Performance anxiety or erectile dysfunction?

How do we tell the difference?


If you are suffering in the bedroom department and feel as though you are unable to ‘perform’ then it is likely that you couldn’t care less what the cause is - you would just like to find a solution! 

The point is that if we know the cause, we are much better placed to find the solution.  The best way to do this is to consult your GP and ask for his advice.  Whilst this may lead to more anxiety for some men who may already be feeling a degree of inadequacy, it is important that we find the root of the problem in order to treat it 

Erectile dysfunction has both physical and psychological causes and for any one individual it may be that there is a combination of these causes present; however, the performance anxiety can in itself result in erectile dysfunction and we need to rule out any possible physical causes in order that we can look at the possibility of performance anxiety being the main issue.

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The physical cause of erectile dysfunction

There are a variety of physical conditions that can either directly cause or contribute to erectile dysfunction.  Invariably, if the physical condition in some way interferes with the vascular health of the individual and so contributes to or causes a restricted circulation to the penis, this is likely to interfere with the ability to achieve or maintain an erection.


Conditions that can have this effect on the body are:-

  • Diabetes
  • Heart disease
  • High cholesterol
  • High blood pressure
  • Smoking
  • Nerve damage cancer treatments, for example, removal of the prostate in cancer of the prostate
  • Thyroid disorder
  • Low testosterone
  • Some medication


Psychological causes of erectile dysfunction

In some cases, erectile dysfunction that a person has suffered as a result of physical disease can lead to performance anxiety as he becomes anxious about his ability to perform in the future as he has had a problem in the past

For a person with sexual performance anxiety, it may be that he worries and so feels anxious about his ability to please his partner sexually and this may manifest in anxiety about a number of issues.  He may, for instance, be concerned about one or a combination of the following:-

  • Can he get a good erection and maintain it?
  • Is his penis large enough to satisfy his partner?
  • Will he be able to climax?
  • Does he have enough experience to please his partner?
  • Will he be good enough to make his partner climax?
  • Will he ejaculate too quickly?
  • What will his partner do if they are not sexually satisfied
  • Is he too fat to be attractive to anyone?

The use of pornography can lead to or make performance anxiety worse when an individual compares their own sexual experiences with those depicted on the screen.  Pornography, after all, is seldom intended to depict reality but more sexual fantasy.

In general, it is negative thought processes that result in performance anxiety and so other spheres of life may also lead to performance anxiety such as the inability to provide for the family following redundancy, worries about work in general, anxiety about children and personal relationships to name a few.

Performance anxiety manifests not only as of the inability to achieve and maintain an erection but also includes loss of libido and problems ejaculating


Treatment for performance anxiety

Treatment for the physical causes of erectile dysfunction can be sought through your GP.  If your erectile dysfunction has performance anxiety as its cause, there are a number of approaches you can try to help alleviate the problem

  • Be open about anxieties with your partner.  Doing this will enable you to work through the problems together
  • Take your time!  Sex is a pleasure better savoured than rushed!
  • Go with the flow, just do what feels right for you and your partner - communication!
  • See a therapist and talk about all the things that worry you.  It is amazing the difference that ‘getting things off your chest’ can make in relieving stress and anxiety about issues
  • Educate yourself!  It is important that you learn facts about sexual behaviour and  don’t rely on what you may have ‘learnt’ from mates at school
  • As far as possible, remove or deal with things in your life that are a source of stress to you
  • See a sex therapist with your partner in order that you can resolve any intimacy and performance problems
  • Change your lifestyle!  Take more exercise, maybe this could be something you could do with your partner?  Improve your diet!



At the end of the day, performance anxiety is not rare and is a normal reaction to the many pressures of life. It is eminently treatable and if you have erectile dysfunction that is directly attributable to the performance anxiety, treatment for the anxiety will undoubtedly help improve the erectile dysfunction


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