Psychological factors that can interfere with sexual functioning include unconscious fears, ongoing stress, anxiety, depression, guilt, anger, fear of infidelity, partner conflict, fear of intimacy, dependency, abandonment, and/or loss of control, all of which may im­pair the ability to respond sexually. As we discussed in Chapter 10, the various pressures and time commitments of two-career families may often lead to an absence of sexual in­timacy. Problems may also arise from the desire to have children, commitment demands, the children leaving home, or guilt about past sexual relationships.

We also know that anxiety plays an important role in developing and maintaining sexual dysfunctions. Both performance fears and an excessive need to please a partner interfere with sexual functioning (Bancroft et al., 2005; Kaplan, 1974; Masters & Johnson, 1970). When anxiety levels are high, physiological arousal may be impossible. Therefore, sex therapy usually begins by overcoming performance fears, feelings of sex­ual inadequacy, and other anxieties. Therapy may also treat emotional factors such as de­pression, anger, or guilt.

Men and women with sexual dysfunction also tend to underreport their own levels of sexual arousal (Barlow, 1986). A man who has trouble maintaining an erection may begin thinking, “I’m a failure,” or “I can’t have an erection,” and his anxiety leads him to avoid sex and dampens his sexual desire. Distractions, shifts in attention, or preoccu­pation during sexual arousal may interfere with the ability to become aroused, as can spectatoring. We will talk about treatment for psychological factors more later in this chapter.