“I can’t make love, I have a terrible headache.” This phrase has become well-recognized, and even a subject of humor to epitomize a popular belief that women may often need an excuse to avoid love-making with a man whose sexual appetite is much more insistent that hers. In recent years, however, we have been hearing increasingly about men who are intimidated by women, or for one reason or another, cannot perform–”performance anxiety.” Do women or men have a higher incidence of inhibited sexual desire to the point where it becomes a problem in their life? Perhaps it is much more equal than is popularly thought, but men are more reticent to talk about it. It’s no joke to many men when it comes to what is called in the Merck Manual (14th ed.) abnormal fear of the vagina. Other intrapsychic (it’s all in the mind) causes in men for “inhibited sexual excitement” (impotence) are listed as sexual guilt, fear of intimacy, depression, and some recreational drugs (see sidebar).

In no other area of human health does the mind enter in more thoroughly than in human sexuality–an ironic statement, because most of us realize that this is precisely one area of human activity where the mind can often do more harm than good. But in fact, statistics show that for both men and women, up to 80% of sexual dysfunction and inhibited sexual desire are of mental or emotional origin.

According to the Merck Manual, impotence in men is of two types: primary, which is rare, and “generally indicates severe psychopathology;” and secondary, “in which erectile dysfunction prohibits completion of successful sexual intercourse in about 25% (or more) of opportunities.” As mentioned, a full 80% of the secondary impotence is directly attributable to mental and emotional factors and only 20% to disease and functional abnormalities such as diabetes, cardiovascular diseases, surgery, and disorders of the hypothalamic-pituitary-gonadal hormone processes, which might lead to lowered levels of testosterone. Although low levels of testosterone might even be found in a majority of men with impotence, it is difficult to know whether psychological factors inhibiting sexual contact leads to lowered testosterone levels, or visa versa.

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Drugs and their effect on Sexual Performance
Drugs, such as alcohol, can also be a factor. I recently read a study that was carried out in the 60s in San Francisco with a group of volunteers, which clearly showed that while cocaine (which is considered the ‘cadillac’ of sexual stimulants) and marijuana led to increased sexual interest and improved performance, drugs such as heroin, alcohol, and a variety of downers (such as reds and quaaludes) and amphetamines actually led to a mild to strong decrease in these areas. Common prescription drugs can also lead to impotence as a side-effect. This is especially notable with hypertensives, sedatives, and tranquilizers.

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A common myth in this culture is that older people loose their sexual desire and ability to have satisfactory intercourse. Statistics and studies do not support this, however. According to the Merck Manual again, “Aging is not an inevitable cause of impotence, even into the 70s and 80s.” Of course, the desire to have sex will cool off somewhat as we get older. I’ve often felt how fortunate I am to not have the same desire in my 40s as I did when I was 19!

The most common prescription for functional impotence is yohimbine hydrochloride. The drug originated from a West African tree, Pausinystalia johimbe, which has been sold for years on the herb markets of countries world-wide, including the U.S. The alkaloid is an -adrenergic blocker, increases parasympathetic tone and decreases sympathetic tone, as well as a central nervous system (CNS) stimulant. There are a few modern studies showing that it is effective for some types of impotence, especially ones of vascular, diabetic, or psychogenic origins, and it can improve the quality and staying power of erections, usually without increasing sexual excitement. However, the drug should be used cautiously, because it is a CNS stimulant and can lead to side-effects such as dizziness nervousness and anxiety (Physicians Desk Reference, 43rd edition). Yohimbe is also available in some products sold in health food stores, but again, it should be used with caution.

Because many cases of impotence are associated with our mind and emotions, it is appropriate to seek the services of a qualified psychologist, marriage and family counselor or social worker. I prefer to work with practitioners who do not view such problems as pathological, but as a process of self-discovery and personal growth. It is important to clearly understand the root causes of impotence, and often doing so, the problem will disappear on its own.

As an herbalist, and Traditional Chinese Medicine practitioner, I use herbs as a major part of my “bag of tricks” in a clinical situation, as well as personally and with friends and acquaintances. Besides herbal therapies, I recommend proper exercise and deep breathing daily, to make sure the circulation is moving. Hydrotherapy (cool showers, for instance) can also be effective for this, and it is essential to eat a strong diet that avoids foods rich in saturated fats, refined sugars, and processed foods in general, and emphasizes high-fiber foods such as grains and legumes, fresh lightly cooked vegetables, and a variety of fruits in season. Following this diet and the other recommendations will often lead to improvement within a few weeks.

Women with increased levels of anxiety and nervous tension often need to develop more effective ways of dealing with day to day stresses the minor everyday pressures that women with a healthy emotional balance handle easily but that can be overwhelming for women whose anxiety responses are easily triggered. Such stress can include riding in an elevator, being in crowds, going to the dentist, or any situation, place, or person that sparks a woman’s emotional charge. Often these charged issues evoke anxiety, fear, or upset feelings. Moreover, significant lifestyle changes death of a loved one, divorce, job loss, financial problems, major changes in personal relationships can be almost impossible to handle when a woman is already feeling anxious and tense. Being unable to cope with stress effectively can also damage a woman’s self esteem and self confidence. A woman with anxiety episodes may feel a decreasing sense of self-worth as her ability to handle her usual range of activities diminishes. Life stresses themselves don’t necessarily change, so how a woman copes with them can really make the difference.

How Stress Affects the Body
Your emotional and physical reactions to stress are partly determined by the sensitivity of your sympathetic nervous system. This system produces the fight or flight reaction in response to stress and excitement, speeding up and heightening the pulse rate, respiration, muscle tension, glandular function, and circulation of the blood. If you have recurrent anxiety symptoms, either major or minor lifestyle and emotional upsets may cause an overreaction of your sympathetic system. If you have an especially stressful life, your sympathetic nervous system may always be poised to react to a crisis, putting you in a state of constant tension. In this mode, you tend to react to small stresses the same way you would react to real emergencies. The energy that accumulates in the body to meet this “emergency” must be discharged in order to bring your body back into balance. Repeated episodes of the fight or flight reaction deplete your energy reserves and, if they continue, cause a downward spiral that can lead to emotional burnout and eventually complete exhaustion. You can break this spiral only by learning to manage stress in a way that protects and even increases your energy level.

Techniques for Relaxation
Many patients have asked me about techniques for coping more effectively with stress. Although I send some women for counseling or psychotherapy when symptoms are severe, most are looking for practical ways to manage stress on their own. They want to take responsibility for handling their own problems observing their inadequate methods of dealing with stress, learning new techniques to improve their habits, and then practicing these techniques on a regular basis.

I have included relaxation and stress reduction exercises in many of my patient programs. The feedback has been very positive; many patients report an increased sense of well being from these self help techniques. They also note an improvement in their physical health. This chapter includes fourteen stress reduction exercises for women with anxiety. They will take you through a series of specific steps to help alleviate your symptoms. The exercises will teach you the following helpful techniques: focusing and meditation, grounding techniques (how to feel more centered), exercises that help you to relax and release muscle tension, erasure techniques (how to erase old programs), healing the inner child, visualizations, and affirmations. These techniques will help you cope with stress more efficiently, make your thoughts more calm and peaceful, and help you learn to relax, while you build self esteem and self confidence. Try them all; then decide which ones produce the greatest benefits for you. Practice these on a regular basis.

Quieting the Mind and Body
Women with recurring symptoms of anxiety and nervous tension are usually barraged by a constant stream of negative “self-talk.” Throughout the day your conscious mind may be inundated with thoughts, feelings, and fantasies that trigger feelings of upset. Many of these thoughts replay unresolved issues of health, finances, or personal and work relationships. This relentless mental replay of unresolved issues can reinforce the anxiety symptoms and be exhausting. It is important to know how to shut off the constant inner dialogue and quiet the mind.

The first two exercises require you to sit quietly and engage in a simple repetitive activity. By emptying your mind, you give yourself a rest. Meditation allows you to create a state of deep relaxation, which is very healing to the entire body. Metabolism slows, as do physiological functions such as heart rate and blood pressure. Muscle tension decreases. Brain wave patterns shift from the fast beta waves that occur during a normal active day to the slower alpha waves, which appear just before falling asleep or in times of deep relaxation. If you practice these exercises regularly, they can help relieve anxiety by resting your mind and turning off upsetting thoughts.

Exercise 1: Focusing
Select a small personal object that you like a great deal. It might be a jeweled pin or a simple flower from your garden. Focus all your attention on this object as you inhale and exhale slowly and deeply for one to two minutes. While you are doing this exercise, try not to let any other thoughts or feelings enter your mind. If they do, just return your attention to the object. At the end of this exercise you will probably feel more peaceful and calmer. Any tension or nervousness that you were feeling upon starting the exercise should be diminished.

Exercise 2: Meditation

• Sit or lie in a comfortable position. 
• Close your eyes and breathe deeply. Let your breathing be slow and relaxed. 
• Focus all your attention on your breathing. Notice the movement of your chest and abdomen in and out. 
• Block out all other thoughts, feelings, and sensations. If you feel your attention wandering, bring it back to your breathing. 
• As you inhale, say the word “peace” to yourself, and as you exhale, say the word “calm.” Draw out the pronunciation of the word so that it lasts for the entire breath. The word “peace” sounds like p-e-e-a-a-a-c-c-c-e-e-e. The word “calm” sounds like: c-a-a-a-l-l-l-l-m-m-m. Repeating these words as you breathe will help you to concentrate. 
• Continue this exercise until you feel very relaxed.

Grounding Techniques
Many women suffering from anxiety episodes often feel ungrounded and disorganized. There is a pervasive sense of “things falling apart.” When anxiety episodes occur, it often takes a concentrated effort just to get through the day, accomplishing such basic daily tasks as cooking, housecleaning, taking care of children, or getting to work or school. The next two exercises teach you grounding techniques that will help you feel more centered and focused. Practicing either of these exercises will allow you to organize your energies and proceed more effectively with your daily routine.Exercise 3: Oak Tree Meditation

• Sit in a comfortable position, your arms resting at your sides. 
• Close your eyes and breathe deeply. Let your breathing be slow and relaxed. 
• See your body as a strong oak tree. Your body is solid like the wide, brown trunk of the tree. Imagine sturdy roots growing from your legs and going down deeply into the earth, anchoring your body. You feel solid and strong, able to handle any stress. 
• When upsetting thoughts or situations occur, visualize your body remaining grounded like the oak tree. Feel the strength and stability in your arms and legs. 
• You feel confident and relaxed, able to handle any situation.

Exercise 4: Grounding Cord Meditation

• Sit in a comfortable position, your arms resting comfortably at your sides. 
• Close your eyes and breathe deeply. Let your breathing be slow and relaxed. 
• Imagine a thick wide cord attaching itself to the base of your spine. This is your grounding cord. It can be a thick piece of rope, a tree trunk, or any other material that feels strong and stable. Make sure your cord is wide and sturdy enough. Then imagine a thick metal hook attaching itself to the end of your cord. 
• Now visualize your grounding cord dropping down two hundred feet below the earth and hooking on to the solid bedrock below the earth. 
• Continue to breathe deeply and notice the sense of peace and stability that your grounding cord can bring you. 
• Replace the cord with a new one each day or whenever you feel your emotions getting out of control.

Releasing Muscle Tension
The next three exercises will help you get in touch with your areas of muscle tension and then help you learn to release this tension. This is an important sequence for women with emotional symptoms of anxiety and nervous tension since habitual emotional patterns cause certain muscle groups to tense and tighten. For example, if a person has difficulty in expressing feelings, the neck muscles may be chronically tense. A person with a lot of repressed anger may have chest pain and tight chest muscles. Contracted muscles limit movement and energy flow in the body, since they tend to have decreased blood circulation and oxygenation and accumulate an excess of waste products, such as carbon dioxide and lactic acid. Therefore, muscle tension can be a significant cause of the fatigue that often accompanies chronic stress. The following exercises help release tension and the blocked emotions held in tight muscles. Exercise 5: Discovering Muscle Tension

• Lie on your back in a comfortable position. Allow your arms to rest at your sides, palms down, on the surface next to you. 
• Raise just the right hand and arm and hold it elevated for 15 seconds. 
• Notice if your forearm feels tight and tense or if the muscles are soft and pliable. 
• Let your hand and arm drop down and relax. The arm muscles will relax too. 
• As you lie still, notice any other parts of your body that feel tense, muscles that feel tight and sore. You may notice a constant dull aching in certain muscles.

Exercise 6: Progressive Muscle Relaxation

• Lie on your back in a comfortable position. Allow your arms to rest at your sides, palms down, on the surface next to you. 
• Inhale and exhale slowly and deeply. 
• Clench your hands into fists and hold them tightly for 15 seconds. As you do this, relax the rest of your body. Visualize your fists contracting, becoming tighter and tighter. 
• Then let your hands relax. On relaxing, see a golden light flowing into the entire body, making all your muscles soft and pliable. 
• Now, tense and relax the following parts of your body in this order: face, shoulders, back, stomach, pelvis, legs, feet, and toes. Hold each part tensed for 15 seconds and then relax your body for 30 seconds before going on to the next part. 
• Finish the exercise by shaking your hands and imagining the remaining tension flowing out of your fingertips.

Exercise 7: Release of Muscle Tension and Anxiety

• Lie in a comfortable position. Allow your arms to rest at your sides, palms down. Inhale and exhale slowly and deeply with your eyes closed. 
• Become aware of your feet, ankles, and legs. Notice if these parts of your body have any muscle tension or tightness. If so, how does the tense part of your body feel? Is it viselike, knotted, cold, numb? Do you notice any strong feelings, such as hurt, upset, or anger, in that part of your body? Breathe into that part of your body until you feel it relax. Release any anxious feelings with your breathing, continuing until they begin to decrease in intensity and fade. 
• Next, move your awareness into your hips, pelvis, and lower back. Note any tension there. Notice any anxious feelings located in that part of your body. Breathe into your hips and pelvis until you feel them relax. Release any negative emotions as you breathe in and out