Sexual Performance Anxiety and Erectile Dysfunction

Many men are troubled by sexual performance anxiety. Learn about its’ true causes, symptoms and what can you do to get your sex life back on track!

man lying in bed thinking about sexual performance anxiety erectile dysfunction

Have you ever felt nervous or anxious before or during sex, that you just couldn’t perform? Well, Sexual performance anxiety is one of the most common sexual issues. How common is sexual performance anxiety? Well, it is estimated that between 9-25% of men suffer from performance anxiety.

Male sexual performance anxiety most commonly lead to difficulty getting or maintaining an erection, but it can also be a cause of premature ejaculation.

There still isn’t a clear definition for performance anxiety, but there are tests that can help you diagnose yourself: But, generally if you experience anxiety during sex and erectile dysfunction, but you can get an erection while masturbating and/or have morning erections, the problem is probably performance anxiety ED.  

Sexual performance anxiety can be frustrating and embarrassing. Left untreated, it can ruin long-term relationships and cause emotional distress.

Luckily, male performance anxiety solutions that will help you overcome this issue are available! But first, let’s learn about the link between performance anxiety and ED.

Can performance anxiety cause erectile dysfunction?

Yes, performance anxiety is one of the leading causes for erectile dysfunction.

Studies show [1][2] that performance anxiety is a major factor in causing or continuing sexual dysfunctions in men.

But why is that? When you become stressed or anxious, your body activates the sympathetic nervous system. It releases stress hormones such as adrenaline (Epinephrine), norepinephrine and cortisol to your blood stream.

This is a natural biological response called the “fight-or flight” response. It causes your muscles to tense and your heart to beat rapidly. Blood vessels in your penis contract and blood flow is reduced and redirected to other organs. This can lead to a loss of erection or difficulty achieving an erection.

Another way in which male performance anxiety effects ED is by blocking arousal. When you’re nervous, it is hard for you to concentrate, relax and enjoy sex. When you’re not mentally aroused, your brain is simply not signaling your body to direct blood flow to your penis, which leads to erectile difficulties.

The performance anxiety cycle

In many cases, men start to become preoccupied by negative thoughts. This leads to more failures and increased anxiety. Once this occurs, a “sexual performance anxiety cycle”, or a “negative feedback loop” can be created.

A graph showing the sexual performance anxiety cycle

That’s why it’s important the treat sexual performance anxiety soon than later!

What causes sexual performance anxiety?

Negative sex-related thoughts are the common cause of sexual performance anxiety. Worries and concerns about getting an erection and about pleasing your partner can make you stressed an anxious.

When you are preoccupied with these kinds of thoughts, it’s harder for you to stay in the moment and experience arousal and the pleasurable sensations of sex. When this occurs, performance anxiety and erectile dysfunction happens.

Concerns about getting an erection or about premature ejaculation are the most common ones. Other common thoughts include worries about not being able to orgasm, insecurities about penis size, and concerns about not being able to please your partner.

Relationship problems, and especially a lack of emotional connection with your partner can also lead to performance anxiety. Unhealthy relationship with porn can also be a cause for performance anxiety.

Feeling stressed about day-to-day issues like money, family or work can worsen or make performance anxiety and erectile dysfunction more likely. Some studies also showed that depression and other mental health conditions are linked to performance anxiety.

Many men are more worried about experiencing performance anxiety with a new partner, but this happens to many men in long-term relationships as well.

man having negative thoughts about performance anxiety

Symptoms of sexual performance anxiety

The most common symptom of sexual performance anxiety in men is erectile dysfunction. It can happen during or before sex. Premature ejaculation is also a common symptom. For other men, it can lead to delayed ejaculation and lack of sexual desire.

Male performance anxiety can be difficult to deal with emotionally. It makes many men feel sexually inadequate and develop low self-esteem and low self-confidence.

How to overcome sexual performance anxiety?

Well, when trying to cope with performance anxiety erectile dysfunction, the main objective should be to reduce, or even eliminate, the negative thoughts that are triggering the anxiety.

Over the next few paragraphs, we’ll cover a few effective relaxation techniques for overcoming male performance anxiety.

Mindfulness meditation

Mindfulness meditation is a powerful technique for treating male performance anxiety erectile dysfunction.

Meditating teaches you how to stay “in the moment” by becoming aware and focused on your senses. Being focused on the present moment clears your head from negative thoughts and basically prevents performance anxiety from happening in the first place.

Performance anxiety is triggered when you’re thinking about painful past experiences or worrying that something negative is going to happen in the future. When you’re focused on the present moment, there’s no room for anxiety provoking thoughts to occur.

Learning to stay in the moment like this requires a bit of practice, but the best part is that meditation is fun and relaxing! It’s no wonder millions of people around the world are meditating.

You start by practicing mindfulness using guided meditations for sexual performance anxiety, and you then use the skills you learn to stop performance anxiety and ED in sexual situations.

A recent study from 2018 has shown that 9 out of 10 men with anxiety-induced erectile dysfunction who practiced meditation techniques for performance anxiety experienced significant(!) improvements after practicing for just 4 weeks.   

Yoga and breathing exercises are also techniques that increase mindfulness levels and can help with anxiety in general, but have yet to be shown as effective specifically for sexual performance anxiety.

Guided imagery

Man listening to guided imagery for performance anxiety and erectile dysfunction

Guided imagery is a simple, but powerful relaxation technique that can help you eliminate negative thought patterns. it is based on the idea that the unconscious mind can’t tell the difference between something you really experience and something you only vividly imagine.

During a guided imagery session, you’ll listen to simple instructions provided in a specific, descriptive language. You’ll be asked to imagine a scenario with the goal of (1) rewiring your mind, so you no longer think negatively about sex and (2) removing psychological barriers that could be triggering your performance anxiety.

During each guided imagery session, you are tasked with visualizing a successful sexual experience. During which you’ll learn how to stay hard and enjoy sex and recognizing that your partner is also enjoying the sex. Your unconscious mind reacts as though what you’re imagining is really happening.

The purpose of these “imagined sexual experiences” is to reinforce positive thinking. Therefore, guided imagery basically reprograms your mind to perceive sex as a non-stressful, positive experience. The good news is that the more you practice it, the less likely you’ll have “issues” during your next sexual encounter.

After a few guided imagery sessions, your unconscious mind truly believes that you have had many successful sexual experiences. As a result, it automatically assumes that future sexual experiences will also be successful. The outcome? Your anxiety is reduced, and your ability to enjoy sex improves.

Guided imagery is a simple, but powerful relaxation technique for treating performance anxiety. it is based on the idea that the unconscious mind can’t tell the difference between something you really experience and something you only vividly imagine.

During each guided imagery session, you are tasked with visualizing a successful sexual experience. Your unconscious mind reacts as though what you’re imagining is really happening.

The purpose of these “imagined sexual experiences” is to reinforce positive thinking. Therefore, guided imagery basically reprograms your mind to perceive sex as a non-stressful, positive experience.

After a few guided imagery sessions, your unconscious mind truly believes that you have had many successful sexual experiences. As a result, it automatically assumes that future sexual experiences will also be successful.

A 1984 study showed how effective this tool is. The study showed that 70% of men who committed to sexual re-education and guided imagery, overcame their psychological erectile dysfunction (i.e., performance anxiety).

You can create and record your own guided imagery script, although it is more effective, when a professional creates and records one for you.

About Dr. Michael Stokes

Mental Health Counselor and Sex Therapist

Dr. Michael Stokes is a Licensed Mental Health Counselor and AASECT Certified Sex Therapist in Rhode Island and a Licensed Professional Counselor in Connecticut who has a Doctorate in Professional Counseling and Supervision.

Dr. Stokes serves as a professional consultant for the Between Us Clinic. He is available for online teletherapy sessions. He also writes and reviews professional materials and articles.

In his private clinic, Dr. Stokes enjoys working with individuals and couples of all genders and sexual orientations who need additional support. He has years of experience providing sex therapy and can treat an array of sexual and intimacy disorders.