Sexual Performance Anxiety Disorder

What is Sexual Performance Anxiety Disorder? The 9 Best Coping Tips You Must Know

Writen By: Sadia Mirza
Reviewed By: Huma Khan
Publish Date: April 30, 2024

Do you ever feel nervous or anxious when it comes to your sexual performance? Do the expectations and desires of your partner cause you to feel pressured and anxious about satisfying them? If so, know that you are not alone in feeling this way. It is common to feel anxious before sex, but if you feel so nervous that you cannot have or enjoy sex, it may be a sign of sexual performance anxiety disorder (SPA).

Sexual performance anxiety (SPA) is a common experience that many people go through at some point in their lives. Sex is supposed to be pleasurable and make you feel happy but when it makes you excessively worry about your performance in bed, it needs to be addressed.

Let’s discuss sexual performance anxiety disorder, its symptoms, and how to get over performance anxiety in bed. This stigmatized issue can cause difficulty achieving and maintaining an erection, premature ejaculation, or difficulty reaching orgasm. In this article, we’ll address all related issues and provide tips to help you overcome performance anxiety in bed.

What is Sexual Performance Anxiety Disorder?

Sexual performance anxiety disorder is a form of anxiety that involves experiencing fear, worry, and anxiety related to sexual activity. People who have this disorder may feel anxious and apprehensive before having sex about their sexual performance and ability to please their partner. While a little nervousness is normal, SPA can become intense enough to interfere with intimacy and enjoyment.


Sexual performance anxiety disorder ranks among the most prevalent sexual disorders, impacting approximately 9–25% of men, leading to issues such as premature ejaculation and psychogenic erectile dysfunction (ED). Similarly, it affects about 6–16% of women, often resulting in a decrease in sexual desire.


Sexual performance anxiety disorder is not listed as a separate diagnosis in the DSM-5, but it can be considered a specifier of other anxiety disorders, such as social anxiety disorder or generalized anxiety disorder. If someone meets the criteria for social anxiety disorder and their primary fear or anxiety is related to sexual performance, then the specifier “performance only” can be added to the diagnosis.

It is important to note that not everyone who experiences sexual performance anxiety meets the criteria for a diagnosable mental disorder.

Symptoms of Sexual Performance Anxiety (SPA)

Symptoms of sexual performance anxiety disorder include both physical and mental impacts on individuals going through it. These symptoms can be severe and occur frequently or only occasionally. Its symptoms include:

  • Negative thoughts or self-doubt during sexual activity
  • Fear of sexual failure or inadequacy
  • Avoidance of sexual encounters
  • Decreased interest in sexual activity
  • Inability to reach orgasm
  • Physical symptoms such as sweating, trembling, or rapid heartbeat
  • Impact on self-esteem and relationship satisfaction

Specific Symptoms In Men

  • Difficulty achieving or maintaining an erection
  • Premature ejaculation
  • Delayed ejaculation

Specific Symptoms In Women

  • Pain during sex
  • Vaginal dryness
  • Difficulty getting aroused
Sexual performance anxiety disorder

Effect Of Sexual Performance Anxiety on Individuals 

Sexual performance anxiety disorder can impact an individual’s mental and emotional well-being, affecting their relationships and overall quality of life. 

  1. Sexual performance anxiety creates a vicious cycle. The worry about performing well can lead to more stress and anxiety, making it harder to relax and enjoy intimacy. This, in turn, can lead to difficulty getting or staying aroused, reinforcing the fear of failure.
  1. SPA can make you question yourself and your abilities, leading to feelings of insecurity, shame, and low self-esteem. This can further worsen the anxiety and create a barrier to open communication with your partner.
  1. In some cases, SPA can lead to a decrease in sexual desire (libido) and difficulty achieving or maintaining arousal. 
  1. Additionally, physical symptoms like tension and discomfort during sex can arise due to anxiety. This can actually make it harder for you to relax and enjoy yourself.
  1. If left untreated, SPA can take a significant toll on your mental health, contributing to feelings of depression, other anxiety disorders, and even decreased self-worth. It’s important to remember you’re not alone, and help is available.

Effect Of Sexual Performance Anxiety on Relationships 

SPA can affect the quality of our relationship. Let’s look at how it affects: 

  1. Sexual performance anxiety can make it difficult to talk openly and honestly with your partner about sex. The fear of judgment or disappointing them can lead to frustration and misunderstandings.
  1. The anxiety might make you withdraw emotionally or physically from intimacy. This can create distance in the relationship and leave your partner feeling rejected.
  1. When SPA takes hold, the focus can shift from enjoying intimacy to worrying about “performing well.” This can take away from the natural flow of intimacy and make sex less pleasurable for both partners.
  1. Unresolved sexual performance anxiety can strain the entire relationship. It can lead to feelings of resentment, insecurity, and dissatisfaction on both sides.
  1. The anxiety can make both partners less likely to initiate intimacy for fear of things going poorly. This can decrease overall sexual satisfaction and closeness in the relationship.

Causes Of Sexual Performance Anxiety (SPA)

Sexual performance anxiety disorder can be caused by a variety of biological and psychological factors. Let us talk about what exactly triggers anxiety related to sexual performance:

  • Viewing excessive pornographic content may lead to sexual performance anxiety disorder, as it may give you a distorted perception and expectation of what sex should look and feel like. Unrealistic portrayals in the media can make people believe that sex should be flawless, leading to feelings of inadequacy and anxiety.
  • If you struggle with body image and self-esteem, it can lead to sexual performance anxiety. This can happen during sexual activities if you’re overly self-conscious about your height, weight, or the appearance of certain body parts.
  • Are you experiencing emotional disconnection with your partner? This, too, could be a reason for your sexual performance anxiety, as unresolved emotional issues could lead to SPA.
  • Being stressed out impacts every part of our lives, including sexual performance anxiety disorder. SPA can occasionally be brought on by stress related to work-related issues or other circumstances.
  • Past negative sexual experiences and trauma can also lead to sexual performance anxiety disorder, as feelings of shame, guilt, and fear can interfere with sexual function and arousal. A research study showed that people who have traumatic pasts may feel awful mentally when experiencing orgasm, thus leading to performance anxiety in bed. 
  • Physical health issues such as erectile dysfunction, premature ejaculation, or other sexual dysfunctions can also develop sexual performance anxiety disorder, as the fear of not being able to achieve an erection and not being able to satisfy your partner can lower your self-esteem, exacerbating anxiety and sexual issues.
  • The use of alcohol, cigarettes, or other illegal drugs (cocaine, ecstasy, and marijuana) can impair blood flow and nerve function, essential for sexual arousal and response, causing sexual performance anxiety. All of these can impair sexual function, reduce libido, and also affect a person’s ability to achieve an erection.
  • Some prescription medications, including anti-depressants, anti-hypertensives, and anti-anxiety drugs, may have sexual side effects such as decreased libido or difficulty achieving orgasm, thus leading to SPA.
  • Certain chronic illnesses, like diabetes, heart disease, and hormonal imbalances, can affect sexual function and contribute to anxiety.
  • Recovering from illness or undergoing surgery can lead to physical discomfort or changes in body image, which may affect sexual confidence and performance.
  • As individuals age, they may experience changes in hormone levels, blood circulation, and physical stamina, which can impact sexual function and contribute to performance anxiety.
  • In some cultures and social groups, sexual performance is wrongly equated with masculinity and virility. This pressure to prove oneself sexually can be a significant source of anxiety, especially for men.
  • Fear of failure to satisfy a partner or fear of being judged can create performance anxiety. Additionally, some people may have a general fear of intimacy due to emotional vulnerability or past experiences. This makes it difficult to fully engage in sexual encounters, which can manifest as performance anxiety.

When a person has sexual performance anxiety disorder, they become even more anxious when they engage in sexual activity the next time, as they were unable to perform the last time. 

Many people also confuse sexual performance anxiety with erectile dysfunction, so now we are going to read about what erectile dysfunction is and how it is related to SPA. 

Sexual performance anxiety disorder

What is Erectile Dysfunction

The inability and difficulty to achieve and maintain an erection strong enough to engage in sexual activity is known as erectile dysfunction. It is also known as impotence or ED. 

According to a study conducted in Massachusetts, it was found that approximately 52% of men experience erectile dysfunction. The study also showed that erectile dysfunction is more common in older adults. For instance, around 40% of men are affected by erectile dysfunction at the age of 40, while the percentage rises to 70% by the age of 70.

The Link Between SPA and Erectile Dysfunction

Performance anxiety and erectile dysfunction are not the same but they are closely linked. In fact, Performance anxiety is a common psychological cause of ED, as it triggers the release of stress hormones like cortisol, which can interfere with blood flow to the penis, thus making it difficult to get an erection. 

On the other hand, ED can worsen performance anxiety, as having ED can be frustrating and embarrassing for an individual, which can contribute to more anxiety in future sexual activities.

Treatment Of Sexual Performance Anxiety

Now coming back to our main point, how to overcome male performance anxiety and how to overcome sexual performance anxiety in females. Furthermore, this part will also answer how to overcome the fear of sex. By treating performance anxiety, we also treat the fear of sex. 


Psychotherapy or talk therapy can be effective in overcoming sexual performance anxiety.

  1. Cognitive behavioral therapy (CBT) is the type of talk therapy that helps you identify your thoughts and behavioral patterns, learn how to change them, and develop new coping strategies. It has been recommended for the treatment of sexual performance anxiety. Research conducted on the effects of CBT on anxiety related to sex found it effective for treating sexual performance anxiety and sexual dysfunction. 
  1. Exposure therapy can also be used to reduce feelings of fear related to sex. In exposure therapy, a person with sexual performance anxiety is exposed to their fear in a safe and controlled environment to help them overcome that fear. 
  1. Sex therapy is another option, which focuses on addressing sexual concerns and dysfunctions through open communication, education, and tailored techniques, helping individuals and couples overcome sexual performance anxiety by exploring intimacy, enhancing pleasure, and building confidence.
  1. Couple therapy may also be employed, in which individuals with sexual performance anxiety talk openly with their partner and delve into emotions that may impact sexual performance. This therapy concentrates on the couple’s overall relationship, aiming to eliminate shame, fear, and misunderstandings. By fostering a peaceful and supportive environment, couple therapy helps reduce anxiety related to sexual performance.
Sexual performance anxiety disorder


If erectile dysfunction is the root cause of sexual performance anxiety, then specific medications are recommended to treat the condition and reduce anxiety related to it. These medications include oral pills such as phosphodiesterase type-5 inhibitors, suppositories, and penile injections. 

Male patients suffering from sex anxiety who are unable to sustain an erection may find relief with erective dysfunction drugs such as Cialis (tadalafil) and Viagra (sildenafil). These drugs help maintain an erection by increasing blood flow to the penis.

If the individual has low libido and low testosterone levels, then testosterone replacement therapy is done with gels and injections. 

There is also hope for treating the symptoms of sexual performance anxiety with buspirone, bupropion, and trazodone.

How to Cope with Sexual Performance Anxiety?

Beyond talk therapy and medications, overcoming male performance anxiety also includes different coping mechanisms. Let’s read some coping strategies that can be helpful in overcoming performance anxiety in bed.

1. Effective Communication With Your Partner

Talking with your partner about your sexual problems can help you overcome them. It is important because it facilitates understanding of sexual performance anxiety challenges between partners, maintains stronger relationships, and also helps in seeking practical solutions together. 

2. Yoga 

Yoga is also an effective method for overcoming sexual performance anxiety, as it helps in managing premature ejaculation and improving overall sex functions. Studies have demonstrated the efficacy of yoga techniques like yoga postures (yogasana), breathing techniques (pranayama), locks (bandha), hand gestures (mudra), relaxation exercises, chanting of Aum, yoga nidra, and meditation in addressing different types of sexual dysfunctions, particularly premature ejaculation.

Yoga is also used to help with different types of anxiety, as research shows that yoga is used for treating different mental health disorders. So, if the main reason behind your sexual performance anxiety is psychological, then yoga can help you cope with it.

3. Mindfulness Meditation

Study shows that mindfulness meditation has been shown to be effective for sexual performance anxiety disorder.

It helps you get into a relaxed state by calming the mind’s thoughts and replacing negative thoughts with positive ones so it is beneficial for overcoming anxiety related to sex.

4. Exercise 

There are many exercises that you can practice to help with sexual performance anxiety, as sometimes the underlying reason behind SPA is how you look while you are having sex and not being able to do it. 

You can try deep breathing exercises, which can help calm your mind and body, progressive muscle relaxation, sensate focus exercises, self-compassion exercises, and pelvic floor exercises for overcoming sexual performance anxiety, as all of these exercises can be helpful.

5. Try New Things

Trying new things in the bedroom and experimenting with different types of sexual activities can help reduce sexual performance anxiety. It can help you discover what works for you and your partner and improve your sexual experience.

Like you can spend more time in foreplay before having sex. It will help to reduce the anxiety that you feel about sex and eventually be helpful for your sexual activity.

6. Sexual Education 

One of the reasons that causes Sexual Performance Anxiety is lack of knowledge and understanding about sexual health and anatomy. It’s necessary that you educate yourself about sexual anatomy, as it can help you alleviate fears and anxiety related to sexual performance. 

To feel more in control and self-assured during sex, invest some time in learning about human sexuality, sexual response, and the emotional and physical aspects of sexual activity.

7. Focus On Your Senses During Sex

The big mistake that many individuals make during sexual activity is that they focus on performance rather than enjoying it. You can try to focus on sensations during sex like touch, pleasure, and intimacy. 

Focusing on your senses can help you be aware of the present moment and enjoy the sexual experience, rather than being anxious about sexual performance.

8. Accept Yourself Unconditionally

You can deal with SPA better if you fully accept your body and who you are. Try to focus on your own desires, strengths, and needs rather than comparing yourself to others. Many times, comparing yourself and having unrealistic expectations of your own sexual performance can contribute to SPA.

Every time you start to compare, remember that sex is an individual and unique experience and what might work for someone else may not work for you. 

9. Masturbation

Masturbation can be helpful in coping with sexual performance anxiety disorder. During masturbation, you explore your own body and sexual responses and it can help you gain a better understanding of what feels good to you and what doesn’t. 

Masturbation can help you feel more comfortable with your own sexuality. It builds your confidence and can help you focus on your own pleasure and sexual experience rather than worrying about performance.

Self-Help Books for Sexual Performance Anxiety 

There are many self help books available that could be helpful for sexual performance anxiety. 

1. ANXIETY AND SEXUAL PERFORMANCE: Strategies to Improve Sexual Performance by Overcoming Anxiety

This book is by Ekene Ugwuanyi. It helps with problems that are related to sexual performance anxiety. This book provides proven strategies to break free from SPA and enjoy sexual intimacy.

Sexual performance anxiety disorder

2. Sexual Performance Anxiety: How Desire To Be Liked Is Leading Men Towards Psychological Erectile Dysfunction (Mental Impotence) 

This book is written by Leon Miklai. This book addresses the core issues behind sexual performance anxiety. The author of this book assists men in regaining their confidence in their sexuality and getting rid of sexual performance anxiety.

Sexual performance anxiety disorder

3. Performance Anxiety: Life After Sexual Abuse: A Story of Brokenness, Redemption, and Freedom

This book is by Jackie McCown. The author went through sexual trauma and by sharing her story, she gave other people a safe place to share their story, which is going to eventually help them heal and make their sexual lives better.

Sexual performance anxiety disorder

Organizations for Sexual Therapy 

1. American Association of Sexuality Educators, Counselors, and Therapists (AASECT): 

AASECT is a nonprofit organization that promotes sexual health and wellness through education, counseling, and therapy. AASECT has certified sex therapists, counselors, and educators on its website to help people according to their situations. 

2. The World Association for Sexual Health (WAS)

It is a global organization that provides information and resources on various sexual health-related topics.

3. Society for Adolescent Sexual Health (SASH): 

It is a nonprofit organization that works to improve sexual health and helps people overcome problematic sexual behaviors. It also provides resources and training for professionals who work with adolescents and young adults.


We all know that the topic of sex is a difficult one to address, especially for men. When they are going through any sexual problem, like erectile dysfunction, it becomes harder for them to talk about it and go to a doctor to address their problem. 

But in this blog post on sexual performance anxiety disorder, we have tried to answer all questions related to it, especially overcoming sexual performance anxiety and which treatment options you can take. 

Remember, sexual performance anxiety is a psychological phenomenon, so you should take steps to address your concerns and fears regarding it and there is no shame about it. By practicing self-care, relaxation techniques, and focusing on intimacy rather than performance, you can work towards overcoming sexual performance anxiety disorder and erectile dysfunction.


How do I stop sexual performance anxiety?

You can stop SPA by developing strategies such as doing yoga, meditation, and talking with your partner about your anxiety so you both can sort it out together. You can also get professional assistance for it, in which case drugs and psychotherapies can help you get past it.

How do you support your partner with sexual performance anxiety?

You can support your partner with SPA by listening and validating their feelings. Let them know that what they are experiencing is normal and show empathy and understanding towards them. You can also encourage your partner to share their thoughts and feelings with you, as open and honest communication can also help alleviate symptoms of anxiety. 

You can also motivate them to seek professional therapy, as professional guidance can help them learn new techniques to cope with sexual anxiety. Encourage your partner to practice relaxation techniques such as deep breathing, meditation, or yoga to help reduce anxiety and stress before engaging in sexual activity.

How does a man with ED feel?

A man with erectile dysfunction (ED) may feel various emotions, including frustration, embarrassment, disappointment, and even shame. He may feel inadequate or less masculine because he cannot perform sexually as he desires. ED can also lead to anxiety and stress, especially during intimate moments, as he may worry about his ability to satisfy his partner or fear rejection. Additionally, feelings of sadness or depression can arise due to the impact of ED on self-esteem and relationships. Overall, ED can profoundly affect a man’s emotional well-being and quality of life.

Is performance anxiety curable?

Yes, performance anxiety is often curable. With the right approach, which may include therapy, different mindfulness practices, lifestyle changes, and communication with a partner, many people can overcome performance anxiety and improve their sexual experiences. It’s essential to seek help and explore various strategies to address and manage performance anxiety effectively.