Nervous trembling before intimacy

Dear Trembling,

Since the tremors you describe are creeping up on you during intimate situations, it's possible that the shaking you experience is caused by stress surrounding sex. The funny thing about stress is that even positive events, such as getting close with someone special, can throw you off balance (literally and figuratively) and provoke undesirable symptoms. Although there isn’t a quick fix, there are steps you can take to quell the trembling. Tremors are an involuntary muscle contraction that leads to shaking, usually of the hands, that frequently occurs when someone is stressed, anxious, or even just over-tired. When tremors are associated with a change in emotional state, such as becoming intimate or even thinking about being intimate, they typically aren’t a major medical concern. Tremors may also be caused by: 

• Excessive caffeine
• Stress, anxiety, and fatigue
• Alcohol or alcohol use disorder
• Aging
• Drugs or prescription medications
• Low blood sugar
• Medical conditions including Parkinson's disease, multiple sclerosis, and overactive thyroid.

You mention drinking alcohol as a potential way to calm your nerves. Although drinking alcohol may provide temporary relief from tremors because of its depressant effect, using it as a long-term strategy may not be a great idea, since excessive alcohol use can actually cause more severe tremors. A more effective approach may be to manage your stress and anxiety by practicing relaxation, visualization, meditation, exercise, and related techniques. Meditation and Stress, anxiety and learning to cope may be helpful questions and provide ways to help you deal with anxiety and stress.

The tremors you experience could also be caused by 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). Sexual performance anxiety, more specifically, is any nervousness related to sexual activity. Though there is no formal diagnosis for this condition, it’s estimated that 6 to 16 percent of women and around 9 to 25 percent of men struggle with anxiety about their sexual performance. Unfortunately, sexual performance anxiety often leads to a cycle in which a person worries about being intimate, is unable to have sex with a partner because of those worries, and then continues to worry in the future because of the bad experience. If left untreated, sexual performance anxiety may lead a person to lose self-confidence or avoid sex altogether.

Thankfully, there are ways to combat feelings of anxiety during intimacy, such as:

• Eliminating potential distractions that could impact sexual performance
• Focusing on physical sensations rather than sexual functions
• Practicing mindfulness exercises to remain “in the moment”
• Communicating your nervousness to your partner so that you two can find a solution together

If you’d like additional support in exploring potential sexual performance anxiety, treatment such as cognitive behavioral therapy (CBT) could also be an option. With the guidance of a mental health professional, you could work on changing your negative thoughts surrounding intimacy and finding ways to cope with nervousness. You might also want to consider exploring some aids such as lubricants and toys that help make sex a more relaxing, enjoyable experience.

Learning to relax may help you deal with the trembling, but it’s also critical that you are comfortable with your partner. You could try talking to them about the trembling to make it less awkward for you if your hands or body starts to shake. Who knows? They might be feeling nervous too, even if they’re not showing it.

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. They can help you determine whether or not your tremors are related to a medical concern or if they're associated with something else.