Do I Have Performance Anxiety or Erectile Dysfunction?

An image of a man deliberating if he has ED or performance anxiety

At one moment or another, almost all men have wondered if their sexual performance is up to par or if they are satisfying their partner sexually. While these thoughts are normal occasionally, when fears and anxiety creep into your sexual life, sexual performance anxiety can happen.

Performance anxiety refers to negative thoughts and preoccupations with one’s inability to sexually perform or provide satisfaction to one’s partner. It can lead to a self-fulfilling prophecy in which a man’s worry regarding his sexual performance becomes true, leading to psychological erectile dysfunction.

In fact, up to 25% of men admit to persistent sexually related anxieties lasting several months. Research also shows that anxiety, depression and emotional and life stressors are common causes of erectile dysfunction (ED).


an infographic that shows that 20% of men suffer from psychological impotence

Up to 20% of men face the problem of psychological ED

Is it erectile dysfunction or performance anxiety?

So, how can you tell if erectile problems are due to performance anxiety and not a sign of an underlying medical problem? Well, men who regularly get morning erections, but then have difficulty achieving or maintaining an erection with their sexual partner are more likely to have psychological ED.

The same goes for masturbation—if you are able to have a strong erection when you masturbate, but not with your sexual partner, your erectile problems are probably due to performance anxiety.

Another clue to performance anxiety is if you notice that ED only occurs in certain situations— for example with a new partner you really want to impress. Or, if ED comes and goes, popping up when you are dealing with stressful life situations but disappearing when life is going well it may be psychological in nature.

On the other hand, organic ED, which is caused by an underlying medical problem, persists regardless of the situation.

Why does performance anxiety cause erectile dysfunction?

The link between performance anxiety and erectile dysfunction is physiological. For our ancestors, stumbling upon a lion triggered the “fight of flight” response to get them ready for a life threatening situation. The stress hormones— cortisol and adrenaline— shot up and sparked the sympathetic nervous system, that part of our hard wiring that accelerates our heart and breathing rate, to provide much needed energy to escape with our lives.

Anxiety triggers the same hormone spikes, but unfortunately, when the stressor is our perceived inability to please our sexually partners, the results are disastrous. As stress hormones trigger blood flow to the heart and muscles, it diverts blood away from the penis making it difficult to get an erection.  This cycle can perpetuate itself. Studies show that panic disorder can closely resemble and

an illustration of the sexual performance anxiety cycle

therefore trigger sexual performance anxiety. Since sexual activity increases heart and breathing rate, it can mimic a life-threatening stressor, causing anxiety or panic in predisposed individuals.

Does Viagra work for performance anxiety?  

These medicines directly increase blood flow to the penis, minimizing the effect of performance anxiety, but still require enough sexual stimulation to work. This means that for some men with severe anxiety, Viagra and other medicines may not be enough.  Additionally, these medicines come with significant side effects and should not be taken without a medical health professional’s guidance. 


Performance anxiety can seem like an insurmountable mountain. Fear of failure is real and when the fear is related to something as fundamental as your ability to get an erection, it can be marred with feelings of shame and hopelessness. Yet, sexual performance anxiety is quite common and there are tried and true methods to not only deal with it but to surmount it. Take action now to rid yourself of performance anxiety!

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About Oreoluwa Ogunyemi, MD

Urologist and Health and Wellness Coach

Dr. Ogunyemi is a medical doctor, trained urologist and a health and wellness coach. She received her medical degree from the David Geffen School of Medicine at UCLA. Her professional background and love of writing, allow her to efficiently synthesize complex and detailed research, making it accessible to a broader audience.

She serves as a medical writer for the Between Us Clinic.