Sexual Performance Anxiety: How To Address And Overcome This Common Condition

Article Summary:

• Sexual performance anxiety is a condition where someone fears that a sexual encounter won't go well, or will be disappointing.
• Sexual performance anxiety can stem from a number of different factors, including stress, trauma or a pressure to “perform”.
• There are several ways to address sexual performance anxiety. These include therapy and medication. Open and honest communication with your partner(s) may also help.

Erectile dysfunction is more common than you may think. In fact, it’s estimated to affect nearly half of people assigned male at birth (AMAB) in Canada between the ages of 40-88. [1]

However, while it’s normal to occasionally experience erectile dysfunction, becoming stressed or anxious about the possibility of disappointing sex may result in a “self-fulfilling prophecy”: the more you worry about it happening, the more likely it is to happen. This is known as sexual performance anxiety, and it may affect anywhere between 9-25% of AMAB people. [2]

The good news is that, with the right support, it’s treatable. In this article, we’ll explore the science behind sexual performance anxiety, its potential root causes and techniques to prevent it.

What is sexual performance anxiety?

Sexual performance anxiety is a condition where someone fears that a sexual encounter won't go well, or will be disappointing.

For AMAB people, this anxiety may trigger the release of stress hormones, which may interfere with the chemical and mental processes involved in getting and maintaining an erection. [3] [4]

Sexual performance anxiety in AMAB people might manifest itself in a number of ways:

• You can’t achieve an erection.
• You can get an erection, but it’s not hard enough for satisfactory sex.
• You get an erection and have sex for a while, but it’s not sustained.
• You’re able to get an erection but cannot orgasm.

Anxiety and sex don’t go well together. And it’s completely reasonable to experience negative thoughts after a disappointing sexual experience. However, it’s important to address any sexual performance anxiety as early as possible. Otherwise, when you next have sex, you may find these anxious thoughts returning. And the more “oxygen” you give to the anxiety, the more likely it is to grow. This may create a vicious cycle, which can affect your sexual confidence in the long term.

What are the causes of sexual performance anxiety?

You might feel anxious about sex for a whole range of reasons. Here are some of the most common causes:

The pressure to “perform”
Our social feeds and the wider media constantly inundate us with information on how to optimize every aspect of our lives, from our looks to our lifestyles. However, that world doesn’t always represent reality. 

The same can be true for sex. Pornographic consumption, in particular, can create unrealistic expectations around what sexual performance can, or should, look like. This is often linked to other insecurities, like body image and penis size, which can also feed into sexual performance anxiety.

Try to avoid comparing yourself to others, and focus on what feels right for you and your sexual partner(s).

Day-to-day stress
Stress is both a cause and effect of sexual performance problems. If you're feeling worried about work or money, you’re experiencing relationship issues or you have a lot on your mind, it may affect your performance in the bedroom.

While it’s not always easy to put these thoughts to the back of your mind, identifying where your points of stress lie may help you to manage your performance anxiety.

Your upbringing
You may have been raised in a cultural or family setting where sex was a taboo topic, or where you learned to think about sex and your own body in a certain way. For example, some people may learn to feel shame about sex and masturbation. This can also lead to sexual performance anxiety.

Childhood trauma
Anxiety about sex can sometimes be triggered by a childhood trauma, especially if it’s related to sexual or physical abuse. If this applies to you, consider speaking to your clinician or seek out private counselling.

How to overcome performance anxiety

The relationship between anxiety and sex is complicated. However, its associated conditions, like erectile dysfunction and premature ejaculation, are common among people of all ages. [5] Fortunately, a wide range of treatment options are available. Certain medications may help you to achieve and maintain a stronger erection, for longer.

Most oral erectile dysfunction treatments work by improving blood flow into the penis when you’re sexually aroused. By allowing more blood to flow into the penis, they increase your chances of achieving and maintaining an erection. [6] This may also relieve some of the pressure around performance anxiety, resulting in a more relaxed and enjoyable sexual experience. As you gain confidence after a few uses of the treatment, you may eventually feel you no longer need to take it.

However, as with any treatment, clinical approval for erectile dysfunction medication is subject to eligibility.

If you’re not sure whether you’re ready to try medication, you may want to consider other routes first:

Communicate with your sexual partner(s)
While it can be difficult to talk about your worries, especially with a new partner, communication can be a really effective way of tackling performance anxiety. Find a moment to talk, and explain your experience. In most cases, they’ll be supportive and will most likely appreciate your honesty. In fact, a 2021 British study found that 82% of female partners think erectile dysfunction should be talked about more openly. [7]

It’s sometimes easy to forget that sexual dysfunction can affect a partner too, especially when they don’t have the full picture. Sometimes, simply talking about the issue can make you feel a lot more relaxed and relieve some of your anxiety.

Focus on your senses
Much of erectile dysfunction is linked to what’s going on in your head, rather than in your body. [8] If you recognize performance anxiety creeping in, try and concentrate all your attention on your senses: what you can see, feel and hear. By slowing your mind and shifting it to the present, focusing less on performance and more on physical sensation, you may reduce any anxious feelings. 

Avoid drinking before sex
Alcohol consumption has been linked to erectile dysfunction. [9] And, if you decide to take erectile dysfunction medication, alcohol could also affect your results. [10] This is why it’s best to avoid drinking before sex. 

Find other ways to be intimate
Films and TV have conditioned many of us to think of sex as a straight line from A to B, and that it must always include penetrative sex. But in reality, this is not the case.

Think less about performance, and more about pleasure. What works for you and your sexual partner(s)? For example, you may want to try using touch (sensate focus) to build trust and intimacy.

Exercise
Alongside diet, exercise is an important lifestyle factor for our physical health. And research suggests that it may help to improve sexual function. [11] However, we also know how important regular exercise is for our mental health, too. It can increase the production of endorphins, a type of “happy hormone” that may reduce stress and improve your sense of well-being. [12]

Health Canada recommends at least 2.5 hours a week of moderate to vigorous physical activity, broken into sessions of 10 minutes or more.

Kegel exercises
We often associate kegel exercises with postpartum recovery. But did you know that they may also improve erectile dysfunction and premature ejaculation? To perform a kegel exercise, try contracting then releasing your pelvic floor muscles as if you’re trying to stop a urine flow. Hold for 5 seconds, and release. Repeat 8-10 times, in 3-5 sets, daily. With consistent daily practice, within a few months these exercises may help you to achieve and maintain an erection. [13] This may improve your confidence, and reduce sexual performance anxiety.

Talk to a professional about anxiety and sex

For many AMAB people, erectile dysfunction is linked directly to sexual performance anxiety. However, help is available.

It may be useful to talk to a professional about these issues, especially if sexual performance anxiety is a common occurrence. A clinician might be able to test for any underlying medical issues, and assess your suitability for medical treatment. It may also be worth exploring whether additional treatments, like cognitive behavioural therapy, are right for you.

By addressing sexual performance anxiety head-on, you’re already taking positive, proactive steps. With time, this may lead to a more relaxed approach to intimacy and an improved sexual experience.

Find out what treatment is suitable for you with MedExpress.

References

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