Overcoming Performance Anxiety and Erectile Dysfunction

Learn about the causes, diagnosis, and solutions for performance anxiety and ED.

men in bed thinking about performance anxiety and erectile dysfunction

Have you ever been so worried, during sex, that you just couldn’t perform? Well, sexual performance anxiety is one of the most common sexual issues. In men, performance anxiety can often lead to erectile dysfunction.

Performance anxiety and ED is likely to happen to most men at some point in their lives. Even in physically healthy young men, who previously had no sexual performance issues.

The most common sexual issue performance anxiety leads to in men is erectile dysfunction (ED). This is the focus of this article. You can learn about premature ejaculation and performance anxiety In this comprehensive article.

Also, although less common, performance anxiety can lead to an inability to orgasm and a loss of libido in both men and women.

Can performance anxiety cause erectile dysfunction?

Hormones that are released during performance anxiety reduce blood flow to the penis which is necessary for an erection and can lead to erectile dysfunction.

When you become anxious, your body releases adrenaline and cortisol. These hormones elevate your blood pressure and heart rate so you can flee dangerous situations. They also halt many bodily functions by constricting certain blood vessels. In some cases, it reduces blood flow to your penis. This can lead to a loss of erection or difficulty achieving an erection.

Studies show a clear link. These two studies from 2005 and 2015, found that performance anxiety can trigger or continue sexual dysfunctions in men, including erectile dysfunction.

What causes performance anxiety?

Negative sex-related thoughts

man having negative thoughts about performance anxiety
Negative thoughts about sexual performance can lead to performance anxiety and ED

Negative sex-related thoughts are the common cause of performance anxiety. Being insecure about your ability to please your partner, and worries about body image and penis size are common examples.

Many factors can trigger these kinds of thoughts. Cultural and social pressures can affect your perception of manliness and of how a man should perform during sex.

Have you ever had the following thoughts?

  • What if I can’t get or maintain an erection?
  • What if I can’t make her orgasm?
  • What if I ejaculate too early?
  • What if she doesn’t like my body?
  • What if she thinks my penis is too small?
  • What if she tells others about her bad experience?

These kinds of thoughts can trigger performance anxiety and lead to ED.

Sexual performance anxiety cycle

A graph showing the sexual performance anxiety cycle

The performance anxiety cycle happens when a man starts to become preoccupied with negative thoughts after experiencing erectile dysfunction. This leads to more failures and increased anxiety. Once this occurs the performance anxiety cycle is created.

It is completely normal to be unable to achieve an erection once in a while but many men are unaware of this. Healthy men may experience erection problems as much as one in four times.

The performance anxiety cycle is one of the leading causes of chronic performance anxiety cases.

Other causes for ED

Erectile dysfunction is a symptom of performance anxiety, but it can be caused by several other reasons.

Remember that some men can have both physiological and psychological reasons for ED.

Psychological causes

Other psychological factors could also lead to ED. These include:

a chart that lists the psychological causes of erectile dysfunction

If you want to learn more about the causes of psychological erectile dysfunction read this article

Physiological causes

a chart that lists the physiological causes for erectile dysfunction

Some of the physiological causes for ED include:

  • Diabetes
  • Low testosterone
  • Hormonal imbalance
  • Cardiovascular disease
  • Atherosclerosis
  • Kidney disease
  • Multiple sclerosis
  • Parkinson’s disease
  • Peyronie’s disease
  • Prostate cancer treatment
  • Smoking
  • Alcohol and drug abuse
  • Chronic illness
  • Stroke
  • Traumatic injury

If you want to learn more about the physical causes of ED, read this article we wrote about erectile dysfunction.

Medication side-effects

A bottle of prescription medication that may had a side effects of erectile dysfunction
Prescription Antidepressants Can Help but may have Side-Effects

Medication side-effects may also prevent some men from achieving an erection. Some of these medications include:

  • Cimetidine (Tagamet)
  • SSRI antidepressants (i.e. Paxil, Prozac)
  • Blood pressure medicines (i.e. Aldactone, Catapres, Oretic, Apo-Hydro and many others)
  • Anti-inflammatory medicines
  • Drugs for irregular heartbeat
  • Antihistamines
  • Tranquilizers
  • Antiseizure pills
  • Chemotherapy
  • Muscle relaxers
  • Hormone therapy

Diagnosis

How can you tell if erectile dysfunction is caused by performance anxiety? Well, ask yourself the following questions:

  1. Are you able to have an erection when you masturbate?
  2. Do you have morning erections?

If the answer to one of these questions is “Yes,” then the ED is probably caused by performance anxiety.

If the answer is “No,” there may be another reason for your ED.

If you believe that your erectile dysfunction could be physical in nature, consult a doctor.

Treatments

When trying to overcome performance anxiety and ED, the main objective should be to reduce the negative thoughts that are triggering the performance anxiety. Some of the common treatment options include:

  1. Guided imagery

    Man listening to guided imagery for performance anxiety and erectile dysfunction

    Guided imagery is a simple relaxation technique that can help you overcome performance anxiety by removing reoccurring stressful thoughts you have about sex.

    During a guided imagery session, you’ll listen to simple instructions provided in a specific, descriptive language. You will be instructed to imagine a successful sexual experience. During which you’ll stay hard and enjoy sex. You’ll also recognize that your partner is enjoying the sex. Your unconscious mind reacts as though what you are imagining is happening.

    Guided imagery is based on the idea that the unconscious mind can’t tell the difference between something you experience and something you only imagine.

    With time, this exercise reduces reoccurring stressful thoughts and fears you may have about sex. It also helps to remove psychological barriers that could be triggering performance anxiety. The purpose of guided imagery is to reinforce positive thinking.

    Efficacy

    A 1984 study,  conducted by Professor K. Kuruvilla showed how effective guided imagery is. Professor Kuruvilla found that 70% of men, who committed to sexual re-education and guided imagery, overcame erectile dysfunction that was caused by performance anxiety. Those, who completed the treatment-experienced long-term positive results.

    How to get started

    You can create and record your own guided imagery script. Although, it may be more effective when a professional creates and records one for you. You can seek professional help with a certified sex therapist. A sex therapist can create and record a guided imagery script for you to follow.

    You can also try the Mental Impotence Healer program by our sister brand – a guided imagery program created specifically for performance anxiety and ED. 

  2. Sensate focus

    Couple practicing sensate focus

    Sensate focus can help couples overcome performance anxiety by making them feel more sexually at ease with one another. It is intended to help the couple feel more comfortable with communicating and intimately touching one another.

    Sensate focus centers on touch. During the sensate focus sessions, partners touch and caress each other, while focusing on their sensations. The goal is not to orgasm, but to simply immerse yourself in the sensations you are experiencing.

    Remember, you and your partner are not allowed to orgasm. You are not allowed to have an erection. And, your partner is not allowed to help you have an erection. Genital and breast touching is forbidden.

    During these sessions, you are required to remove “sexual tension,” so you can be completely stress-free.

    Once the session is over, the couple is instructed to sit down and talk about their experiences.

    How to get started

    In some cases, sensate focus is guided by a professional. But, in most cases, the exercises are performed by the couple in the comfort of their home. If you’d like to learn more about sensate focus exercises, you can find more detailed information in Helen Singer Kaplan’s book.

    The Illustrated Manual Of Sex Therapy by Helen Singer Kaplan
  3. Consult with a sex therapist

    Man consulting with a therapist about performance anxiety and erectile dysfunction

    Cognitive-behavioral therapy (CBT) is commonly used to help men overcome performance anxiety. A sex therapist is usually required to use this approach. The goal of CBT is to help men better understand the origin of their anxiety, and how it is impacting their sex lives, so they can alter their thought patterns.

    Therapists spend the majority of CBT sessions teaching clients the signs of anxiety, so they know how to handle these feelings when they arise. CBT also aims to teach men that their thoughts, feelings, and behaviors are connected. A sex therapist could help explore areas in depth which could be difficult for a man to explore on his own.

    Once, men are more aware of their anxiety, they can challenge any negative thoughts. According to researchers, CBT is effective in treating anxiety disorders.

    Sex therapists can also recommend other treatment methods and can prescribe anxiety or erectile dysfunction medication if necessary.

    You can search for a certified sex therapist near you at the ASSECT website.

  4. Couples counseling

    Couple in couples counselling

    Relationship issues can be a great source of anxiety. Issues such as jealousy, infidelity and intimacy issues can cause a man to develop performance anxiety and can, in turn, lead to erectile dysfunction. Professional couples counseling is often needed to resolve these issues.

    For help with relationship issues, head to our relationship advice section.

  5. Talk to your partner about performance anxiety

    A man talking to his partner about performance anxiety

    Sharing your concerns with your partner may help defuse stress and reduce performance anxiety. Good communication creates an “openness” in it that helps build intimacy.

    Men tend to become anxious when they are overly worried, concerned, or focused. Especially when they try to make a good impression on their partners. Therefore, being honest about your anxiety can help you overcome erectile dysfunction.

  6. Sexual education

    A board with the words sex education written on it

    Current theory suggests that the recent boost in performance anxiety and ED cases stems from unrealistic expectations. Sexual education may reduce these expectations and therefore resolve many of these cases.

    Another recent study found that educating the public on what is happening during normal sexual relations can reduce or eliminate the stigma of performance anxiety.

    Unrealistic expectations can arise after watching porn. Unfortunately, many people report that their sexual education came from watching porn at a young age.

    It’s important to know what is reasonable to expect from yourself:

    • You are not expected to last more than a few minutes bed
    • It is OK to experience erectile dysfunction occasionally
    • You don’t need to have sex in Olympic-worthy positions
    • It is not realistic to think that your partner must orgasm every time you have sex.

    Remember, porn is a fantasy and fantasies are supposed to be unrealistic.

    To learn more about porn and erectile dysfunction go to this article

  7. Anxiety medication

    a bottle of anti anxiety medications
    Anti-anxiety medications may help performance anxiety

    Anti-anxiety medications are sometimes used to treat performance anxiety in men. Although there aren’t medications on the market specifically designed to treat performance anxiety and erectile dysfunction, some anti-anxiety medications may reduce or eliminate the symptoms in some men.

    Researchers have recently discovered that anti-anxiety medications such as Buspirone, Trazodone and Gepirone may be an effective treatment for sexual performance anxiety.

    Side effects

    It’s important to highlight that anti-anxiety medications can cause side-effects. These side-effects may include addiction, lethargy, and drowsiness. Anti-anxiety medications may even worsen sexual dysfunction in some men.

    Benzodiazepines can be extremely addictive with prolonged use. They can also cause tiredness, slurred speech, and delayed reflexes. Beta-blockers and anti-anxiety medications, like Buspirone, can cause fatigue and sleepiness.

    Selective serotonin reuptake inhibitors (SSRIs) like Zoloft and Prozac can cause some men to experience the following sexual side effects: low sex drive, impotence, or an inability to ejaculate.

  8. Defuse other stress sources

    A man taking a break from work to reduce his stress levels

    Any kind of stress can impact your sexual performance and lead to erectile dysfunction. So, only engage in sexual activities, if you are relaxed. If you are stressed, postpone these activities until you are calmer and more relaxed.

    If you find yourself constantly stressed it might be a good idea to search for the root cause of these stressors before you begin to treat the performance anxiety itself. In more severe cases, the help of a psychologist may be required.

  9. Practice slowing sex down

    Man practicing slowing sex down

    Men with performance anxiety often rush to penetrate immediately after they become erect. Unfortunately, reacting to anxiety can make you lose your erection. Instead, take your time. Invest in foreplay and create intimacy before you proceed to intercourse. 

    Keep in mind that most women don’t reach orgasms during penetration. So, don’t be too focused on providing penetration-based orgasms. Pleasing your partner before you penetrate can also reduce stress and make you feel more aroused.

    If you are feeling stressed during sex, stop and return to oral or manual sex for a while. When you feel ready again, resume the intercourse. Meanwhile, focus on getting to know your partner’s body, and enjoy the sensations you are experiencing. These changes may also incite passion in your partner with your spontaneity.

  10. Mindful focus

    Man practicing mindful focus during sex to reduce performance anxiety

    Mindful focus is a mindfulness technique that involves blocking out negative thoughts during sex by focusing on physical sensations. Blocking negative thoughts can help men overcome performance anxiety and erectile dysfunction.

    According to Zoe Peterson, author of The Wiley Handbook of Sex Therapy. It is common for many men to try and read their partner’s mind during sex. This anxiety of wanting to please a partner sexually can lead to performance anxiety and ED. Mindful focus prevents your mind from wandering during sex, so you are fully present during the act.

    According to a study, mindfulness may decrease or eliminate sexual insecurities that can trigger performance anxiety and erectile dysfunction, thereby improving sexual satisfaction.

    To apply this technique, you’ll need to intentionally focus on the sensations. Allow your body to soak in the imagery, feelings, sounds, touches, movements, and smells. Be one with each other and immerse yourself in the moment.

  11. Exercise

    A man working out

    Physical activity releases certain chemicals known to decrease anxiety. These chemicals also referred to as neurotransmitters, are dopamine, norepinephrine, GABA, and serotonin. When you have less anxiety and stress, you better able to perform during sex.

    According to a study on exercise and performance anxiety, exercising helps reduce anxiety by diverting your attention away from whatever is stressing you, which in this case is a fear of leaving your partner sexually unfulfilled.

    Exercise may also help strengthen erections. This study, published in the Journal of Sexual Medicine, showed that men, who exercise regularly, have better erectile and sexual function, regardless of race. 

    Exercising also improves your body’s appearance which may help you feel better about yourself. And, this can lead to more confidence in the bedroom.

    So, if you are suffering from performance anxiety, you may want to improve your exercise and diet.

  12. Improve your diet

    a man eating a healthy meal to improve his mental health

    A well-balanced menu with plenty of healthy foods may improve your sexual function and reduce instances of performance anxiety. More specifically, a healthy diet can strengthen your heart and blood flow to your penis. It can also boost your energy, so you feel like having sex.

    According to a study on diet and mental health, a healthy diet may lower your risk of anxiety. Conversely, a poor diet may trigger or exacerbate anxiety. Therefore, it is important to adopt a healthy diet.

    Another study, published in JAMA, found that consuming lower levels of saturated fats, trans fats, and cholesterol-rich foods (often found in meat-based foods) and consuming more foods that contain vitamin C and fiber (often found in plant-based foods) may improve erectile dysfunction.  

  13. Treat body image issues

    A man with body image issues anxious about taking of his shirt before sex

    Performance anxiety and erectile dysfunction are often symptoms of body image issues. “Talk therapy” is one of the most common ways to address this problem. This treatment approach helps you acknowledge your body issues, and then address it with the guidance and support of a therapist.

    A multidisciplinary treatment approach is usually used to treat a body image issue or disorder, this typically involves:

    • CBT
    • Individual therapy
    • Family therapy
    • Group therapy
    • Support groups
    • In- patient psychiatric care
    • Body image therapy
    • Spiritual therapy
    • Music therapy
    • Nutrition therapy

    Although it may also involve anti-anxiety medications or antidepressants. The treatment approach is based on what is best for the client or patient.

    According to a study on body image and anxiety, men with “attachment-related anxiety” tended to be over-invested in sexual appearance, sexual objectification, and performance-based sexuality. Conversely, men with a positive image have a lower risk of sexual dysfunction and performance anxiety. These men also typically have more loving and sexually-satisfying relationships.

When to see a doctor

If the solutions listed above don’t work and the problem persists you should consult a doctor. Also, if you have cause to believe that the erectile dysfunction has a physical cause you should consult your doctor as well.

Doctors can perform a physical exam and may take blood work to try to find the underlying cause of ED. Doctors may also have more tools to help identify if the problem is psychological or physical in nature.

Will doctors prescribe Viagra?

Doctors may prescribe Viagra, Cialis and other PDE 5 inhibitors may for men with performance anxiety. But we recommend not using them for performance anxiety when there is no medical reason.

Recreational use can ultimately lead to more performance anxiety and psychological dependence as this study shows. These medicines may also have side effects.

This is a treatable condition

Performance anxiety can be both embarrassing and extremely frustrating. The good news is – it can be successfully treated. Unlike some sexual issues, sexual performance anxiety almost always resides in your head. It means that usually, you can overcome this issue with non-intrusive techniques and without medication.

About Dr. R.Y Langham

Psychologist and Marriage Therapist

Dr. R.Y. Langham holds a PhD in family psychology from Capella University and an MMFT in marriage and family therapy from Trevecca Nazarene University. She counsels on adjustment issues such as relationship issues, blended families, same-sex couples, dysfunctional family relationships, etc.

She serves as a medical contributor, health & wellness contributor, copywriter, and psychological consultant for the Between Us Clinic.