What is sexual performance anxiety?

Navigating a new relationship can be exciting, but if you’re feeling nervous when it comes to the bedroom, you’re not alone. Many men experience performance anxiety, a type of psychological erectile dysfunction (ED) that can make intimacy feel challenging.

Understanding sexual performance anxiety and knowing that effective treatments are available can significantly improve your worries, your relationship, and your time in the bedroom. In this article, we’ll break down what sexual performance anxiety is. We’ll also explain how it relates to ED and the treatments available to help you regain confidence and enjoy intimate moments.

What are the signs of sexual performance anxiety?

Sexual performance anxiety occurs when worries about performing well sexually lead to feelings of stress, which can affect your physical performance. Some signs of performance anxiety include:

• Overthinking sexual performance
• Avoiding intimacy due to fear of failure
• Tension and stress before or during sex
• Difficulty achieving or maintaining an erection despite feeling physically healthy

This anxiety can create a cycle: stress leads to psychological erection problems, which leads to more stress around sex and can make it even harder to maintain erections. Understanding that this is a common experience is the first step toward finding solutions that work for you.

What causes sexual performance anxiety?

While every man is unique, certain situations and thought patterns often contribute to sexual performance anxiety. Usually, it stems from fear of disappointing a partner sexually. Many men feel pressure to meet their partner’s expectations, leading them to worry about not “measuring up.”

Several factors can contribute to doubts about sexual performance:

• New relationships: Meeting a new partner is exciting, but it is also common to feel nervous about having sex early in a relationship. You want to please your partner sexually but haven’t yet learnt their likes and dislikes, which may trigger performance anxiety.
• A long period without sex: Feeling nervous about having sex after a long time is another common cause of sexual anxiety. You may worry that you lack experience, feel like you’ve “forgotten” how, or question your ability to satisfy a partner.
• Negative past experiences: Men who’ve experienced prior sexual difficulties or trauma may develop anxieties that it could happen again, making them feel nervous about sex. This could be negative experiences with your current partner or a former partner.
• Body image or self-esteem issues: Concerns about appearance, weight, height, or other personal features can carry over into the bedroom, affecting confidence. While sometimes related to penis size, these insecurities are often more broadly about self-image.
• Overconsuming pornographic content: There is evidence that men who watch too much porn often develop sexual dysfunction (1). Pornography can give false impressions of what “good sex” looks like, which can cause anxiety about performing in the same way.

Are performance anxiety and erectile dysfunction connected?

Performance anxiety and erectile dysfunction are absolutely connected. While physical issues like heart disease, diabetes, or certain medications can lead to ED, psychological factors like stress or anxiety are also common causes. This type of erectile dysfunction is known as psychological ED.

How can stress cause erectile dysfunction? Well, when anxious or stressed, the body releases cortisol, a stress hormone linked to erectile issues (2). Cortisol constricts blood vessels, which in turn restricts blood flow to the penis. Since erections rely on healthy blood flow, this can make it challenging to maintain an erection and cause psychological erection problems.

Sexual performance anxiety is a type of psychological erectile dysfunction and the most common cause of ED in men under 40 (3). Unfortunately, when performance anxiety affects your ability to maintain an erection, it can form a hard-to-break cycle: each experience of “failing” to perform builds anxiety, making it harder to feel confident the next time you have sex.

But here’s the good news: just because you struggle with psychological distress erectile dysfunction, it doesn’t mean you’re “stuck” with it. There are various erectile dysfunction treatments to improve psychological ED and help you get your confidence and sex life back on track.

Sexual performance anxiety and ED treatment options

If you’re dealing with sexual performance anxiety and psychological erection problems, there are two main ED treatment options to consider: erectile dysfunction medicine and psychological therapies.

ED medications for sexual performance anxiety

For men experiencing performance anxiety ED, erectile dysfunction pills like Sildenafil (Viagra) or Tadalafil (Cialis) can help you get stronger erections (4)(5). These are prescription-only ED tablets you can get from a doctor or, for a more discreet option, order online using our independent online doctor service.

One of the great things about these erectile dysfunction pills is that by improving erections, they also reduce psychological distress (6). Some men need to take ED medication while they adjust to a new relationship or environment and find they no longer need it after a few weeks. Others might take Viagra or Cialis every time they have sex. Either option is fine, it’s about finding what works for you.

Alternatively, over the counter ED medications, such as Viagra Connect, Cialis Together, and Exoron Gel, are also available. You can access these from registered pharmacies in person or online by answering a short health questionnaire and receiving pharmacist approval.

Remember, both over-the-counter and prescription-only ED medications work only when there’s sexual arousal. If your anxiety is so severe that you can’t relax or enjoy sex, then these drugs may not work. In this case, therapy and mindfulness techniques may be helpful in combination with ED pills.

Other techniques to manage performance anxiety

Erectile dysfunction tablets aren’t the only option for improving sexual performance anxiety:

• Therapy: Therapy, especially cognitive-behavioural therapy (CBT), can help identify and shift anxious thoughts. Recent pilot studies have found CBT to be an effective way to treat sexual performance anxiety, and it’s a great option if you feel nervous about sex but don’t want to take erectile dysfunction tablets (7).
• Mindfulness: Feeling anxious about sex makes it hard to be present and feel aroused. Practising mindfulness techniques, like deep breathing and visualisation, can help teach you to be more present. In turn, this may help you relax during sex, increasing arousal and improving sexual satisfaction (8).
• Communication: Studies have found that open communication about sex can improve your relationship and sexual satisfaction (9). Talking to your partner about your concerns over your sexual performance creates a supportive environment that eases pressure, and learning their sexual likes and dislikes can boost your confidence.

Performance anxiety sex: FAQs

How common is sexual performance anxiety in men?

Sexual performance anxiety in men is very common. One study found that it affects up to 25% of men, making it the most common cause of sexual dysfunction (10). It is especially prevalent in younger men, being the leading cause of ED within this age group (3).

Why does my partner get performance anxiety?

Performance anxiety often stems from fear of disappointing a partner sexually. Factors like body image, negative past experiences, relationship stress, or the excitement of a new relationship can all contribute to these feelings of fear.

How can I help my partner with their performance anxiety?

Letting your partner know it’s okay to take things slowly and communicating openly can help reduce performance pressure. They can also help improve their confidence in the bedroom by considering options like therapy, mindfulness, or ED medications.

Improving sexual anxiety: Take the next step

Performance anxiety can feel isolating, but it’s common, manageable, and doesn’t have to stand in the way of a fulfilling sex life. By exploring ED treatment options, practising relaxation techniques, and reaching out for support when needed, you can approach sex with confidence.

If you’re ready to seek help, Oxford Online Pharmacy offers safe, convenient access to both prescription and over-the-counter erection pills. View our full range of ED treatments here.

Citations

1. Park B, Wilson G, Berger J, Christman M, Reina B, Bishop F, et al. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behavioral Sciences [Internet]. 2016 Aug 5;6(3):17.
2. Harrina Erlianti Rahardjo, Becker AJ, Viktoria Märker, Kuczyk MA, Ückert S. Is cortisol an endogenous mediator of erectile dysfunction in the adult male? Translational Andrology and Urology [Internet]. 2023 May 1 [cited 2023 Aug 28];12(5):684–9.  
3. Papagiannopoulos D, Nehra A, Khare N. Evaluation of young men with organic erectile dysfunction. Asian Journal of Andrology [Internet]. 2015 [cited 2019 Apr 10];17(1):11.
4. Mulhall J, Creanga D, Stecher V. Improvement in erection hardness and intercourse success with first dose of sildenafil citrate 100 mg. International Journal of General Medicine. 2013 Nov;849.
5. Kim ED, Seftel AD, Goldfischer ER, Ni X, Burns PR. A Return to Normal Erectile Function with Tadalafil Once Daily after an Incomplete Response to As‐Needed PDE5 Inhibitor Therapy. The Journal of Sexual Medicine. 2014 Mar;11(3):820–30.
6. Bocchio M, Pelliccione F, Mihalca R, Ciociola F, Necozione S, Rossi A, et al. Treatment of erectile dysfunction reduces psychological distress. International Journal of Andrology. 2009 Feb;32(1):74–80.
7. Bilal A, Abbasi N ul H. Cognitive Behavioral Sex Therapy: An Emerging Treatment Option for Nonorganic Erectile Dysfunction in Young Men: A Feasibility Pilot Study. Sexual Medicine. 2020 Jun;8(3).
8. Valderrama F, Sánchez-Sánchez LC, García-Montes JM, Petisco-Rodríguez C. A Scoping Review of the Influence of Mindfulness on Men’s Sexual Activity. 2023 Feb 20 [cited 2023 May 16];20(4):3739–9.
9. Pyke RE. Sexual performance anxiety. Sexual Medicine Reviews. 2019 Aug;8(2).