How to Overcome Sexual Performance Anxiety and Erectile Dysfunction

Many men are troubled by sexual performance anxiety. Learn about its’ true causes, symptoms, and what you can do to overcome performance anxiety and erectile dysfunction

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? Well, it is estimated that between 9-25% of men suffer from performance anxiety.

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

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

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

Luckily, solutions are available to help you overcome this issue! 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 of erectile dysfunction.

Studies show [1][2] that performance anxiety is a significant factor in causing or continuing sexual dysfunctions in men, including erectile dysfunction.

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 into your bloodstream.

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 usually leads to loss of erection or difficulty achieving an erection.

Another way in which performance anxiety affects 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 with negative thoughts. This leads to more failures and increased anxiety. Once this occurs, a “sexual performance anxiety cycle” or a “negative feedback loop” is created.

A graph showing the sexual performance anxiety cycle

That’s why it’s important to treat sexual performance anxiety sooner rather 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 pleasing your partner can make you stressed and 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 happen.

Concerns about getting an erection or premature ejaculation are the most common thoughts that lead to performance anxiety in men. 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. An unhealthy relationship with porn can also be a cause of 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 performance anxiety is also very common in men in long-term relationships.

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 a lack of sexual desire.

Performance anxiety can be difficult for men 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 cure performance anxiety and erectile dysfunction, the main objective should be to reduce or even eliminate the negative thoughts that are triggering the anxiety.

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

Mindfulness meditation

Man listening to guided imagery for performance anxiety and erectile dysfunction

Mindfulness meditation is a powerful technique for overcoming performance anxiety and 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 will 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 four 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 curing sexual performance anxiety.


A sexual performance anxiety therapist can help you cope with performance anxiety.

“Sexual therapy offers an opportunity to explore the thoughts that go with those stressful feelings, to understand the anxiety cycle and the underlying issues. These can then be addressed using a variety of techniques.

Sometimes the underlying issues may be directly related to the relationship outside of the sexual arena and that is when a therapist that specializes in both sex and relationship issues is called for.”

Sarah Calvert – psychotherapist, psychosexual and relationships therapist

A sex therapist who is also a psychologist or a mental health counselor can be the best option. He or she can use methods such as cognitive-behavioral therapy (CBT) or talk therapy to help change the negative thinking patterns causing you to experience performance anxiety and erectile dysfunction.

They can also lay out a treatment plan for any other undelaying sexual condition such as premature ejaculation, low libido, or delayed ejaculation. All of these might be causing or contributing to your performance anxiety and ED.

General stress, anxiety or depression, and performance anxiety are sometimes related. This is something a psychologist can help you treat so you can overcome performance anxiety.

A relationship counselor can help in case you’re suffering from problems in your relationship. Feeling safe and open with your partner is a must for having a healthy sexual relationship. By fixing the relationship, we can sometimes automatically fix sexual performance anxiety.

Man having online telehealth consultation with a sex therapist
If you need professional advice, our highly trained sex therapists are here to support you.

Physical exercise

Regular physical exercise is a great way to reduce anxiety in general and performance anxiety specifically.

It has also been proven to make you less likely to develop physical erectile dysfunction and can even improve erectile function if you already have erectile issues.

Exercising and keeping a healthy diet, quitting smoking, and drinking less alcohol improve mental health, body image, erectile function, and sexual health. This can help you feel more confident overall and in the bedroom, therefore helping you overcome performance anxiety.


You might be asking yourself, “can I take Viagra for performance anxiety?” Well, yes, but we don’t recommend you do. Taking Viagra, Cialis, Levitra, or any other generic ED medication will only mask the symptoms, but the problem triggering the anxiety will remain. These medications don’t cure performance anxiety or ED.

If you’re physically healthy, there is no reason to become dependent on prescription ED medication (that can have serious side effects)!

Also, when performance anxiety isn’t mild, it usually blocks arousal. When you’re not mentally aroused, Viagra and other ED medications will not even work (you can learn why this is true here).

Some medical doctors will prescribe Propranolol for performance anxiety or other anxiety-reducing medications such as Xanax or Atenolol. But like with ED medications, this doesn’t fix the problem but only the symptoms, and there’s a high chance of becoming dependent on the medication.

Taking medication for performance anxiety can have a “reverse placebo” effect. After you were able to perform while taking them, you’ll become worried that without them you will experience failure. This sets you straight on the path of falling into the vicious performance anxiety cycle.


This technique gets a bad name but, hypnosis for sexual performance anxiety can work. In fact, a recent meta-analysis found that hypnosis can be effective in reducing anxiety, as well as performance anxiety specifically.

While hypnosis is a genuine psychotherapy treatment method for performance anxiety, many medical professionals aren’t convinced it actually works. If you’re interested in trying hypnosis, talk with a certified hypnotherapist.

Guided imagery

Guided imagery is a simple, but powerful relaxation technique that can be used 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. This essentially cures performance anxiety by changing the way your mind perceives sex.

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).

There are many parallels between mindfulness meditation and guided imagery, but more studies have looked into the effectiveness of mindfulness-based sex therapy, including this aforementioned 2018 study in which 9 out of 10 men went through mindfulness meditation sessions overcame sexual performance anxiety within as little as 4 weeks.


Performance anxiety can be frustrating and embarrassing to talk about. The good news is – that performance anxiety can be overcome! This is definitely a plus because, unlike some sexual issues that are harder to fix, sexual performance anxiety almost always resides in your head. 

Simple, non-intrusive techniques like mindfulness meditation, for example, may help you get over performance anxiety in as little as a few weeks. And, if you feel like you need a little bit more help, a certified sex therapist may be able to lay out a treatment plan that will help you gain the confidence you lack in the bedroom – so reach out to a qualified professional.

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.