Dr Clare Morrison

Article by Dr Clare Morrison

Sexual Performance Anxiety

Not being able to get or keep an erection is one of the biggest taboos in modern society – which is ironic given how common it is. The Sexual Advice Association say that millions of mean men encounter this ‘problem’ on a fairly regular basis.

While occasionally having erection problems is perfectly normal, becoming stressed about disappointments may result in a ‘self-fulfilling prophecy’ where you expect another disappointment. The more you worry about it happening, the more likely it is to happen. This is known as sexual performance anxiety and affects millions of men in the UK.

The good news is that this is a highly treatable condition. So, let’s look at why this becomes a problem, and see how to overcome performance anxiety about sex.

What is sexual performance anxiety?

Sexual performance anxiety is a condition where a man (or a woman) becomes fearful that an upcoming sexual encounter will go in a way which they perceive as wrong or disappointing. In men, this anxiety causes the heart to race and stress hormones to be released – all of which interferes with the chemical and mental processes involved in getting and maintaining an erection.

Sexual performance anxiety might manifest itself in a number of ways in men:

  • You simply can’t get an erection at all
  • You can get an erection, but it’s not hard enough for satisfactory sex
  • You get an erection and have sex for a while, but then it goes
  • You’re able to get an erection but cannot orgasm

Anxiety and sex don’t go well together. Unfortunately, for many men a negative experience in the bedroom can feel devastating, and this means the next time they come to have sex, they feel anxious again and experience the same issue. It’s a vicious circle and, since people rarely talk about this subject, it can leave you feeling very much alone.

If it’s any consolation, around one in ten men has this kind of issue – so, in all likelihood, people you know are probably going through it too.

What are the causes of sexual performance anxiety? 

You might feel anxious about sex for a whole range of reasons. Let’s look at some of the common causes of sexual performance anxiety.

  • Beliefs about performance

We’re all exposed to countless messages from the media, society and porn about being a ‘good lover’. It’s understandable to feel the pressure to be a ‘stud’ between the sheets. All the same, it’s important to take these media messages with a pinch of salt – they often create unrealistic expectations about what real sex is like.

  • Stress

Stress is both a cause and effect of sexual performance problems. If you’re feeling worried about work, money, are having problems in your relationship or something else, that may mean you’re distracted in the bedroom.

  • The way you were brought up to think about sex

You may have been raised in a cultural or family setting where sex was a taboo topic, or where you learnt to think about sex and you own body in a certain way. Some people learn to feel shame about sex and masturbation, and that can lead to issues in the bedroom.

  • Body image

As with the first point, the media and porn have skewed a lot of our ideas about what we are all supposed to look like. Feeling worried about your body or the size of your penis can cause a lot of anxiety.

  • Childhood trauma

Anxiety about sex can sometimes be triggered by a childhood trauma, especially if it’s related to sexual or physical abuse. If this applies to you, consider speaking to your GP who can refer you to an NHS counsellor – or seek out private counselling.

How to overcome performance anxiety: ways to manage

Anxiety and sex issues are very common among men of all ages. Fortunately, a wide range of treatment options are available. Common approaches include:

  • Communicate with your partner

While it can be difficult to talk about your worries, especially with a new partner, communication can be a really effective way of tackling performance anxiety. Find a moment to talk to them about your worries. In most cases she or he will be supportive and understanding (and if they’re not, they might not be the right person for you). Often just talking about the issue can make you feel a lot more relaxed and take the pressure off.

  • Focus on your senses

A lot of erection problems are linked to what’s going on in your head, rather than in your body. If you can, try and concentrate all your attention on your senses – what you can see, feel and hear. By focusing on your senses, you might find you’re not so worried about whether you’re ‘hard’ enough and nature will take its course.

  • Keep fit and avoid ‘Dutch courage’

Alcohol is a big factor in causing erection problems, so drinking for ‘Dutch courage’ could be counterproductive. It’s also smart to get fit – this can help with your body image while also improving circulation too.

  • Consider medication

There is now a wide range of erectile dysfunction medicine which can help you get an erection more easily and stay hard longer. Taking drugs like Viagra, Cialis or Levitra make it a lot easier to get an erection. That can take away the pressure and mean you can enjoy sex without having to worry. After taking these pills a couple of times, you might feel confident enough that you don’t need to take them going forward.

  • Find other ways to be intimate

Films and TV have conditioned many of us to think of sex as a straight line journey from A to B, and must always include penetrative sex. But this is a pretty limited view of what you can do in the bedroom! There are many other ways you can be intimate with your partner that don’t involve the pressure to constantly ‘perform’. Try taking a warm, sensual bath together or use touch and mutual masturbation to pleasure one another.

  • Distract yourself

Many men experience erection problems because they’re so focused on whether their penis is hard or not. Try and distract yourself – when you’re not thinking about your erection it might just ‘magically’ work of its own accord. Try taking your mind off yourself by talking to your partner about your fantasies, watching a sexy movie together or thinking about something that turns you on.

  • Exercise

A lack of exercise has been linked to erection problems. Taking up three or four light, 20-30 minute workouts each week can improve your overall health and may improve your erection problems. This doesn’t immediately require signing up for a gym membership – why not start walking home from work the long way?

  • Kegel exercises

If you’ve ever stopped yourself while peeing, you’ve done a Kegel exercise. Kegel exercises involve contracting then releasing your pelvic floor muscles – this can improve blood flow to the penis. Try and get into the habit of clenching then releasing these muscles a handful of times throughout the day.[3] 

Talk to a professional about anxiety and sex

For many men, erection problems are linked directly to sexual performance anxiety and fears about ‘not being good enough’. As we’ve seen, there are plenty of things you can do to tackle this issue and have great sex.

That said, it can be useful to talk to a professional about these issues, especially if you are experiencing them all the time. A doctor might be able to test for any underlying medical issues and might be able to recommend additional treatments tailored specifically to you.

In any case, this is a totally treatable condition, and by taking some simple steps you can fix the issue fast.

Dr Clare Morrison
Dr Clare Morrison
Experienced General Practitioner in Hampshire since 1995, with particular interest in Nutrition, Obesity and Smoking Cessation.
Originally published August 06 2019, updated March 10 2020