Premature Ejaculation and Performance Anxiety

Learn about the causes and treatments for premature ejaculation and performance anxiety

premature ejaculation and performance anxiety are related

It is common for some men to experience performance anxiety before and during sex. In some cases, this type of anxiety can lead to premature ejaculation (PE). In fact, studies suggest that performance anxiety may be either partially or fully to blame for many cases of PE. In other cases, performance anxiety is the result, not the cause, of PE.

The goal of this article is to explain the relationship between anxiety and premature ejaculation and provide you with an overview of the various treatment options available.

Can anxiety cause premature ejaculation?

Men suffering from anxiety are also at risk of experiencing premature ejaculation (PE). When you’re feeling anxious, there is a high chance that you’ll miss the physiological signs that lead to orgasm. This makes it harder for you to pace yourself during sex and may lead to premature ejaculation.

It is important to note that the underlying causes of PE vary depending on the individual. The underlying cause usually cannot be pinpointed. But, the end result is the same – a “disconnection” that prevents the man from sufficiently identifying the feelings and sensations leading up to orgasm. Men with premature ejaculation issues can have a hard time properly identifying their ‘points of no return’ during sexual activities. This makes them unable to pace themselves during sex.

When you’re feeling anxious, there is a high chance that you’ll miss the physiological signs that lead to orgasm.

Some men experience performance anxiety when pressured to “perform” during sex. Unresolved shame, guilt, anxiety, anger, hostility, and resentment can lead to psychological distress, triggering PE. Moreover, a chronic worrier may “overthink” or constantly fret over his sexual performance. He becomes tense, nervous, and/or frightened at the possibility of having sex.

Performance anxiety and the types of premature ejaculation

It is important to distinguish between the four types of PE (lifelong, acquired, subjective, and variable) and their relationship with performance anxiety.

A man, who suffers from lifelong premature ejaculation (PE), has never had sexual intercourse without ejaculating prematurely. If a man first experienced performance anxiety during his first sexual encounters, he may have developed a habit of ejaculating prematurely because of it. The truth is, ejaculating too quickly during a man’s first sexual encounter is normal, but most men learn how to pace themselves with time and experience.

Conversely, a man with acquired PE had “normal” sexual function at one time but could no longer delay ejaculation long enough to satisfy his partner.

Variable PE happens when a man experience PE inconsistently, either with a specific partner or with multiple partners.

In the cases of acquired PE and variable PE, the culprit may be the relationship. Being afraid of “disappointing” your partner during sex can also lead to anxiety and PE.

Subjective PE occurs when a man believes he is experiencing premature ejaculation – consistently or inconsistently. In this case, a medical doctor or sex therapist may determine the man does not have a PE issue – even though he still believes he does.

A recent study found that anxiety is more common in men with acquired premature ejaculation than in men with lifelong premature ejaculation. Researchers also found that anxiety may play a causal or enabling role in men suffering from PE.

How to overcome sexual performance anxiety and premature ejaculation

There is a wide variety of treatments available for premature ejaculation. Deciding which approach to take depends on the origin of the PE. If PE and performance anxiety co-occurs, you’ll need to decide whether to treat one or both issues.

In the next section, we will talk about behavioral therapy for PE, which can also help in cases of anxiety. This method includes masturbation and/or full penetration exercises. We will also review a few treatments for reducing performance anxiety which may help with PE.

It is important to note that a technique may work for one man with PE but not the other. This is normal. In this situation, it is important to try different things until you find something that works for you and your partner. If you try these techniques and cannot garner success, you may need to consult with a sex therapist.

The stop-start method and the squeeze technique

The stop-start method and the squeeze technique involve teaching men with premature ejaculation (PE) how to become more self-aware. More specifically, these exercises help men recognize what is happening in their bodies during sex. It also helps them better understand the role their thoughts play in their behaviors, which in this case, is PE. Masturbation and/or full penetration exercises not only help men identify their ‘points of no return’ but also improve their stamina.

Behavioral sex therapy exercises also teach men how to interpret their “bodily signals” during sex. “Signals” that would probably happen naturally if the man was not grappling with anxiety issues. These exercises teach men with PE how to pay close attention to the feelings and sensations that occur during sexual stimulation.

You can learn to perform these exercises with the help of a sex therapist in a face to face sessions. This usually entails a 12 sessions treatment protocol. Alternatively, you can try the Between Us Clinic’s Premature Ejaculation Program. The program will create a personalized exercise plan and guide you through the treatment protocol, all from the comfort of your own home.

Mindfulness Meditation

For the types of PE caused by psychological factors, such as anxiety, mindfulness-based practices can help calm the mind and body.

Mindfulness-based practices and experiences help individuals become aware of and attune to bother y’s sensations and responses, allowing them to be comfortable in their body and with their sexual sensations rather than being distracted by anxious or worrisome thoughts or other thoughts distracters.

Mindfulness can also help with depressive thoughts and feelings that can also create ejaculatory and/or erectile difficulties.

Contrary to what many people imagine mindfulness practices to look like – which is basically sitting on the floor with crossed legs, eyes closed, and chanting – mindfulness practices include a wide variety of experiences that allow stillness of the mind and soul.

Such activities include gardening, putting a puzzle together, coloring, knitting/crochet, word searches, listening to peaceful music, walking, slow movement-based exercise, etc.

Dr. Sandra Lindholm, Psychologist/Board Certified Sex Therapist

Recent studies have shown mindfulness meditation practices to effectively treat various sexual dysfunctions in both men and women.

Guided imagery

Guided imagery may also be an option if a man suffers from acquired PE. Guided imagery, also known as visualization, guided meditation, and/or guided self-hypnosis, is a soothing, powerful treatment approach that proactively “guides” one’s imagination towards a more positive experience.

Guided imagery may also be an option

Guided imagery may also be an option.

A man with PE may be instructed to imagine a lengthy, sexually-fulfilling experience right before having sex. Guided imagery is especially beneficial for men suffering from performance anxiety and PE because this exercise involves all the senses. Therefore, it can reduce stress, tension, and anxiety before and during sexual activities, so men with PE can last longer in bed.

Sensate focus

Another treatment that may be beneficial for men with PE is sensate focus. This exercise was initially developed as a sex therapy technique in the 1960s. It involves a group of behavioral exercises couples performs to improve their intimacy and strengthen their bonds. The goal is to increase intimacy and help couples reconnect, so the sex lasts longer and is more satisfying. This is especially beneficial for couples experiencing relationship issues because relationship dissatisfaction can trigger PE – in some men.

Sensate focus involves seven key features:

  1. Both partners must share a mutual responsibility when addressing sexual wants, needs, preferences, fears, and concerns.
  2. Both partners must commit to learning more about healthy sexual function and sexual activity.
  3. Both partners must be willing to change their attitudes about sex.
  4. Both partners must work together to reduce or eliminate sexual performance anxiety.
  5. Both partners must improve their communication styles when it comes to sex and sexual techniques.
  6. Both partners must work together to reduce problematic sexual and non-sexual behaviors.
  7. Both partners must complete homework tasks.

The Illustrated Manual Of Sex Therapy by Helen Singer Kaplan

According to Helen Singer Kaplan’s book, “Illustrated Manual Sex,” sensate focus is only successful if both partners share responsibility and commit to doing the work, as instructed by a sex therapist. Mutual responsibility is essential because it presents premature ejaculation and other sexual dysfunctions as a “couple problem,” not an individual problem. The one thing that separates sensate focus from other behavioral approaches is structured homework assignments. The goal of this treatment approach is to temporarily remove stressful behaviors from the couple’s relationship. Once the stress has been removed, the couple can follow a “series of steps” to lengthen the sex and improve the “experience.”

Self-help exercises for PE and performance anxiety

Yes, you can do things that may help reduce or eliminate acquired PE when performance anxiety isn’t too bad.

These exercises include:

  • Communicate
    It is important for you to communicate if you are experiencing stress, anxiety, worry, and/or agitation. How can your partner help you if she doesn’t even know you are struggling with something? She can’t. So, talk to your partner and tell her what is going through your mind. If you keep your problems to yourself, it will destroy not only your sex life but also your relationship. If your partner knows what is really going on with you, she may be able to help you resolve the issues that are stressing you.
  • Slow down
    Sex is not a sprint. So, slow down. Enjoy each and every sensation, image, smell, and taste, leading up to the sex. And, take your time. Spend time engaging in sensual foreplay. Learn about one another’s bodies. Calm your mind and visualize lasting longer in bed. And lastly, remember that your partner is not judging you – she just wants to help you. Rushing will only make you more anxious and jittery, which is not good for sexual performance. Slowing down, however, can help ease performance anxiety, so you can enjoy what’s happening to your body. Slowing down can also help you focus on the “here and now,” which is important for long-lasting sex.
  • Change positions
    If performance anxiety is causing you to experience PE, you may want to change your sexual position. In other words, if you are generally on top during sex, you may want to change places with your partner. Let her be on top and you on the bottom, and see if that delays ejaculation. If that doesn’t work, change to a position that allows your partner to get up if you alert her that you are about to ejaculate too soon. Wait for the urge to pass, and then ask her to return, so you can continue having sex.

Read Next: These 5 Sex Positions Will Help You Last Longer In Bed

In summary

It is common for some men to feel anxious, nervous, worried, fearful, and/or uncomfortable before and/or during sexual activity. Many times, these feelings are linked to sexual performance anxiety.

This type of anxiety affects men of all ages, causing a variety of sexual dysfunctions like PE and ED (erectile dysfunction). Every man wants to please his partner – it’s normal, but when this urge takes over your life, it can lead to anxiety – and PE. With the “right” treatment approach –it’s possible to reduce or eliminate performance anxiety and PE, so you and your partner can enjoy longer and better sex.

*Click here to learn more about the Between Us Clinic’s Premature Ejaculation Program – an online exercise program for the treatment of premature ejaculation

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.