Sexual performance anxiety and erectile dysfunction are common sexual problems. Concerns about a partner’s expectations and personal worries are among the contributing factors.

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Stress about sex can lead to performance anxiety. This, in turn, can lead to erectile dysfunction (ED), which is when a person has difficulty getting or keeping an erection.

Some simple coping methods may help people deal with ED when it stems from performance anxiety.

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Performance anxiety and ED may be linked in several ways. Stress and anxiety about performing sexually or pleasing a partner can cause sexual dysfunction in anyone, regardless of their sex.

When a person feels unable to meet a partner’s sexual expectations, they may start feeling unworthy or incapable.

These feelings of inadequacy and low self-esteem may lead to physical symptoms, such as ED.

Researchers list psychological factors as one of several causes of ED. In other words, a person’s state of mind can affect their ability to perform sexually.

Performance anxiety typically results from a person’s negative thoughts about their ability to perform well during sexual activity. A person may be worrying about sexual inadequacy or the inability to please a partner.

Factors that can influence these feelings include:

Dealing with financial concerns, family issues, or stress at work may also affect a person’s mental state and contribute to performance anxiety.

ED can happen when various contributing factors interact, including:

  • hormonal balance
  • neurological factors
  • blood circulation
  • mental health and psychological factors

Other things that may contribute to ED include:

  • depression
  • disinterest
  • loss of attraction
  • stress
  • low testosterone levels
  • smoking
  • alcohol or drug abuse
  • chronic illnesses
  • kidney disorders
  • nerve damage from diabetes
  • stroke
  • injury
  • pelvic irradiation
  • recent surgery

Some medications may also cause ED, especially those that disrupt or alter the hormones, nerves, or blood pressure.

They include:

A doctor or pharmacist can help identify potential side effects before a person starts a new medication.

ED is not just a physical problem. It can affect a person’s mental health, relationships, and social life.

Experts have found links between ED and:

  • anxiety
  • depression
  • stress
  • low self-confidence
  • low self-esteem
  • relationship difficulties
  • sleep issues

These can trigger performance anxiety, and they can also result from it.

If a person has an erection on waking in the morning but not during sexual activity, there may be an emotional or psychological cause.

Psychological treatment and counseling, such as cognitive behavioral therapy, may help overcome concerns about sexual performance and ED.

Performance anxiety affects everyone differently, as not everyone responds to stress and anxiety in the same way.

In addition to ED, performance anxiety could lead to:

Research also suggests that heterosexual people who experience performance anxiety may be more likely to seek sexual experiences outside of a steady relationship.

The physical symptoms of ED include difficulty getting or keeping an erection. It may also lead to a loss of sexual desire.

Various tips can help people cope with performance anxiety and ED and enable them to have positive sexual experiences.

Avoid the cycle

Most people have a disappointing sexual experience from time to time. Occasional ED is not usually a cause for concern.

However, if disappointment leads to fear and anxiety, and these feelings persist, they can hinder future sexual activity.

It is essential to recognize that an inability to perform from time to time does not mean that a person is unable to have sex.

It may mean that they were under stress or facing anxiety at that time. At another time, when the stress is not present, they will be able to enjoy sex as before.

Shifting the focus to the cause, rather than the symptoms, may help a person reduce the pressure that they place on themselves to perform well every time, especially during times of increased stress.

Focus on the senses

A person with performance anxiety may mentally relive their perceived sexual failures and continually worry about what their sexual partner is thinking or how another partner may perceive them.

It may help to focus the mind fully on the senses during sexual activity, rather than overthinking or analyzing the event.

Focusing on what the hands are feeling or what the eyes are seeing can help block out anxious thoughts about performance.

Scented candles or music might also add to the sensory experience and help reduce anxiety.

Exercise

Research has noted a link between getting little or no physical exercise and experiencing ED symptoms. Completing a simple 20-to-30-minute exercise routine a few times a week can boost overall well-being and reduce stress levels, which may be helpful.

Other techniques

Many other techniques can help treat performance anxiety and ED. These include:

  • guided meditations, such as guided imagery therapy
  • couples counseling
  • sex therapy
  • sexual education
  • stress-relieving practices, such as mindfulness and yoga

It may also help for a person to be open with any sexual partners about their feelings of performance anxiety. Doing this can reduce stress, and the partner can help the person find solutions to relieve their anxiety.

If symptoms do not improve with lifestyle and relaxation techniques, or if they worsen over time, medical treatment may help.

A doctor may:

  • ask about symptoms
  • carry out a physical examination
  • perform blood tests to help identify any physical causes
  • ask questions about mental health and stress levels

A healthcare professional can help a person find a therapy or treatment that relieves their symptoms and encourages positive sexual experiences.

There are various ways to treat sexual performance anxiety and ED. A doctor will prescribe a treatment plan after identifying the cause of the problem.

Guidelines from the American Urological Association (AUA) recommend an integrated approach for ED and ejaculation disorders that will take into account the individual’s mental health, social situation, and physical well-being.

This approach may include:

  • relationship counseling
  • psychotherapy
  • medication for ED
  • treatment for specific diseases, such as benign prostatic hyperplasia
  • lifestyle measures, such as a diet and exercise plan

The AUA recommend that partners, too, should discuss the treatment options and their risks and benefits with the doctor, as this may increase the chance of a positive outcome.

There are many possible causes of sexual performance anxiety, including relationship issues and poor body image. If it becomes persistent, this anxiety can lead to physical symptoms, such as ED.

People can try certain at-home techniques to manage ED. Being open with any sexual partners about performance anxiety may also help reduce the associated stress.

If these techniques are ineffective, a doctor can offer advice on treatment options, which may include a combination of psychotherapy and medication.