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!

men in bed thinking about performance anxiety and erectile dysfunction

Have you ever been so overwhelmed, during sex, that you just couldn’t perform? Well, sexual performance anxiety is one of the most common sexual issues. In fact, the pressure and stress that can occur during sexual activity often stems from an innate need to impress your partner. It can also be a result of low body image issues. Both of which are real concerns.

It’s only when this stress turns into anxiety that sexual dysfunctions can arise. This can affect a man’s performance, and eventually his sex life. Performance anxiety can occur even in physically healthy men, who previously had no sexual performance issues.

The most common sexual issue performance anxiety leads to in men is erectile dysfunction (ED). The focus of this article is anxiety-induced erectile dysfunction. But, it may also lead to premature ejaculation (PE).

If you think you may be suffering from premature ejaculation (PE), check out our online premature ejaculation evaluation tool. If you do suffer from PE, learn about premature ejaculation and performance anxiety, so you can regain a healthy, happy sex life.

Also, although less common, performance anxiety can lead to an inability to orgasm and/or a loss of libido (sex drive) in both men and women.

What causes sexual performance anxiety?

Well, negative sex-related thoughts are the common cause of sexual performance anxiety.

There are many factors that can trigger these kind of thoughts. As a man, you are flooded with cultural and social pressures. You are told that you should perform a certain way during sex. It is these pressures that can lead to negative self-talk, fears, concerns, and unhealthy thought processes.

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 I’m too small?
  • What if she tells others about her bad experience?

If these kinds of thoughts run through your head, before or during sex, you may be at-risk for developing sexual performance anxiety issues.

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

Sexual performance anxiety cycle

A graph showing the sexual performance anxiety cycle

Almost all men experience the “sexual performance anxiety cycle” at some point. It is important to keep in mind that it’s completely “normal” to be unable to achieve an erection – once in a while. After all, you’re not a machine and sexual performance is typically influenced by a variety of factors.

The question is: “How do you deal with this first sexual failure?” Well, in many cases, the man starts to become preoccupied by negative thoughts. This leads to more failures and increased anxiety. Once this occurs, a “sexual performance anxiety cycle” is created!

It is important to note that other psychological factors which are not directly linked to anxiety could also lead to psychological ED. These include: life stresses, relationship issues, depression, low body image, low sex drive, and poor self-esteem.

Remember, it is “normal” to experience performance anxiety from time-to-time. But, if it becomes a pattern or you become overly preoccupied with your “sexual failures,” you’ll increase your risk of falling into a “sexual performance anxiety cycle.”

How does anxiety affect sexual performance?

First, it is important to understand that fear and anxiety are not the same thing.

Fear is a natural emotion designed to protect us from danger. Because, when a person is unaware of possible danger, he is unable to avoid it – and his chances of survival decline.

Anxiety is an extreme sense of fear that goes beyond what a person should feel in a particular situation – which in your case is sex!

Keep in mind that when you become anxious, your body responds, as if you are in real danger – even if you aren’t. As a result, your body produces and releases adrenaline and cortisol. These are stress-related hormones, that illicit a “fight-or flight” response in your body.

These hormones elevate your blood pressure and heart rate, and increase your energy, so you can flee dangerous situations. They also halt many bodily functions. When it comes to sex, adrenaline and cortisol cause your muscles to tense and your heart to beat rapidly. And, in some cases it reduces blood flow to your penis. This can lead to a loss of erection or difficulty achieving an erection.

Studies on sexual function and anxiety support this claims. These two studies from 2005 and 2015, for example, found that performance anxiety can trigger or continue sexual dysfunctions in men.

Therefore, it is important to reduce sex-related anxiety, because it may be the only way you’ll get your erection back.

How can I tell if my erectile dysfunction is stress-related?

Well, ask yourself the following question: “Are you able to perform sexually, when you are not stressed?” If the answer is “Yes,” then it’s probably stress-related. If the answer is “No,” there may be another reason for your ED.

If you have morning erections and can control your erection, while masturbating, your ED is probably stress-related.

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

The good news is if you are able to have an erection, while masturbating, you’re probably physically ok.

It can happen to anyone!

Experts believe that approximately 20% of all ED cases are psychological.

Yet, there is a common misconception that performance anxiety is only a young men’s issue. Well, the truth is that men of all ages can experience ED. In fact, even some elderly men suffer from performance anxiety. Men can also develop performance anxiety even if they are in long-term relationships.

And, after having one or two “bad experiences,” you could fall into a vicious sexual performance anxiety cycle.

Performance anxiety can happen to men of all ages

Performance anxiety can happen to men of all ages

How can I overcome my sexual performance anxiety?

Well, when trying to cope with sexual performance anxiety, the main objective should be to reduce, or even eliminate, the negative thoughts and fears that are triggering the anxiety. Therefore, over the next few paragraphs, I’ll cover two effective relaxation techniques that may help you overcome your sexual performance anxiety: guided imagery and sensate focus.

  1. 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.

    It’s as simple as that.

    Has guided imagery been proven to work?

    Professor K. Kuruvilla found guided imagery to be effective in treating psychological erectile dysfunction

    Guided imagery may be effective in treating psychological erectile dysfunction

    Did you know that guided imagery is actually a well-known therapeutic technique? Well, it’s true. Studies suggest that it may be effective in the treatment of different types of anxiety, hypertension (high blood pressure), and other stress-related issues.

    A 1984 study, conducted by Professor K. Kuruvilla, Head of the Psychiatry Department at Christian Medical College in Vellore, India, showed how effective this tool is. Professor Kuruvilla found that most men, who committed to sexual re-education and guided imagery, overcame their psychological erectile dysfunction. They were able to achieve an erection – whenever they wanted to. Those, who completed the treatment experienced long-term positive results.

    Guided imagery was even proven to be effective in cancer treatment. A 1982 study, published in the Journal of Consulting and Clinical Psychology, suggested that guided imagery “may be an effective procedure for helping cancer patients cope with the adverse effects of chemotherapy.”

    And, according to the researchers, patients, who received guided imagery therapy experienced the following results:

    • Significantly fewer episodes of anxiety and nausea, during chemotherapy treatments
    • Significantly fewer episodes of physiological arousal, anxiety, and depression immediately following chemotherapy treatments
    • Significantly fewer episodes of severe nausea following chemotherapy

    Where can I get guided imagery treatment?

    The good news is there are several guided imagery treatment options available for psychological erectile dysfunction, if you need it. For instance, you can seek professional help with a certified sex therapist. This person will not only teach you to correctly perform these relaxation exercises, but also create and record a guided imagery script for you to follow.

    If you’d rather do it yourself, you can create and record your own guided imagery script, although it is more effective, when a professional creates and records one for you.

  2. Sensate focus

    Couple practicing sensate focus

    Sensate focus is a therapeutic technique developed by sex therapists, William Masters and Virginia Johnson Masters, in the 1960s. The goal of sensate focus is to help couples overcome a variety of sexual problems, including sexual performance anxiety.

    Sensate focus centers on touch. More specifically, 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.

    Sensate focus is intended to help couples feel more comfortable with communicating and intimately touching one another. During these sessions, you are required to remove “sexual tension,” so you can be completely stress-free, during sexual activities.

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

    Once the session is over, the couple is instructed to sit down and talk about their experiences. However, keep in mind that this technique requires the full cooperation of both partners. In some cases, sensate focus is guided by a professional, but in most cases, the accompanying 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

8 Tips for reducing sexual performance anxiety

It is important to note that the following tips can be used as a stand-alone solution, if you have mild anxiety, or they may help, if you chose a structured treatment option, such as a guided imagery or a sensate focused exercise plan.
But, regardless of whether you choose one of the treatment options listed above, they may help reduce your anxiety.

  1. Communication

    A man talking to his partner about performance anxiety

    Men tend to become anxious when they are overly worried, concerned, and/or focused. Especially when they try to make a good impression on their partners. The best thing to do, in this situation, is to be honest about your anxiety. Sharing your concerns with your partner may defuse any stress in your relationship and create an “openness” in it that helps build intimacy.

  2. This is not a race

    An image of a keyboard with the word porn written on it

    A current theory suggests that the recent boost in sexual performance anxiety cases stems from unrealistic expectations. These can arise after watching porn online. Unfortunately, many people report that their “introduction to sex” came from watching porn on their computers, smartphones, and/or televisions. But, the thing is, sex is not a race! And, it’s not a test! It’s not even a “performance!”

    What is it then? Well, it’s fun, genuine, and real experience. More specifically, you are not expected to last an hour in bed. You don’t need to have sex in Olympic-worthy positions. And, It is not realistic to think that your partner must have at least ten multiple orgasms. Remember, porn is a fantasy and fantasies are supposed to be unrealistic. So, give yourself a break – and just enjoy it!

  3. Defuse other stress sources

    Man sitting and relaxing

    Any kind of stress can impact your sexual performance. So, only engage in sexual activities, if you are relaxed. If you are stressed, postpone these activities until you are calmer and more relaxed. Why? Well, because, a partner, who is preoccupied, distant, indifferent, and/or inattentive, is not a good lover. Even if you can perform sexually. So, what should you do to relieve your stress?

    If you have been experiencing high levels of stress lately, start taking evening strolls with your partner. You could use this activity to reconnect with each other. Another option is signing up to a “couples” yoga class. You could also ask your partner to ease your tension with a sensual massage. Taking a hot steamy bath together and taking turns “washing” each other with a sponge is a good idea as well. You could also meditate, practice deep breathing exercises, and/or add in regular exercise into your daily routine.

  4. Take your time

    couple practicing slow sex

    The truth is, some men with performance anxiety have one single goal—to get it up and in. So, If they are able to become erect, they rush to penetrate before they lose it. Unfortunately, reacting to stress in these ways can make everything worse. As you’ve probably guessed, stress and “rushing” can have a negative impact on sexual performance. So, don’t do that. Instead, take your time. Invest in foreplay and create intimacy before you jump into full-fledge intercourse.

  5. Mix it up

    a couples mixing it up in bed

    Some men believe that sex must follow a certain sequence. For instance, it should begin with kissing and cuddling, followed by foreplay (hopefully), and then intercourse. These men believe that once penetration occurs – there is no going back. But, that is far from the truth! It’s okay to mix it up from time-to-time. In fact, you may incite passion in your partner with your spontaneity.

    So, 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. Keep in mind that most women don’t reach orgasms during penetration anyways. So, don’t get too caught up on providing penetration-based orgasms.

    The truth is, for many women, foreplay is the best part of sex. In this scenario, you are not tied to penetration-based orgasm. The result? Less stress and a better sexual experience.

  6. Focus on the sensations

    A man focusing on the sensations during sex

    As mention above, if you want to relieve stress and enjoy the experience, focus on the sensations. In other words, stay in the present. Allow your body to soak in the imagery, feelings, sounds, touches, movements, smells, etc. Be one with each other and immerse yourself in the moment.

  7. Learn about sex!

    A classroom board with the words SEX ED written on it

    You may think you know everything you need to know about sex. Although you may know a lot – there are probably new things you could learn. The truth is, learning about sex may reduce unrealistic sexual expectations. How? Well, Sex is such a sensitive topic.

    As a result, many times we are limited to learning about it through porn, sitcoms, movies, sex magazines, internet articles, and friends. And, according to Professor Kuruvilla, a combo of guided imagery and sexual education may be one of the most effective treatments for sexual performance anxiety.

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The truth is performance anxiety can be both embarrassing and extremely frustrating. The good news is – it can be successfully treated. This is definitely a plus. Because, unlike some sexual issues, sexual performance anxiety almost always resides in your head. What does that mean? Well, it means that you can conquer this “issue” with non-intrusive techniques.

For example, guided imagery and sensate focus exercises may help you leave your performance anxiety behind you, so you can resume a healthy and happy sex life. Lastly, if none of these suggestions work for you, a certified sex therapist may be able to get your sex life back on track – so reach out to a qualified professional.

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 performance anxiety.

About R.Y Langham, PhD

Psychologist and Marriage Therapist

Dr. R.Y. Langham is a certified psychologist and marriage therapist. She holds a PhD in family psychology from Capella University and an MMFT in marriage and family therapy from Trevecca Nazarene University.

Dr. Langham serves as a professional consultant for the Between Us Clinic, where she writes, edits, and reviews professional materials and articles on the topics of sex and relationships.