What Is Sexual Performance Anxiety?
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Medically reviewed by Kathleen Daly, MD
Sexual performance anxiety is a form of performance anxiety that causes intense fear or worry before or during sex. Many people feel nervous before having sex. However, if you feel so anxious about sexual expectations or body image that you can’t perform sexually, you may have sexual performance anxiety.
Sexual performance anxiety can affect anyone, but it is more common in people in males. Eventually, sex-related anxiety can make it impossible to have sex with your partner and may eventually strain your relationship. Sexual performance anxiety can also lead to other sexual disorders, like erectile dysfunction.
Fortunately, there are a few ways to address and get past sexual performance anxiety.
Symptoms of Sexual Performance Anxiety
Like other forms of performance anxiety, sexual performance anxiety can affect you mentally and physically. People with sexual performance anxiety are so overwhelmed by sex-related worries, negative thoughts, or fears that they have trouble engaging in sexual activity. These negative thoughts or fears may happen before or during sex.
As a result, you may be unable to maintain an erection, climax, or ejaculate. You can completely lose your desire to have sex. You may also experience physical symptoms of anxiety, like increased heart rate, upset stomach, and shaking.
Sexual performance anxiety symptoms commonly found in males include:
Inability to orgasm during sex
Premature ejaculation
Delayed ejaculation
Symptoms of sexual performance anxiety in females may include:
Inability to orgasm during sex
What Causes Sexual Performance Anxiety?
People can have different fears, experiences, and worries that can affect sexual performance. Potential causes of sexual performance anxiety include:
Feeling worried about your partner’s sexual expectations or satisfaction
Feeling concerned about how masculine or feminine you come across during sex
Lacking self-esteem or having a negative body image
Being physically or emotionally unattracted to your partner
Feeling anxious about past negative sexual experiences
Feeling fear or anxiety related to sexual trauma
How exactly do stressful and anxious thoughts affect sexual performance? When you become stressed or anxious, your body kicks off its stress response by producing more of the stress hormone cortisol. When cortisol levels rise, levels of the sex hormone testosterone drop—decreasing your sex drive, or libido. In males, low testosterone is also linked to erectile dysfunction.
People with substance use disorders, anxiety, and depression may also experience sexual dysfunction and disinterest that can lead to sexual performance anxiety. Medications used to treat anxiety and depression can also negatively affect libido and sexual performance.
How Does Sexual Performance Anxiety Affect Relationships?
Lack of sex due to sexual performance anxiety can harm romantic relationships. Studies show couples who engage in higher rates of sexual activity build greater intimacy and have a lower divorce rate.
Being unable to have sex or enjoy sex can make partners feel less connected and intimate. As a result, your partner may feel like you are avoiding intimacy because you do not desire or care for them. People with sexual performance anxiety may also start to feel cautious of their partners, which disrupts trust and intimacy.
How To Cope With Sexual Performance Anxiety
Identifying your triggers and finding ways to destress can often help you learn how to manage the negative thoughts and feelings affecting your sex life. Coping strategies include:
Mindfulness meditation to better understand your thoughts and desires related to sex
Yoga to help manage stress and improve the mind-body relationship as it relates to sex, which can also help manage premature ejaculation
Masturbating to learn more about what you enjoy and feel during sex
Seeing a sex therapist to identify thoughts or feelings that lead to sexual performance anxiety.
Talking with your partner can also help you cope with sexual performance anxiety. Open communication can help partners better understand your feelings and struggles related to sex. Your partner may also offer valuable insight into the false, preconceived thoughts that prevent you from performing sexually—like your body image or performance concerns.
Accepting sex isn’t perfect or spending more time focusing on foreplay can also help improve intimacy. Other ways you can help build intimacy without sex include:
Cuddling
Kissing
Hugging
Holding hands
Spending quality time together
When To See a Healthcare Provider
Reach out to a healthcare provider if your anxieties around sexual performance and dysfunction are affecting your relationships and quality of life. They can refer you to a licensed sex therapist, psychologist, or psychiatrist for therapy services. You may also be able to contact these mental health professionals directly.
Some symptoms of sexual performance anxiety may also point to an underlying sexual dysfunction disorder. If you’re unable to perform sexually for a few months, see a healthcare provider to make sure you don’t have an underlying condition.
Sexual dysfunction symptoms that warrant a visit to your primary care provider, urologist, gynecologist, or OB-GYN include:
Premature ejaculation
Delayed ejaculation
Erectile dysfunction
Reduced or no interest in sex
Vaginal dryness
Pain during sex
Inability to orgasm
Treatments for Sexual Performance Anxiety
Sexual performance anxiety treatment often depends on the cause, and research on the overall success of these treatments is limited. However, treatment typically involves a combination of therapy and medication.
Cognitive Behavioral Therapy (CBT)
Talking out your feelings with a therapist is a common approach to treating sexual performance anxiety. Cognitive behavioral therapy (CBT) is a common talk therapy used to treat performance anxiety.
CBT helps people learn to reframe negative thoughts around sex that make it difficult or impossible to perform. This helps build awareness of triggers while learning to actively dismantle and redirect them.
Mindfulness sex therapy can also help people with sexual performance anxiety learn to understand their bodily sensations and become aware of how they react to sex. This type of therapy often incorporates CBT practices.
Couples Therapy
Couples therapy helps people with sexual performance anxiety communicate their feelings with their partner and explore feelings that may affect sexual performance. This therapy focuses on the couple as a whole, not just the partner with sexual performance anxiety.
This approach can help remove shame, fear, and miscommunication between couples. Couples therapy helps create an open dialogue related to sources of emotional distress or negativity while creating active solutions to solve them.
Medication
Erective dysfunction medications like Viagra (sildenafil) and Cialis (tadalafil) may help males with sexual performance anxiety who are unable to maintain an erection. These medications increase blood flow to the penis to help keep an erection.
Limited research shows anxiety medications like BuSpar (buspirone) and antidepressants like Wellbutrin (bupropion) and Desyrel (trazodone) can help reduce sexual performance anxiety. Unlike some anxiety drugs that decrease sexual function, these medications can affect brain chemistry in a way that may improve sexual arousal and sex drive.
A Quick Review
Sexual performance anxiety affects sexual performance before or during sex. If you have this type of performance anxiety, you may be unable to have sex, become aroused, or climax. Males with sexual performance anxiety often have issues with erectile dysfunction.
If you or your partner is experiencing sexual performance anxiety, having open communication and seeing a healthcare provider, like a licensed sex therapist, can help. Cognitive behavioral therapy, couples therapy, or medication may also help.
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