Sexual Wellness

Solutions for Overcoming Sexual Performance Anxiety

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If you’re suffering from sexual performance anxiety, you’re not alone. Here’s what it is and how you can overcome this common sexual dysfunction.

Last Updated: 12/13/2022

Written by

Kimberly Wilkes

If you’ve ever felt anxious or nervous before or during sex, you’re not alone. Sexual performance anxiety is a common sexual dysfunction. It’s estimated that it affects 9% to 25% of men. This condition can lead to erectile dysfunction or premature ejaculation and is responsible for many frustrating experiences in the bedroom. This blog post will address how this disorder can affect your sexual function and what you can do to help resolve it. 

What Is Sexual Performance Anxiety and How Can It Lead to ED?

Sexual performance anxiety—sometimes called sexual anxiety—is a feeling of nervousness, anxiousness, or fear during or before sexual intercourse. It can come from having negative thoughts or feeling inadequate, insecure, or fear of not being able to please your partner. It can also result from being nervous about whether or not you’re going to reach orgasm.

An important cause of ED and premature ejaculation, sexual performance anxiety causes men to worry about how they’re going to perform. This can become a Catch-22 situation. The more a man worries about having and maintaining an erection, the less he’s likely to have one.  

Whereas erectile dysfunction is a physical problem, sexual performance anxiety is caused by psychological factors. It’s a mental health issue that can lead to ED. Over time, it can result in a lack of interest in sex and really take a toll on a man’s quality of life.

One way in which sexual performance anxiety leads to ED is through the release of stress hormones such as cortisol. These hormones narrow blood vessels and reduce blood flow to the penis. Impaired penile blood flow can stop you from having or maintaining an erection that’s hard enough for sexual intercourse. Since reduced penile blood flow is the cause behind 70% of ED cases, sexual performance anxiety can lead to erectile dysfunction. 

Causes of Sexual Performance Anxiety

A number of factors can cause a man to feel anxious before and during sex. For example:

• Worry that you won’t be able to satisfy your partner

• Fear of not being able to have an erection or having premature ejaculation problems. This is what can lead to a vicious cycle. You have trouble having an erection, so the next time you try to have sex that’s on your mind and you find it difficult to become hard.  

• Poor body image issues such as worrying that you’re overweight or your penis isn’t large enough.

• Being under a lot of pressure at work or stressed about family issues or other non-sexual situations

• Having an anxiety disorder. In one study, men with an anxiety disorder were more likely to suffer from both sexual performance anxiety and premature ejaculation rather than ED.

• General anxiousness about sex 

• Relationship problems, such as not feeling connected to your partner or not being satisfied with your relationship. 

• Having had a bad experience with sex in the past, such as being with a partner who was overly critical

• Watching Internet porn, which may lead to unrealistic expectations and lead to sexual performance anxiety. 

Is It Sexual Performance Anxiety or Something Else?

First, you want to make certain that it really is sexual performance anxiety that’s causing your problem. 

Certain health conditions such as diabetes and medications like beta blockers used to treat high blood pressure can lead to erectile dysfunction. Your healthcare provider can help you rule out whether these are causing the problem in the first place. 

Your healthcare provider will probably also talk to you about your sexual history. They’ll want to find out how long you’ve been suffering from this problem and what might be causing it.

Overcoming Sexual Performance Anxiety

Usually, if the origin of the problem is found to be mental, your doctor will suggest you talk to a therapist or counselor. It’s best to consult with someone who is experienced in treating sexual disorders. Talking with a therapist can help you understand the underlying issue behind your problem. You may need to undergo a specialized type of psychotherapy known as sex therapy.

Other options for getting rid of sexual performance anxiety include:

• Waiting to see if it resolves on its own. Sometimes, as you become more comfortable when you’re in a new relationship, your anxiousness may go away. 

• Reduce your stress level. Your anxiety might be caused because you’re stressed about something that has nothing to do with sex. In that case, getting rid of that stressful situation or learning ways to cope with it may improve your sexual encounters. Meditation and yoga, as well as exercise are all known stress reducers. Some botanical supplements like sage, passionflower, L-theanine, and bitter orange may also promote a calm mood.   

• Taking ED Medications. If mental health therapy on its own doesn’t work, you can try ED pills like Viagra, Cialis, and Stendra. These drugs are the most effective in men who are anxious and self-conscious about ED. However, they can have serious side effects such as:

  • Vision loss in one or both eyes

  • Sudden full or partial hearing loss

  • Ringing in the ears (tinnitus)

  • Dizziness

  • Erections that last more than 4 hours, a medical condition that must be treated right away to avoid penile damage. 

More common and less severe side effects of ED medications include:

  • Headache

  • Flushing

  • Upset stomach or nausea

  • Blurred vision or changes in your color vision. Some men have reported a blue color tinge.

  • Stuffy or runny nose

  • Back pain

  • Muscle pain

  • Rash

In addition, ED medications can stop working over time.

Frequently Asked Questions About Sexual Performance Anxiety

Wondering whether you or your partner have sexual performance anxiety? Here are the answers to some common questions about what it is and what you can do about it.

Is sexual performance anxiety the same as ED?

No. The two conditions are slightly different. Sexual performance anxiety is a mental health condition where men become anxious about having sex. It can be caused by being nervous about sex itself or because you’re stressed over some non-sex related matter like pressure at work. 

Low self-esteem and body image and worry that you can’t satisfy your partner can also cause you to feel anxious in the bedroom. 

ED, on the other hand, is a physical problem. Namely, it’s the inability to have or maintain an erection. However, sexual performance anxiety can cause ED. For example, if you start to obsess too much over the fact you couldn’t get hard one time, the next time you have sex you might find the same thing happening again. This can lead to a vicious cycle. 

Likewise, if you’re worried about your weight or penis size, you might have problems with erectile function. 

What are the symptoms of sexual performance anxiety?

There are several ways to tell if you have sexual performance anxiety. Some indications that you may have this condition include:

Feeling nervous or worried before or during sex

Loss of interest in sex due to the fear of not being able to perform effectively under the sheets

Being overly focused on how you look to your partner, such as being concerned about your weight or penis size

Will ED medications work on sexual performance anxiety?

They might. PDE5 inhibitors like Viagra can temporarily increase blood flow to the penis and therefore can help keep and maintain an erection. However, they’re not addressing the root cause of the problem. 

It’s best to figure out what’s causing your anxiety in the first place. If you’re stressed about work, find ways to feel more relaxed. Stress reduction and open communication with your partner can also relieve the nervousness you feel when having sex with a partner for the first time. If you have low self-esteem, work with a mental health provider or sex therapist to rebuild your self-confidence in the bedroom. 

How can I help my partner with sexual performance anxiety?

If your partner suffers from stress in the bedroom there are a number of ways to ease the tension such as:

Talking openly together about the problem, which can lead to a closer relationship. However, it’s best to have these conversations when you’re not in the middle of trying to have sex. Otherwise, your partner may feel pressured and even more stressed.   

Find other ways for the two of you to create intimacy and sensual pleasure. For example, give your partner a massage or soak in the hot tub together.