Medically reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
Last updated 6/13/2022
Performance anxiety: the most vicious cycle that can invade your bedroom. Even more vicious than having to move your partner’s throw pillows every morning and every night. While the pillow cycle can be broken with a late morning in bed on the weekends, many men struggle with the question of how to break the cycle of sexual performance anxiety.
It’s actually a perfectly logical problem — not that logic makes things any easier. Performance anxiety is a form of anxiety, so fearing the same result over and over from a stressful situation can cause you nothing but more anxiety. Repeat that event enough and, well, you have a cycle.
So how do you break the cycle of performance anxiety? How do you get your sex life going without anxiety? Why do they have so many damn throw pillows?
The answers to these questions aren’t simple — in fact, we don’t have all the answers, especially about the pillows. But what we do know, we can share. Let’s work through this, one pillow at a time.
Performance anxiety is a medical condition defined by the inability to get or keep an erection due to anxiety about performance. Erectile dysfunction due to anxiety can be a result of uncertainty or anxiousness about the soon-to-be encounter, or many other anxiety-inducing psychological factors.
Generally, we understand that psychological factors like depression and anxiety can cause erectile dysfunction, but what causes those anxieties is less well-defined.
These underlying causes may be anything from situational anxieties due to relationship pressure, expectations to be met, low self-esteem, shame or even previous traumatic experiences that have associated intimacy with fear.
It might also just be the idea of performance itself — a sort of stage fright. One could even argue that performance anxiety is just a really specific case of social anxiety disorder, which is a kind of anxiety brought on by public performance and social interaction (which could both apply to your sex life if you have certain perferences).
Performance-type anxiety is an individual category of social anxiety listed in the most up-to-date medical literature, and though technically it’s related to speaking, we could argue that sexual performance and giving a speech are in the same ballpark for stressful performances if you’re not confident.
That lack of confidence (and performance problems in general) during sexual activity could come from a number of sources. The National Library of Medicine lists many, including depression, anxiety and obesity.
While obesity might make certain bodily functions less efficient, struggling with body issues and the related confidence problems are just as likely to be the cause of your performance problems.
Another potential performance anxiety cause you should consider? A new partner.
New partners are a common cause of performance anxiety, as are most life-changing events or changes to the status quo.
If you’re seeing someone new after a long-term relationship, it might really be the case that “this never happens,” because well, you didn’t have clear sources of uncertainty or anxiety before. The last partner was familiar. This one is new.
Novelty comes with its benefits, but for a person whose anxiety sometimes invades the bedroom, it can be a trigger for performance problems.
If you’re experiencing ED and you suspect it might be due to performance anxiety, chances are you might already have suspicions about the root cause. The good news is that, even if you haven’t taken your investigation that far, you’re still on track to solve the problem.
Whether you’re struggling with performance anxiety or have simply avoided intimacy because of it, the problem isn’t going to go away without some discomfort.
That discomfort will likely involve facing some of these psychological causes of ED that bring about anxiety in bed and can be rooted in generalized anxiety disorder.
You can talk to a therapy professional or mental health professional about your anxious feelings before and during a sexual experience, as well as any wider fears of inadequacy in a sexual encounter, self-consciousness or low self-esteem causing you to miss out on meaningful intimacy.
A mental health professional might employ popular therapeutic techniques like cognitive behavioral therapy (CBT), a therapy technique which can help you control and replace those negative thoughts, negative self-talk, and intrusive beliefs about yourself that are crushing your libido from inside your head.
You may also want to consider the physical sources of your psychological symptoms. If you’re experiencing sexual dysfunction, you might benefit from support in the form of treatment for erectile dysfunction as an illness of its own.
The best way to do this is with medical advice and support from a healthcare provider. They can give you the professional and tailored support you need to deal with ED. There’s a wide range of potential treatments for ED, but they’ll likely recommend research-backed ED treatment types like medication for your physical symptoms.
If you go the medication route, you’ll likely be prescribed a phosphodiesterase type 5 (PDE5) inhibitor. Most people are familiar with these medications, which go by the names Cialis® (tadalafil) and Viagra® (sildenafil), among others.
These medications enhance the dilation of the blood vessels in your penis, which leads to more opportunity for becoming and staying aroused, which then leads to your erection having more firmness and stamina overall.
Sildenafil works as a medication you take as needed — 30-60 minutes before sex for the best effect. Tadalafil is what you might choose if you’d like to have the option of sex at anytime, anywhere. Certain doses of tadalafil allow you to take it daily, although it can also be taken on an as-needed basis.
Both of these medications do come with some risks of side effects — if blood pressure or hypertension issues are part of your personal or family medical history, tell your healthcare provider before starting on these medications.
Oh, and one more thing: if you’ve been neglecting your overall health recently (or always), a healthcare provider might suggest (or insist) on lifestyle changes. These might include changes to your diet or drug and alcohol use (which includes smoking), or you might be encouraged to get more exercise for its nearly countless health benefits, including erectile health.
Breaking the performance anxiety cycle is about getting the right treatment plan for your needs but, as you can imagine, all searches for treatment start in the same place: a conversation with a healthcare provider.
Your self-diagnosed performance anxiety isn’t really a formal diagnosis without a healthcare professional involved in the conversation, and your internet searches for solutions are unlikely to get you the results you want without someone qualified there to guide you through those options.
In the big picture, your performance anxiety may be a tag-team problem alongside physical health-related ED issues — ED might even be the sign of entirely different problems than the one you’re self-diagnosing.
Do this the right way — avoid the unnecessary worry and talk to someone to get the support you need to get ED and performance anxiety under control today. Expert help is just a click away, and like the “real” pillows under the decorative ones, it’s something you can comfortably sleep on.