Sexual Performance Anxiety: Symptoms, Causes, Treatments

Key Takeaways

• Sexual performance anxiety is a type of anxiety that makes people too nervous to enjoy sex.
• Treatments like cognitive-behavioral therapy and medication can help reduce the symptoms.
• Focusing on enjoyment and less on performance can help ease anxiety during sex.

Feeling anxious before sex is normal. However, feeling so nervous that you cannot have sex or enjoy sex might be sexual performance anxiety (SPA).

Sexual performance anxiety is a type of performance anxiety that affects sexual activity in particular. A person who has this condition will often be overcome by a fear that they’ll be unable to perform either before sexual activities or during them.

This disorder is more prevalent in men than in women. It can also lead to the development of sexual disorders such as erectile dysfunction.

Sexual performance anxiety is one of the most common sexual conditions in the world today. Some research shows 9% to 25% of men are affected by this type of performance anxiety, and 6% to 16% of women are affected by this condition.

Sexual performance anxiety looks a little different when it happens before sex than during sex. When it occurs before sex, it makes having sex almost impossible. You’ll most likely be unable to have or sustain an erection. However, when it happens during sex, you’ll find that you cannot enjoy sex or even climax.

If left untreated, sexual performance anxiety could cause other sexual dysfunctions and cause you to lose interest in sex and other sexual activities. In one study, researchers found that performance anxiety plays a huge role in the development of sexual dysfunction in both men and women.

Symptoms of Sexual Performance Anxiety 

People with sexual performance anxiety experience it in different ways. It’s important to recognize all the possible symptoms, including:

• Having little or no interest in sexual activities 
• Premature ejaculation during sex 
• Inability to have or maintain an erection
• Difficulty achieving orgasm during sex

Symptoms can vary for women, who might experience:

• Vaginal dryness 
• Difficulty becoming aroused
• Pain during sex

Identifying Sexual Performance Anxiety 

Sexual performance anxiety is sometimes mistaken for erectile dysfunction. Although it can lead to erectile dysfunction, they are distinct conditions.

Because sexual performance anxiety isn’t a recognized medical condition, diagnosis and treatment can be challenging. The stigma associated with sexual dysfunction often discourages people from seeking help.

To diagnose sexual performance anxiety, other causes of reduced sexual performance, such as medical conditions, must be ruled out. Typically, a psychotherapist can make this diagnosis.

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Causes of Sexual Performance Anxiety 

When you are anxious, your body undergoes changes that might impact sexual performance. Hormones like norepinephrine and cortisol increase, raising blood pressure and potentially reducing blood flow to the penis, which can prevent an erection.

Sexual performance anxiety doesn’t have a single cause and may result from various biological and psychological factors, such as:

• Body image and self-esteem issues. Concerns about height, weight, or specific body parts can lead to anxiety during sexual activities.
• Emotional disconnection from your partner. Relationship issues might trigger sexual performance anxiety.
• Mental health conditions. Depression and generalized anxiety disorder can play a role.
• Lack of sexual experience. Less experience can lead to anxiety when beginning sexual activities.
• Stress. Stress can affect all areas of life, including sexual performance.
• Previous negative sexual experiences/trauma. Having had negative sexual experiences in the past, either with your current partner or a former partner can lead to sexual performance anxiety.
• Overconsuming pornographic content. This can sometimes give you a false perception of what sex should look and feel like. Research has linked porn to the development of sexual dysfunction.

Sexual performance anxiety can sometimes feed into itself and cause an unfortunate cycle. It starts with a person feeling anxious before sex which affects their performance, and then becoming even more anxious the next time they engage in sexual activity because they were unable to perform the last time. 

Treatment for Sexual Performance Anxiety 

Treatment for sexual performance anxiety typically depends on what’s causing it. In general, a combination of medication and psychotherapy can be used to treat its symptoms. 

• Psychotherapy: Cognitive-behavioral therapy is sometimes recommended for the treatment of sexual performance anxiety. 
• Medication: Medication used to treat erectile dysfunction, such as Viagra and Cialis, is sometimes recommended for people who have SPA. 

More research needs to be done to find adequate treatment for sexual performance anxiety. Cognitive-behavioral therapy and medication have so far proven to be some of the most effective treatments for sexual performance anxiety. Buspirone, bupropion, and trazodone have also shown potential in helping treat symptoms of this type of performance anxiety.

How to Cope With Sexual Performace Anxiety 

The first step to coping with sexual performance anxiety is removing any shame you might be feeling about not having an optimal sex life. In some instances, sexual performance anxiety goes away with time, especially in situations caused by having a new sexual partner or where a relationship issue with your partner has been resolved. 

People with sexual performance anxiety often operate under the false belief that they are somehow inadequate or incapable of satisfying their partners. Focusing more on your enjoyment and that of your partner instead of how adequate your performance is can help you overcome your anxiety.

Here are some other tips that can help you overcome sexual performance anxiety: 

• Meditate: Meditation is often recommended for coping with any form of performance anxiety. 
• Masturbate: Spend some time with yourself to get a better understanding of your own needs.
• Get out of your head: When you are having sex, try to spend more time enjoying its motions instead of worrying about what could be going wrong.
• Accept that sex isn’t always perfect: There’ll be some days you might not just feel up to having sex. This most likely has nothing to do with your physical ability. 
• Slow down and take your time: Sometimes, you might not have spent enough time engaging in foreplay for both you and your partner.
• Eliminate stress from your life: One of the causes of sexual performance anxiety is stress over other factors in your life like finances or work. Managing stress with meditation, exercise, and regular sleep can help. 
• Speak to a therapist: Speaking with a sex therapist may help you discover the root of your sexual performance anxiety.

Frequently Asked Questions

• How common is performance anxiety in men?

  Research indicates that somewhere around 9% of 25% of men experience sexual performance anxiety.

• How can I help my boyfriend with his performance anxiety?

  You can help you partner by being supportive, taking things slow, and not putting pressure on one another. Give encouraging, non-critical comments about things that you enjoy, and focus on activities that bring you both pleasure. Communicating effectively and reframing your sex life to focus on physical intimacy rather than sexual performance can alleviate pressure and reduce performance anxiety.

• Why does my boyfriend get performance anxiety?

  Performance anxiety often stems from negative thoughts people experience about their ability to perform during sex. Feelings of insecurity, past negative experiences, or poor body image can also play a role.

• What does performance anxiety look like?

  Some signs that someone has performance anxiety include:

  • Worry, anxiety, and negative thoughts before and during sex
  • Inability to orgasm
  • Premature or delayed ejaculation
  • Erectile dysfunction
  • Lack of interest in sex
  • Physical symptoms such as rapid heart rate, upset stomach, and sweating

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

By Toketemu Ohwovoriole

Toketemu has been multimedia storyteller for the last four years. Her expertise focuses primarily on mental wellness and women’s health topics.

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