A few years ago, while an ex-partner was going down on me, I realized I was having trouble breathing. Then a sense of dread filled my head, and I felt like I was being stabbed in the chest. So I quickly asked him to stop — not because he was doing anything wrong, but because I was having a panic attack during sex.
One of the (few) good things about panic attacks is that they usually only last for about 15 minutes, says Gail Saltz, MD, psychiatrist and author of The Power of Different: The Link Between Disorder And Genius. When I had my attack, I sat on the edge of the bed and did a series of breathing exercises. Gradually, I did begin to feel better.
But one of the most perplexing aspects of panic attacks is that they're intensely fearful physical reactions that occur in the absence of any real danger or identifiable cause, as the Mayo Clinic explains. In my case, I was in a safe space with someone I trusted when my ex was going down on me. However, I had very real and terrifying feelings of detachment, the aforementioned shortness of breath, and chest pains.
Of course, I'm speaking about panic attacks during consensual sex. Fear that happens during an assault or dangerous sexual experience is completely different than having a panic attack during healthy sexual intimacy. (Reach out to RAINN if that's the case.)
Although there are many causes for panic attacks, post-traumatic stress disorder (PTSD) is often to blame, says Barbara Greenberg, PhD, clinical psychologist and relationship expert. That was true for me: I'm a survivor of multiple sexual assaults and have been diagnosed with PTSD by a psychiatrist. As a result, sometimes during sex, I'll have a flashback of an incident and experience a panic attack. Although the attacks subsided thanks to therapy and medication, it's an ongoing process.
That said, panic attacks during sex can also happen to people who haven't been sexually assaulted or diagnosed with PTSD. Dr. Greenberg says that generalized anxiety disorder and panic disorder can also trigger panic attacks during intimacy, but anyone can have one during their life — with or without a diagnosed disorder. Sometimes these things just happen.
However, if your panic attacks are, like mine, recurring and have an identifiable root cause, it's an especially healthy idea to see a psychiatrist, Dr. Saltz says. "If you are having multiple panic attacks or PTSD flashbacks you should 100% get treatment," Dr. Saltz says. Treatment will begin with an evaluation of the cause of the panic attacks with a mental health professional. Then, that person will suggest therapy, medication, or both.
But is there anything you can do when you're in the midst of a panic attack during sex? The first thing to do, if you can, is explain to your partner what's happening — and step back from sex to take care of yourself. You can always try having sex again later when you're feeling better. Deep breathing exercises, mindfulness practice, and reassuring self-talk can all be helpful in calming a panic attack, says Michael Aaron, PhD, a sex therapist and author of Modern Sexuality: The Truth about Sex and Relationships. Changing your physical position or getting up to walk around can also help comfort you.
At that point, Dr. Aaron says it's okay to take any anti-anxiety medication you've been prescribed, such as benzodiazepines (e.g. Xanax, Ativan, and Klonopin). Because you can become dependent on such medications over time, they're meant to be used on an as-needed basis, Dr. Aaron says. But, depending on your individual needs, you may be taking them for a week or have a prescription at-the-ready for the rest of your life. While you're taking these medications, though, you're also (ideally) learning other self-soothing techniques in therapy that will come in handy when you stop taking the meds as frequently.
On top of managing what's happening in your own mind and body, explaining it to your partner presents another challenge. In particular, when I had a panic attack, my partner had a hard time understanding that he did nothing wrong. But Dr. Saltz says that, in the moment, it's enough to "tell your partner [your panic attack] will pass, take slow and deep breaths, and relax your muscles." After the crisis has passed, you can get into a more detailed description of what you experienced — and how it wasn't your partner's fault.
If you've been a witness to someone else's panic attack, know that they have likely experienced panic attacks before meeting you and probably will have them after you've parted ways, says Amanda Luterman, MA, OPQ, a psychotherapist who specializes in sexuality. "What you can do is be a soothing and stabilizing partner for that person, keep the focus on them, and reassure them that it’s going to pass," she explains.
So, remember that panic attacks do go away. But if you continue to have them during sex as part of a larger mental health issue or due to unresolved trauma, you should seek treatment. Trust me, it can be a life- (and sex life-) saving experience.