Emotion regulation difficulties and sexual arousal in women with anxiety disorders: the mediating role of sexual concern

Introduction: Anxiety has been conceptualized as an important risk factor for alterations in many areas of sexual functioning (i.e., sexual desire, arousal, lubrification, orgasm). Specifically, women with anxiety disorders frequently report problems with sexual arousal, conceived as the physiological and psychological response to internal or external sexual stimuli. However, it is still unclear which specific factors may undermine the experience of sexual arousal in this clinical population. Emotion dysregulation has a crucial role in the development of anxiety disorders and has been shown to be related to many sexual dysfunctions, including alterations in sexual arousal. Different mechanisms may explain this association. Among these, sexual concern (or sexual distress), defined as negative emotional responses (i.e., worry, frustration) related to personal and relational aspects of sexual experience, may be associated with both emotion regulation difficulties and decrease in sexual arousal. Thus, the aim of this study was to explore the mediating role of sexual concern in the relationship between emotion regulation and sexual arousal in women with anxiety disorders. Methods: Participants were 156 women ranging in age between 18 and 57 years (Mage = 28.22, SD = 7.46); 89.7% were heterosexual, whereas 9.0% declared themselves as bisexual and 1.3% as homosexual. Women completed three self-report questionnaires: DERS, for the assessment of emotion regulation abilities; “Relational Concern” and “Personal Concern” subscales of the SSS-W, for the evaluation of sexual concern; “Sexual Arousal” subscale of the FSFI, for the assessment of female sexual arousal. Results: Results showed that worse emotion regulation abilities were associated with lower levels of female sexual arousal. Moreover, sexual concern fully mediated this relationship, so that lower levels of emotion regulation skills were associated with increased sexual concern, which in turn was associated with decreased sexual arousal. Discussion: Our findings suggested that difficulties of women with anxiety disorders in accepting and regulating their emotions may impair their ability to cope with negative responses of worry related to different aspects of sexual experience. In turn, increase in sexual concern and distress may favor the onset or the exacerbation of difficulties in sexual arousal.