Performance Anxiety

What is performance anxiety and how to avoid it

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Medically reviewed by: Dr Nicholas Antonakopoulos

Last reviewed: 27 Feb 2019

Man sat on the side of a street looking up performance anxiety on his smartphone

Key takeaways

  • Performance anxiety is having anxiety around having sex and can make erections difficult

  • The stress of performance anxiety causes blood vessels to constrict and stops blood flow that would normally cause erections

  • You can treat performance anxiety with lifestyle changes, exercise, and therapy or counselling

  • Erectile dysfunction caused by performance anxiety can be treated with PDE5-inhibitors like Viagra

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What is performance anxiety?

Sometimes people can worry about having sex. These worries might come in many different forms, such as whether or not your partner will enjoy it or a lack of body confidence. These concerns are often called performance anxiety, and they can have an impact on how much you enjoy sex. For men, these worries can sometimes make it difficult to get and maintain an erection.

Why does performance anxiety make it difficult to get an erection?

When we get stressed or anxious our bodies react by releasing hormones, cortisol and adrenaline. This physical response is designed to help us in times of danger, but it isn’t very helpful on other occasions, like worrying about having sex.

These hormones constrict the body’s blood vessels. You get an erection from blood flowing to the penis, so if this blood flow is constricted it can make it difficult to get and keep an erection.

What can I do if I find it difficult to get an erection?

If you find it difficult to get an erection, or think you might have performance anxiety, talking to your doctor could help.

Your doctor will also talk to you about your medical history. Certain medications and health conditions can affect your ability to get and maintain an erection so it’s important to check for these. They may also do a medical examination to check for any underlying health issues. If there is a physical reason for the lack of ability to get an erection, then you may have erectile dysfunction which can be treated with common medication.

It might be the case that you’re finding it difficult to get an erection due to anxiety or stress. You can talk to your doctor about what might be causing this, and what lifestyle changes you could make to help improve your stress and anxiety levels.

Performance anxiety and stress

Sometimes people get stressed or anxious. But if this is affecting your ability to have sex, you may want to think about how you can reduce your stress levels. This could be through exercise, lifestyle changes or talking to a counsellor.

Talking to your partner openly can also help with performance anxiety. Talking about your concerns may help to reassure you and build up your confidence.

Is there a cure?

There’s no single cure for performance anxiety.

If your performance anxiety is caused by erectile dysfunction (ED), then ED medicines such as Viagra can help you to get and keep an erection.

If your performance anxiety is caused by stress and anxiety, either about sex or other areas of life then you might try to:

  • Take the focus away from sexual intercourse - there are many different ways to be intimate with your partner without penetration. Placing too much of an emphasis on sexual intercourse can put a man under pressure to ‘perform’, and focusing on other ways of pleasuring your partner can help you to relax and enjoy sexual intimacy without the pressure to have an erection.
  • Make healthy choices - eating the right balance of foods and exercising regularly can help to combat stress and anxiety

Performance anxiety and erectile dysfunction

If you’re stressed and tense about having sex, the hormones you release can mean not enough blood flows to the penis and it can be more difficult to get an erection. This creates a ‘negative feedback loop’, meaning that your worries and concerns might cause physical problems such as erectile dysfunction.

Erectile dysfunction medications can help you to get an erection but it’s also important to think about why you get stressed or anxious about sex and try to reduce this so you can break the loop.

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Medically reviewed by:
Dr Nicholas Antonakopoulos

Dr Nicholas Antonakopoulos graduated from the University of London in 2006. He did his postgraduate training in hospitals in the London area, and he trained for four years in Trauma and Orthopaedic Surgery before completing his training in General practice in 2015.

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Last reviewed: 27 Feb 2019

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