Sexual performance anxiety frequently becomes a self-perpetuating cycle, making it increasingly difficult for a person to enjoy sex. Self-consciousness and worry can overtake enjoyment and cause sexual dysfunction. Fear about sexual inadequacy or the inability to please a partner is a common problem for all genders, but especially men.
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What Is Sexual Performance Anxiety?
Sexual performance anxiety is self-consciousness and concern over how a partner perceives you during sex. This can be related to how your body looks and feels, or what you say and do during sex. Most commonly, sexual performance anxiety is genital-related, with concerns about achieving and maintaining an erection or lubrication.
Sexual performance anxiety is a term encompassing any stress related to how a person is perceived during partnered sexual activity and not a specific medical diagnosis. It can cause erectile difficulties like premature ejaculation in men and anorgasmia in women, and may also be precipitated by those same issues.
Thoughts about what is normal, attractive, or optimally pleasurable can become intrusive during sex and interrupt the process of embodied sexual exploration, leading to sexual frustration. Hyper focus on sexual performance can create disconnection from physical sensations. This disconnect from the body can cause tension and prevent healthy erections, lubrication, and orgasm from occurring.
Fixation About Orgasm
Fixations about having an orgasm, or helping your partner to achieve an orgasm, are common components of sexual anxiety. Equating orgasm with successful or enjoyable sex can create internalized pressure for both you and your partner to “finish” or else feel like your sexual experience was a failure. Focusing too much on you or your partner’s orgasm paradoxically makes climax less likely to occur, as a balance between relaxation and tension is necessary in order to reach an orgasmic release and experience the benefits of orgasm.
Sexual Anxiety in Men
Men in particular can become overly focused on genital function at every stage of the sexual response cycle. Men may worry about their ability to achieve an erection, to have an appropriately sized erection, to maintain a sufficiently strong erection, to illicit pleasure with their erection, to have sufficient ejaculatory pressure or amount of semen, to control their orgasm and not climax too soon or too late, or climax at all.
What Causes Sexual Performance Anxiety?
Sexual performance anxiety can be caused by a wide range of stressors, underlying mental health issues or other sexual dysfunctions. While there is no single cause, performance anxiety is typically part of a broader issue with anxiety in the relationship or within the individual.
Here are six common causes of sexual performance anxiety:
1. Body Image Issues
Someone’s self-confidence in their physical appearance can have a significant impact on whether a person is able to enjoy a sexual experience. Physical signs of aging or fluctuations in weight often contribute to problems with body image that can catalyze anxiety about sexual performance.
2. Lack of Exercise
Being out of shape can cause breathlessness and loss of stamina during sex, making it necessary to adjust sexual activity. An inability to engage in sex in a way that is desired or was previously accessible can lead to feelings of inadequacy and sexual avoidance.
3. Genital Fixation
An overemphasis on the importance of genital size and function often plays a part in performance anxiety – whether a penis is big enough or hard enough, whether a vagina is wet enough or tight enough. Cultural messages about ideal genital function and appearance can distract from the ability to connect and enjoy sex in a realistic way.
4. Orgasm Fixation
The moment of orgasmic release frequently becomes the measure of a successful sexual experience. Performance anxiety can develop around not climaxing or not eliciting a partner’s climax within an optimal time frame (or at all). Not being able to control the timing of orgasm can illicit anxiety.
5. Relationship Stressors
When there’s a lack of communication in a relationship or high amounts of conflict, particularly if emotional abuse is present, and that relationship conflict can contribute to low self-esteem and performance anxiety. Sex often becomes one more area of relational distress when a relationship is already experiencing discordance.
6. Other Stressors
Anxious thinking and life stressors may exacerbate performance anxiety. Stress, whether sex related or otherwise, makes it difficult to relax and be comfortable during sexual activity. Stress hormones, such as cortisol, can change blood flow to the genitals, making it more difficult to maintain an erection or vaginal lubrication.1,2
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Sexual Anxiety & Common Co-Occurring Issues
There are several common co-occurring disorders that may appear alongside sexual performance anxiety:3
- Female Orgasmic Disorder (FOD)/Anorgasmia: An inability to achieve orgasm, or a significant reduction in the frequency or intensity of orgasms.
- Erectile Dysfunction (ED): An inability to achieve and maintain an erection sufficient for satisfying penetrative sex.
- Delayed Ejaculation (DE): An inability to achieve orgasm and/or ejaculation despite adequate sexual stimulation.
- Orgasm Anxiety: A hyper-focus on achieving orgasm and a fear that orgasm will not occur, typically experienced during partnered sexual activity.
- Generalized Anxiety Disorder (GAD): Excessive anxiety and worry causing restlessness, irritability and/or fatigue.
- Decreased libido: Decreased desire or drive for sex.
- Erotophobia: The fear of sexual intimacy
When to Get Help for Sexual Performance Anxiety
Occasional anxiety about sex is normal, particularly with a new partner. However, if performance anxiety is escalating, or has been occurring for longer than three months, it may be time to seek help with a medical professional and/or a sex therapist, especially if performance anxiety is occurring with more than one partner or is causing distress in other areas of your life.
The sooner that underlying issues are addressed, the easier it will be to eliminate performance anxiety and avoid a sexless marriage or relationship. Anxiety can easily become entrenched if it isn’t addressed quickly, and even lead to sexual aversion. A sex therapist can help you, with or without a partner, to explore the anxiety cycle and offer interventions for reducing performance anxiety during sex and increasing confidence in the bedroom.
Treatment for Sexual Performance Anxiety
There are a few common factors that may lead to performance anxiety which can be medically addressed, such as generalized anxiety or physiological sexual dysfunctions. If you’ve ruled out these medical factors, there are several options for treating sexual performance anxiety directly.
Therapy
A certified sex therapist is trained to address sex-specific issues related to sexual function or well-being, such as performance anxiety. While a traditional psychotherapist can help treat anxiety, they may not have undergone any sex-specific training.
Medication
Medication interventions for performance anxiety may include:
- Anti-Anxiety Medications
- Benzodiazepines
- Selective Serotonin Reuptake Inhibitors
- Hormone Therapy
- Phosphodiesterase (PDE) Inhibitors
Medical interventions will be most effective in conjunction with individual or couples counseling with a qualified sex therapist.
Lifestyle Changes
Improved diet and exercise can decrease performance anxiety in all genders. Exercise and a healthy diet keep the body functioning optimally, increasing confidence and sexual stamina. Exercise can also be helpful in the reduction of generalized anxiety. There is strong evidence that exercise and regular activity can reduce anxiety symptoms. Numerous studies show that exercise is also associated with reduced anxiety in clinical settings.6
How to Get Help for Sexual Performance Anxiety
If you are experiencing frequent or chronic performance anxiety and you believe your symptoms to be related to an underlying physical issue, you should first seek treatment through your primary care provider. They will be able to assess whether further medical treatment is needed or if referrals to other medical providers should be made. It’s important to make sure that there are no underlying medical conditions, hormone imbalances, or side effects to current medications before treating the psychological components of performance anxiety.
Once medical factors have been addressed, seeking further treatment with a mental health practitioner is the next step. Even if the initial cause of performance anxiety is physiological, anxiety can become cyclical and may not dissipate once underlying causes have been addressed. When a sexual dynamic has been disrupted, regardless of the underlying cause, avoidance of sexual interactions or anxiety about sexual intimacy often occurs. In order to adequately treat avoidance or anxiety cycles around sex, an AASECT certified sex therapist should be consulted.
How to Find the Right Therapist
To ensure that you receive adequate and knowledgeable care, make sure that your therapist is AASECT certified. “Sex therapist” and “sex therapy” are not protected terms, meaning that anyone can call themselves a sex therapist in their marketing. Additionally, most mental health licensure requirements contain little or no instruction in human sexuality. AASECT certified providers receive an additional 18-24 months of training and a minimum of 300 additional hours of supervision in sex specific psychological issues.
You can find an AASECT certified sex therapist by visiting an online therapist directory and filtering for sex therapists in your area.
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3 Ways to Deal With Sexual Performance Anxiety
There are a few steps you can take on your own to improve partnered sexual experiences and reduce anxiety related to sexual performance. While a sex therapist may be able to guide you through interventions more specific to your situation, these tips will be generally applicable to anyone experiencing performance anxiety.
Here are three useful tips for dealing with sexual performance anxiety:
1. Reduce Distractions & Enjoy the Moment
General stress can be a major contributor to performance anxiety. Make sure to reduce distractions during your sexual encounters and set aside plenty of time to relax and enjoy each other. Go slowly and forget about everything else except the feeling of being fully present with your partner(s).
Notice what happens when you immerse yourself in sensations all over your body, not just your genitalia. Heightened awareness of all five senses and of subtle sensations can help to quiet a spinning mind and enhance full-bodied pleasure. You might also try focusing on your breathing by slowing down and extending your exhales, which can reduce anxiety and bring you back into your body.
There is no right way to have sex. Set aside cultural messages of what sex should look like and how different genders are expected to perform during sexual encounters. Let go of self-judgment about your physique. Don’t worry about whether you have an erection or if you’re sufficiently wet. Forget about the right moment or right way to have an orgasm and be present in the unique connection you are sharing with your partner(s) instead.
You might feel like focusing on yourself more than your partner’s experience is selfish, but if you are both overly focused on the other person’s pleasure you’ll get stuck in mental preoccupation and self-consciousness. Remember that, for most people, their partner’s pleasure is a turn-on and makes them feel good about themselves, so staying inside your own experience can enhance enjoyment of the moment exponentially for both of you.
2. Communicate Clearly With Sexual Partners
Tell your partner(s) about the anxiety you have been experiencing. Communicate frequently and openly about your anxiety to help diffuse the escalation cycles. Sometimes simply naming performance anxiety out loud as an issue can be enough for it to dissipate, and receiving reassurance from your partner(s) that they enjoy the sexual experiences you share can decrease anxiety significantly.
Tell your partner(s) what kind of touch or other stimulation that you enjoy. This information can be either broad or specific, but gives your partner(s) a pleasure map to follow. Do not fake pleasure to avoid anxiety. This can create a feedback loop which makes it increasingly difficult to be present with your experience instead of performative, reducing your ability to feel genuine engagement with the experience.
Ask your partner(s) about their priorities during sex. You may discover that stamina or orgasm (yours or theirs) is less important than you thought. Ask them what kind of touch and interaction they prefer, so you don’t have to guess about what makes them feel good. What works with one person may be uninteresting to the next.
Employ more verbal feedback during sex, such as “Is this pressure okay?” or “I’m feeling like you need me to climax soon.” Or you may feel more comfortable communicating through non-verbal signals which you have discussed ahead of time with your partner(s). Performance anxiety can often originate from lack of communication and from feeling pressure to respond to stimulation that is not suitable for your body.
3. Self-Exploration
Even if you already masturbate, allotting a little more time to be alone and explore can enhance your sexual experiences and reduce anxiety. The goal with self-exploration is to notice what creates pleasurable sensations and what relaxes you mentally. Then you can mimic those practices during partnered sex.
Self-Exploration for Women
Most women who experience sexual performance anxiety are feeling self-conscious about their bodies. Masturbating can help you get more comfortable with yourself in a sexual context. You may choose to use visual pornography, written erotica, and/or sex toys to enhance your play. If you are not sure where to start with erotic self-stimulation, you might try the site OMGYes.com, which is a non-pornographic approach rooted in scientific research that guides exploration in female self-pleasure techniques.
When you explore self-pleasure in private, you remove any pressure to please or perform for a partner. The knowledge you gain through self-exploration will help shift partnered sexual experiences as well, allowing for increased self-awareness and confidence. Knowing what is pleasurable for your own body and mind can help you to participate more fully in partnered sexual encounters and to experience your body as erotic and beautiful.
Self-Exploration for Men
Most men who experience sexual performance anxiety are concerned about how their penis is functioning during sex. If you are concerned about maintaining an erection during sex, not being able to orgasm, or taking too long to orgasm, change up your masturbation techniques for something new. Explore different types of stimulation to the genitals in terms of pressure, location and style of touch. “Idiosyncratic masturbation” is when a man becomes accustomed to a specific rhythm, pressure and/or type of visual stimulation that is not easily mimicked in partnered sex.
This can contribute to a difficulty in maintaining an erection or achieving orgasm with a partner. Frequency of masturbation over 3 times a week can also reduce the ability to orgasm, particularly when masturbation occurs in a habitual manner. Masturbation habits can be shifted through mindful exploration, potentially allowing erection and orgasm to become more easeful with a partner.
If you are concerned about ejaculating before you want to during sex, try the following techniques when you masturbate.
The “Stop-Start” Technique
Recognized as the most effective behavioral treatment for ejaculatory control,12 the Stop-Start technique involves stopping stimulation as soon as the urge for orgasm arises, waiting 30-60 seconds, then resuming stimulation until the urge arises again and repeating multiple times. Short term benefits have been shown for this technique in 45-65% of men; long term benefits are less clear.13
The “Squeeze” Technique
Similar to the Stop-Start technique, the Squeeze technique involves squeezing the area between the shaft and the glans of the penis when the urge to climax arises for approximately 30 seconds then resuming masturbation and repeating multiple times. The Squeeze technique can feel awkward or mechanical and it can occasionally affect the erection of the penis as well, which is why the Stop-Start technique is generally superior. However, trying both techniques is worthwhile to establish which technique is more effective for an individual.
Sexual Performance Anxiety Statistics
While there are no statistics for sexual performance anxiety as a unique diagnosis, we can gain a sense of how prevalent sexual anxiety is by looking at statistics for related issues:
- Anxiety disorders are the most common mental illness in the U.S. An estimated 19.1% of U.S. adults had any anxiety disorder in the past year and an estimated 31.1% of U.S. adults experience any anxiety disorder at some time in their lives7
- Erectile Dysfunction (ED) occurs in 18% of men over 20 in the U.S.8
- Lifelong Delayed Ejaculation (DE) affects approximately 1% of sexually active men and acquired DE affects approximately 4% of sexually active men9
- Female Orgasmic Disorder (FOD) is present in approximately 26% of premenopausal women10
- 10-15% of women report never having had an orgasm11
Additional Resources
To help our readers take the next step in their mental health journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy is compensated for marketing by the companies included below
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