"I'm a 42-year-old woman now afraid I'll get pregnant from my husband of 20 years," Elena, who has withheld her last name for privacy reasons, writes in an email to USA TODAY. "I'm over 40, so what if I became pregnant with a fetus that had a fatal developmental defect? What if I miscarried, and my body didn't expel all the tissue? What if something went horribly wrong?"
"What if I left my husband a widower and my children motherless?"
According to the National Abortion Rights Action League, Nebraska outlaws abortion after 20 weeks but allows exceptions to save the life of the mother. But after the overturning of Roe, Elena fears what may happen if her state's lawmakers implement tighter restrictions.
She isn't alone in these fears.
In the wake of Roe's overturning, sex therapists say they've observed a dramatic increase in anxiety when it comes to sex – and for some people, this anxiety has forced them to reconsider how they approach sex, dating and relationships altogether.
"Anxiety is really the enemy of arousal," says Ian Kerner, a sex therapist in New York. "Sexuality is a fundamental part of life, and the enjoyment of sexuality is a part of life. Anxiety really gets in the way of that enjoyment."
'Sex is a little scary to me right now'
Brittany Johnson, a 26-year-old writer in central Florida, has always been cautious about sex.
But with Roe overturned, sex, even with extra precautions, doesn't seem worth the slimmest possibility of pregnancy.
"Sex is a little scary to me right now," Johnson says. "I am protected. I have an IUD. I wear condoms. I do all the 10 million steps my mother taught me to stay safe when I am intimate, but I don't want to have to go through that anxiety. I don't want to have to wonder, 'Oh my gosh, if I decide to have fun... is this going to be either a costly or deadly situation that I end up in?' "
Victoria James, a mental health counselor in Oklahoma specializing in intimacy, sex and relationship therapy, says anxiety often inhibits sexual desire – and she's seen this play out in most of her clients post-Roe.
"We talk about arousal and desire having things that press on the gas and then things that press on the brakes," she says. "For most of the clients I'm seeing, this decision has been like a massive, 500-pound weight on the brakes."
Amber Goldsmith, an administrative assistant in Lee County, Florida, understands these feelings.
One of her past relationships, she says, ended in 2016 due to her ex's anxiety over abortion access being jeopardized by Donald Trump's presidency.
"We stopped seeing each other because he was just too afraid," Goldsmith says. "He was too anxious to even consider dating somebody and having a sexual relationship with them if there was a possibility of them getting pregnant, however small."
Her ex's fear wasn't unfounded. During his term, Trump appointed three Supreme Court justices, all of whom backed the overturning of Roe.
Now, Goldsmith says she knows more and more people who, like her ex, are too scared to pursue romantic relationships.
Laura Brito, a therapist and social worker in North Carolina, says people were already feeling heightened fear toward sex due to the pandemic – and this fear is getting compounded by the Roe decision.
What does sex look like post-Roe?
Post-Roe, Kerner speculates more Americans will seek alternatives to vaginal sex – such as anal sex, oral sex and mutual masturbation – to avoid pregnancy. But overall, he thinks the ruling will result in less sexual exploration, especially for younger generations.
"For Gen Z-ers and some millennials, they're not going to get to have the same freedom around sexually exploring and developing their sexual history," he says.
Though Kerner bemoans this, he says a positive outcome is couples will likely communicate more openly about having safer sex.
This also includes making sure partners are on the same page about abortion. After all, "if someone does happen to get pregnant, you would like to be aligned with the person you had sex with, rather than it being divisive and polarizing," Kerner says.
For some, the Roe decision has highlighted relationship issues larger than sex. For example, James says one of her clients has struggled to feel emotionally safe in her marriage after seeing her husband's flippant reaction to the ruling.
“A result of this has impacted the relationship outside of just 'What if I get pregnant?' " she says. "What if my partner doesn't understand? What if I'm not heard? What does that mean for me? I think it's bigger."
'I have wondered if having sex with my own husband would eventually kill me'
Earlier this month, Elena had her Nexplanon, a contraceptive implant in her arm, replaced.
She wasn't due for the replacement yet, but her doctor, who is pregnant, said other patients have been doing the same since the Roe ruling.
Nexplanon is considered one of the most effective forms of birth control. Still, it can't completely silence the voice in the back of her head that makes her scroll through online reports about its effectiveness before she and her husband have sex.
"I never thought about abortion, or the Supreme Court, or if a judge would determine the value of my life when I should be thinking about whether we should go out for General Tso's chicken or carne asada tacos," she writes. "But in the past week, I have. I have wondered if having sex with my own husband would eventually kill me."
The fears people are feeling post-Roe are valid, says James. And the best way to cope is to communicate about safe sex and focus on what you can control.
"You're not crazy. You're not being dramatic. You're having a response to something that is scary."
This article originally appeared on USA TODAY: Sexual anxiety on the rise after overturning of Roe, therapists say