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

Do I have performance anxiety or erectile dysfunction?

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.

What causes performance anxiety?

man having negative thoughts about performance anxiety
Negative self-talk, fears, and unhealthy thought processes may lead to sexual performance issues – in some men

Typically, performance anxiety stems from negative self-talk. Negative thoughts like, “will I ejaculate too early?” ,” Will I be able to get or keep an erection?”, “What if she doesn’t have an orgasm?” What if she’ll leave me or doesn’t want to see me again?” are common in men dealing with performance anxiety.

When our minds are working overtime, we can’t fully tune into the pleasurable sensations, which are so integral to stimulating our sexual response and for having an erection.

Of course, it is completely normal to occasionally have a difficult time getting an erection. In fact, this can happen up to once every four times in a man without any psychological or medical problems. However, when the stresses of daily life— such as career, relationships, or finances— weigh heavily on your mind it can be difficult to focus on sexual pleasure or being in the moment.

It is often enough to experience performance anxiety once to get into the sexual performance anxiety cycle. A single failure to achieve an erection can make some men become preoccupied with thoughts about whether this will happen to them again. This leads to more anxiety and more occurrences of erectile dysfunction.

Sometimes embarrassment around performance anxiety can give men the sense that they alone deal with these issues. This can be especially true when societal norms, locker room talk, or excess porn watching gives an unrealistic expectation of “normal” sexually.

Male performance anxiety solutions

  1. Talk about it with your partner

    A picture of a man talking to his partner about his performance anxiety

    While men may feel shame around performance anxiety and not want to talk about it, the silence around unmet expectations only worsens the situation. Like the proverbial elephant in the room, embarrassment and anger about performance anxiety can claim important space in your relationship. Setting up a time (outside of sex) when both you and your partner are willing and able to talk about your sexual relationship can help bring some understanding and some space to decrease unnecessarily high expectations.  

  2. Focus of the senses

    An image of a man focusing on his senses while having sex

    Another helpful option is to focus on the pleasurable sensations during intimacy, rather than the specific goals of achieving or maintaining an erection. By focusing on the sensual experiences, it becomes more intuitive for the body to take over and for an erection to occur. The focus on experience, rather than goals, can really help men get out of their head and focus on the pleasures of intimate connection.

  3. Guided imagery and meditation

    Research indicates that meditative practices and guided imagery can be helpful for men dealing with performance anxiety and erectile dysfunction. Clearing your mind of limiting thoughts and visualizing success can help to assuage anxieties.  It may be helpful to involve a committed partner in this practice or at least give yourself time before the sexual activity to use these techniques.  

    Guided Imagery for Psychological Erectile Dysfunction

    Advertisement: you can also try the Mental Impotence Healer Program – a guided imagery program created specifically for psychological erectile dysfunction.

  4. Talk to a therapist

    Finally, some men who are feeling overwhelmed with performance anxiety may benefit form sexual psychotherapy. A therapist can provide resources to help break the cycle of negative self-talk as well as formalize steps you can take on your own or with your partner to manage the anxiety and get back to enjoying your sexual relationships.

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Does Viagra work for performance anxiety?  

An image of blue pills

Some men may wonder if it is a good idea to take Viagra, Cialis or other erectile dysfunction medicines for sexual performance anxiety. While these medications have been used in psychogenic ED, for example in men with depression, there is a potential for dependence on the medications for sexual intimacy.

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. 

What can you do if your partner has performance anxiety?

Sexual performance anxiety can be challenging for the man’s sexual partners. The shame and secrecy can play a toll on the relationship and the repercussions often spill outside of the bedroom. First, understanding whether your partner has performance anxiety versus an underlying medical condition causing ED is important, as the treatments are quite different.  As men who have morning erections or erections when masturbating are more likely to have performance anxiety, this is an important clue.

As performance anxiety can be wrapped up in a man’s self-esteem and sense of masculinity, it’s important to have compassion and create an open and non-judgemental space when communicating. Refrain from having the conversation during sex and encourage your partner that erections are simply one part of sexual intimacy and highlight other ways or methods that your intimacy needs can be met. With openness, compassion and patience, sexual performance anxiety can be overcome.  

Summary

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!

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. As a urologist, she counsels and treat genitourinary disorders. As a Wellness Coach, she counsels individuals on best practices to reach their health goals.

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