Premature Ejaculation and Performance Anxiety – Causes and Treatments

Could anxiety be wrecking your sex life?

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 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, who suffer 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 they feel 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 encounters, 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 is no longer able to 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 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, who suffer from PE.

What Treatments are Available for Anxiety-Induced 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-occur you’ll need to decide whether to treat one or both issues.

In the next section we will talk about behavioural 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.

A side note: There are two other treatment methods for PE that we do not cover in this article: anti-depressant medications and desensitizing creams and sprays. We published a different article about the full range of treatment methods that are available for 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 are unable to garner success, you may need to consult with a sex therapist.

Behavioral Sex Therapy Exercises

Behavioral sex therapy involves 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 PE Program. The program will create a personalized exercise plan and will guide you through the treatment protocol. All from the comfort of your own home.

the PE Program

Overcome Premature Ejaculation with the PE Program

Anti-Anxiety Medications

Anti-anxiety medications may help a man, who has acquired, variable or subjective PE. This is if he was once able to control his ejaculatory functions. It may also help men with lifelong PE when combined with a formal treatment plan for PE.

Some anti-anxiety meds commonly prescribed are anti-depressants (i.e. Prozac, Celexa, Zoloft, Paxil, Lexapro, Amitril, Elavil, Wellbutrin, etc.), Benzodiazepines (i.e. Xanax, Klonopin, Ativan, and Valium), Buspirone, Hydroxyzine, and beta-blockers (i.e. Propranalol).

Anti-anxiety medications may help a man, who has acquired, variable or subjective PE

Listed below are medications that may help reduce symptoms in men, who suffer from PE:

  • Benzodiazepines help ease performance anxiety by improving neurotransmitter activity in the brain. When this occurs it produces a sedative effect in the body. As a result, anxiety levels decrease, and the risk of PE lowers. Benzodiazepines tend to work quickly – usually within an hour or two. Unfortunately, however, this medication can lead to a drug addiction, if not carefully monitored.
  • Buspirone is commonly used to treat generalized anxiety disorder; however, it can also be used to treat sexual performance anxiety issues. This drug is often used in conjunction with an anti-depressant.
  • Beta Blockers are typically used to control blood pressures and stabilize heart rates; however, they are most commonly prescribed to people, who suffer from performance anxiety. In fact, beta blockers can help reduce anxiety, agitation, nervousness, worry, and fear – in some men, who suffer from performance anxiety, before or during sex.
  • Hydroxyzine is an antihistamine that effects the processing of serotonin. And, similar to benzodiazepines, this medicine works quickly, but doesn’t come with addiction risks.
  • Anti-Depressants are selective serotonin reuptake inhibitors (SSRIs) that are usually the first line of defense for depression and anxiety issues and disorders. SSRIs aid in the production of serotonin, a neurotransmitter that helps stabilize mood and produces a calming sensation in the body. These medications are not addictive; however, they can take between six-and-eight weeks (or longer) to work. These medications may also have a side effect of delaying ejaculation.

Guided Imagery

Guided imagery may also be an option, if a man suffers from acquired PE. Guided imagery, also referred to as visualization, guided meditation, and/or guided self-hypnosis, is a soothing, but 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, who suffer 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 originally developed as a sex therapy technique in the 1960s. It involves a group of behavioral exercises that couples perform together 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, who are 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-mobile

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.”

Are There Any Self-Help Exercises for PE?

Yes, there are things you can do 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 some level of stress, anxiety, or 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 let her know what is going through your mind. If you keep your problems to yourself, it will not only destroy 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, on the other hand, 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 normally on top during sex, you may want to change places with your partner. Allow her to 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.

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 PE Program – a online exercise program for the treatment of premature ejaculation

About Dr. R.Y Langham

Psychologist and Marriage Therapist

Dr. R.Y. Langham holds a PhD in family psychology from Capella University and an MMFT in marriage and family therapy from Trevecca Nazarene University. She counsels on adjustment issues such as relationship issues, blended families, same-sex couples, dysfunctional family relationships, etc.

She serves as a medical contributor, health & wellness contributor, copywriter, and psychological consultant for the Between Us Clinic.