Dear Alice,

Whenever I am physically intimate with a girl or even if I suspect eminent intimacy, I begin to tremble uncontrollably. This makes me feel quite awkward and self-conscious. Also this is the only time it happens. Is this a treatable disorder? Is there perhaps some sort of quick fix solution such as getting slightly inebriated before such an encounter?

—Trembling

Dear Trembling,

Since the tremors you describe are creeping up on you during intimate situations, it's possible that the shaking you describe is caused by stress and/or anxiety. The funny think about stress and anxiety is that even positive events, like getting cozy with someone special, can throw you off balance (literally and figuratively) and provoke undesirable symptoms. Although there is no quick fix, there are steps you can take to quell the trembling. Tremors are an involuntary shaking, usually of the hands, and frequently occur when someone is stressed or anxious, or even just over-tired. When tremors are associated with a change in emotional state, (like becoming intimate, or even thinking about being intimate) they are typically not a major medical concern. Tremors may also be caused by:

  • Excessive caffeine
  • Stress, anxiety, and fatigue
  • Alcohol or alcoholism
  • Aging
  • Drugs or prescription medications
  • Low blood sugar
  • Medical conditions including Parkinson's disease, multiple sclerosis, and over-active thyroid.

You mention drinking alcohol as a way to calm your nerves (the nickname 'liquid courage' comes to mind…). Although drinking alcohol may provide temporary relief from tremors because of its depressant effect, using it as a long term strategy isn't a great idea, since excessive alcohol use can actually cause tremors. A more effective approach is to try to manage your stress and anxiety by practicing relaxation, visualization, meditation, exercise, and related techniques. See Meditation, Stress, anxiety and learning to cope for ways to deal with anxiety and stress.

Your symptoms could be tremors caused social anxiety disorder or general anxiety. Social anxiety disorder is generally associated with fear of public places or social situations, but could also be a result of a single fear or circumstance (in your case, being intimate). Check out Anxiety Disorder Association of America's online self evaluation tool which may help you to start thinking about how your symptoms affect your life.

If your tremors spread to your entire body or cause movements other than shaking, or if anxiety starts to interfere with your daily activities, it's a good idea to seek medical attention. Your health care provider can offer referrals to a counselor.

Learning to relax may help you deal with the anxiety and trembling, but it is also important that you are comfortable with your partner. You could try talking to her about the trembling to make it less awkward for you if your hands or body starts to shake. Who knows? She might be feeling anxious too, even if she's not showing it.

Take a deep breath and try to relax. Anxiety is very common, but there are many people who learn to manage it and enjoy intimacy, and other social situations, tremor free.

Alice!
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