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What are the Treatments for Sexual Performance Anxiety?

Kelly Brown MD, MBA

Reviewed by Kelly Brown MD, MBA

Written by Shannon Ullman

Published 02/21/2018

Updated 03/16/2024

Anxious about your sexual performance? Don’t worry — feeling this way isn’t uncommon, and you’re definitely not alone.

Anxiety around sex, especially for men, is actually “a thing.” If you feel nervous, anxious or uncomfortable before, during or after sex, you might have a condition known as sexual performance anxiety.

Sexual performance anxiety can affect men of all ages and backgrounds. This condition can be a drag on your emotions and contribute to common sexual dysfunction issues like erectile dysfunction (ED) and premature ejaculation (PE).

Sexual dysfunction might affect you, but did you know it can negatively impact your partner, too? There’s actually research on this. It turns out that ejaculatory dysfunction could increase your and/or your partner’s risk of developing depression.

Sounds like a vicious cycle, if you ask us.

It’s not all bad, though. Sex anxiety and its surrounding health issues are fixable. There are medical treatments and sex therapists who can help, plus lifestyle habits you can adopt to improve your sexual performance in the bedroom.

Here’s a look into this sexual condition, including what causes it, how it may affect sexual activity and how to beat performance anxiety to revamp your sex life. 

As you’re probably well aware, a big part of having sex is getting an erection.

An erection occurs when sexual arousal from your partner, masturbation or a toy sends nerve impulses to your brain. Your sexual nerves alert the blood vessels in your penis to dilate, increasing blood flow to the penis.

Once this happens, the blood fills the erectile tissue in the penis causing it to harden or become erect then a fibrous membrane tightens around your penis keeping the blood from draining  until you ejaculate and enter the refractory period. The refractory period is the time after ejaculation, when you may be unable to have another erection.

In some cases, getting or keeping an erection long enough for sexual activity doesn’t happen easily — which is where sexual performance anxiety comes into play. 

A whole bunch of factors, both physical and mental, that may cause sexual performance anxiety. Some of the main culprits are.

  • Worrying about your sexual performance, satisfying your partner or potential trouble ejaculating

  • Body image insecurities or self-esteem problems, such as concerns about weight, height or penis size, affecting sexual confidence

  • Stress about male sex problems, like ED, premature ejaculation, anorgasmia (inability to reach orgasm) or delayed ejaculation

  • Other health conditions that can impact sexual satisfaction, such as neurological diseases, metabolic syndromes or hormonal issues

  • Current or previous substance abuse

  • Relationship problems, like a lack of emotional connection, relationship anxiety or feeling dissatisfied in your relationship

  • Sources of stress, like issues with work, relationships, family or other non-sexual aspects of your life

  • Previous experiences or relationships that left a negative impact on how you approach sex

  • Mental health conditions, such as post-traumatic stress disorder (PTSD), social phobia, social anxiety disorder and panic disorder

  • Overall nervousness about having sex

From the list above, relationship issues seem to have the most impact on sexual performance anxiety. Research has revealed that everyday internal stresses within your relationship impact sexual performance more than a job, finances or other external factors.

With stress and anxiety comes stress hormones like adrenaline, which causes your body to get out of whack, leaving little room for arousal. 

For many men, this can lead to erectile dysfunction, making sex more difficult and less satisfying. ED occurs when you’re unable to get hard or stay erect long enough to have sex.

Another major factor that can cause men to have sexual performance anxiety and ED is depression. According to a meta-analysis of 48 different studies on a total of nearly 170,000 male participants, those with depression had a 39 percent higher chance of developing erectile dysfunction than those without the mental health condition.

If you’ve been diagnosed with depression, ask your healthcare provider to do routine ED screenings. That way, you can get proper erectile dysfunction treatment if it’s impacting your sexual experience and self-confidence. 

Sexual performance anxiety can also cause anorgasmia or delayed orgasm. Associated with a lack of sexual satisfaction, this condition can make it difficult to achieve an orgasm, even with sexual stimulation. 

Is performance anxiety causing my ED?

Sexual performance anxiety can affect you mentally and physically. The symptoms range from mild to severe, with some requiring medical treatment.

Symptoms of sexual performance anxiety may include:

  • Erectile dysfunction

  • Inability to get an erection sometimes (but not always) when you want to have sex

  • Ability to get an erection but unable to maintain it

  • Inability to ever get an erection

  • Premature ejaculation

  • Delayed ejaculation

  • Difficulty orgasming during sex

  • Negative thoughts before and during sex

  • Fear when thinking about sex

  • Fear before or during sex

  • Less interest in sex

  • Increased heart rate

  • Upset stomach

  • Sweating

Keep reading for tips on how to get past sexual performance anxiety, improve your sex life and boost your overall well-being.

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How can you get over sex anxiety? Different things can cause sexual performance anxiety, so your treatment will depend on what’s causing yours.

You might need treatment for an underlying medical condition or a stressor that caused the anxiety in the first place.

In some cases, sexual performance anxiety may resolve on its own as you become more comfortable with yourself and your sexual partner. Anxiety over sexual encounters could also disappear once you begin to identify and handle the stressors in your life. 

If you aren’t able to overcome sexual performance anxiety by yourself, there are plenty of male performance anxiety solutions you could try.

Therapy

A common treatment for sex anxiety symptoms is counseling, such as cognitive behavioral therapy (CBT), sex therapy and other forms of psychotherapy.

A mental health professional can help you work on your intimacy and sexual performance issues while addressing any underlying conditions, such as depression or anxiety.

Through therapy, you can learn how to implement lifestyle changes, such as practicing mindfulness, to reduce stress and negative thinking. You can also get your partner involved to address relationship problems that could be contributing to your sexual performance anxiety.

Sexual dysfunction can also affect your partner, potentially causing marital issues, a lack of emotional bonding and a lower quality of life.

Behavioral marital therapy and cognitive behavioral couples therapy can help you explore what’s influencing performance anxiety sex in your relationship. 

If you’re considering the therapy route, we offer online therapy with licensed sex therapists and mental health professionals who can assist you with sexual performance anxiety.

ED Medications

ED drugs — such as sildenafil (generic Viagra®), tadalafil (generic Cialis®), avanafil (generic Stendra®) and even chewable hard mints containing ED medication — are available.

These prescription medications are phosphodiesterase 5 (PDE5) inhibitors. They can help with sexual anxiety symptoms, offering confidence for men with sexual performance anxiety.

PDE5 inhibitors work by inhibiting the PDE5 enzyme, causing blood vessels near the penis to relax and expand, increasing blood flow to the penis. Taking PDE5 medications can help you keep and maintain a hard-on.

We also want to mention that PDE5 inhibitors may help treat premature ejaculation, too. 

If you’re interested in taking ED drugs for sexual performance anxiety, speak with your healthcare provider or set up an online consultation with Hims.

Erectile dysfunction medications can help with performance anxiety ED by opening your blood vessels and increasing blood flow to the penis before sexual intercourse. 

Other ED treatments include:

ED drugs are especially effective for treating sexual performance anxiety if your anxiety disorder is caused by feeling self-conscious about ED. In this case, performance anxiety is a side effect of erectile dysfunction, and medication can help solve that physical problem.

It’s important to note that ED is often underreported to healthcare providers because of the taboos and fear surrounding it. Remember, ED is a common sexual problem many men go through, so don’t feel ashamed to discuss it with your provider.

If you’re experiencing erectile dysfunction, talk to a provider on our telehealth platform about erectile dysfunction medication today.

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Coping Skills for Performance Anxiety

A healthy lifestyle offers tons of overall health benefits, including sexual health. 

Some lifestyle habits for performance anxiety can include:

  • Avoiding drugs, smoking and heavy drinking. Illegal drugs, cigarettes and alcohol can all contribute to ED, so limiting or avoiding consumption may help improve your performance.

  • Engaging in regular physical activity. Forty minutes of moderate to vigorous aerobic exercise at least four times a week has been shown to reduce ED symptoms.

  • Adopting and maintaining a healthy, balanced diet. Research has shown that a diet filled with vegetables, fruits, nuts, legumes and fish can lower the chances of ED symptoms.

  • Using stress management techniques. Stress management techniques, like breathing exercises, in combination with ED medication, have been shown to reduce stress levels among men with ED.

Breaking the cycle of performance anxiety can help you cope with sexual anxiety and improve sexual performance.

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Don’t feel like you’re alone — sexual performance anxiety is a common issue among men and women.

For guys, it can be a stressful experience — after all, no one wants to let their sexual partner down or miss out on the joys of sex because they feel anxious and uncomfortable.

Here’s what to keep in mind:

  • Sex anxiety can lead to sexual dysfunction. Sexual performance anxiety can increase your chances of developing erectile dysfunction, premature ejaculation, anorgasmia and other sexual dysfunction disorders.

  • Sexual performance anxiety issues. This condition can cause several issues in the bedroom, like the inability to get and stay erect, worry and fear about being unable to perform, relationship problems and much more.

  • Symptoms of sexual performance anxiety. Men with performance anxiety can experience ED, premature ejaculation and other erection or ejaculation issues. 

  • There are multiple ways to overcome sexual anxiety symptoms. From being open with your partner and going to therapy to seeking erectile dysfunction treatments, you have options for addressing performance anxiety sex and leading a healthier sex life.

  • Change your lifestyle habits. Avoiding drugs and alcohol, exercising, eating healthy and using stress management techniques can help with sexual performance anxiety.

Interested in learning more about the psychological side of sexual performance? Our guides to porn-induced erectile dysfunction and average penis and erection size go into detail about two of the most common causes of sexual performance anxiety.

Looking for a way to reduce feelings of anxiety? Our guide to meditation for anxiety explains how meditation can help you overcome stress, anxiety and negative thought patterns.

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Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Kelly Brown MD, MBA
Kelly Brown MD, MBA

Dr. Kelly Brown is a board certified Urologist and fellowship trained in Andrology. She is an accomplished men’s health expert with a robust background in healthcare innovation, clinical medicine, and academic research. Dr. Brown was previously Medical Director of a male fertility startup where she lead strategy and design of their digital health platform, an innovative education and telehealth model for delivering expert male fertility care.

She completed her undergraduate studies at University of North Carolina at Chapel Hill (go Heels!) with a Bachelor of Science in Radiologic Science and a Minor in Chemistry. She took a position at University of California Los Angeles as a radiologic technologist in the department of Interventional Cardiology, further solidifying her passion for medicine. She also pursued the unique opportunity to lead departmental design and operational development at the Ronald Reagan UCLA Medical Center, sparking her passion for the business of healthcare.

Dr. Brown then went on to obtain her doctorate in medicine from the prestigious Northwestern University - Feinberg School of Medicine and Masters in Business Administration from Northwestern University - Kellogg School of Management, with a concentration in Healthcare Management. During her surgical residency in Urology at University of California San Francisco, she utilized her research year to focus on innovations in telemedicine and then served as chief resident with significant contributions to clinical quality improvement. Dr. Brown then completed her Andrology Fellowship at Medical College of Wisconsin, furthering her expertise in male fertility, microsurgery, and sexual function.

Her dedication to caring for patients with compassion, understanding, as well as a unique ability to make guys instantly comfortable discussing anything from sex to sperm makes her a renowned clinician. In addition, her passion for innovation in healthcare combined with her business acumen makes her a formidable leader in the field of men’s health.

Dr. Brown is an avid adventurer; summiting Mount Kilimanjaro in Tanzania (twice!) and hiking the incredible Torres del Paine Trek in Patagonia, Chile. She deeply appreciates new challenges and diverse cultures on her travels. She lives in Denver with her husband, two children, and beloved Bernese Mountain Dog. You can find Dr. Brown on LinkedIn for more information.

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