The relationship between stress and sex is complex, but clinicians and lovers have long recognized stress's ability to interfere with human sexuality and reproduction. The stress response is controlled by the hypothalamic-pituitary-adrenal (HPA) axis. The sexual response is controlled by the hypothalamic-pituitary-gonadal (HPG) axis. Notice some similarities? The hypothalamus is a part of the brain that controls the "four Fs" of our most basic instincts: fighting, fleeing, feeding, and … mating. The hypothalamus directs the pituitary, or "master gland," which is found as a small protrusion off of the hypothalamus. The pituitary controls the secretion of hormones throughout the body. Depending on the messages it receives from the hypothalamus, it may signal the adrenals to secrete cortisol, a stress hormone, or the gonads to secrete sex hormones. Stress hormones can impact and interfere with sexual function at all three levels of the HPG axis: at the brain, pituitary, and gonads.

However, in addition to stress hormones, the adrenals can also produce DHEA, a sex hormone. DHEA is a precursor to both testosterone and estrogen. Although testosterone is often thought of as a male hormone, women also have it in smaller amounts, and it has a strong impact on libido. In menstruating women, the ovaries are the major source of testosterone, but the adrenals contribute via their production of DHEA. After menopause, the adrenals become critical to a woman’s supply. If a woman has adrenal fatigue, not only will her production of stress hormones decrease, but her testosterone-and her libido-will too.

Higher stress is associated with reduced sexual functioning in general. Women who had higher levels of cortisol (the stress hormone) and lower levels of DHEA (the sex hormone) after watching an erotic movie experienced less physiological arousal than women with a lower cortisol/DHEA ratio. Prolonged stress has been shown to decrease sexual response in women, and women with greater levels of chronic daily stress report more sexual complaints.

Stress can interfere with sex on a psychological level, too. Cognitive distraction (thinking or worrying about problems) interferes with sexual functioning. So if you are ruminating about multiple stressors, it will be difficult to put your full attention on either your partner or your own sensations and responses.