Performance anxiety

How to overcome worry about how good you are in bed?


Is performance anxiety the same as erectile dysfunction? To answer that question, we need to define performance anxiety. Sexual performance anxiety can affect both men and women and concerns their ability to sexually satisfy their partner or enjoy the sexual encounter themselves.

Causes of performance anxiety

Typically, sexual performance anxiety is a result of a person’s negative thoughts surrounding their inadequacies, real or imaginary, relating to sexual performance. Other stressors that may be present in life such as financial problems, family problems, or work stress can also contribute to performance anxiety.

There are a number of anxieties that may contribute to your having sexual performance anxiety and these include:

  • Anxiety around whether you are able to satisfy your partner sexually and if you are ‘good in bed’
  • If you have a poor body image and feel sure that your partner does not find you physically attractive
  • Relationship problems
  • Concern about the size of your penis
  • Worry that you may ejaculate prematurely or could even take too long to ejaculate
  • Anxiety around whether you will be able to enjoy the sexual encounter or achieve orgasm

Symptoms of sexual performance anxiety

Performance anxiety has varying effects on men and in addition to it causing erectile dysfunction it may also cause the following:

Performance anxiety and erectile dysfunction - how is it linked?

Performance anxiety begins with fear about your own self-worth in performing sexually; the result of this for many men is that they are unable to achieve or maintain an erection which is technically the definition of erectile dysfunction. This may also apply to a woman who is, as a result of her fears, unable to enjoy the sexual encounter.

It can be stated that performance anxiety is a psychological cause of erectile dysfunction.

Asking for help and diagnosis

If you are suffering from performance anxiety on a regular basis it is advisable to seek medical advice sooner rather than later. This way you can learn techniques that can help you deal with any negative thoughts, fear and stress. At the same time, your doctor can rule out any other conditions which may be causing your problem. In order to diagnose the problem correctly, your doctor will need to take a detailed case, including a full sexual history as well as carrying out a physical examination and possibly some blood tests.

How to overcome sexual performance anxiety?

As sexual performance anxiety is a psychological condition, there are many ways that it can be managed. If the performance anxiety is causing the ED, then treatment for ED may help to reduce the performance anxiety as the two can work as a vicious circle, one persistently resulting in the other, but once the cycle is broken, things can improve.

Some possibilities which may be considered in the treatment of performance anxiety include:

  • Meditation aims to reduce the overall anxiety and stress levels in a person
  • Learning about sex and sexual behavioral patterns
  • Counselling therapy to help with stress levels, depression and other concerns
  • Relationship counselling if there are problems in the relationship
  • Sex therapy can be useful in working through intimacy and sexual communication issues
  • A change in lifestyle including improved diet and regular exercise can have a positive effect both physically and mentally
  • Learn how to communicate with your partner
  • Removing factors from your life which result in added stress
  • Take a relaxed and slower approach to sexual intercourse
  • A technique called guided imagery may also help with performance anxiety

There are also other ways to become intimate with your partner. Take a bath together, give each other a massage with essential oils or try mutual masturbation. These are all things which you can enjoy and will allow you to give pleasure without putting any undue pressure on each other.

Talk to each other, be open about your concerns and worries - it is amazing how being open and honest can clear issues away and enable you to see that problems were only in your own imagination.

Avoid the cycle

It is quite normal to have a poor sexual experience from time to time and if it happens occasionally, it is not usually a problem. It is important not to allow these occasions to colour your view of sex, allowing them to lead to fear and anxiety but understand that just because it wasn’t great today doesn’t mean it won’t be great tomorrow.


Performance anxiety is completely normal and treatable. If you are also suffering from erectile dysfunction it may well be that the ED is causing your performance anxiety.

Whether you just have performance anxiety or it is also being caused by erectile dysfunction it is important that you seek medical advice. Dr Felix can prescribe erectile dysfunction medication, but your GP will be able to ascertain if there are any underlying conditions, such as diabetes, that may contribute to or cause your ED.

Finally, it is important to be kind to yourself and don’t judge yourself so harshly when it comes to your appearance or abilities. There is also plenty of help out there that will enable you to return to healthy and enjoyable sex life.

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