How to Overcome Sexual Performance Anxiety and Erectile Dysfunction

Many are troubled by sexual performance anxiety. Learn about the 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, leading to performance issues? Well, sexual performance anxiety is one of the most common sexual issues. How common? It is estimated that between 9-25% of men suffer from performance anxiety.

Male sexual performance anxiety often causes difficulty in getting or maintaining an erection., It may also, however, cause premature ejaculation.

There is not yet a clear consensus on the 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 linked to 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.

Sex therapist Megan Pollock explains, “It is common when faced with stress to have a fight-flight-or-freeze response. This response leads to a sudden release of hormones that can make it nearly impossible to stay aroused. This can become a vicious cycle where your negative thoughts take over and keep you from experiencing pleasure.

The ‘fight-or-flight’ response is a natural, biological response. When it is triggered, your body activates the sympathetic nervous system. It releases stress hormones such as adrenaline (Epinephrine), norepinephrine, and cortisol into your bloodstream.

This 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 a loss of erection or difficulty achieving an erection.

The performance anxiety cycle helps us to make sense of why this link exists.

The performance anxiety cycle

In many cases, men start to become preoccupied with negative thoughts about themselves, their bodies or sex. 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! Let’s think further about the underlying causes of performance anxiety, before detailing the specific symptoms and how to get help.

What causes sexual performance anxiety?

Negative sex-related thoughts a common cause of sexual performance anxiety.

Certified sex therapist, Christene Lozano explains, “Unfortunately, many men receive their sex education through pornography and movies, which often are inaccurate representations of how sex can be in real life (e.g, awkward moments, funny noises and smells, and erection difficulties).

It is common for some men to have sexual anxiety due to societal expectations learned from media.

Some men have concerns about getting an erection, maintaining an erection, pleasing their partner, orgasming more quickly than they and/or their partner would like, taking too long to orgasm, or have insecurities about their penis size.

These concerns can get inadvertently reinforced depending on how their partners respond if these erection and orgasm concerns happen. Communicating about sexual concerns is essential when it comes to a fulfilling sex life.”

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

Relationship problems, and especially a lack of emotional connection with your partner, can also lead to performance anxiety.”

Other worries which can impact on sexual performance include feeling stressed about day-to-day issues like money, family, or work. These can cause or worsen performance anxiety and erectile dysfunction. Some studies show 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 for 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. This can happen during or before sex. Premature ejaculation is also a common symptom. For other men, performance anxiety can lead to delayed ejaculation or a lack of sexual desire.

Performance anxiety can be difficult for men to deal with emotionally. It makes many men feel sexually inadequate, triggering feelings of low self-esteem and poor self-confidence.

How to overcome sexual performance anxiety?

When trying to cure performance anxiety and erectile dysfunction, the main objective should be to reduce or even eliminate negative thoughts that are triggering the anxiety.

The next paragraphs will cover some 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 helps one to stay “in the moment” by becoming aware and focused on the senses.

Performance anxiety can be triggered when thinking about painful past experiences, or worrying that something negative will happen in the future.

Being focused on the present moment clears the head from negative thoughts and basically prevents performance anxiety from happening in the first place.

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 meditation can be fun and relaxing! It’s no wonder millions of people around the world are meditating.

How to practice mindfulness meditation for performance anxiety?

Start by practicing mindfulness using guided meditations for sexual performance anxiety. Then, use the skills learned to stop performance anxiety and ED from happening 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 four weeks.   

Yoga and breathing exercises are also techniques that increase mindfulness levels and can help with anxiety in general. However, they have yet to be shown as effective specifically for curing sexual performance anxiety: more research is needed.

Guided imagery

Guided imagery is a relaxation technique that can help treat 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 imagine vividly.

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

The purpose of these “imagined sexual experiences” is to reinforce positive thinking. Therefore, guided imagery essentially 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. This, in essence, cures performance anxiety by changing the way your mind perceives the act of sex.

A 1984 study showed how effective this tool can be. 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 efficacy of mindfulness-based therapy for sexual dysfunctions. For example, we have already discussed this 2018 study, in which 9 of 10 men who practiced mindfulness meditation exercises overcame sexual performance anxiety.


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

Psychotherapist and psychosexual therapist, Sarah Calvert explains, “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.

A sex therapist who is also registered as a psychologist or a mental health counselor may be the best option.

They can draw on methods such as cognitive-behavioral therapy (CBT) or other forms of talk therapy to help change the negative thinking patterns causing you to experience performance anxiety and erectile dysfunction.

Therapists 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.

Note that general stress, anxiety or depression, and performance anxiety are sometimes related. A psychologist can help you address all of these factors simultaneously, so that you can overcome performance anxiety effectively.

Alternatively, a relationship counselor can help if you’re suffering from problems in your relationship. Feeling safe and being open with your partner are important for a healthy sexual relationship. By fixing the relationship difficulties 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.

Lifestyle Factors

Regular physical exercise is a great way to reduce anxiety in general and performance anxiety specifically. It has also been proven to protect against physical erectile dysfunction and improve erectile function in those who already have erectile issues.

What else can help? Maintaining a healthy diet, quitting smoking, and drinking less alcohol can go a long way toward improved mental health, body image, erectile function, and overall sexual health. This can help you feel more confident overall, potentially helping you overcome sexual performance anxiety.


You might be asking yourself, “can I take Viagra for performance anxiety?” Well, yes, but we don’t necessarily recommend this.

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 risk becoming dependent on prescription ED medication, which can have serious side effects!

Also, when performance anxiety is severe, it often blocks arousal. When you’re not mentally aroused, Viagra and other ED medications will not work. You can learn more about why this is the case here.

Some medical doctors will prescribe Propranolol for performance anxiety. Alternatively, they may prescribe anxiety-reducing medications such as Xanax or Atenolol. But, as with ED medications, these do not fix the underlying problem, but only the symptoms.

There is also a high chance of becoming dependent on some anxiety medications.

Furthermore, taking medication for performance anxiety can have a “reverse placebo” effect. After using medications that help performance, you may become worried that without them, you will experience failure. This sets you up to experience a vicious performance-anxiety cycle.


This technique often 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 hypnotherapy is a genuine psychotherapy treatment method for performance anxiety, many medical professionals are not convinced that it actually works. If you are interested in trying hypnosis, talk with a certified hypnotherapist.


Performance anxiety can be frustrating and embarrassing to talk about. The good news is that performance anxiety can be overcome!

The upside to this difficult condition is that, unlike some sexual issues that are harder to fix, sexual performance anxiety almost always resides in your head and therefore can be effectively addressed.

Simple, non-intrusive techniques like mindfulness meditation, for example, may help you overcome 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, if you need expert input, be sure to 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.