety was further described in terms of its prevalence, assessment, covariates and consequences, intervention strategies, and future directions for research. Conclusion: Clinicians addressing sexual dysfunctions should screen for signs of various types of anxiety and assess their interference with sexual situations, overall sexual life, and broader life functioning. The literature suggests specific treatment approaches for different anxiety manifestations, emphasizing the need for tailored interventions. Treatments should be carefully selected based on the type of anxiety identified.