I’m a Neuroscientist. Here’s How to Overcome Sexual Performance Anxiety

Anxious about your sexual performance? If you feel nervous, anxious, or uncomfortable before, during, or after sex, you might have a condition known as sexual performance anxiety. 

You’re also not alone. According to some research, 5 to 25 percent of men and women have reported experiencing anxiety related to sex—with concentrations higher among younger people and men.  

Ultimately, though, sexual performance anxiety can affect men of all ages and backgrounds. In effect, it can be a drag on your emotions and contribute to common sexual dysfunction issues like erectile dysfunction (ED) and premature ejaculation (PE).

In addition to affecting you, sexual performance anxiety and the resulting sexual problems can also impact your partner, Research has shown that long-term issues with premature ejaculation could increase your and/or your partner’s risk of depression.

The good news is that overcoming sexual performance anxiety is possible. Medical treatments and sex therapists are available to help, plus certain lifestyle habits can improve your sexual function in the bedroom.

Below, neuroscientist and sexual psychophysiologist Nicole Prause, PhD, offers tips for overcoming sexual performance anxiety. But first, we’ll first outline why it happens in the first place and the symptoms to look out for.

As you’re probably well aware, getting an erection is a huge component of sex.

An erection begins when sexual arousal—through touch, thoughts, or visual stimuli—activates brain centers that send signals via the spinal cord to dilate blood vessels in the penis.

Once this happens, the blood fills the erectile tissue in the penis causing it to harden or become erect. Erectile tissues also press against a fibrous sheath called the tunica albuginea, which helps trap blood inside the penis to maintain the erection. 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. 

Physical and Mental Causes of Sexual Performance Anxiety

Both physical and mental factors can lead to sexual performance anxiety. Some of the main culprits include:

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

• Body image insecurities or self-esteem issues, such as being self-conscious about weight, height, or penis size

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

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

• 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 and psychological factors, such as post-traumatic stress disorder (PTSD), social phobia, social anxiety disorder, generalized anxiety, and panic disorder

• Nervousness about having sex

• Overconsumption or excessive use of pornography 

Stress triggers the release of hormones like adrenaline and cortisol, which can interfere with sexual arousal by constricting blood vessels and disrupting the balance of the nervous system needed for an erection.

For 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.

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. 

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 who didn’t deal with the condition. The analysis also showed that people with ED are nearly three times more likely to experience depression.

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

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

• Inability to maintain an erection after achieving one

• Inability to ever reach 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.

When it comes to overcoming sexual performance anxiety, Dr. Prause first suggests resisting the urge to pathologize what might be a very normal occurrence.

“If you have erections that are not completely dependable, or become difficult [to maintain] when you are not sleeping well or are intoxicated, that is ‘erectile variability.’ It is normal and not a diagnosis or something that needs any treatment,” she explains. “Many men who believe they have ED actually have normal erectile variability. They can best avoid developing ED by not focusing on their erections or creating pressured sexual experiences.”

To help avoid this self-imposed pressure and shift your focus away from erections, Dr. Prause recommends taking penetration off the sexual menu for three months. “Taking a period away from penetrative intercourse can be useful for learning about the pleasure and consistent erections that can arise from focusing on play and pleasure.”

If you’re still struggling after taking a penetration break, there’s more you can do. First, though, you need to get curious about your sex anxiety. Since there are various reasons for sexual performance anxiety, your treatment plan will depend on the underlying cause of your case, whether that’s a medical condition, a stressor that caused the anxiety in the first place, or something else.

In some cases, sexual performance anxiety may resolve on its own as you become more comfortable with yourself and your sexual partner. Anxiety about sexual encounters may also dissipate 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 anxiety around sex is counseling, whether cognitive behavioral therapy (CBT), sex therapy, or another form of psychotherapy.

With this intervention, 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 as a means to reduce stress and negative thinking. 

You might also involve your partner in therapy if any relationship issues may be contributing to your sexual performance anxiety. Another reason to invite your partner to therapy is that sexual dysfunction can also affect them, 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 everyone involved explore what’s influencing performance anxiety in the relationship. 

ED Medications

Erectile dysfunction medication, such as sildenafil (generic Viagra^®) and tadalafil (generic Cialis^®), may help improve performance (and relieve the anxiety associated with it) by supporting better blood flow to the penis.

These prescription medications are phosphodiesterase 5 (PDE5) inhibitors. They work by inhibiting the PDE5 enzyme, causing blood vessels to relax and expand, and allowing for increased blood flow to the penis. This, in turn, may help you keep and maintain an erection. While PDE5 inhibitors are used to treat ED, they may help treat premature ejaculation in some men—particularly when anxiety contributes to both conditions.. 

If you’re interested in taking ED drugs for sexual performance anxiety, the first step is to seek medical advice from a healthcare provider, who can explore the option with you.

Also bear in mind, you don’t necessarily need to take a PDE5 inhibitor regularly in order to reap the sexual performance benefits. PDE5 inhibitors “can be useful just to have a few ‘success’ experiences that may be enough to recover confidence to move forward without PDE5 inhibitors,” says Dr. Prause

Other ED treatments include:

• Injectable medicines

• Suppositories

• Alternative medicine

• Psychotherapy

• Surgery

• Vacuum devices/penis pumps

• Lifestyle changes

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

Coping Skills for Performance Anxiety

A healthy lifestyle offers tons of overall health benefits that extend to sexual health. 

Some lifestyle habits that may help break the cycle of performance anxiety may include:

• Avoiding drugs, smoking, and heavy drinking. Recreational 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 is recommended for reducing ED symptoms.

• Adopting and maintaining a healthy, balanced diet. Research has shown that a healthy diet is associated with a lower risk of ED. Aim for a diet filled with vegetables, fruits, nuts, legumes, and fish.

• Using stress management techniques. Stress management techniques in combination with ED medication, have been shown to reduce stress levels among men with ED. Some stress management techniques include deep breathing exercises and progressive muscle relaxation.

Sexual performance anxiety is a common issue among men and women, but it’s not a hopeless one.

Here’s what to keep in mind:

• Sex anxiety is associated with sexual dysfunction. Anxiety around sex, including sexual performance anxiety can increase your chances of developing erectile dysfunction, premature ejaculation, anorgasmia, and other men’s health issues.

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

• Changing certain lifestyle habits may help. 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 detail two common causes of sexual performance anxiety.