What is “Performance Anxiety”?

01.12.2021 - Dr. Daniela Mazor

It is normal to feel a little stressed before having sexual intercourse, but when the anxiety is so extreme that it is controlling and does not allow one to relax and have sexual intercourse or enjoy it, it is known as Sexual Performance Anxiety, SPA. This type of performance anxiety is particular to sexual activity.  This is a very common disorder affecting the sexual function of approximately 9-25% of men of different ages worldwide. A study in 2005 found that that sexual performance anxiety plays a very large role in the development of the various sexual disorders amongst both men and women as a whole, although it is much more common in men.

How is sexual performance anxiety expressed?

Normal sexual function is an important part of a man’s physical and mental health, and therefore the lack of ability to get an erection and have sexual intercourse is likely to damage his feeling of masculinity and self-esteem, and even cause anxiety, frustration and damage the general quality of life. “Sexual Performance Anxiety” is a situation in which a man experiences great worry, stress, nerves or discomfort before having sexual intercourse or during it, regarding his ability to function in sexual intercourse and satisfy his partner. The problem is often due to considering sexual intercourse as a “performance” that should be carefully examined and assessed by an audience. This “performance”-orientated thought pattern causes many men to become more aware and increases self-criticism, and so the worry, stress and anxiety increases before or during sexual intercourse. It turns out that for most, the great fear is actually realized in practice and is expressed in psychogenic erectile dysfunction (that is, psychologically-based), premature ejaculation, or difficulty in reaching orgasm.

Why does this happen?

When a person is anxious, his body is affected by an increased secretion of the stress hormones adrenaline and cortisol. These hormones cause constriction of the blood vessels and an increase in blood pressure, and for most will be expressed in a difficulty to achieve an erection or maintain one, since blood flow to the penis is temporarily impaired. However, sexual performance anxiety does not have a single cause, rather for most it is caused by a range of both biological and psychological factors acting together, such as:

  • lack of sexual experience or previous failed sexual attempts
  • concern about premature or delayed ejaculation
  • fear of inability to provide sexual satisfaction to a partner or unrealistic expectations regarding sexual intercourse
  • a negative body image, including worry about being overweight or having a penis that is too short
  • relationship problems or feeling disconnection with the partner
  • past sexual experience that is negative, or some kind of trauma
  • accompanying mental state – occasionally depression or a general anxiety disorder can trigger sexual performance anxiety
  • absence of sexual arousal
  • a general feeling of stress, such a from work or in one’s personal life, can be expressed as sexual performance anxiety
  • overuse of pornographic content that gives a false impression about how sexual intercourse should look or feel


Treatment for Sexual Performance Anxiety

Treatment for Sexual Performance Anxiety will differ according to its cause. Generally, a combination of medicinal treatment with psychotherapy will be effective for most. Medicinal treatment is likely to include anti-anxiety medications and/or those for depression as well as drugs for treating erectile dysfunction. Psychotherapy can include Cognitive Behavioral Therapy (CBT) and/or professional sex therapy that will enable acquisition of methods to reduce stress, anxiety and negative thought processes.

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