How to Break The Cycle Of Sexual Performance Anxiety

Discover how proven techniques such as mindfulness meditation, guided imagery, CBT and more can help you break the cycle

A man who is stuck in the cycle of sexual performance anxiety sitting in bed with his head in his hands

Performance Anxiety Cycle – Key Takeaways

  • Sexual performance anxiety symptoms include ED, PE, anorgasmia, and low libido
  • Mindfulness, guided imagery and CBT can help break the cycle
  • Hypnosis and lifestyle changes may also be beneficial
  • ED medications are usually not the right solution
  • Performance anxiety won’t usually go away on its own
  • To break the cycle, you should address the psychological factors causing the anxiety


Sexual performance anxiety, something we are all susceptible to, can be very challenging to deal with. Once we become anxious about whether our bodies will function the way we want them to in a sexual situation, the anxiety makes it less likely that they will, reinforcing the original fear. 

In this way, sexual performance anxiety is a self-fulfilling prophecy that creates a vicious cycle of fear and reinforcement of that fear. Because most people are vulnerable to developing sexual performance anxiety, many people are looking to overcome this difficult issue. 

Men (and people who have penises), are usually more likely to fall into the performance anxiety cycle, since  its manifestations are more noticeable during sexual activity. Specifically among this group, sexual performance anxiety  is related to erectile dysfunction (ED), premature ejaculation, delayed ejaculation, inability to orgasm (anorgasmia) low sex drive (low libido). 

In my clinical experience, it is usually one of these issues that brings someone to seek for sexual performance anxiety solutions, and they are often resolved after treating the underlying sexual performance anxiety.

How do you break the performance anxiety cycle?

An illustration that explains how to break the cycle of performance anxiety

If you find yourself struggling with performance anxiety in bed, there are a variety of therapy techniques that can help you get rid of the anxieties surrounding sex, and help you improve your sexual experience. 

There is no one-size-fits-all approach, so you may have to try several to find something that works, or use multiple approaches. As with all sexual problems, stress, anxiety and urgency are not good for your sex life. Be patient with yourself, and remember – sexual performance anxiety is both common and treatable.

Mindfulness meditation

Man practicing mindfulness meditation for sexual performance anxiety

Mindfulness meditation is the approach that I prescribe most often to help men break the cycle. Regardless of how sexual performance anxiety presents, mindfulness is the front-line intervention for corralling anxiety in the bedroom. 

Not only is it popular, it works! Studies show mindfulness  to be effective in treating stress and anxiety. and emerging research suggests that mindfulness meditation can be helpful specifically for ED. 

You can engage in a variety of different methods of mindfulness meditation (just ask your preferred search engine!), but the central component of mindfulness is non-judgmental, present-focused awareness.

When you practice mindfulness in any form, you are strengthening the muscles that allow you to shed negative thoughts and self-talk and refocus your awareness when it strays. 

With these skills, you can notice your worry without judgement or shame and redirect your focus to the physical sensations and/or intimacy with your partner that you’re experiencing in the present moment. In doing so, you substantially reduce the impact that your anxiety has on your performance.

Guided imagery

Guided imagery can help you break the performance anxiety cycle, by helping you improve your confidence in the bedroom.

During the guided imagery exercises you visualize yourself performing with confidence. You allow yourself to  experience physical arousal without the pressure of having to perform or be in front of another person. 

Like mindfulness meditation, guided imagery helps to focus the mind, making it less susceptible to anxiety. 

To practice guided imagery, simply imagine yourself in a sexual situation that appeals to you. Allow yourself to become aroused, with or without self-stimulation. Once aroused, allow your erection to soften without climaxing. Repeat the process three to four times before climaxing, if at all. 

With guided imagery exercises, you can practice being sexual and allowing your erection to come and go without panicking. In a sense, you’re reconditioning your mind-body connection to associate getting and losing erections with pleasure and relaxation, rather than anxiety and panic. 

Guided imagery can be especially helpful if you’re struggling with erectile dysfunction or premature ejaculation.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a specific type of skills-based therapy technique that targets the relationships between thoughts, feelings, and behaviors. 

With regard to sexual performance anxiety, CBT helps disrupt the negative self-talk, and shame-based thought patterns that exacerbate the fears surrounding sexual performance. 

Structured CBT protocols have been found to be effective in treating erectile dysfunction, even 6 months after treatment. In fact, CBT can be used in conjunction with mindfulness (called mindfulness-based CBT) to produce significant improvements in sexual anxiety.


Hypnosis is currently being investigated as a potentially helpful treatment for sexual performance anxiety, though the available data is inconclusive. In theory, hypnosis allows you to recondition your brain to associate physical arousal with enjoyment and relaxation. If you’re considering using hypnosis to help with sexual performance anxiety, be sure to work with a certified hypnotherapist.


As mentioned above, CBT is an effective therapeutic modality for treating sexual performance anxiety. Other forms of talk therapy can also be helpful to break the cycle of performance anxiety. 

In fact, certain mental health professionals pursue advanced training in working with issues of sex and sexuality. 

If therapy is of interest, seek out a certified sex therapist in your area.

Couple counselling

Often, when seeking professional help for sexual performance anxiety, we seek individual help. However, most people who struggle with sexual performance anxiety only experience anxiety when engaging in partnered sex. 

Attending counselling with your partner allows both of you to explore and understand the issues that drive sexual performance anxiety. Your partner can learn how to best support you, and you can tackle the problem together. 

In addition, with couples counselling, you have the opportunity to fact check your anxious thoughts with what your partner actually thinks and feels. So much of sexual performance anxiety is worrying about being inadequate or a disappointment to your partner. Couples counselling allows you to hear directly from your partner in a nonjudgmental, supportive space.

Avoid porn

This suggestion is probably the most self-explanatory – avoid porn. But why? Pornography is designed specifically to provide maximum sexual entertainment, not to depict or mirror real-life sexual intimacy. 

Because pornography is entertainment, it reinforces unattainable myths about sexuality (e.g. the quality of sex is directly related to the quality of an erection). This can result in the development of unrealistic expectations which can lower your self-esteem, which further exacerbates anxiety. 

Furthermore, sexual performance anxiety occurs in real-life sexual situations, so your sexual response to pornography is not generalizable to real-life.

Slow down and focus on the senses

Slowing down to focus on sensation is a common practice when treating sexual dysfunction. In fact, these techniques will be found in mindfulness meditation, guided imagery, therapy, and relaxation techniques. 

Slowing down and focusing the mind on physical sensation allows you to get out of your head (where your anxiety lives) and into your body. Focusing on the body and experiencing pleasure turns an anxiety-provoking experience into an enjoyable experience.

Improve foreplay skills

Because fear of disappointing your sexual partner is a big component of sexual performance anxiety. Focusing on sexual activities that aren’t dependent on your ability to have an erection is a way to attend to your partner’s pleasure without the anxiety-provoking stimulus. 

Pie chart the shows what women prefer, sexual stamin or foreplay.
Survey of 1,040 found that 57% of women prefer foreplay over stamin in bed

In fact, our recent survey found that 57% of women said that foreplay skills are more important than lasting longer in bed. Foreplay can be the way to please your partner while bypassing many of the problems performance anxiety can cause.

Relaxation techniques

Relaxation techniques, like many of the other techniques, targets the connection between anxiety and erections. If you can experience relaxation in a situation that is historically anxiety-provoking for you, you will start to associate relaxation with that situation, rather than anxiety. 

To create that relaxation, you may use techniques such as breathing exercises and progressive muscle relaxation. There are a variety of breathing techniques that promote relaxation; often they involve inhaling and exhaling for a specific amount of time, such as a count of four. Progressive muscle relaxation involves systematically scanning your body and relaxing each body part successively.

Lifestyle changes

Sexual health can be affected by general health. Particularly, when it comes to erections, cardiovascular health is critical. To maintain good general health, make sure your diet is healthy and balanced, exercise regularly, and reduce your use of alcohol and drugs.

Can ED medications help performance anxiety?

ED pills for sexual performance anxiety

Yes and no. ED drugs, such as Viagra, Cialis and Levitra, can help improve blood flow to the penis, making erections easier to achieve. 

However, in order to do that, physical arousal is required. Because sexual performance anxiety blocks arousal, these drugs may not be effective. 

That said, for some people, the placebo effect from taking an ED medication (i.e. belief that an erection will happen because of the medication) is enough to combat the anxiety, allowing arousal to take place.

Does sexual performance anxiety go away?

Typically, sexual performance anxiety does not resolve on its own, but it is very responsive to treatment. With proper interventions, you will amass positive sexual experiences. Eventually, positive experiences will become the norm, and then the expectation. sexual performance anxiety arises because you’re anticipating a negative outcome. When that is replaced with anticipating a positive outcome, there is no anxiety.


Sexual performance anxiety can affect anyone’s sex life. For those with penises, sexual performance anxiety can manifest as erectile dysfunction, premature ejaculation, delayed ejaculation, inability to orgasm  and low sexual desire.. Once established, sexual performance anxiety is a cycle of anxiety and sexual difficulty that reinforces itself. 

Fortunately, sexual performance anxiety can be treated effectively. Though ED medications aren’t particularly helpful, especially in the case of severe performance anxiety, there are many other interventions that have been shown to be.

Mindfulness meditation, guided imagery, and therapy (including CBT and couple therapy) are the three most common interventions that I use in my practice.

Used together, these three treatments help to correct maladaptive thought patterns that maintain sexual performance anxiety, improve focus, and promote present awareness, all of which combat anxiety. 

Improving foreplay skills can increase sexual satisfaction, and using relaxation techniques will help decrease psychological stress and create an association between sex and relaxation. 

In addition, some people may find hypnosis to be helpful. Lifestyle changes, including those that promote general and mental health and those that decrease porn consumption, can be effective adjunct changes.

About Bailey Hanek PsyD

Clinical Psychologist and Certified Sex Therapist

Dr. Bailey Hanek is a clinical psychologist and an AASECT-certified sex therapist. She serves as a professional consultant for Between Us Clinic. Dr. Hanek provides sex therapy and general psychotherapy to adults in her private practice. In addition, she works to increase access to information about relationship and sexual health through her founding role in The Relationship Coaches.