Performance Anxiety and ED

Thrones health

Medically reviewed by Dr. Antonio Abreu, DNP
Written by Thrones Editorial Team

couple feeling anxious in bed

It may be hard to believe but sexual performance anxiety is quite common to most men. There are several issues that may affect performance which may include: expectations, stress, inability to please your partner, and body image issues. Performance anxiety can affect men of any age bracket which can have other effects such as premature ejaculation and erectile dysfunction.

In a 2005 study by the American Psychological Association (APA) showed that performance anxiety can be a cause of sexual dysfunctions among men and women. A general feeling of nervousness and anxiety may cause the overproduction of adrenaline which makes it hard for an individual to stay calm and relaxed before and during any sexual activity.

This problem would be more evident in men as it can lead to an erectile dysfunction which makes it difficult for men to perform and/or enjoy satisfying sex. The condition may worsen as the anxiety escalates. Over time, a string of bad experiences creates more tension which may lead to more sexual anxiety that may place a wedge in future sexual activities.


It is typical for a person with performance anxiety issues that their problem lies in a broad range of physical and psychological issues. This in turn heightens a negative mindset that they may perform poorly during sex. A general feeling of being inadequate to satisfy the needs of their partner contributes to this negativity.

These factors may involve:

  • Low self-esteem that may involve a distorted view of one’s body, size, type, and shape. This also includes their view of their penile size.
  • Their mindset about their virility. Too much concern about their sexual performance and the thought of not being able to satisfy their partner.
  • The thought of having erectile dysfunction, premature or delayed ejaculation, inability to reach orgasm, and other factors that may hamper sexual satisfaction.
  • Issues about relationships that triggers an emotional disconnect with one’s partner that can also lead up to a general dissatisfaction within the relationship
  • The feeling of nervousness in performing any sexual activity.
  • Other issues that may affect one’s mindset not related to sex. The stress of daily life that includes work, study, family, finances, etc.
  • Internet porn

Any of these is enough to trigger the body to release potent stress hormones which include adrenaline. Increased amounts of these hormones would make it tough for one to be calm, at ease, and derive pleasure from sex.

Ultimately, these issues can lead to more serious problems including erectile dysfunctions that have their own set of predicaments as detailed in a more recent study. Regardless of which, the end result is always a less satisfying sexual activity.

If left unchecked, performance anxieties can get worse over time. It also doesn’t help that each bad experience has the potential to create or increase additional anxieties which add to more stress in any sexual encounter.


The effects of performance anxiety vary from individual to individual. Each individual has varying thresholds of stress, anxiety, and likewise, has various coping mechanisms to deal with these stresses.

Symptoms of anxiety can manifest itself in various physical forms such as: increased heart rate and/or rapid shallow breathing.

Apart from ED, performance anxiety could lead to:

  • Premature ejaculation
  • Difficulties in achieving orgasm
  • Disinterest in having sex

On the other hand, erectile dysfunctions have its own set of symptoms which includes:

  • Inability to achieve an erection
  • Keeping an erection
  • An absence or complete loss of sexual desire

Diagnosis and Erectile Dysfunction Treatment

It is not uncommon for sexually active individuals to experience some form of sexual disappointment at one time or another. Erectile dysfunction should not be a cause for concern if they happen infrequently.

However, disappointments that have mounted up over time lead to fear and anxiety. Persistent episodes can most assuredly lead to sexual activity problems in future encounters.

The inability to perform occasionally does not automatically equate that a person is incapable to have sex. Several factors may be the underlying cause, such as stress and anxiety. If such causes are absent at other times, it is most likely they will be able to successfully enjoy sex normally.

Instead of focusing on the symptoms, a person must affix on the cause. Doing such may dampen their self-imposed pressure to perform superbly even during periods of heightened stress.

One must recognize the need to seek help, the earlier the better, once performance anxiety increases in frequency. Learning techniques to handle negative thoughts, apprehension, and stress which may eradicate other circumstances that affect one’s ability to perform.

If for some reason, your condition escales to a sexual dysfunction or even an erectile dysfunction, it is prudent to go and visit your doctor right away. Your doctor will most likely have a set of questions that will determine if your problem stems physically, mentally, or even both.

Your doctor might also recommend treatment with ED medication in addition to first line therapy.

Sexual Performance Anxiety Treatment Options

Though it is quite a common occurrence that sexual performance anxiety can affect anyone, mostly men, the experience is undoubtedly quite stressful. Performance anxiety can be easily solved.

If for some reason your performance anxiety is also causing erectile dysfunction, solving your performance anxiety may also help reduce or even eliminate ED. There are available treatment options that can help conquer performance anxiety and help you regain enjoyment when having sex.

Due to a variety of reasons that cause performance anxiety, it is usual that treatment begins with identifying and resolving the issues causing the anxiety. Some situations of performance anxiety may resolve itself as simply as getting to know your sexual partner intimately and getting more comfortable. It may also dissipate once you identify and learn to manage the situations that cause you undue stress and anxiety.

Fret not if performance anxiety does not resolve on its own, there are various treatment options that are available. Counselling is one such common treatment. To address intimacy and sexual performance issues, cognitive-behavioral therapy or sex therapy is employed by your health professional.

Other avenues that are looked into is through the implementation of lifestyle changes aimed at diminishing stress and negative thoughts. Exercise also has been found to have beneficial effects in alleviating performance anxiety.

Another option is through guided imagery therapy. The process involves inducing you to enter a trance-like state while listening to a prepared script that describes a vivid scenario aimed at tapping into your subconscious meant to assist your body overcome any mental or physical problems.

Pharmacologic Therapy for Psychogenic Erectile Dysfunction Treatment

Erectile dysfunction often leads men to suffer low self-esteem. This can have a major impact on their quality of life as they tend to focus on their feeling of being inadequate as men for their ability to have and/or maintain an erection.

In some cases, they begin to think of themselves as no longer real men which eventually affects their intimate relationship with their partners.

By definition, psychogenic erectile dysfunction is a persistent condition where the subject male is unable to satisfactorily maintain an erection necessary for sexual performance.

Treatment options per individual varies for each type of situation the patient is diagnosed with. Traditionally, treatment approaches include:

  • Anxiety reduction and desensitization procedures
  • Cognitive-behavioral interventions
  • Guided sexual stimulation techniques
  • Couples’ relationship counseling

Advancement in therapy procedure now includes pharmacological therapy combined with the traditional approach in the treatment of psychogenic erectile dysfunction.

As in many medical conditions, the first-line in therapy is lifestyle modifications which has a beneficial effect in erectile dysfunction treatment. Men are encouraged to make adjustments in their lifestyles to benefit their sexual function also for the improvement of their overall health.

Regardless of lifestyle and behavior modifications, men with ED implore physicians for measures that can have immediate and impactful effects. In such situations, the options available for ED management beyond behavior modification include, among others, the use of Phosphodiesterase type 5 (PDE5) inhibitors, considered the primary second-line therapy for erectile dysfunction treatment.

The use of PDE5 inhibitors became the mainstay of erectile dysfunction treatment since the release of Viagra (sildenafil) back in 1998.

PDE5 is an enzyme found in the walls of blood vessels. It is responsible for blood flow and how your cells interact with signals within the body. PDE5 inhibitors work by blocking the PDE5 enzyme and preventing it from doing its function.

During arousal, your body releases enzymes causing the smooth muscles in your blood vessels to relax. This in turn increases blood flow which results in an erection. Take note that arousal is a vital component for the PDE5 inhibitor to work and help with Erectile dysfunction.

There are various PDE5 inhibitor drugs available, most are dispensed in tablet form such as:

  • Sildenafil (Viagra) starts working around 30 minutes after dosing
  • Tadalafil (Cialis) starts working around 30 minutes of dosing. It is the longest-lasting up to 36 hours, and in some up to 72 hours effectivity
  • Vardenafil (Levitra) starts working around 60 minutes. Clinical trials found it to be effective though it takes longer for it to work
  • Avanafil (Stendra) found safe and effective for ED and works 15 minutes after dosing

To Summarize

Performance anxiety is normal and treatable. If you happen to have ED, it may be possible that having performance anxiety can be the cause. Apart from behavioral modifications, you also have the option of employing the use of PDE5 inhibitors, of course, as per your doctor’s advice.

It is beneficial to employ the expertise of your doctor if you have any sexual dysfunction so it can be addressed and get valuable guidance in managing your symptoms.

Thrones Health is a discreet telemedicine online service that helps concerned men with their sensitive healthcare concerns. Get started with an online consultation now.

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