The impact of stress on sexual desire
For the past several years, a team at UBC Sexual Health Research (headed by Dr. Lori Brotto) in collaboration with the BC Centre for Sexual Medicine (headed by Dr. Rosemary Basson), have been conducting a research study to learn more about the interaction between mood, early life adversity, and hormone health in the context of low sexual desire. One of our main findings from this study was that women who experience persistently low sexual desire are more likely than women without sexual desire concerns to exhibit a dysregulated hypothalamic-pituitary adrenal axis. Otherwise known as the ‘HPA axis,’ this is the system of the body that is responsible for producing hormones that help us respond and adapt to stress (1). While genetics can play a role in how the HPA axis functions, chronic stress and adverse environmental factors, particularly those that occur early in life, are the primary contributors to HPA axis dysregulation (2). When the HPA axis is dysregulated, it is more difficult to adapt to everyday life stressors. This is likely to result in factors that are known to inhibit sexual desire, such as disruptions in marital quality (3) and low mood (4). Further, the altered cortisol secretions that result from HPA axis dysregulation can impede sexual motivation and interfere in sexual responsivity (5,6).
An important outcome of this research is the indication that regulating the HPA axis through stress management may help to increase sexual desire. With this research in mind, we are providing some information on scientifically supported approaches to supporting the functioning of the HPA axis support.
Progressive Muscle Relaxation
Many people know that they tense their muscles when they are stressed, but most don’t realize that tensing the muscles, not only accompanies stress, but actually increases the stress response! One approach to mitigating this process is Progressive Muscle Relaxation (PMR). This technique, which involves alternately tensing and relaxing the muscles, reduces stress by: 1) increasing one’s awareness of when muscles are tense (this is causing a stress response); and 2) learning to activate muscle relaxation quickly (reducing the stress response).
PMR has been shown to support HPA axis functioning by decreasing cortisol secretions (7).
To practice PMR, start by closing your eyes. Then tense a muscle group in a given area of the body (legs, abdomen, chest, arms and face, etc.) for approximately 5-10 seconds and then release it for 15-20 seconds. Continue this process, sequentially, with each muscle group. The key is focusing on the distinction between the feelings of the tension vs. relaxation.
Link to short instructional video: https://www.hamiltonhealthsciences.ca/share/progressive-muscle-relaxation/
Mindfulness, defined as a state of present-moment, non-judgmental awareness consists of two components: regulating attention to maintain focus on the immediate, experience, and approaching one’s experience with curiosity, openness, and acceptance (8,9). A recent meta-analysis found that practicing mindfulness-based meditation leads to a reduction in some of the physiological processes responsible for the stress response, such as decreased cortisol. In addition to decreasing stress and supporting the HPA axis, mindfulness can increase sexual desire in many other ways as well, such as increasing present-moment and sensory awareness. Check out Dr. Brotto’s book, Better Sex Through Mindfulness for more information. Mindful.org has some great tips and resources for starting a mindfulness practice. There are also some wonderful apps, such as Meditopia, HeadSpace and Calm.
It may surprise you to learn that something as simple as laughter can have significant impacts on your HPA Axis. A recent study found that spontaneous and simulated laughter reduces cortisol levels, but that the effects are longer lasting from spontaneous laughter. Below are some great suggestions for adding more laughter into your life from the University of St. Augustine for Health Sciences:
Follow a funny meme account: There’s a reason funny memes go viral. They make people laugh! Follow some funny meme accounts to put a smile on your face every time you hop on social media.
Create a Pinterest board: Start a Pinterest board full of things that make you laugh, like quotes or hilarious pictures. Next time you find something on the internet that makes you smile, pin it to your board so you can look at it next time you’re feeling stressed.
Spend time with pets: Pets, such as dogs and cats, are a source of laughter and joy for many people. If you don’t have a pet, consider asking a friend to pet-sit theirs or volunteer at an animal shelter in your free time.
Listen to a funny podcast: On your way to work or school, listen to a funny podcast to start your day off with a laugh.
Try laughter yoga: Laughter yoga is a new take on yoga that encourages prolonged voluntary laughter. Try out a class by yourself or take it with a friend next time you’re feeling stressed.
Laugh at yourself: Learning to laugh at yourself is one of the best ways you can add more laughter into your life. Next time you do something that would otherwise upset you, try to find the positive in the situation.
Alter your environment: Your environment can play a huge part in your mood. Reshape your work or study area to include things that make you smile, like a picture with friends from a funny night out, or a photo of your dog in a hilarious costume.
Host a game night: Nothing beats a shared laugh. Invite some friends over for a game night and play party-style games like Charades or Apples to Apples.
Watch YouTube videos: Need a quick laugh? Head to YouTube. Search anything from jumping cats to funny clips from your favorite show for a fast and easy pick-me-up.
Spend time with playful people: We tend to be influenced by the people we hang around. Make an effort to hang out more with the funniest friend in your circle. Ask them to get coffee or lunch and talk about the silly things that happened in your day.
Cognitive Behavioural Therapy
While it is obvious that removing those people, situations, and factors that result in stress will decrease the amount of stress you experience overall, what do you do when certain stressors can’t be avoided? It’s true that we have little choice but to endure some stressors that come our way, but it may be possible to reduce the impact of stress on the HPA axis by learning to perceive and respond to stressful situations in ways that do not stimulate the HPA axis (10). One way we can learn to respond to stressful situations more adaptively is through Cognitive Behavioural Therapy (CBT). This type of therapy involves increasing awareness of the interactions between thoughts, emotions and behaviours, and then learning to challenge and modify thinking patterns in ways that are more balanced, factual, and adaptive. New approaches to thinking can elicit positive changes in the ways we emotionally and behaviourally react to stressors. Not only is CBT the most researched form of psychotherapy (11), it is associated with neurobiological changes linked to HPA axis regulation (12).
When it comes to poor sleep and HPA axis dysfunction, we need to consider both quality and quantity. In the context of sleep, quality is determined by the amount of ‘slow wave’ or ‘deep sleep’ we experience, whereas a good quantity of sleep for most adults is considered to be between 6.5 and 8 hours per night13. When we frequently sleep less than 5 consecutive hours during the night, the natural circadian rhythm of cortisol secretions becomes disrupted14. Even when we get enough sleep (in terms of cumulative hours) our cortisol levels can be impacted negatively if our sleep is frequently interrupted15. Check out this list of sleep hygiene tips compiled by The Centre for Disease Control:
Be consistent. Go to bed at the same time each night and get up at the same time each morning, including on the weekends
Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature
Remove electronic devices, such as TVs, computers, and smart phones, from the bedroom
Avoid large meals, caffeine, and alcohol before bedtime
Get some exercise. Being physically active during the day can help you fall asleep more easily at night.
King, J. A., Mandansky, D., King, S., Fletcher, K. E., & Brewer, J. (2001). Early sexual abuse and low cortisol. Psychiatry and Clinical Neurosciences, 55, 71-74.
Stephens, M. A. C., & Wand, G. (2012). Stress and the HPA axis: Role of glucocorticoids in alcohol dependence. Alcohol Research: Current Reviews, 34, 468–483.
Brezsnyak, M., & Whisman, M. A. (2004). Sexual desire and relationship functioning: The effects of marital satisfaction and power. Journal of Sex & Marital Therapy, 30, 199-217.
Cyranowski, J. M., Bromberger, J., Youk, A., Matthews, K., Kravitz, H. M., & Powell, L. H. (2004). Lifetime depression history and sexual function in women at midlife. Archives of Sexual Behavior, 33, 539-548.
Hamilton, L. D., Rellini, A. H., & Meston, C. M. (2008). Cortisol, sexual arousal, and affect in response to sexual stimuli. Journal of Sexual Medicine, 5, 2111-2118.
Sapolsky, R. M., Romero, L. M., & Munck, A. U. (2000). How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocrine Reviews, 21, 55-89.
Chellew, K., Evans, P., Fornes-Vives, J., Perez, G., & Garcia-Banda, G. (2015). The effect of progressive muscle relaxation on daily cortisol secretion. Stress, 18, 538-544.
Bishop, S.R., Lau, M., Shapiro, S., Carlson, L., Anderson, N.D., Carmody, J., . . ., Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230–241
Brotto, L. A. (2013). Mindful sex. The Canadian Journal of Human Sexuality, 22, 63-68.
Guilliams, T. G., & Edwards, L. (2010). Chronic stress and the HPA axis. The Standard, (2), 1-12.
David, D., Cristea, I., & Hofmann, S. G. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in psychiatry, 9, 4.
Porto, P. R., Oliveira, L., Mari, J., Volchan, E., Figueira, I., & Ventura, P. (2009). Does cognitive behavioral therapy change the brain? A systematic review of neuroimaging in anxiety disorders. The Journal of Neuropsychiatry and Clinical Neurosciences, 21, 114-125.
Chrousos, G., Vgontzas, A. N., & Kritikou, I. (2016). HPA axis and sleep. In Endotext [Internet]. MDText. com, Inc..
Abell, J. G., Shipley, M. J., Ferrie, J. E., Kivimäki, M., & Kumari, M. (2016). Recurrent short sleep, chronic insomnia symptoms and salivary cortisol: A 10-year follow-up in the Whitehall II study. Psychoneuroendocrinology, 68, 91-99.
Späth-Schwalbe, E., Gofferje, M., Kern, W., Born, J., & Fehm, H. L. (1991). Sleep disruption alters nocturnal ACTH and cortisol secretory patterns. Biological Psychiatry, 29, 575-584.