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Sexual Performance Anxiety: Causes And Treatment

Having concerns about our sexual ability is perfectly natural—but it can become a debilitating condition.

While surprisingly common—it’s sadly often under-discussed, leaving many men to suffer in silence.

This article will redress the balance.

Stick with me, and discover what is performance anxiety and how to overcome it.

What Is Performance Anxiety?

Let me tell you about my situation.
couple image

A few years ago, I entered into a new relationship.

At first, the sex was both enjoyable and frequent. I wouldn’t say it was mind-blowing—but I found it satisfying and believed that my partner felt the same way too.

On our first Valentine’s Day together—I pulled out all the stops. Even though I’m not the greatest cook in the world—I made an exceptional effort to make her a special dinner. The table was adorned with candles to help enhance the mood, and I presented her with a small but thoughtful gift.

After a pleasurable evening eating, chatting and downing some rather inexpensive wine—we moved to the bedroom. I was determined to give her the most incredible sex session possible.
bed image

After just two minutes of intercourse—I ejaculated.

To this day, I don’t know whether it was the wine, the heightened anticipation or just my resolve to be perfect in bed that night—but this wasn’t a usual occurrence.

I was highly embarrassed and apologized profusely. She said she was okay about it and declared that it didn’t matter. But, I still felt awful and didn’t believe her words of comfort.

This event played on my mind for the next few days. I ran through the whole experience over and over in my head—reliving the disappointment and apparent shame.

thought imageAbout a week later—after we had retired to bed—she began to instigate sex with some down-below touching. I remember immediately flashing back to that Valentine’s Day night and my early climax.

Despite her gentle caresses to my manhood—it remained limp and flaccid. Whatever she or I tried, it wouldn’t stir into action, and hence, sex was off the cards.

I was now both impotent and a premature ejaculator.

And that, my friend, is performance anxiety.

stress imageIt’s the concern, stress and worries felt either during or before sex to deliver a satisfying and enjoyable experience. This can then exhibit itself through a variety of external symptoms such as erectile dysfunction and premature orgasm.

More specifically, what I faced was the performance anxiety loop.

In simple terms, performance anxiety induces disappointing sex, which makes you feel even more inadequate in the bedroom. This then increases your stress further before future intercourse sessions—leading to greatly impeded sexual performance.
escape image

Luckily I escaped from this awful circle. I’ll share my secrets of how to overcome performance anxiety with you soon.

Statistics Behind Sexual Performance Anxiety

Before we delve into the numbers in this What Is Performance Anxiety article, allow me to ask you a question.

Have you ever had reservations about your own sexual performance?

I’m guessing the answer is—yes.

disappointed image As men, we want to perform in the bedroom. Rightly or wrongly, we often see our sexual skills as an embodiment of our manhood. Failure to perform in this department can be emasculating.

Hence, it’s reasonable to have some pre-intercourse concerns.

But, when this has a negative effect on your sexual capability—it becomes performance anxiety.

Little detailed research exists regarding the exact proliferation of this sexual issue. However, what is known is that anxiety itself affects 40 million adults in the USA alone.1

science report image Furthermore, scientists explain that those who suffer from general anxiety are more likely to also experience more specific forms, such as performance anxiety.2

Finally, the two main symptoms of performance anxiety—premature ejaculation (more) and erectile dysfunction (more)—are extremely prevalent. The former affecting one in three men and the latter 50 percent of middle-aged males.3 4

What Is Happening With Your Body When Experiencing Performance Anxiety?

Understanding the biological answers to what is performance anxiety requires looking at the chemical response to stress.
hormone image

When experiencing anxiety—the body releases two key hormones—adrenaline and cortisol.5 6

Adrenaline redirects blood away from what it considers non-essential areas (i.e., your penis) and pushes it towards the heart. Cortisol can narrow blood vessels, increasing blood pressure, yet lowering blood volume delivery to your member.

These biological factors can contribute to the physical symptoms of performance anxiety—in addition to the psychological pressures.
indicator image

Common indicators of performance anxiety include:

  • Inability to attain or maintain an erection.7
  • Premature ejaculation.8
  • Delayed ejaculation
  • Loss of libido.9
  • Increased heart rate before and during sex.
  • Decreased enjoyment of intercourse.
  • Avoiding sexual intimacy with your partner.
  • Concern that your partner doesn’t enjoy intercourse or find you attractive.
  • Worries that your penis is too small.10
  • Stressing over whether your partner will achieve an orgasm.
  • Concern that your partner will leave you for a “better” man.

Knowing how to overcome performance anxiety requires looking at its origins—discussed next.

Causes of Performance Anxiety

If you recall from earlier in this What Is Performance Anxiety article—there’s a psychological loop.
loop image

This means that many of the symptoms of this condition listed above can also be, ironically, its cause.

For example, climaxing too early or a limp penis—common occurrences which may be insignificant anomalies to your lovemaking—can induce future concerns, increasing the likelihood of it happening again.

In addition to this cause—symptom—cause feedback loop, the reasons behind performance anxiety can include:

Body Image

body image The more dissatisfied you are with your body image—the greater the chance of suffering from performance anxiety and experiencing reduced sexual satisfaction.

A recent study indicates that there are four main areas of male body concern:

  • Muscularity.11
  • Height.
  • Weight.
  • Size of the genitals.

In many circumstances, men simply feel they’re not attractive enough for their partner, or that their manhoods are too small to satisfy their lover.

Previous Sexual Experiences

Experiencing disappointing intercourse on previous occasions can increase the chance of developing performance anxiety. However, this can be both real and self-perceived.

mindset imageIn the “real” sense—some events can be seen as concrete examples—for example, early climax, flaccid penis or an inability to achieve an orgasm. However, in some instances, the “failure” can be a sign of an over-critical mindset.

Men may feel that they have not lasted long enough, haven’t satisfied their partner sufficiently, or have failed to reach the high targets they have set themselves.

In both circumstances, these conditions feed back into the anxiety loop.

Concerns About Female Orgasm

During intercourse, men are more likely to achieve orgasm than women.

research imageResearch shows that on average, guys climax 85.5 percent of the time during sex compared to only 61.6 percent for women.12

Despite this being a scientifically proven fact—men often deem themselves a failure in the bedroom if their partner doesn’t achieve an orgasm. Studies illustrate that men consider it their responsibility to stimulate their partner to reach the big-O.13

Hence, this can induce further pressure on a man’s performance—concentrating on satisfying his other half rather than enjoying the act of lovemaking itself.

happiness imageSometimes, possibly as a result of watching unrealistic pornography movies, they believe that pounding away at a tremendous rate is the best way to induce a female climax. ​Firstly, this is wrong. Experts have concluded that longer and drawn out sex is more likely to lead to a female orgasm.14

Secondly, hard and fast isn’t only ineffective at pleasuring your partner—it also increases the chances of experiencing premature ejaculation. Thus, elevating your performance anxiety even further.

Porn Consumption

Possibly the newest cause of 21st-century male performance anxiety.

fantasy imageThe ease and plethora of free pornography online can instill a sense of false expectations. The issue is that these movies are idealized and totally unrealistic (you know anyone who has had sex with the TV repairman? Me neither).

Typically, they can generate anxiety as they display:

  • Men with unfeasibly enormous penises.
  • Extended lovemaking sessions, often around 30 minutes—usually the average guy lasts six minutes.15
  • Women achieving orgasm 100 percent of the time.
  • Athletic and numerous sexual positions.
  • Muscular and toned male porn stars.
  • Indulging in acts which some guys may find uncomfortable—such as anal sex—yet believe this is what all women desire. pressure image

All of the above can lead to a sense of inadequacy and put pressure on men to perform to this impossible standard.

Difference Between Performance Anxiety & Erectile Dysfunction?

If you ask a guy on the street—what is performance anxiety? They may respond by saying it’s the inability to achieve an erection.
distinguish image

It’s essential to separate the two.

Firstly, erectile dysfunction (failure to attain or maintain a firm erection) is both a cause and symptom of performance anxiety.

A one-off failure inability to become hard may promote concerns for future intercourse leading to performance anxiety.

differences imageEqually, being concerned about your performance and producing stress hormones can promote penile flaccidity. However, erectile dysfunction (ED) is also an independent condition. Here are the main differences between ED and performance anxiety.

  • Performance anxiety has numerous symptoms, including ED, premature ejaculation and low libido—erectile dysfunction is concerned primarily with penis rigidity.
  • Erectile dysfunction may have a mental cause, but it can also be induced by other illnesses, such as heart disease, diabetes, and high cholesterol—performance anxiety is mainly psychological.
  • Performance anxiety can occur both before sex and during—ED typically only happens during solo or duo sexual performance.

How to Overcome Performance Anxiety?

Depending on the cause of performance anxiety, there are many techniques and treatments available to alleviate its symptoms and enjoy satisfying sex life.

Here are some of the most effective:

Guided Imagery

This is a visualization technique to induce a relaxed and less anxious state.

calm imageBefore you have sex, close your eyes and imagine a scene that you find calming. Often used images are a beach, forest or ocean—but in truth, whatever works for you.

During this mind-journey, you try to experience every aspect of the location—sounds, smells and sights.

This method places your overactive brain into a more relaxed state—relieving stress and hopefully allowing you to enter into intercourse in a positive and calm state of mind.

If you really want to know how to overcome performance anxiety with this technique—I’d recommend using it more specifically.

relax image Imagine yourself making love to your partner—with all the associated sounds and smells—but instead of being anxious, you feel yourself calm and in control. Delivering both satisfaction to both you and your girl.

Research shows that guided imagery is a proven method to alleviate anxiety in around 79 percent of users.16

If you want to know more, visit the American Psychological Association (APA).17

Focus on Sensations

Concentrating on the feelings you experience during intercourse is a kind of in-sex mindfulness.

lovemaking imageDuring lovemaking—try to forget about your concerns, worries, expectations, and anticipations. Instead, focus on the present moment—the sensations you feel not only in your genitalia but also throughout your whole body.

In doing so—not only are you distracted from performance-inhibiting anxieties—but you also can achieve greater control over your ejaculatory response.

Research shows in around 60 percent of cases, this technique is effective at relieving stress.18
website image

For further information, visit the APA.19

Lower Your Stress

As illustrated earlier in this What Is Performance Anxiety article—stress, and the hormones this condition releases can have a dramatic effect on our sexual performance and confidence.

Here are my two favorite ways to alleviate this condition:


Scientists have proven that regular exercise not only lowers stress but can also prevent its occurrence.20 exercise image

While there are immense health benefits to being a regular gym attendee—don’t assume you have to become a fitness freak to relax your busy mind.

Research explains that just going for a brisk walk in the great outdoors is a powerful stress-reliever.21


meditation imageUsing meditation to take time out to be peaceful and concentrate on nothing but your feelings and thoughts can be a potent mind-cleanser and an effective treatment to relieve stress.22

Yet, if you want to know the ultimate way of how to overcome performance anxiety through meditation—target your efforts.

The key is to notice and recognize your thoughts regarding sexual intercourse—but don’t allow yourself to be controlled by them. Acknowledge that they exist but don’t judge them as either being positive or negative.

Instead, use this time to identify your areas of concern—be it penis size, premature ejaculation or erectile dysfunction.

Accept that your assumptions are just a state of mind—not a mirror to how things “are.” state of mind image

Furthermore, manage your expectations.

Neither you, me, nor your buddies are going to perform to the false-image provided by online media. Concentrate on accepting that you are a man who can give and receive pleasure without requiring a massive member or powering through mammoth sex sessions.


The simplest and possibly one of the most efficacious methods.

Think about it—what is performance anxiety?

Admittedly, some of this stress may be your concern about not achieving the satisfaction you desire. But, to a larger extent, it’s about under-performing for your partner.

conversation image Speak to her about your area of concerns—and be completely open.

Firstly, you may find this relieves much of your anxiety just by talking about it. You are no longer carrying these feelings of inadequacy alone.

Secondly, there may be a revelation that your concerns are completely unfounded. Perhaps you’re punishing yourself for only lasting 5 minutes—yet your partner considers this a perfectly enjoyable length of time for making love.

However, if you don’t have a relationship like this—speak to someone else. Sexual therapists are trained to identify the causes of performance anxiety—and recommend solutions.

sexual therapy imageRemember, these men and women have heard it all before—so don’t be embarrassed. What’s more, it’s often beneficial to obtain an “outsiders” point of view—making suggestions and observances that may not be immediately obvious to you or your partner.

Recent clinical research shows that sexual therapy is an effective solution to performance anxiety.23

The American Association of Sexuality Educators, Counselors and Therapists (AASECT) has a useful database which enables you to locate a professional in your particular state.24

Educate Yourself

Hopefully, this What Is Performance Anxiety article has gone some way in putting your mind at rest—and offering positive solutions.

brain imageWhat’s more—following the included links will provide much more in-depth and peer-reviewed information to furnish you with more detail.

Educating yourself regarding the way your body reacts to stimulation—both physiologically and psychologically—means you can improve your sexual performance (more).

Think of it like this—you can’t fine-tune a car engine unless you first know how it works.

If you’re the academic type—there are numerous accredited sex courses that can be completed online or in person.

Change the Order of Things in the Bedroom

Remember the loop I mentioned earlier?
couple image

You can break this vicious circle by mixing things up a little.

Following the same pattern of intercourse is a sure way to perpetuate the problem. For example—kissing precedes touching, followed by sex and then premature ejaculation (or whatever issue you may have).

Don’t allow your mind and body to be conditioned into this process like Pavlov’s dogs—surprise it.

Involve anything in your sexual activities that are a break from the norm—food, toys, costumes, role-play, BDSM, dirty talk, etc. etc.

What’s more—don’t think of intercourse as an inevitability.

vbrator image Research shows that the majority of female orgasms are induced by stimulating the clitoris—not the vagina.25

So, use anything to pleasure your partner’s love button except your penis. Utilize dildos, vibrators, fingers, tongue—in fact, anything to take her to climax.

Equally, you can both achieve orgasm together without penetration. Mutual masturbation or engaging in positions such as the amazing ‘69 can provide both parties with immense gratification.

Improve Your Diet

Do you want to know how to overcome performance anxiety easily? Watch your food intake.
diet image

A healthy diet can prevent obesity, which, as already discussed, can induce negative self-image issues and contribute to anxiety.

Furthermore, some foods are proven libido boosters. The most effective include:

  • Oysters—high in testosterone boosting zinc.26
  • Chilies.27
  • Pistachio nuts—lowers cholesterol—a cause of erectile dysfunction.28 29
  • Pumpkin.
  • Figs—high in the testosterone elevating magnesium.30
  • Asparagus.31

Take Supplements

Depending on the symptoms of your performance anxiety—supplements can be a solution.

supplements imageFor erectile dysfunction, the two most powerful products are Viagra and Cialis. Both of these prescription medications work by inhibiting enzymes which prevent erections and through increasing blood flow to the penis.32

Men who suffer from low libido, excess fat or premature ejaculation may find that testosterone replacement therapy is beneficial.33

However, some males are reluctant to use these medications as they can induce side effects and involve awkward conversations with their doctor or pharmacist.

pharmacist imageIn these circumstances, over-the-counter products may be more desirable.

These products contain nothing but scientifically proven natural ingredients to alleviate the issues surrounding performance anxiety.

The most potent are testosterone boosters for libido and nitric oxide heighteners for erectile dysfunction.

Give Yourself Time

Performance anxiety isn’t solved overnight—so don’t be disappointed when following the above tips if things aren’t improving rapidly.

time imageOften it takes trying out a number of methods, or indeed a combination, to improve your sexual ability. Patience is key—both for you and your partner.

But, eventually, you will be rewarded with a satisfying and fulfilling sex life.

When Do I See a Doctor?

If you continue to have issues after following the above advice in this What Is Performance Anxiety article—speak to your physician.

medical imageAdditionally, if you find that you experience any of the following, it’s also time to consult with a doctor:

  • Pain or soreness during sexual activity.
  • Symptoms which increase in number or worsen over time.
  • Performance anxiety which induces severe distress or depression.
  • Bleeding during intercourse.
  • Change in size, shape or appearance of your penis or testicles.
  • A relationship that is becoming damaged by the anxiety.

Will Performance Anxiety Stay With Me Forever?

Here’s the good news—it’s not a chronic issue.

In rare cases, it can be caused by an underlying medical condition. However, most often, it can be treated by addressing your concerns, worries, and fears regarding intercourse.

healthy food image​My six top tips for relieving performance anxiety are:

  • Eat healthily.
  • Take regular exercise.
  • Meditate.
  • Talk to your partner.
  • Vary your bedroom activities.
  • Be patient with yourself.

Follow these guidelines, and you will soon be enjoying the fulfilling, frequent and fun sex life you deserve.

This article has been medically reviewed by Dr. Nazish Idrees Chaudhary on January 2020

The information on this website has not been evaluated by the Food & Drug Administration or any other medical body. We do not aim to diagnose, treat, cure or prevent any illness or disease. Information is shared for educational purposes only. You must consult your doctor before acting on any content on this website, especially if you are pregnant, nursing, taking medication, or have a medical condition.

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