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Sexual Performance Anxiety and ED: Causes, Symptoms & More

Michele Emery, DNP

Medically reviewed by Michele Emery, DNP

Written by Our Editorial Team

Last updated 1/15/2021

Have you ever felt anxious before sex? It’s far from uncommon for men to feel nervous, anxious or uncomfortable before and during sexual activity — a common problem that’s known as sexual performance anxiety.

Performance anxiety affects men of all ages, resulting in everything from premature ejaculation to erectile dysfunction. It’s a common issue with a variety of solutions, from guided imagery and other anxiety reduction techniques to medication.

In this guide, we’ll go into more detail about what performance anxiety is, how it happens and what you can do to prevent it from affecting your sexual performance.

What is Sexual Performance Anxiety?

Sexual performance anxiety is a feeling of nervousness and sexual anxiety before and during sex.

When you experience these feelings, your body might release increased amounts of powerful stress hormones such as adrenaline, making it more difficult for you to relax and enjoy sexual activity.

For many men, this can lead to erectile dysfunction, making sexual activity more difficult and less satisfying.

Sometimes, performance anxiety ed worsens over time, as one bad experience creates more sexual anxiety and stress about sexual activity. It’s very common, affecting men of all ages and backgrounds, and has many different causes.

Causes of Sexual Performance Anxiety

Sexual performance anxiety can occur because of a wide range of different physical problems and psychological factors, including:

  • Concern about sexual performance (for example, worrying that you may not fully satisfy your partner or that you may have trouble ejaculating)

  • Self-esteem or body image issues, such as concern over your weight, height or penis size

  • Stress about erectile dysfunction, premature ejaculation, delayed ejaculation, failure to reach orgasm and other medical conditions that can affect sexual satisfaction

  • Relationship issues, such as a lack of emotional connection or dissatisfaction with your relationship

  • Other mental health or sources of stress, such as difficulties regarding work, relationships, family or other non-sexual aspects of your life

  • Nervousness about sexual activity, in general

When you experience these feelings, your body might release increased amounts of powerful stress hormones such as adrenaline, making it more difficult for you to relax and enjoy sexual activity.

For many men, this can lead to erectile dysfunction, making sexual activity more difficult and less satisfying. Sometimes, performance anxiety worsens over time, as one bad experience creates more anxiety and stress about sexual activity.

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How Performance Anxiety Happens

When you feel anxious, your body activates its sympathetic nervous system resulting in, among other things, constriction of blood vessels and increases in production of stress hormones such as epinephrine, norepinephrine and cortisol. This leads to an increase in blood pressure levels and a subsequent reduction in blood flow to parts of your body such as your penis.

This makes it much harder than normal to develop and keep an erection, affecting your ability to enjoy sex with your partner. Simply put, the psychological effects of performance anxiety lead to a physical response from your body that, in turn, makes sex more difficult.

What this means is that even men with none of the main physical causes of erectile dysfunction (ED) can have trouble getting an erection if they feel anxious or nervous before sex.

Performance anxiety can happen before sexual activity or during sex. During sex, performance anxiety can make it more difficult to orgasm, or even anorgasmia as anxiety over your sexual performance can make it tough to concentrate on the physical and emotional sensations of sex.

Over time, performance anxiety can have a significant negative effect on an individual’s sex life, resulting in (for some people) a reduced level of interest in sexual activity.

Performance Anxiety and Erectile Dysfunction (ED)

Right now, there isn’t a lot of research on the physical effects of performance anxiety. However, one study from 2005 shows that performance anxiety is one of the factors most closely linked to sexual dysfunction in both men and women.  

A more recent study from 2020 also found that sexual performance anxiety “causes or maintains most common sexual dysfunction.”

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Treatment Options for Sexual Performance Anxiety

How to break the cycle of performance anxiety? Because performance anxiety can occur for a variety of reasons, treatment usually focuses on identifying and solving the factor or factors that caused the anxiety in the first place.

Sometimes, performance anxiety may solve itself as you become more familiar and comfortable with your sexual partner. In other cases, performance anxiety may disappear as you identify and manage sources of stress in your life.

If sexual performance anxiety does not resolve on its own, there are other treatment options available.


One of the common treatments for performance anxiety is counseling, such as cognitive-behavioral therapy or sex therapy, to work on intimacy and sexual performance. Through therapy, you can learn how to implement lifestyle changes, such as mindfulness, aimed at reducing your total level of stress and negative thinking.

Research has also shown that that guided imagery, a therapeutic technique for dealing with anxiety, can be effective in helping treat sexual performance anxiety.

ED Medications

ED drugs like sildenafil (Viagra®, generic Viagra), tadalafil (Cialis®), and avanafil (Stendra®) can also be used in sexual performance anxiety treatment as a way to provide more confidence for men with sexual performance concerns. Like with all prescription medications, you should seek medical advice from a healthcare professional.

ED drugs are especially effective for treating sexual performance anxiety if your anxiety disorder is caused by feeling self-conscious about ED. In this case, performance anxiety is a side effect of erectile dysfunction and medication can help solve that physical problem.

If you are experiencing erectile dysfunction, talk to a provider on our platform about erectile dysfunction medication today.

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Sexual Anxiety Is a Common Issue

Performance anxiety is a common problem that can affect anyone. For men, it can be a stressful experience — after all, no one wants to let their sexual partner down or miss out on enjoying sex because they feel anxious and uncomfortable.

Luckily, performance anxiety can easily be fixed. From open communication with your partner to guided imagery, relaxation exercises and ED medication, there are a range of treatment options that can help you overcome performance anxiety and enjoy a healthy sex life.

Interested in learning more about the psychological side of sexual performance? Our guides to porn-induced erectile dysfunction and average penis and erection size go into more detail about two of the most common causes of sexual performance anxiety.

Looking for a way to reduce feelings of anxiety? Our list of five science-backed reasons to start meditating explains how meditation can play a role in helping you overcome stress, anxiety and negative thought patterns.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.