How to Deal with Sexual Performance Anxiety

Co-authored by Trudi Griffin, LPC, MS

Last Updated: December 16, 2022 References

Sexual performance anxiety can affect both men and women, and it can range from unwarranted fears about the outcomes of sex (pregnancy, STDs, shame) to hyper-critical evaluations of the self (worrying that one is unsexy, un-masculine/feminine, etc.).^{[1]
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Research source} Whenever these kinds of anxious thoughts and feelings become attached to sex and performance, the body releases stress hormones that can interfere with sexual arousal and performance. This failure to perform can cause even greater anxiety, resulting in a vicious circle. Knowing how to break the cycle of sexual performance anxiety can help both partners have a healthier sex life and a happier relationship.

Method 1

Method 1 of 3:

Allowing Yourself to Enjoy Sex

1
Talk to your partner about your anxieties. Let your partner know what you're experiencing, and work together to find a way around those problems.^{[2]
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- Allow yourself to be vulnerable. When you see time and again that your partner does not think less of you in your most vulnerable state, you may begin to build trust in the relationship and confidence in yourself.^{[3]
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2
Trust your partner. Some health professionals believe sexual performance anxiety may have some roots in social anxiety. All of the thoughts typically associated with sexual performance anxiety, whether of feeling self-conscious or feeling un-masculine/feminine, boil down to a fear of other people's judgment. Though it will take time and effort, counseling for couples or individual counseling may help you let go of your fears about yourself and allow you to trust your partner.^{[4]
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3
Be confident. Focus on the things you love about yourself and your body. Whether you feel insecure about your weight, your appearance, or any other physical factors, specialists agree that the first step to overcoming issues of self esteem lies in accepting yourself as you are: a wonderful human being who deserves to be happy.^{[5]
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- You are more than a sexual creature. Think about the positive qualities you have that your partner sees in you, and let yourself feel good about those qualities.^{[6]
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4
Remind yourself of who you are. One of the frequent causes of sexual performance anxiety is feeling guilty or otherwise bad about the things that pop up in sexual fantasies. The fear is that these kinks will come to define the person, and that he or she will end up acting them out in reality. Experts agree that fantasizing about a particular act or even a particular person does not necessarily mean that there is any real desire to actually act it out in real life.^{[7]
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- Be open and honest with your partner about what you like and don't like, and ask your partner to do the same.^{[8]
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- It's okay to have sexual fantasies and desires. You and your partner can act out your fantasies safely, through role playing or other strategies for couples.^{[9]
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Method 2

Method 2 of 3:

Changing the Way You Have Sex

1
Practice deep breathing beforehand. Take a moment to focus on your breathing before initiating sex. Use that time to clear your head of any thoughts that might distract you or cause you additional anxiety. If you find it impossible to let go of the stresses from that day, try having sex on a less-stressful day instead. Trying and failing when you can't clear your mind will only cause further stress and anxiety.^{[10]
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- It may also help to meditate before having sex as meditation is known to alleviate anxiety.
2
Take your time. Some doctors and couples therapists recommend slowing down during foreplay to help ease into sex. Focus on touching/caressing your partner, and take your time during foreplay to get comfortable with one another and ensure that your partner's needs are met. This can help take some of the pressure off.
3
Focus on your partner. Practice mindfulness during sex. Think about how each part of your body feels and how you are connected to your partner. You can enjoy sexual play without an orgasm. Try to enjoy the time you're spending with your partner and allow yourself to be happy in the moment, no matter what happens.^{[11]
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- Try to remove expectations. Taking away the expectations associated with sex can help alleviate some of the pressure you might be feeling.^{[12]
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4
Communicate during sex. Enjoy every sensation you are having with your partner, and communicate throughout the experience with your partner. Communication can help alleviate a lot of anxiety and ensure both you and your partner are comfortable throughout the experience.
- Tell your partner when you like something while it's happening.
5
Take a break from intercourse for a while. Sex therapists will often advise a couple to abstain from intercourse until the affected partner can overcome his or her anxiety associated with performance. Even if you don't think you need a break from sex, it's important to allow yourself to simply not want sex from time to time. This can help take some of the pressure off of performance anxiety.^{[13]
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Method 3

Method 3 of 3:

Knowing When to Seek Professional Help

1
Learn the signs of sexual performance anxiety. Sexual performance anxiety manifests itself in a number of different ways. It's important to identify how the anxiety is affecting you—both physically and psychologically—before you can learn to deal with it. The most common signs of sexual performance anxiety include:^{[14]
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- Negative thoughts about love making, performance and being attractive to your partner.
- Constant mental images of previous failures.
- Shortness of breath and an inability to control your bodily sensations.
- Inability in men to experience an erection as a result of such thoughts and feelings, and thus withdrawal from sexual activity (erectile dysfunction).
- Lack of proper lubrication (among women).
- Constant, excessive worry about how your will perform.
- A constant cycle associated with not performing that further debilitates the performance.
2
Learn whether your medications could be a factor. Certain prescription medications can reduce a patient's sex drive or ability to perform sexually. These include:
- antidepressants (especially in the select serotonin reuptake inhibitor class, or SSRI) such as clomipramine, Amoxapine, amitriptyline, isocarboxazid, phenelzine, tranylcypromine, and fluoxetine
- tranquilizers, such as thioridazine, fluphenazine, trifluoperazine, and chlorpromazine
- certain anxiolytic (anti-anxiety) medications, such as diazepam and alprazolam
- blood pressure medications, such as clonidine, labetalol, and methyldopa
3
Talk to your doctor. While anxiety about sexual performance can certainly be a factor in failure to perform or an inability to achieve orgasm, there could be underlying problems causing these problems.
- Hormone imbalances could cause problems. If your body is not producing adequate levels of hormones such as testosterone, estrogen, or progesterone, you may experience a decreased sex drive and an inability to enjoy sex. This can become especially problematic in older individuals. Talk to your doctor about having your hormone levels tested.
- Reduced blood flow can lead to reduced sexual pleasure and an inability to become aroused.^{[15]
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  Cleveland Clinic
  Educational website from one of the world's leading hospitals
  Go to source}
- Chronic health problems, including diabetes, heart disease, and elevated blood pressure, could affect sexual arousal and pleasure.^{[16]
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  Trustworthy Source
  Cleveland Clinic
  Educational website from one of the world's leading hospitals
  Go to source}
- Mental illness, especially depression, generalized anxiety disorder, and bipolar disorder, can significantly reduce a person's sex drive and ability to enjoy sex.^{[17]
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4
Evaluate whether you have erectile dysfunction (ED). ED typically manifests in a reduced sex drive and an inability to have or maintain an erection during sex, which could be mistaken for sexual performance anxiety. Approximately half of all American men over the age of 40 experience ED.^{[18]
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Trustworthy Source
Cleveland Clinic
Educational website from one of the world's leading hospitals
Go to source} There are many causes of erectile dysfunction, and it's important to talk to your doctor if you believe you are experiencing ED so that you can work out a treatment plan, including medication that can help you have and maintain an erection. Common causes include:
- damaged or blocked blood vessels
- nerve damage
- high cholesterol or blood pressure
- obesity
- low testosterone
- metabolic syndrome
- prostate problems, including swelling and cancer of the prostate
5
Evaluate whether you're going through menopause. The onset of menopause, which reduces the body's production of estrogen, can cause reduced sex drive and changes in mood that may be mistaken for sexual performance anxiety. Most women experience menopause some time between the ages of 48 and 55 years of age, although some women may experience menopause under the age of 40 (called premature menopause).
- Consult with your doctor if you believe your menopausal symptoms are affecting your sex life. Certain medications are available, including estrogen and testosterone therapy, that can improve sexual desire and allow patients to enjoy sex once again.
6
See a sex therapist. Seeking professional help may allow you to let go of whatever anxieties you're experiencing. You can see a therapist individually or as a couple.
- A therapist may even help you to identify problems that you didn't know you had. This is why a professional perspective can be very useful.
- A therapist can give you a number of tips and techniques you can try to lessen your anxiety and improve your sexual performance.
7
Try cognitive behavioral therapy (CBT). Some individuals may experience sexual anxiety because of psychological factors. CBT is the process through which a therapist can explore the traumatic past of the individual, working through how it affects the person and how to separate the person from the unpleasant feelings and emotions.^{[19]
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PubMed Central
Journal archive from the U.S. National Institutes of Health
Go to source}