Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 7/20/2021
A little anxiety before or during sex is fairly normal. Maybe you’re with a new partner or just feeling a bit nervous about ensuring the other person finds maximum pleasure.
But when anxiety gets in the way of enjoying sex (hello, muscle tension!) or prevents you from wanting to have it — that kind of performance anxiety can be a problem. In fact, it can get so severe that it leads to erectile dysfunction or premature ejaculation.
Rest assured: A positive sexual experience can be yours, and we’re here to help! Keep reading for more details on what causes sexual anxiety and most important, how to relax during sex.
Sexual performance anxiety is defined as the fear that you won’t measure up during sex. This type of anxiety doesn’t just affect your mental health, it can have physical effects, too, and let’s face it — disrupt your overall quality of life.
What can be most concerning about sexual anxiety is that it can not just cause difficulty with orgasm and make for so-so sexual intercourse — it can lead to erectile dysfunction or premature ejaculation, too.
If you have sexual performance anxiety, it may be due to a variety of factors. Some of the most common concerns are evidenced by the questions you may worry over before and during intercourse. They might include:
Will I be able to get an erection?
Will I ejaculate too soon?
Does my partner find me attractive?
Is my penis big enough?
Will my partner experience pleasure?
Will my partner reach orgasm?
A negative body image can also cause sexual performance anxiety in men. In a study of male military personnel under the age of 40, one third of men experienced erectile dysfunction as a result of preoccupation with body image, particularly with their genitals.
For some men, watching porn can also result in sexual performance anxiety. When real life experiences are compared to those seen in porn, it can create feelings of inadequacy.
When you’re feeling anxious about sex and can’t relax, it takes a physical effect on your body. Nervousness triggers the sympathetic nervous system, resulting in the constriction of blood vessels and the release of the stress hormones epinephrine, norepinephrine and cortisol.
The unfortunate result of this biological process? It becomes harder to develop and keep an erection. This makes sex much less pleasurable and much more difficult.
One study found that sexual performance anxiety is one of the things most closely linked to sexual dysfunction in both men and women. (And for women, sexual anxiety and an inability to relax can even cause pain during sex.)
Sometimes sexual performance anxiety will disappear on its own. For example, if it’s caused by being with a new person, once you’re used to your partner it could go away.
But if it doesn’t go away, you’ll need to identify why you’re anxious about sex. Knowing what is driving the anxiety will determine the best course of treatment.
Here are some of the most common solutions for a better time in bed:
Cognitive behavioral therapy (CBT) and sex therapy are both commonly used to treat sexual performance anxiety. In therapy, you’ll talk about what causes your anxiety and come up with techniques to address it.
CBT is based on the idea that psychological problems are partially based on unhelpful ways of thinking and behavior. In CBT, a person is taught to recognize distorted thinking and given problem-solving skills to cope with difficult situations.
Sex therapy can be attended individually or as a couple. A sex therapist who specializes in sex therapy may begin by asking about a client’s sexual history, sex education, beliefs about sex and concerns.
If your inability to relax during sex has led to ED, medication may help. Prescriptions like sildenafil (Viagra®, generic Viagra), tadalafil (Cialis®), and avanafil (Stendra®) can assist with giving you a healthy erection, and reduce or eliminate anxiety around getting or staying hard.
ED medications work by opening blood vessels and increasing blood flow to the penis.
If your sexual performance anxiety is causing ED or your ED is preventing you from enjoying sex, speak with a healthcare professional about your potential treatment options.
If your anxiety stems from concerns you will prematurely ejaculate, you’re not alone. Research has found concerns over premature ejaculation are closely tied to sexual performance anxiety.
SSRIs are mostly used to treat depression, but they have been found to sometimes help with premature ejaculation.
Another common way to solve ejaculating too soon is to apply an anesthetizing cream or spray to the penis. This helps desensitize the penis so that you can go longer before ejaculating. Hims offers a spray that can be applied 10-15 minutes before sex and works to ward of premature ejaculation.
Sex — and time in bed — should be enjoyed; end of story. And if you have anxiety, you are definitely not enjoying your sexual encounters as much as you should be.
No matter what’s at the root of your anxiety — whether it’s premature ejaculation, erectile dysfunction concerns or just that you’re with someone new and want to impress them — there are ways to relax during sex.
If you think medication will help you most, talk to a healthcare professional as soon as possible so you can reap the health benefits positive sexual experiences can offer, and hey, get your sex life back on track.