Causes of Sexual Anxiety among US Southern Black Women

Abstract

Research on sexual anxiety has primarily focused on sexual performance anxiety among White male samples. A more in-depth investigation of the multiple causes of sexual anxiety needs to be explored to expand the focus beyond sexual performance and account for various sociocultural factors that may increase the risk of sexual anxiety among marginalized groups. The purpose of this study was to explore the precedents of sexual anxiety among n=184 Black cisgender women living in the Southern United States. Participants were recruited in 2020 to complete an online Qualtrics survey and answer the open-ended question, “What makes you feel anxious during sexual experiences?”. Only those who reported that they experienced sexual anxiety in their lifetime were asked this question. Data was analyzed using an inductive structural tabular thematic analysis approach. There were a total of 10 themes: 1) pressure to meet societal expectations, 2) psychological barriers, 3) partner unfamiliarity, 4) oppressive body standards, 5) sexual violence, 6) anticipation, 7) relationship factors, 8) general insecurities and judgment, 9) cultural factors and 10) fear of pregnancy or sexually transmitted infections (STIs). Implications for therapists and counselors are discussed.

Lay Summary

Sexual anxiety prevents Black women from experiencing pleasurable sex and can hurt their romantic relationships. We found that there were 10 causes of sexual anxiety among Black women. We provide guidance for sex therapists and counselors on how to work with Black women to develop coping strategies to deal with these causes.

Introduction

Most research on sexual anxiety has primarily focused on White, cisgender men (Pyke, 2020). Additionally, sexual anxiety has been minimized to focus specifically on sexual performance anxiety; however, narrowing the definition of sexual anxiety strictly to performance may not fully describe the experience of sexual anxiety among marginalized groups. The focus on sexual performance limits the conceptualization of sexual anxiety as solely a way to address the consequences of sexual anxiety (e.g., erectile dysfunction, sexual pain disorders), but not the distinct causes or origins of sexual anxiety (Hertlein et al., 2009). There have been three identified facets of sexual anxiety, including tension, discomfort, and fears about sex (Snell et al., 1993). Exploring sexual anxiety outside of sexual performance and sexual dysfunction allows for a more comprehensive understanding of this phenomenon. Further knowledge about the causes of sexual anxiety can provide insight into possible factors to address, which can be important for developing coping skills. Additionally, sexual anxiety can hamper pleasurable sex due to the increased likelihood of spectating during sex (Masters & Johnson, 1970; Lacefield et al., 2013; Thorpe et al., 2022; Vigil et al., 2021). Physiological and psychological manifestations of sexual anxiety can be influenced by someone’s environment, religious values (Jayne et al., 2020), quality of romantic relationships, and history of sexual violence. Despite over 50 years of research on sexual performance anxiety (Pyke 2020), the research on cisgender women, and more specifically, Black cisgender, is scant. Given that sexual anxiety is a phenomenon informed by sociocultural factors and Black women experience unique forms of intersectional oppression on the axes of both race and gender, it is especially important to study sexual anxiety among Black women.

o\Our previous qualitative study explored experiences of sexual anxiety among twenty-five Black cisgender women living in the US South (Thorpe et al., 2022). From the participants interviewed, a working definition of sexual anxiety for Black women wascreated:

Sexual anxiety is the persistent worry or fear that can occur before, during, or after sexual intercourse. Sexual anxiety is more likely to occur with casual sex partners or partners women are less familiar with but may also occur with long-term partners. Sexual anxiety has somatic (e.g., tense, crying, shaking), cognitive (e.g., racing thoughts, catastrophizing), and emotional (e.g., frustration, dread, panic) symptoms that can happen simultaneously or individually. Sexual anxiety can be related to past sexual experiences, non-sexual stressors, partner dynamics, sexual performance, sexual trauma, fears of stereotyping, and issues of pain and/or reproductive health. Sexual anxiety can be experienced across a spectrum of severity. Sexual anxiety is influenced by social contexts like sexual stereotypes and cultural upbringing (Thorpe, 2022).

The present factors prevent Black women from being fully present during sex and hinder their ability to access pleasure. For Black women, pleasurable sex can be an act of resistance in the face of interlocking systems of oppression and controlling images (See Collins, 2000) that work to suppress liberation (Hargons et al., 2024). Controlling images such as Jezebel and Superwoman schema has a significant impact on Black women’s sexual decision-making and sexual functioning (Davis & Tucker-Brown, 2013; Dogan et al,., 2023, Jerald et al., 2017; Leath et al., 2021). Additionally, Black cisgender women face other factors, such as partner scarcity, which may cause them to engage in sex despite their anxiety about pleasing their male partners in fear of losing them (Bowleg, 2004). Additionally, 1 in 5 Black women are likely to experience rape in their lifetime (Barlow, 2020), which increases their odds of experiencing mental health challenges such as post-traumatic stress disorder (Bryant-Davis et al., 2010). As previously mentioned, PTSD symptomology and a history of sexual violence heighten Black women’s risk of sexual anxiety (Thorpe et al., 2022). Although the initial study provides foundational knowledge and a working definition of sexual anxiety, a more expansive examination of the cause of sexual anxiety among Black women is needed.

Study Purpose

As such, it is important to understand the causes of sexual anxiety for Black women because this knowledge can provide the foundation for interventions created to address sexual anxiety, which, when disseminated, can improve Black women’s sexual self-expression and freedom. This study aims to build upon our prior research on Black women’s experiences of sexual anxiety by investigating precedents of sexual anxiety in a larger sample of Black cisgender women.

Materials and Methods

Participants and Procedures

Data was collected from the explanatory mixed methods study, the Pain and Pleasure study. Data for the current study was collected during Phase 1 online Qualtrics Survey. The survey was completed by 294 Black women who met the eligibility criteria. Upon IRB approval, participants were recruited through convenience and snowball sampling, including word of mouth and social media postings. Phase 1 inclusion criteria were: 1) premenopausal, 2) under the age of 50, 3) identify as a cisgender Black woman, and 4) live in the Southern region of the US (which included a state list). After completing the online informed consent form, participants were asked a series of questions about sexual pleasure, sexual pain, and sexual anxiety. The survey incorporated short-form questions to capture broad data about the causes of participants’ sexual anxiety.

For the current study, only participants who responded to the question “What makes you feel anxious during sexual experiences?” were included in the analysis. A definition of sexual anxiety was not provided for participants. A total of 184 participants reported that they experienced sexual anxiety. Participants who experienced sexual anxiety were then asked one open-ended follow-up question regarding their sexual anxiety and a scale question about the frequency of their sexual anxiety. Most participants rarely experienced sexual anxiety, but nearly a quarter experienced it very often. The majority of participants identified as ethnically African American (n=176; 94.6%), heterosexual (n=145; 78.8%), single (n=77; 41.8%), college educated (tech college, some college, bachelor’s degree or graduate professional degree) (n=181; 98.4%), and the average age of the participants was 30.2 (SD=6.2 years; range 19–45 years old). For more details see Table 1.

Table 1.

Participant Demographics (N=184)

Descriptives	N(%) or M±SD (Range)
Ethnicity
African American	17 (94.6)
Latinx	8 (4.3)
Caribbean	16 (8.7)
African	16 (8.7)
Biracial	3 (1.6)
Sexual Orientation
Heterosexual	145 (78.8)
Bisexual	13 (7.1)
Queer	9 (4.9)
Pansexual	8 (4.3)
Lesbian	7 (3.8)
Demisexual	1 (0.5)
Other	1 (0.5)
Education
Graduate or professional degree	101 (54.9)
Bachelor’s degree	57 (31.0)
Some college	21 (11.4)
High school diploma	3 (1.6)
Technical college	2 (1.1)
Age	30.22 ± 61.12 (19–45)
Relationship Status
Single	77 (41.8)
In a relationship	43 (23.4)
Married	36 (19.6)
Dating	17 (9.2)
Cohabitating	7 (3.8)
Divorced	4 (2.2)
Sexual Anxiety Frequency
Always	13 (7.1)
Very often	43 (23.4)
Sometimes	102 (55.4)
Rarely	23 (12.5)
Seldom	3 (1.6)

^*Note: Participants could select more than one ethnicity.

Reflexivity Statement

The first author is a Black queer cisgender woman from the Southern US. She is a sexuality researcher who explores Black women’s sexual well-being using sex positive frameworks and Black feminisms. Her primary research focuses on Black women’s experiences of and barriers to sexual pleasure, including genito-pelvic pain/penetration disorder symptomology, mental health concerns (e.g., anxiety), and sociocultural factors. She has been a sexuality educator for 12 years. She is an assistant professor and the research lab director, of which the co-authors are a part.

The second author is a Haitian-American heterosexual cisgender woman from the Northeast region of the US. She is a Family Nurse Practitioner with over a decade of healthcare experience and a PhD candidate focused on addressing political, social, and structural drivers of sexual reproductive health (SRH) disparities among Black women. Guided by Black feminist, justice and health equity frameworks, her primary focus is to design and implement community-informed interventions to safeguard the SRH of Black women throughout their lifespan.

The third author is a Nigerian-American queer cisgender woman from the US South. She is a clinical psychologist and researcher focused on the intersection of trauma, pleasure, and sexual and reproductive health, particularly for Black women. She is a postdoctoral scholar in health promotion.

The fourth author is a biracial Black queer ciswoman from the South. She is a counseling psychology PhD student, and her research interests include Black women’s sexual pleasure and well-being, Black motherhood and breastfeeding experiences, sense of belonging in college and substance use among historically marginalized populations.

All of the co-authors have experienced sexual anxiety during their lifetime.

Analysis

Due to the short-form qualitative nature of the data, hybrid (inductive and deductive) structural tabular thematic analysis (ST-TA) was used (Robinson, 2021). ST-TA allows researchers to calculate theme frequencies among longer samples and is suited for open-ended questions within a larger survey (Robinson, 2021). These frequencies allow researchers to report how many people endorsed a specific theme or subtheme; however, it is up to the reader to decide how to use that information, and it does not mean that higher-rated themes are more important than lower-rated themes (Robinson, 2021). ST-TA highlights the importance of using direct quotes from the data to convey the meaning and context of qualitative themes, providing clear support and illustration for the concepts presented. A hybrid approach was taken, which allowed the researcher to code using the causes of anxiety that were found in the previous study on Black women’s sexual anxiety (Phase 2 of the Pain and Pleasure Study; Thorpe et al., 2022) while also accounting for new themes in the data. A codebook was created for the second coding round. The pluralist epistemological argument for working with brief text (e.g., open-ended survey questions) alongside in-depth data (Phase 2 interviews) is that the more varied forms of qualitative data that can be analyzed then, the more effectively we can understand the complexities of human behavior or in this case, the complexities of sexual anxiety (Frost et al., 2010; Robinson, 2020).

The first author familiarized herself with the data and then began to code each cause of anxiety. Most participants reported more than one cause of anxiety. After counting each cause, the first author collapsed the causes into themes. Themes were then discussed with the co-authors to discuss differences and create a more consistent, clear set of themes; this is known as the discussion-based approach to internalist agreement (Robinson, 2021). Recoding was conducted twice until the final themes were decided upon and all poorly defined themes were removed. Reasons for changing themes and changes in interpretation of themes were documented. Additionally, the research team documented reasons why the lower rated themes were not consolidated with other themes. This form of documentation allows reflexivity among the research team as to why certain coding decisions were made (Guba, 1981; Johnson & Waterfield, 2004).

Results

The results of the abductive analysis showed that participants reported all factors from the previous study on Black women’s sexual anxiety in addition to several new factors (new factors are bolded in Table 1). There are a total of ten themes: 1) pressure to meet societal expectations, 2) psychological barriers, 3) partner unfamiliarity, 4) oppressive body standards, 5) sexual violence, 6) anticipation, 7) relationship factors, 8) general insecurities and judgment, 9) cultural factors and 10) fear of pregnancy or sexually transmitted infections (STIs). One person reported that they were “unsure” what caused them to experience sexual anxiety. There was some overlap in codes, as some quotes contained multiple themes that were related to each other. For example, one participant stated, “feeling vulnerable while engaging in something new”, indicating that fear of vulnerability with her partner (relationship factors) was evident when they tried something new for the first time (sex skills with a subtheme of pressure to meet societal expectations). See Table 2 for a description and count of each theme.

Table 2.

Themes, Subthemes, and Descriptions

Theme (count)	Subtheme/Components
Pressure to Meet Societal Expectations (n=94)	Sexual Performance Anxiety worry about performance; this was cross coded with pressure to please partner in some cases Pressure to Meet Partner’s Expectations pressure (typically negative) to make sure their partner is pleased and orgasms due to fear of their partner leaving or personally feeling inadequate. Lack of Confidence in Sex Skills not feeling sexually skilled due to late sexual debut or not being able to participate in certain positions because they feel awkward, body size; this also includes when the novelty of trying out new sex positions or engaging in positions they aren’t confident in such as riding Pressure to Orgasm Feeling pressured to have an orgasm in a timely manner and fears of not being able to have one at all. Engaging in Unwanted Sex engaging in consensual sex despite not desiring to; also not feeling in the mood or sexy
Oppressive Body Standards (n=74)	Body Image Concerns General concerns about appearance of body and issues with nudity Being Wet Enough not being lubricated enough or aroused Fear of Body Odor worry about smell Weight Concerns Concerns about body weight, weight gain, fatphobia Vulvar Appearance worry about what genitals look like including any scarring or hyperpigmentation
Psychological Factors (n=38)	Sexual self-consciousness/spectatoring sexual embarrassment and sexual self-focus (being aware of how your body looks during sex, feeling uncomfortable or embarrassed); thinking about other things during sex instead of being present (spectatoring) Low sexual self-esteem not feeling confident in themselves; this is different than performance anxiety (this code does not include those that are not confident in their skills or abilities or their body image) Generalized Anxiety reported having generalized anxiety disorder
Anticipation of Pain and Being Displeased (n=20)	worry that sex will be painful worry or expectation that the sex will not be pleasurable for them
Relationship Factors (n=29)	Lack of communication with their partner during sex Not being in sync with partner during sex or being able to read cues Worries about if their partner desires them Not feeling desired by partner Partner unfamiliarity Having sex with a new partner for the first time Fear of vulnerability struggling to release control, be open emotionally, and be intimate and connect with a partner Desire for emotional connection focusing on connection with partner and the need to be wanted and desired by their partner; desiring to be in a relationship with their sex partner (unrequited emotional connection)
Trauma (n=8)	Sexual abuse Sexual abuse, trauma, or violence reported in childhood and/or adulthood General trauma Trauma reported without context
General Insecurities and Fear of Judgement (n=5)	general mention of insecurities and judgement without context
Life Stressors (n=5)	kids in the home, inability to prioritize sex, thinking about chores or other duties
Cultural Factors (n=4)	Fear of confirming racist-sexist stereotypes worry about being perceived as hypersexual or a Jezebel by society and sex partners for desiring to engage in sex Religious guilt feeling shame for engaging in sex because it is a sin or breaks a vow to God
Fear of pregnancy or STIs (n=3)	worry about a condom coming off and/or getting a STI or pregnant

Pressure to Meet Societal Expectations

Sexual Performance Anxiety & Pressure to Meet Partner’s Expectations

The most common cause was pressure to meet societal sexual expectations (n=94). This pressure manifested itself in six different subthemes. The first two are interconnected, so they are presented together: sexual performance anxiety (n=44) and feeling pressure to meet their partner’s expectations (n=50). Participants reported: “people pleasing or wanting to please my partner rather than concern about needs. Fearful to ask for what I need”, “not meeting my partner’s expectations”, “how am I performing”, “wondering if I’m doing too much or too little”, and “wondering if my performance will be good as others”. Additionally, participants stated, “I wonder if I’m performing correctly or pleasuring the other partner,” indicating that participants were not only concerned about their performance based on societal expectations but also partner expectations. Participants also experienced anxiety when they compared their performance to that of their previous partners. Finally, participants were concerned about their partner’s ability to reach orgasm, which seems to be a perceived partner expectation: “is he able to reach orgasm?”, “I feel like I will not be adequate enough for my partner,” “Am I good enough? Is he actually satisfied by me?” The last quote also highlights the overlap between pressure to meet partner’s expectations and having a lack of confidence in sex skills.

Lack of Confidence in Sex Skills

For many participants, performance anxiety and perceived partner expectations often led to a lack of confidence in their sex skills (n=27). Participants reported: “feeling confident in my skills is big to me”, “being inexperienced”, “I made a sexual debut over a year ago at 33, so I’m not fully confident in my skills”. These are examples of general sex skills concerns; however, participants also reported specific sex acts such as “riding” and “oral sex.” Participants were concerned about “riding dick and feeling off beat”, and trying new sex positions were major causes of sexual anxiety. Being in these positions (e.g., riding dick on top) often heightened their body image concerns and performance anxiety. One participant in particular mentioned that “trying new positions, like angling my body in certain ways that feel good to him but not good to me,” indicating that she is sacrificing her personal pleasure due to the pressure to please her partner.

Pressure to Orgasm

In society, the end of sexual intercourse is often denoted by one or both parties having an orgasm. This resulted in participants feeling pressured to orgasm (n=6). Participants stated they become anxious when “it is taking too much time for me to orgasm” and/or “struggling to focus so I can have an orgasm because I am more focused on my partner.” Not only was the amount of time to orgasm a point of concern, but participants struggled to have orgasms because they were focused on pleasing their partner. This pressure to orgasm can be linked to society’s expectations of sexual intercourse ending in orgasm and women feeling pressured and socialized to protect their partner’s egos regardless of gender. This pressure can also result in participants faking orgasms to alleviate their anxiety.

Engaging in Unwanted Sex

Participants also felt anxiety when they felt obligated to engage in unwanted but consensual sexual intercourse (n=4). One participant said they felt anxious when “they weren’t sure if they wanted to have sex at that time”. While others stated, “I worry about disappointing my partner if I say no during sex or tune out”, “wanting it [sex] to be over”, and “…my partner/husband feels rejected (inadequate or unwanted). I usually choose to engage and hope that he will be satisfied quickly”.

Oppressive Body Standards

The second most common cause was oppressive body standards (n=74). Participants reported experiencing sexual anxiety due to body image concerns (n=47), which also included fear of not being properly aroused or “wet enough” (n=12), fear of body odor (n=6), weight concerns (n=6), and worry about how their partner perceives the appearance of their vulva (n=3). Additionally, participants reported general discomfort with being nude in front of their sex partner. Being nude often brought up feelings of vulnerability and fear of judgment. Body image concerns included hyperawareness or being in their head about how their body looked during sexual intercourse, which is linked to sexual self-consciousness and sexual self-esteem (see Psychological Barriers theme).

Participants typically presented one or more body image concerns, such as “My vaginal taste and/or smell. My weight. Scars/hyperpigmentation”, “If I smell fresh…my body isn’t pretty”, “…but I often think about how I look or how I sound or how I taste or smell. It’s really overwhelming”, and “The way my body looks and moves. The pain that can come from penetration. Hair on my body. Smells. Softness. Lack of lubrication from my vagina. Color of my vulva and labia.”

One participant in particular mentioned how having an inflammatory condition led to her body image issues:

I have hydradinitis suppurativa, which is a skin disorder that causes my sweat glands to sometimes swell, leading to a lot of hyperpigmentation on my butt as well as around my bikini area from ingrowns. I often find myself preoccupied with anxiety around these marks being unattractive.

Another participant stated how her body weight and body image concerns prevent her from being able to experiment with new sexual positions:

I’m not confident in my body, so I’m not confident in myself. I enjoy having sex and I would like to have it more regularly, but I don’t want my partners to look at my body and be turned off. I also don’t like to engage in certain sexual positions (e.g., riding) because of my size and how much they would be looking at me. I think that can lead to partners thinking that I’m lazy, but I’m really just anxious/uncomfortable.

Additionally, one participant also mentioned that she gained weight during the course of her relationship, which made her nervous. For those who were concerned about their vaginal lubrication, it was usually due to rushing into having penetrative sex. For example, participants stated, “not being able to get wet enough, rushing”, “feeling I’m not lubricated enough (naturally)”, “not being aroused enough to enjoy the experience”, and “the foreplay of sex if I’m not yet physically prepared [aroused]”.

Psychological Factors

The third most common theme was psychological barriers (n=38); this includes sexual self-consciousness and spectatoring (n=30), low sexual self-esteem (n=5), and generalized anxiety (n=3). Sexual self-consciousness, also referred to as spectatoring, consists of two concepts: sexual self-focus and sexual embarrassment. Sexual self-consciousness can result in psychological distress, worry about body image during sex and what their partner is thinking, and overthinking or even zoning out/withdrawing (i.e., spectatoring) during sex. Many participants who reported concerns about sexual performance, sex skills, and body image also reported heightened sexual self-consciousness. A participant reported, “I feel anxiety when I feel like I’m being watched by my partner. Specifically, during oral sex”, and worry about “how I feel”, “how I look”, “self-conscious on odor and skills”, “are they really enjoying it? How do I look? Am I doing this right?”, “the way my body looks, whether or not they are enjoying me”, and “what the person is thinking…if they like it. Maybe if they’ll want more? If what I’m doing is sufficient”.

Sexual self-consciousness and sexual self-esteem are intertwined and can have a bidirectional relationship. For example, one participant stated, “my self-esteem affects my image and gives me anxiety about how my spouse sees me during sex.” Another mentioned, “My body/body hair, if I am ‘sexy’ enough, if they can see the things about my body that I don’t like, if they like me/my body/my voice”.

Sexual self-esteem is closely related to general self-esteem and is an individual’s evaluation of themselves during sexual encounters, including if a person feels sexually competent, sexually appealing, desirable, and worthy of pleasurable sex. Participants stated they felt anxious when they weren’t sure how to be sexy, appealing, or desirable. For example, participants stated they feel anxious “when I do not feel attractive or sexy”, “sometimes I do not feel that I’m sexual enough as a person”, and “not being sure of how to be sexy or appealing”. Finally, one participant reported how their history of sexual trauma negatively impacted their sexual self-esteem and increased their sexual self-consciousness. One participant reported having general self-esteem issues due to past trauma, stating, “I feel as though they might not like my body”.

Three participants reported that they had generalized anxiety disorder, which often led to heightened anxiety during sexual encounters. Participants mentioned “overthinking, wondering what they are thinking” and “generalized anxiety disorder, struggles with perfectionism and people pleasing”. One participant mentioned that generalized anxiety disorder was the “main reason” why she was anxious during sex. Still, it led to an increase in sexual self-consciousness: “It’s really overwhelming. Most of the time I’m so focused on myself that I can’t even enjoy the pleasure.”

Relationship Factors

A total of 29 participants reported relationship factors as the source of their sexual anxiety. Relationship factors included any issues related to relationship clarity, relationship status, lack of communication with their partners during sex (n=5) and worries about if their partner desires them (n=3). For example, participants reported fears that “the fact that my husband doesn’t seem that into me” and “if he desires me the way I desire him.” One participant’s quote explained how partner familiarity also informed the amount of desire, performance anxiety, and desire for connection she had with that partner:

A combination of things such as...under/over performing, not really having a connection with that person, and transitions in the relationship or defining what the relationship may be. Regarding underperformance, it’s difficult for me to be ‘all in’ if I really have no interest in the person and it’s strictly for pleasure. Overperforming can show when I am really interested in this person and want them to have a pleasurable time as well, but don’t want to paint myself into the corner of being identified in a certain way (i.e., Freak, etc.). Also, when defining what the relationship is or could be, I don’t want to lead with sex and be in a ‘friends with benefits’ scenario with no room for the relationship to evolve. Especially if we have sex earlier on.

The theme of partner unfamiliarity from the previous study is also included in this theme and was endorsed by 12 participants. Participants reported anxiousness when they were having sex with a person for the first time because they did not know what to expect.

Participants also expressed fears of feeling emotionally vulnerable and connected with their sex partner (n=9). For example, “being vulnerable in front of my partner”, “physical closeness, the intimacy, feeling judged, letting go of control”, “lack of comfort with intimacy”, and “for me, it’s the emotions that are involved with a partner, I get anxious about sharing sexual encounters”. Participants were anxious when they had “deep eye contact” with their partner because it felt vulnerable. Additionally, there were concerns about whether there would be “sexual chemistry”, “ensuring that my partner and I are connected”, and wondering, “if he’s going to read my cues”.

Anticipation of Pain and Being Displeased

Similar to the previous study, 14 reported that their anticipation of sexual pain caused sexual anxiety. They anticipated pain from “penetration” and “internal pressure.” Of the participants that reported a fear of pain, three reported general pain such as “chronic knee pain”, “chronic hip pain”, and “physical discomfort.” Additionally, 6 participants also reported the anticipation of being displeased. These participants were engaging in sexual intercourse and feared that the sex would not be pleasurable, so they became anxious about the entire sexual experience. For example, one participant stated, “I will not feel the amount of pleasure as my husband”, while another feared the communication that would have to happen after unpleasurable sex: “if it’s not going well I’m not sure how to communicate my discomfort”.

Trauma

A total of seven participants reported that previous trauma caused their sexual anxiety. For 4 participants, sexual abuse and rape caused them to be anxious during sex and have “flashbacks during sex” or led to them feeling insecure about their bodies and performance. For example, participants reported, “I was sexually assaulted so it makes me anxious and emotional sometimes. My partner is very understanding and helpful, but it’s something that just happens” and “I am uncomfortable or sometimes unsure maybe unsafe in letting go during sex. I feel sexual anxiety due to being judged in the past and sexual trauma”. One participant reported that due to previous emotional and sexual abuse, she “avoided sexual situations for the past five years and have maintained an abstinent lifestyle due to trauma”. Additionally, childhood sexual abuse was often a cause for present anxiety: “I am a survivor of childhood sexual abuse and so I am constantly in my head about what feels good versus if I feel bad”. For 4 women, childhood traumas caused them to have sexual anxiety during sexual intercourse in adulthood, (e.g., “previous experiences and trauma from teen years to early adulthood. It’s never the current sexual experience; it’s always the effect of what has happened in the past playing in the present”). Because the women did not explicitly state what type of trauma, we did not combine them with sexual trauma; however, it can be inferred that they were referring to sexual abuse without naming it.

Other, Less Common Themes

Three themes were not endorsed by five or fewer participants but were still important to mention for this study’s context. Although participants reported insecurities and judgment related to their body image and sexual performance, 5 participants reported general insecurities and fear of judgment without further context. Five participants reported life stressors such as children (n=2) and being aware that “someone else is in the house,” and general stressors such as “time/scheduling”, “cooking, laundry, work”, and “preoccupied by work or other stress”.

Cultural factors specific to Black women were causes such as fear of confirming racist, sexist stereotypes (n=2), such as being viewed as a Jezebel by “wanting too much sex as a woman” and fear of “painting myself into the corner of being identified a certain way (i.e., Freak)”. Additionally, 2 participants reported religious guilt. For example, participants reported that they “violated that [celibacy] commitment to myself and to God” and that they were “sinning”.

Finally, although fear of sexually transmitted infections or pregnancy was reported as a theme in the previous study, only 3 participants reported it in this study.

Discussion

The current study expands our understanding of sexual anxiety among Black cisgender women by identifying and analyzing the various contributors to this common phenomenon. Our findings align with previous research, which indicates that societal expectations, body image concerns, and psychological factors significantly contribute to sexual anxiety among Black women. These insights are crucial for developing targeted interventions and future research recommendations aimed at alleviating sexual anxiety and improving sexual and mental health outcomes for this population.

The study’s identification of societal and partner expectations as prevalent causes of sexual anxiety underscores the pervasive influence of cultural norms and gender roles on individual sexual experiences. The unique pressures Black women face constitute gendered racism, defined as the specific oppression Black women experience due to the simultaneous experience of being both Black and woman (Essed, 1991; Spates et al., 2020) These pressures are also rooted in historical and contemporary stereotypes that portray Black women in a hypersexualized or demeaning manner (Collins, 1991, Fritz et al., 2021; Leath et al., 2021; Marshall, 1995). This societal lens impacts their self-perception and influences their intimate relationships, where they may feel an acute need or be pressured to conform to societal standards and their partner’s expectations. This finding corroborates prior studies that highlight the significant impact of societal norms and partner expectations on sexual performance anxiety (Carter et al., 2019

The significant impact of oppressive body standards on sexual anxiety highlights the urgent need for interventions that address body image concerns among Black women. The findings of this study align with prior research, which underscores that Black women’s body image concerns are rooted in sociocultural factors such as gendered racial microaggressions and objectification specific to Black women’s experiences (Watson et al., 2019; Hughes et al., 2021). Participants expressed anxiety about various aspects of their bodies, from weight and body shape to concerns about genital appearance and natural bodily functions like lubrication. These concerns often lead to self-consciousness and a diminished ability to enjoy sexual experiences fully. Considering the gaps in sexual pleasure (Rowland, 2020; Townes et al., 2021;) and the disproportionate burden of sexual trauma and adverse sexual health among Black women (Prather et al., 2016, Rowland et al., 2022), increasing positive and pleasurable sexual experiences is a matter of justice that is critical to their sexual wellbeing (Hargons, 2023).

The psychological barriers identified in this study, such as sexual self-consciousness and low sexual self-esteem, are intertwined with broader issues of mental health and well-being. These findings suggest that sexual anxiety among Black women cannot be fully addressed without considering the psychological context in which it occurs. For many, sexual anxiety is linked to broader patterns of anxiety and self-doubt that permeate throughout their lives. Dual minority status of gender and race places Black women at an increased risk for anxiety (Lewis, 2023; Neal-Barnett & Crowther, 2000). Research on middle-class Black women suggests that Black women may already carry a disproportionate burden of baseline anxiety (Neal-Barnett & Crowther, 2000), which may also be tied to the gendered-racial stereotypes imposed on Black women (Neal-Barnett, 2018), and can exacerbate situation-specific anxieties such as sexual anxiety. Given this context, it is plausible that Black women with existing anxiety disorders are more susceptible to developing sexual anxiety. This aligns with our findings, where psychological barriers such as sexual self-consciousness, low sexual self-esteem, and generalized anxiety were prominent among participants.

Limitations

Though this study is one of few to explore factors that cause sexual anxiety among a large sample of Black cisgender women, this study has limitations. First, this study was a convenience sample limited to cisgender Black women living in the southern US; therefore, the sample may not be generalizable to women outside of the southern region of the US or those without college degrees. Additionally, their responses are retrospective, and because some participants reported that they rarely experience sexual anxiety, there may be recall bias. Moreover, southern Black women’s understandings of sexual anxiety are informed by their cultural backgrounds, and sexually conservative socialization commonly found in the “Bible Belt” region may influence their perceptions of sexual anxiety. While sexual anxiety may stem from similar causes for Black womxn regardless of sexual identity or gender, queer and gender diverse Black womxn may experience additional identity-related factors that cause anxiety during sex. For example, queer Black women’s sexual anxiety may show up differently, as they navigate queer sex – particularly when experiencing queer sex for the first time. Gender diverse Black womxn may struggle to experience gender euphoria during solo or partnered sex, which may lead to sexual anxiety. Additionally, participants were not given a definition of sexual anxiety. Generally, we were not able to glean their definitions through their responses; therefore, participants’ definitions may vary. While an open-ended question provides insights into participants’ experiences, this study’s short form survey question format did not allow for follow-up questions that could have clarified responses. Finally, we did not look at differences in antecedents of sexual anxiety based on identities such as sexual orientation and age. Having a sample that has an equal age distribution and sexual orientation samples will provide a better understanding of how varying identities may impact their sexual anxiety.

Future Implications

Addressing Cultural Factors

Future research should explore cultural narratives that dictate these expectations among Black women and how they can be reshaped to create different norms and expectations. For instance, community-based interventions that promote inclusive body positivity and sexual self-empowerment could help counteract these harmful norms. Couple-based interventions and sexual health education focused on fostering open and honest communication about sexual preferences, boundaries, and concerns could be beneficial and help strengthen relationships. In combination or separate from couples counseling, individual counseling aimed at unlearning unhelpful sexual scripts, encouraging individual exploration, and enhancing sexual self-efficacy and communication skills may be useful. To make this possible, providers should be trained to recognize and address these pressures and stereotypes during sexual health consultations and sessions to create a more supportive and understanding environment for Black women, who already experience disparities in communication about sexual health (Alexander, 2019; Thorpe et al., 2022; Townes et al., 2020). Lastly, exploring the role of media representation in perpetuating harmful stereotypes and misogynoir (see Bailey, 2018; Bond et al., 2021; Webber, 2017) can provide insights into broader cultural changes needed to support Black women’s sexual health and pleasure.

Addressing Body Image

Interventions aimed at promoting positive body image should be culturally tailored to resonate with Black women’s experiences. This could include creating platforms for Black women to share their stories, fostering a sense of community and support. Additionally, clinicians should receive training on how to discuss body image issues sensitively and constructively, understand the cultural context of body image for Black women, and how to combat misinformation about Black women’s bodies in order to help patients build a more positive body image (Dunn et al., 2019; Hughes et al., 2021; Overstreet et al., 2010). Mental health clinicians can work with Black women to help promote body acceptance regardless of shape, weight, and/or changes in the body over time. Research should further investigate how set body standards specifically affect different aspects of sexual health and well-being among Black women, considering intersectional factors such as age, socioeconomic status, education, and sexual orientation.

Addressing Mental Health Concerns

Future research should investigate the effectiveness of integrating mental health support and sexual mindfulness into sexual health interventions (Brotto et al., 2018 Thorpe et al., 2022). Further, it may be useful for mental health interventions to also highlight the psychosocial context in which individual experiences of sexual anxiety occurs; such psychoeducation can be validating, create additional understanding for why sexual anxiety is present, and reduce feelings of shame or isolation Black women may experience because of sexual anxiety. Additionally, longitudinal studies could provide insights into how psychological interventions can sustainably improve sexual health outcomes over time and across a woman’s lifespan. This intervention approach requires that healthcare providers are trained in trauma informed care and thoroughly assessing sexual history to identify patient needs and offer resources that help navigate their sexual health—especially for sexual trauma survivors.

Conclusion

Few studies investigate cisgender Black women’s experiences of sexual anxiety. The present study examines how societal, psychological, and relationship factors cause sexual anxiety among Black women. Many participants cited harmful stereotypes and societal expectations as main contributors to their sexual anxiety. Similarly, participants’ body concerns regarding their appearance and genitals, psychological barriers connected to sexual self-consciousness, and relationship concerns that their partners were not attracted to them often presented as Black women questioning their sexual performance and desirability. These concerns may hinder Black women from experiencing sexual pleasure, as they prioritize their partners’ pleasure and takes them out of the present moment. An essential step in reducing sexual anxiety is to examine and confront the social systems, such as gendered-racism, which underlie sexual anxiety for Black women. These insights not only necessitate future research but also the creation of targeted interventions, which should aim to resist internalized oppressive expectations, promote sexual mindfulness, and increase healthy sexual communication As such, these findings exemplify the importance of examining and mitigating sexual anxiety to increase sexual well-being among Black women.

Biographies

Shemeka Thorpe, PhD is an Assistant Professor in Health Promotion at the University of Kentucky. Her research uses mixed methodologies to explore the sexual well-being of Black women through sex-positive frameworks and Black feminisms.

Brenice Duroseau, MSN, FNP-C, RNC-OB, AAHIVS, is a Haitian-American board-certified Family Nurse Practitioner with extensive healthcare experience, who is dedicated to pioneering innovative solutions aimed at safeguarding the sexual and reproductive health of Black women across their lifespan. With expertise in infectious diseases, women’s health, and community health, she combines her knowledge and experience to inform her ongoing work as a PhD candidate at Johns Hopkins University School of Nursing. Her research focuses on community-informed interventions that enhance the sexual reproductive health of Black women from a justice and health equity framework.

Praise Iyiewuare, PhD (she/her) is a postdoctoral scholar in Health Promotion at the University of Kentucky with an interdisciplinary background in anthropology, neuroscience, clinical psychology, and public health. Praise’s research interests include studying the interplay between trauma, the experience of pleasure, and mental health symptoms among individuals with multiple marginalized identities.

Kaylee Palomino, M.S., is a doctoral student in Counseling Psychology at the University of Kentucky. Her diverse research interests include Black women’s sexual pleasure and well-being, Black motherhood and breastfeeding experiences, sense of belonging in college and substance use among historically marginalized populations.