My new book Sex Again: Recharging Your Libido comes out next year. I wrote the book because patients tell me they wish they were more interested in sex and when I ask them what they think lowers their libido they often mention stress. Stressed out people usually don’t feel like having sex, which is a shame really because sex is a great stress reliever. The relationship between sex and stress goes deep. Sex often becomes just one more thing on the to-do list, one more chore, one more occasion to be under pressure to perform. Physiologically, stress triggers a hormonal chain reaction that ultimately suppresses libido.

Stress also causes a wide range of other physical ailments. And anything that dents your health is likely to dampen your sex life as well. Furthermore, sex is a great pressure release, and when we skimp on that we also deprive ourselves of one of the best ways we have of dealing with stress—and create a new stressor to boot.Everyone can feel stress, of course, but it tends to show up somewhat differently in women than it does in men. The familiar “fight or flight” response to stress is really more of a male paradigm. Women under stress are more likely to go into “tend and befriend” mode under duress. Instead of running away or violently confronting a threat, women generally respond first by protecting offspring (“tending”) and joining together in groups for mutual defense (“befriending”). Once upon a time, this might have meant that when a saber-toothed tiger came to call, women rounded up the children and banded together to keep them all safe. In today’s world, the female response is more likely to involve reaching out to a friend for support and focusing on caring for others. Of course, generalizations are not going apply to every single individual, but to many.

By this point you may be wondering if stress wouldn’t be rather good for your sex life, if you’re going to respond with all that reaching out, and coming together, etc. But there’s a hormonal catch. The tending and befriending is driven by a rise in oxytocin, which is triggered by stress. Estrogen enhances the effects of oxytocin, which accounts for the stronger showing of this strategy in women than in men. As oxytocin rises, however, so does a protein called sex hormone binding globulin (SHBG). SHBG binds to testosterone in the cells, reinforcing a less aggressive reaction to stress— and leaving less testosterone available for the body to use for other things. Like libido.

That, in a nutshell, is Western medicine’s understanding of the stress response in women as it affects libido. Chinese medicine tells a different tale based on similar observations. The basic view is that stress throws off the body’s energetic balance, and/or blocks the flow of qi. It works the other way around, too: an imbalance of energy and qi that isn’t moving causes stress. And either way, the result is a variety of symptoms with loss of libido prime among them. With stress and without moving qi, your ability to enjoy sex will be undermined, which will push sex even further down your list of priorities, causing strain on your relationship, thereby creating guilt and even more stress—and even less sex.

So what can you do if stress is affecting your sex life?
  • Exercise. Aerobic exercise is best, with yoga or tai chi a close second. Either way, you want to get your blood pumping.  Stress leads to stagnation and stagnation leads to low libido. Exercise moves the stagnation and has the added effect of making you feel good about your body. All good for a healthy sex drive.
  • Eat right for your sex life. Qi moves best when you are eating a largely plant-based diet with lots of leafy greens, some lean protein, and a small amount of whole grains. Refined carbs (too much pasta and bread) will make you more stuck. So will using food (or alcohol or coffee) as a way to try to relieve stress. Choose qi-moving foods including broccoli, kohlrabi, turnips, cauliflower, peppermint, radish, parsley, tomato, celery, asparagus, oranges, lemons, plums, strawberries, barley, buckwheat, rye, brown rice, sesame seeds, chicken, lima beans, fish, fava beans, chia seeds, pistachios, and yogurt.
  • Avoid caffeine. That morning joe stagnates qi, which is why it is infamous for exacerbating PMS symptoms and fibrocystic breasts.
  • Avoid toxins like processed foods or milk tainted with hormones and antibiotics.
  • Relax. Experiment to find what works for you—a relaxation tape, a warm bath, massage, meditation
  • Manage stress. Meditation, laughing, aerobic exercise, and sex (yes, even if you don’t feel like it at first) are all excellent candidates. Combinations of movement and meditation are particularly effective, such as tai chi or yoga, or simply walking mindfully.
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