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What is performance anxiety sexually

Sex is supposed to be enjoyable, but it’s tough to have fun if you’re constantly worrying about how well you’re doing. If you want to put the sparkle back in your love life, learn why sexual performance anxiety might be happening to you and get some tips to put yourself at ease.

Sex is more than just a physical response. Your emotions have something to do with it, too. When your mind is too stressed out to focus on sex, your body can’t get excited either.


Your state of mind can have a big impact on your ability to get aroused. Even if you’re with someone who you find sexually appealing, worrying about whether you’ll be able to please your partner can make it impossible for you to do just that.

One of the effects of the stress hormones is to narrow blood vessels. When less blood flows into your penis, it’s more difficult to have an erection. Even guys who normally don’t have any trouble getting excited might not be able to get an erection when they’re overcome by sexual performance anxiety.

Sexual performance anxiety isn’t diagnosed as often in women as it is in men, but it can affect arousal in women, too. Anxiety can prevent women from getting lubricated enough to have sex, and it can take away the physical desire to make love.

Anxiety can take you out of the right mind-set for sex. When you’re focused on whether you’ll perform well, you can’t concentrate on what you’re doing in bed. Even if you are able to get aroused, you may be too distracted to reach orgasm.

Sexual performance anxiety leads to a cycle of troubles. You might become so anxious about sex that you can’t perform, which leads to even more sexual performance anxiety.

Sexual performance anxiety and erectile dysfunction are common sexual problems. Concerns about a partner’s expectations and personal worries are among the contributing factors.

Stress about sex can lead to performance anxiety. This, in turn, can lead to erectile dysfunction (ED), which is when a person has difficulty getting or keeping an erection.

Some simple coping methods may help people deal with ED when it stems from performance anxiety.

What is the link between performance anxiety and ED?

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Performance anxiety and ED may be linked in several ways. Stress and anxiety about performing sexually or pleasing a partner can cause sexual dysfunction in anyone, regardless of their sex.

When a person feels unable to meet a partner’s sexual expectations, they may start feeling unworthy or incapable.

These feelings of inadequacy and low self-esteem may lead to physical symptoms, such as ED.

Researchers list psychological factors as one of several causes of ED. In other words, a person’s state of mind can affect their ability to perform sexually.

Causes of performance anxiety

Performance anxiety typically results from a person’s negative thoughts about their ability to perform well during sexual activity. A person may be worrying about sexual inadequacy or the inability to please a partner.

Factors that can influence these feelings include:

  • body image
  • penis size
  • perceptions of virility
  • ideas about gender roles
  • relationship issues
  • the use of internet porn

Dealing with financial concerns, family issues, or stress at work may also affect a person’s mental state and contribute to performance anxiety.

For more research-backed information and resources for men’s health, please visit our dedicated hub.

Causes of ED

ED can happen when various contributing factors interact, including:

  • hormonal balance
  • neurological factors
  • blood circulation
  • mental health and psychological factors
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Other things that may contribute to ED include:

  • depression
  • disinterest
  • loss of attraction
  • stress
  • low testosterone levels
  • smoking
  • alcohol or drug abuse
  • chronic illnesses
  • kidney disorders
  • nerve damage from diabetes
  • stroke
  • injury
  • pelvic irradiation
  • recent surgery

Some medications may also cause ED, especially those that disrupt or alter the hormones, nerves, or blood pressure.

They include:

  • antidepressants
  • anti-inflammatory medicines
  • high blood pressure medications
  • drugs for an irregular heartbeat
  • muscle relaxers
  • hormone therapy
  • chemotherapy
  • drugs that affect the prostate

A doctor or pharmacist can help identify potential side effects before a person starts a new medication.

ED and mental health

ED is not just a physical problem. It can affect a person’s mental health, relationships, and social life.

Experts have found links between ED and:

  • anxiety
  • depression
  • stress
  • low self-confidence
  • low self-esteem
  • relationship difficulties
  • sleep issues

These can trigger performance anxiety, and they can also result from it.

If a person has an erection on waking in the morning but not during sexual activity, there may be an emotional or psychological cause.

Psychological treatment and counseling, such as cognitive behavioral therapy, may help overcome concerns about sexual performance and ED.


Performance anxiety affects everyone differently, as not everyone responds to stress and anxiety in the same way.

In addition to ED, performance anxiety could lead to:

  • premature ejaculation
  • an inability to orgasm
  • a lack of interest in sex

Research also suggests that heterosexual people who experience performance anxiety may be more likely to seek sexual experiences outside of a steady relationship.

The physical symptoms of ED include difficulty getting or keeping an erection. It may also lead to a loss of sexual desire.

How to cope

Various tips can help people cope with performance anxiety and ED and enable them to have positive sexual experiences.

Avoid the cycle

Most people have a disappointing sexual experience from time to time. Occasional ED is not usually a cause for concern.

However, if disappointment leads to fear and anxiety, and these feelings persist, they can hinder future sexual activity.

It is essential to recognize that an inability to perform from time to time does not mean that a person is unable to have sex.

It may mean that they were under stress or facing anxiety at that time. At another time, when the stress is not present, they will be able to enjoy sex as before.

Shifting the focus to the cause, rather than the symptoms, may help a person reduce the pressure that they place on themselves to perform well every time, especially during times of increased stress.

Focus on the senses

A person with performance anxiety may mentally relive their perceived sexual failures and continually worry about what their sexual partner is thinking or how another partner may perceive them.

It may help to focus the mind fully on the senses during sexual activity, rather than overthinking or analyzing the event.

Focusing on what the hands are feeling or what the eyes are seeing can help block out anxious thoughts about performance.

Scented candles or music might also add to the sensory experience and help reduce anxiety.


Research has noted a link between getting little or no physical exercise and experiencing ED symptoms. Completing a simple 20-to-30-minute exercise routine a few times a week can boost overall well-being and reduce stress levels, which may be helpful.

Other techniques

Many other techniques can help treat performance anxiety and ED. These include:

  • guided meditations, such as guided imagery therapy
  • couples counseling
  • sex therapy
  • sexual education
  • stress-relieving practices, such as mindfulness and yoga

It may also help for a person to be open with any sexual partners about their feelings of performance anxiety. Doing this can reduce stress, and the partner can help the person find solutions to relieve their anxiety.

When to see a doctor

If symptoms do not improve with lifestyle and relaxation techniques, or if they worsen over time, medical treatment may help.

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A doctor may:

  • ask about symptoms
  • carry out a physical examination
  • perform blood tests to help identify any physical causes
  • ask questions about mental health and stress levels

A healthcare professional can help a person find a therapy or treatment that relieves their symptoms and encourages positive sexual experiences.


There are various ways to treat sexual performance anxiety and ED. A doctor will prescribe a treatment plan after identifying the cause of the problem.

Guidelines from the American Urological Association (AUA) recommend an integrated approach for ED and ejaculation disorders that will take into account the individual’s mental health, social situation, and physical well-being.

This approach may include:

  • relationship counseling
  • psychotherapy
  • medication for ED
  • treatment for specific diseases, such as benign prostatic hyperplasia
  • lifestyle measures, such as a diet and exercise plan

The AUA recommend that partners, too, should discuss the treatment options and their risks and benefits with the doctor, as this may increase the chance of a positive outcome.


There are many possible causes of sexual performance anxiety, including relationship issues and poor body image. If it becomes persistent, this anxiety can lead to physical symptoms, such as ED.

People can try certain at-home techniques to manage ED. Being open with any sexual partners about performance anxiety may also help reduce the associated stress.

If these techniques are ineffective, a doctor can offer advice on treatment options, which may include a combination of psychotherapy and medication.

What Is Sexual Performance Anxiety?

Feeling anxious before sex is normal. However, feeling so nervous that you cannot have sex or enjoy sex might be sexual performance anxiety (SPA).

SPA is a type of performance anxiety that affects sexual activity in particular. A person who has this condition will often be overcome by a fear that they’ll be unable to perform either before sexual activities or during them.

This disorder is more prevalent in men than in women. It can also lead to the development of sexual disorders such as erectile dysfunction. Sexual performance anxiety is one of the most common sexual conditions in the world today. Some research shows 9% to 25% of men are affected by SPA, and 6% to 16% of women are affected by this condition.

SPA looks a little different when it happens before sex than during sex. When it occurs before sex, it makes having sex almost impossible. You’ll most likely be unable to have or sustain an erection. However, when it happens during sex, you’ll find that you cannot enjoy sex or even climax.

If left untreated, SPA could cause other sexual dysfunctions and cause you to lose interest in sex and other sexual activities. In a 2005 study, researchers found that performance anxiety plays a huge role in the development of sexual dysfunction in both men and women.

Symptoms of Sexual Performance Anxiety 

Symptoms of sexual performance anxiety typically include: 

  • Having little or no interest in engaging in sexual activities 
  • Premature ejaculation when you have sex 
  • Being unable to have or sustain an erection 
  • Finding it difficult to orgasm during sex

Symptoms of sexual performance anxiety, however, look a little different in women. Women with this condition might experience: 

  • Vaginal dryness 
  • Difficulty getting aroused 
  • Experiencing some pain during sex 

People with sexual performance anxiety experience it in different ways, making it essential to look out for all symptoms typically associated with the condition. 

Identifying Sexual Performance Anxiety 

Sexual performance anxiety is sometimes misdiagnosed as erectile dysfunction. While the condition could cause erectile dysfunction, these are two different conditions.

Sexual performance anxiety is not a recognized medical condition, which often makes diagnosis and treatment difficult. The shame usually attached to sexual dysfunction conditions also prevents people from seeking help from a doctor or healthcare provider.

For a diagnosis of sexual performance anxiety to be made, any other reasons for your diminished sexual performance, such as other medical conditions, will have to be ruled out. A psychotherapist typically makes a diagnosis of SPA. 

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Causes of Sexual Performance Anxiety 

Your body goes through specific changes when you are anxious that could affect your sexual performance. When you are anxious, you typically experience an increase in hormones like norepinephrine and cortisol.

An increase in these hormone levels also causes an increase in your blood pressure levels, which could cause a reduction in blood flow to your penis, preventing you from getting or sustaining an erection. 

Sexual performance anxiety has no single cause. It’s typically caused by a range of biological and psychological factors such as: 

  • Having body image and self-esteem issues. People who are overly concerned about their height, weight, or appearance of particular body parts might experience SPA when they engage in sexual activities.
  • Feeling emotionally disconnected from your partner. Sometimes SPA is brought on by emotional issues you might be going through with your partner. 
  • Dealing with mental health conditions. Depression and generalized anxiety disorder may contribute to SPA.
  • A lack of sexual experience. People who have less sexual experience might feel some performance anxiety when they first begin to have sex.
  • Feeling stressed. Stress affects all aspects of our lives, including our sex lives. Sometimes SPA could be brought on because you are stressed at work or by some other situation.
  • Previous negative sexual experiences/trauma. Having had negative sexual experiences in the past, either with your current partner or a former partner can lead to SPA.
  • Overconsuming pornographic content. This can sometimes give you a false perception of what sex should look and feel like. Research has linked porn to the development of sexual dysfunction.

SPA can sometimes feed into itself and cause an unfortunate cycle. It starts with a person feeling anxious before sex which affects their performance, and then becoming even more anxious the next time they engage in sexual activity because they were unable to perform the last time. 

Treatment for Sexual Performance Anxiety 

Treatment for sexual performance anxiety typically depends on what’s causing it. In general, a combination of medication and psychotherapy can be used to treat its symptoms. 

  • Psychotherapy: Cognitive-behavioral therapy is sometimes recommended for the treatment of SPA. 
  • Medication: Medication used to treat erectile dysfunction, such as Viagra and Cialis, is sometimes recommended for people who have SPA. 

More research needs to be done to find adequate treatment for sexual performance anxiety. Cognitive-behavioral therapy and medication have so far proven to be some of the most effective treatments for SPA. Buspirone, bupropion, and trazodone have also shown potential in helping treat symptoms of SPA.

How to Cope With Sexual Performace Anxiety 

The first step to coping with sexual performance anxiety is removing any shame you might be feeling about not having an optimal sex life. In some instances, sexual performance anxiety goes away with time, especially in situations caused by having a new sexual partner or where a relationship issue with your partner has been resolved. 

People with sexual performance anxiety often operate under the false belief that they are somehow inadequate or incapable of satisfying their partners. Focusing more on your enjoyment and that of your partner instead of how adequate your performance is can help you overcome your anxiety.

Here are some other tips that can help you overcome SPA: 

  • Meditate: Meditation is often recommended for coping with any form of performance anxiety. 
  • Masturbate: Spend some time with yourself to get a better understanding of your own needs.
  • Get out of your head: When you are having sex, try to spend more time enjoying its motions instead of worrying about what could be going wrong.
  • Accept that sex isn’t always perfect: There’ll be some days you might not just feel up to having sex. This most likely has nothing to do with your physical ability. 
  • Slow down and take your time: Sometimes, you might not have spent enough time engaging in foreplay for both you and your partner.
  • Eliminate stress from your life: One of the causes of sexual performance anxiety is stress over other factors in your life like finances or work. Managing stress with meditation, exercise, and regular sleep can help. 
  • Speak to a therapist: Speaking with a sex therapist may help you discover the root of your sexual performance anxiety.