Sexual Performance Anxiety: How To Break The Cycle

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What is sexual anxiety or performance anxiety?

The desire to please a new partner, or satisfy another individual can result in the creation of personal sexual expectations that are unrealistic. In the event that a man can’t perform to the level of these self-imposed standards, the fear of failure can lead to erectile dysfunction (ED).

This article will examine potential causes of sexual performance anxiety (SPA), and detail how you can combat the stress and physical effects that can compound as a result.


What causes performance anxiety?

While there can be many root causes of sexual performance anxiety, certain psychological triggers are commonly associated with the emergence of this condition. Some of the more prevalent manifestations include:

  • Fear of losing an erection
  • Fear of not measuring up
  • Fear of not being able to satisfy your partner
  • Fear of ejaculating early
  • Poor self-esteem
  • Stress, including other things on your mind such as your relationship, work, finances, illness,
  • pressure to conceive


Let’s face it, it’s difficult to stay erect when nervous. Whilst anxiety is the body’s biological ‘fear or flight’ response mechanism to perceived danger, the ‘rest and digest’ response required for sexual performance is at the polar opposite end of the spectrum. The clash of the sympathetic nervous response and parasympathetic nervous response effectively cancel each other out, resulting in an inability to perform. 

In simple terms, when you are nervous about being able to perform, your mind finds it difficult to relax and stimulate the biological response that is required in order to get an erection and keep it. However, it is important to note that there are many ways a man can overcome sexual anxiety.


Signs of performance anxiety

The main signs and symptoms of performance anxiety are:

  • Not being able to get an erection
  • Not being able to keep an erection
  • Loss of interest in sexual activity
  • Premature ejaculation
  • Fear of sex

With sexual performance anxiety, there is not usually any physical reasons such as high blood pressure or uncontrolled diabetes, which prevent you from achieving and maintaining an erection. The fear of not being able to get hard and stay hard plays on your mind, causing SPA. “Off days” are common, and can happen from time to time. Tiredness, fatigue, stress, can all contribute to failed attempts at times. It is normal, and not usually a cause for concern. Some men may forget about it and carry on as usual the next time without any problems. For others, the experience can play on their mind, causing anxiety and the fear of failure. This leads to a cycle which can be difficult to break.


Sexual performance anxiety solutions

The individual treatment for SPA is different for every man. Like most anxiety disorders, sexual performance anxiety is ultimately curable, although it may require significant time and effort to identify the correct protocol. Both medication and therapy have been utilised effectively in order to overcome SPA. Your doctor is the best person to speak to about the most effective way to overcome sexual performance anxiety. The following are methods which can help you to break the cycle:


As defined by the National Health Service (NHS), cognitive behavioural therapy (CBT) is a structured, time-limited and problem-focused form of psychotherapy commonly utilised to combat mental health conditions such as sexual dysfunction.

The positive results associated with this type of therapy have been huge, due to the personalised nature of treatment for each individual. A common CBT strategy involves having affected men recognise that there is no immediate danger or threat associated with sexual performance, allowing them to face their fears and realise that associated anxieties and perceived dangers are unfounded.

Men who become comfortable disassociating danger from sexual intimacy may overcome the fear of humiliation or inadequacy that triggers SPA. The suppression of the ‘fight or flight’ response can result in the increased enjoyment associated with the ‘rest and digest’ biological impetus to engage in sexual activity.

Speak to your partner

Stage fright is a common occurrence when men are dating or entering a new relationship. Many men fear discussing their feelings regarding sexual performance, and how their partner may perceive their ability to engage in mutually rewarding experiences. 

Simply having an open and honest conversation with a partner can go a long way toward overcoming the negative effects associated with SPA. Discussing what is enjoyable, what isn’t, and any fears associated with the events leading up to or during sex can provide immediate relief and increase sexual desire. Discovering a shared – or differing – viewpoint can offer a new perspective, and aid in the ability to overcome the mental or physical effects of this elevated form of stage fright.

Don’t be afraid to ask your partner what helps them achieve orgasm, and what will help you. Talk about the elements of sexual arousal you enjoy the most, and what may be holding you back from achieving a higher level of sexual satisfaction. 

You may also be worried that you don’t measure up. It may be useful to know that the average penis size is around 5 inches. If you are worried about the size of your penis, speaking to your partner may help to settle some of the anxiety you have around their expectations.
Whilst these topics may seem uncomfortable to vocalise at first – particularly if you’re entering a relationship or interacting with a new partner – discussing them can go a long way to helping one overcome the negative thoughts associated with sexual performance anxiety.


Easing into sexual encounters by engaging in foreplay can help overcome the anxiety symptoms associated with SPA. Slowly ramping up to sex can help ease the mind by focusing on simple and compounding sensations that eventually result in a satisfying experience. 

Try beginning with a simple series of touches, or light kisses that lead to heavier physical engagements. 

Don’t rush to the finish line

Don’t have sex with the intention of reaching climax as soon as possible. Embrace the experience and focus on what is happening in front of you – or to you. Instead of succumbing to the over analysis of every action your partner makes, reflect internally on how you feel, and how you can subsequently please them. 

Consider lighting candles or playing music in order to enhance the overall sensory experience surrounding you during sex. Becoming more attuned to the effects all around you can aid in your ability to slow your sexual anxiety, focus on performance and enjoy the moment so your brain can be fully engaged and relax during sex.

Avoid porn

Watching pornography prior to sex can have a negative impact on your healthy perception of pending intimacy. Porn often offers augmented, idealistic depictions of sexual encounters that can exacerbate feelings of inadequacy, negative body image or thoughts of ‘not measuring up.’ 

Unrealistic depictions of performance, or ‘acting’ in porn can set the bar impossibly high. You may want to consider focusing on learning how to please your partner – and yourself – by relaxing into a mutually rewarding sexual relationship, and avoid opening the door to the potentially triggering elements of pornography as it relates to SPA.

Avoid alcohol and drugs

Stimulants and depressants can alter body chemistry and enhance the symptoms of ED. Alcohol reduces blood flow to the penis, increases angiotensin (a hormone linked to erectile dysfunction), and depresses your central nervous system. Certain narcotics affect blood flow and alter your mental state, impacting a man’s ability to achieve an erection for sex.

Engage in a healthy lifestyle

Committing to a healthier lifestyle is one of the more effective, natural ways a man can overcome the effects of sexual performance anxiety. By engaging in a routine that practices physical and mental wellness, you can effectively aid in the chemical release of dopamine and endorphins – important biological releases that aid sexual performance.

Here’s how to these processes bolster your ability to combat SPA:

  • Exercise. Regular physical activity releases serotonin in the body, a hormone that aids in mood regulation and is commonly known as the ‘happy hormone.’
  • Meditation. Practising mindfulness and meditation can calm the body and mind. Learning how to enter a relaxed state can ease racing thoughts, replace negative self-perceptions with positive affirmations and gain awareness and control of the stimulus that may trigger symptoms of SPA. 
  • Eating well. Diet plays a huge part in our mental and physical well-being. Nutritional deficiency can augment anxiety and result in a decreased libido and exacerbate ED symptoms. A balanced diet with plenty of fruits and vegetables can enhance your performance.


While exercise, meditation and eating a balanced diet won’t cure performance anxiety, the biological, mental and chemical processes enhanced by a healthy lifestyle can aid in your ability to achieve a healthy erection, feel more confident about sex, and ward off the negative self-images and feelings that contribute to the rise of SPA symptoms. 


Performance anxiety & ED medication

As it pertains to battling the physical effects of sexual performance anxiety, there are treatment options available to help you to get an erection and keep it. However, ED treatments will not help the state of mind that can trigger an SPA episode. Many therapists encourage the use of ED treatments, as a way to reduce the stress of feeling like you can't fail. Just knowing that a little extra help is in the draw next to the bed can help to lower stress levels and reduce anxeity. Once you’ve worked to overcome the negative feelings that cause SPA, you may find that you no longer need treatment to assist your healthy sex drive.

The most popular ED medications include: 

  • Viagra. Also known by the generic name sildenafil tablets, or ‘the little blue pill,’ Viagra works by enhancing blood flow to the penis. This fast-acting medication begins to work within 60 minutes, and the effects can last for 3-4 hours.
  • Cialis.  An effective aid in combating the effects of ED, Cialis is available in 2.5 & 5mg doses (called Cialis Daily), where the effects are ongoing allowing for spontaneous sex. Cialis 10mg and 20 mg doses (called Cialis 36 hour – or 'the weekend pill’), is taken around 30 minutes before sex and can last for up to 36 hours. It is also available in a generic form called tadalafil tablets.
  • Levitra. This is the recommended treatment option for diabetics. Taken around 30 minutes before sex, the effects can last for up to 5 hours. It is also available as a generic from, known as vardenafil tablets.


Once you break the cycle, it gets easier

Overcoming sexual performance anxiety can be difficult at first, but once you’ve identified the triggers that exacerbate the condition, you can begin to work on methods to overcome it. SPA is a treatable ailment, one that can get over by adopting a healthy lifestyle and change in mindset.

The more you practice the methods that enhance your ability to relax and enjoy sexual intimacy, the more confident you’ll become when new encounters and situations arise. The positive momentum associated with renewed confidence can have a tremendous effect on your ability to rise to the occasion, pleasing your partner – and, just as importantly – yourself.

Whilst all of our content is written and reviewed by healthcare professionals, it is not intended to be substituted for or used as medical advice. If you have any questions or concerns about your health, please speak to your doctor.