What Is Sexual Performance Anxiety?

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What Is Sexual Performance Anxiety?

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

SPA 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 SPA, and 6% to 16% of women are affected by this condition.

SPA 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, SPA could cause other sexual dysfunctions and cause you to lose interest in sex and other sexual activities. In a 2005 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 

Symptoms of sexual performance anxiety typically include: 

  • Having little or no interest in engaging in sexual activities 
  • Premature ejaculation when you have sex 
  • Being unable to have or sustain an erection 
  • Finding it difficult to orgasm during sex

Symptoms of sexual performance anxiety, however, look a little different in women. Women with this condition might experience: 

  • Vaginal dryness 
  • Difficulty getting aroused 
  • Experiencing some pain during sex 

People with sexual performance anxiety experience it in different ways, making it essential to look out for all symptoms typically associated with the condition. 

Identifying Sexual Performance Anxiety 

Sexual performance anxiety is sometimes misdiagnosed as erectile dysfunction. While the condition could cause erectile dysfunction, these are two different conditions.

Sexual performance anxiety is not a recognized medical condition, which often makes diagnosis and treatment difficult. The shame usually attached to sexual dysfunction conditions also prevents people from seeking help from a doctor or healthcare provider.

For a diagnosis of sexual performance anxiety to be made, any other reasons for your diminished sexual performance, such as other medical conditions, will have to be ruled out. A psychotherapist typically makes a diagnosis of SPA. 

Causes of Sexual Performance Anxiety 

Your body goes through specific changes when you are anxious that could affect your sexual performance. When you are anxious, you typically experience an increase in hormones like norepinephrine and cortisol.

An increase in these hormone levels also causes an increase in your blood pressure levels, which could cause a reduction in blood flow to your penis, preventing you from getting or sustaining an erection. 

Sexual performance anxiety has no single cause. It’s typically caused by a range of biological and psychological factors such as: 

  • Having body image and self-esteem issues. People who are overly concerned about their height, weight, or appearance of particular body parts might experience SPA when they engage in sexual activities.
  • Feeling emotionally disconnected from your partner. Sometimes SPA is brought on by emotional issues you might be going through with your partner. 
  • Dealing with mental health conditions. Depression and generalized anxiety disorder may contribute to SPA.
  • A lack of sexual experience. People who have less sexual experience might feel some performance anxiety when they first begin to have sex.
  • Feeling stressed. Stress affects all aspects of our lives, including our sex lives. Sometimes SPA could be brought on because you are stressed at work or by some other situation.
  • 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 SPA.
  • 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.

SPA 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. 

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 SPA. Buspirone, bupropion, and trazodone have also shown potential in helping treat symptoms of SPA.

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 SPA: 

  • 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.
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3 Sources
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.
  1. McCabe, M. P. The role of performance anxiety in the development and maintenance of sexual dysfunction in men and womenInternational Journal of Stress Management, 2005 12(4), 379–388

  2. Park BY, Wilson G, Berger J, et al. Is internet pornography causing sexual dysfunctions? A review with clinical reports. Behavioral Sciences. 2016;6(3):17.

  3. Pyke RE. Sexual performance anxiety. Sexual Medicine Reviews. 2020;8(2):183-190.