Sexual anxiety is caused by the external frustration of instinctual gratification and is internally anchored by the fear of the dammed-up sexual excitation. This leads to orgasm anxiety, which is the ego's fear of the over-powering excitation of the genital system due to its estrangement from the experience of pleasure. Orgasm anxiety constitutes the core of the universal, biologically anchored pleasure anxiety. It is usually expressed as a general anxiety about every form of vegetative sensation and excitation, or the perception of such excitation and sensations. The pleasure of living and the pleasure of the orgasm are identical. Extreme orgasm anxiety forms the basis of the general fear of life.

Ch. V : The Development of the Character-Analytic Technique - The Function of the Orgasm (1927)