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Sexual Performance Anxiety: What It Is & How To Overcome It.

Sexual Performance Anxiety: What It Is & How To Overcome It.

By Dr Dean Knoll

A healthy sex life is important to most of us. We all know that a great performance in bed can mean increased self-confidence and satisfaction for both parties. A fulfilling sex life is also linked to an array of positive side effects including greater connection, more endorphins, and even increased cardiovascular health. Unfortunately, sometimes things can get in the way of truly enjoying the moment. Feelings of anxiety can inhibit someone's performance in between the sheets. Occasionally feeling anxious before sex is normal, especially if you are with a new partner or trying something new in the bedroom. However, feeling so nervous that one cannot have sex or enjoy sex might be sexual performance anxiety, or for short, SPA.  

What is sexual performance anxiety?

SPA is self-consciousness or concern over how a partner perceives you before or during sex. SPA can occur before or during sex, but having it beforehand can make having sex almost impossible.

For the most part, SPA is genital related where a person has concerns about achieving and maintaining an erection or having adequate lubrication. The condition causes psychological stress and can lead to erectile dysfunction (ED), which refers to the inability to obtain and maintain an erection or premature ejaculation (PE) in men and lack of lubrication, painful intercourse, and/or anorgasmia in women.

Physical sensations and pleasure are dampened or absent when a person is so hyper-focused on their sexual performance. The common components of sexual anxiety are related to the fixation on having an orgasm or helping one’s partner achieve an orgasm. These psychological stresses contribute to poor performance ability.  

What are the causes of sexual performance anxiety?

While there is no single cause of SPA, this anxiety is typically part of a broader issue within the relationship or the individual. Some people may be concerned about body image issues such as physical signs of aging or changes in weight. Things that lead to low self-esteem and low confidence can often lead to sexual avoidance.  

Another cause of SPA is genital fixation. One can overemphasize the importance of genital size and function. Concern about penile size or whether the vagina is lubricated enough or tight enough can distract from one’s ability to perform during sexual activity and enjoy the moment.    

Relationship issues can also be a significant factor contributing to SPA. Previous negative sexual experiences or relationship issues in the past can lead to a lack of communication between partners in a new relationship. The inability to communicate can lead to anxiety and make one feel emotionally disconnected from the other.      

General stress (societal anxiety) or non-sexual anxiety related to work or family, alcohol, smoking, illegal drugs, and side effects of certain prescription medications can all be possible contributing factors to creating SPA. Stress both sexual or otherwise can lead to the release of stress hormones like cortisol and epinephrine. These stress hormones can create changes in blood flow to the genitalia and can make it difficult to obtain and maintain an erection or create vaginal lubrication. Issues like anorgasmia, delayed ejaculation, premature ejaculation, and delayed orgasm can coexist alongside SPA.                        

Is sexual performance anxiety common?

SPA is more common than you may think. Many people suffer from SPA and are not aware. Disinterest in sex and/or the inability to perform often cause feelings of resentment, bitterness, a breakdown in communication, or feelings of low self-esteem. The signs and symptoms of SPA may have debilitating effects on other parts of one’s relationship with their partner. In many cases, SPA is related to different forms of depression.

In large-scale studies of men and women in the United States and the United Kingdom, 6-16% of women and 9 -25% of men reported feeling anxious about SPA for at least one month over the past year.  

Symptoms of sexual performance anxiety.

Although SPA is one of the most common sexual issues among men and women, it is not recognized as a diagnosis. Unfortunately, one of the most negative effects of SPA is that mental issues can end up becoming physical issues. Worrying about sex can affect one’s ability to become sexually aroused, enjoy sex, or reach orgasm.

An example of how mental symptoms of SPA can become physical is that stress hormones, like cortisol and epinephrine, cause blood vessels to constrict. This can decrease blood flow to the penis making it difficult to obtain and maintain an erection. Even if one can get an erection, one might find that they are unable to reach orgasm due to not being fully present at the moment. 

SPA can affect women’s ability to become aroused also. Not being able to fully focus on sex can also release stress hormones which can decrease blood flow to the vagina. This decrease in blood flow leads to decreased lubrication which can make sex uncomfortable and also make it difficult to reach orgasm.

SPA can take one out of the right mindset for sex. Repeated episodes of SPA may leave you not wanting to engage in sexual activity for a while or at all. 

Is there a link between sexual performance anxiety and erectile dysfunction?

It’s easy to confuse SPA with ED, as both have the same effect on men. However, that is where most of their similarities end because they are not the same. If you want to improve your sexual health, correctly identifying which sexual dysfunction you are suffering from is integral. 

SPA deals with the worries and anxieties regarding sexual function and whether or not one’s partner will be satisfied with one’s performance. These anxieties cause a release of stress hormones which can make it difficult for one to obtain and maintain a good-quality erection and/or reach orgasm.

ED refers to the inability of men to obtain and maintain an erection due to physical and medical conditions like diabetes mellitus, heart disease, high cholesterol, smoking, hormonal imbalance, prostate cancer therapy, nerve damage, and medications.

Not all men who suffer from SPA have ED. However, men with SPA can develop ED due to chronic stress caused by worrying about sexual activity. Mental anxiety causing poor erections (SPA) can manifest itself physically (ED). If a person has an erection on waking up during the middle of the night or in the morning but not during sexual activity, they're more than likely is an emotional or psychological cause. 

How to overcome sexual performance anxiety.

When SPA is escalating in a relationship and has persisted for several months, it is time to seek help from a medical professional and/or sex therapist, especially if SPA is causing distress in other areas of one’s life. To manage SPA, try to practice being in the moment during a sexual experience, eliminating distractions, and focusing on sensations rather than function.

While there are no proven treatments for SPA, studies on non-SPA and ED treatments may prove a good starting point. Since SPA is a mental health condition, there are several treatment options available to overcome it. Psychotherapy (talk therapy), mainly cognitive behavioral therapy and medications to treat anxiety, depression, and ED have proven to be some of the most effective treatments. 

Cognitive behavioral therapy (CBT) 

Cognitive behavioral therapy (CBT) is a type of psychotherapy (talk therapy) with a medical professional that can be effective for treating non-sexual performance anxiety and social anxiety and is therefore recommended for SPA. CBT is aimed at changing patterns of thinking and behavior that are harming a person’s life and well-being. 


Mindfulness meditation training is another technique that is useful for treating non-sexual performance anxiety and social anxiety. Mindfulness-based interventions have been shown to help individuals regulate their emotions and manage their anxiety, which has positive implications for managing SPA.


Yoga is another practice that is often used to cope with different types of anxiety and many other physical and mental challenges. There are even bedroom yoga practices specifically for SPA that you can try by yourself or with a partner. 

Open Communication 

Communication is paramount when trying to manage SPA. Talking to a healthcare provider, medical doctor, or sex therapist honestly and openly will allow them to determine the cause(s) of one’s SPA either psychological, physical, or both. Talking with a sexual partner can help a person cope with SPA. This is beneficial because it facilitates understanding between sexual partners of performance anxiety challenges, builds stronger relationships, and can lead to determining practical solutions together. Communication with partners can also be used as part of mindfulness or yoga practices.


Exercise, whether it’s taking up strength training or pelvic floor exercises to gain control of one’s vaginal muscles, can be a great way to help overcome a range of different causes of SPA and boost self-confidence. Exercise causes the body to release endorphins which increase feelings of happiness and positivity. It can also help reduce stress levels and improve mental well-being.


Some medications can be useful in managing SPA. Oral pills for treating ED (PDE5 inhibitors; i.e. Viagra, Cialis, Levitra, Stendra), have been available for many years and also can be effective in treating premature ejaculation. Women can choose to use a personal lubricant and/or hormonal treatment for menopausal women to address sexual pain associated with SPA. The use of a vibrator may be beneficial in achieving orgasm. There are several anti-anxiety medications available to manage non-sexual and societal anxieties which could have the potential for treating SPA.

SPA is one of the most prevalent sexual complaints, yet no diagnosis is recognized for either gender. It can become a self-perpetuating cycle, making it increasingly difficult for a person to enjoy sex. SPA causes self-consciousness, anxiety, and worry which all contribute to sexual dysfunction. No treatments are well proven, although cognitive behavioral therapy, mindfulness meditation training, and anti-anxiety and ED medications have potential.

With a variety of medicinal, and psychotherapy treatments and coping techniques available, SPA is a condition that can be overcome. 

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