Sexual Performance Anxiety in Men: How Counselling & Psychotherapy Can Help.
Sexual performance anxiety is something many men experience, yet it can be surprisingly difficult to talk about.
An erection that disappears, ejaculating sooner than you wanted, difficulty reaching orgasm or simply not feeling as sexually responsive as expected can quickly become more than a one-off experience. You may start wondering whether it will happen again.
And that's often where the difficulty grows.
Instead of being absorbed in intimacy, part of your attention starts checking what your body is doing. Am I going to lose my erection? Am I taking too long? What is my partner thinking?
Sex can gradually become something you're monitoring rather than experiencing.
What is sexual performance anxiety in men?
Sexual performance anxiety describes anxiety or worry connected with sexual activity and concerns about how you will respond or perform.
Research suggests sexual performance anxiety can contribute to or maintain common sexual difficulties, including psychogenic erectile dysfunction and premature ejaculation (Pyke, 2020).
For some men, difficulties begin during a particularly stressful period. For others, one unexpected sexual experience becomes significant because of what happens afterwards.
The mind remembers it.
Next time, you're more alert. You monitor your response and try harder to make sure everything works. Unfortunately, trying to control something that usually happens relatively automatically can create even more pressure.
Erection difficulties, premature ejaculation and anxiety
It's understandable that men can attach considerable meaning to sexual functioning.
An erection can become interpreted as evidence of attraction. Maintaining it becomes evidence that you're sexually capable. How long sex lasts can become another measure of whether you've performed successfully.
When something changes, thoughts can quickly move from “that didn't go as expected” to “what if there's something wrong with me?”
That can affect confidence beyond sex.
Some men withdraw from intimacy. Others seek reassurance or become increasingly focused on satisfying their partner. You might avoid initiating sex because avoiding the possibility of another difficult experience feels safer.
These responses may reduce anxiety temporarily, but they can also reinforce the idea that sex is something to worry about.
Sexual confidence and self-esteem
Sexual performance anxiety doesn't necessarily exist in isolation.
Perhaps you're already someone who puts considerable pressure on yourself to get things right. You might overthink, compare yourself with others, worry about disappointing people or find uncertainty difficult.
Those patterns can enter intimate relationships too.
There can also be expectations around what being a man sexually is supposed to look like: being confident, wanting sex and having a body that responds reliably.
Real human sexuality is considerably less predictable.
Stress, tiredness, emotional wellbeing, relationships, medication and physical health can all affect sexual response.
Sexual anxiety, relationships and intimacy
Performance anxiety can gradually affect how you relate to your partner.
Physical affection may become complicated because you worry it will lead to sex. You may become more sensitive to perceived rejection or question whether your partner still finds you attractive.
For some men, the emotional vulnerability involved in intimacy can be just as significant as the physical experience.
Research into adult attachment and sexual functioning has found associations between anxious and avoidant attachment, lower sexual satisfaction and greater sexual difficulties (Stefanou & McCabe, 2012).
This doesn't mean attachment explains everyone's experience. Therapy is about understanding your individual patterns rather than trying to fit you into a particular theory.
Can counselling and psychotherapy help with sexual performance anxiety?
As an integrative counsellor and psychotherapist, I don't assume there is one explanation for sexual performance anxiety or one therapeutic approach that will suit everyone.
We might explore confidence and self-esteem, relationships, earlier experiences or the meaning you've started attaching to what happens sexually. We may look at patterns of thinking, anxiety and self-monitoring, alongside developing different ways of responding to them.
My integrative practice also means that, where appropriate, I can incorporate Solution-Focused approaches and clinical hypnotherapy into our work.
A Solution-Focused approach can help us look beyond the problem itself towards what you would like to be different, noticing existing strengths, resources and signs of progress. Clinical hypnotherapy can offer another way of working with attention, relaxation and patterns associated with anxiety and confidence.
Neither is about promising a quick fix or making your body respond in a particular way.
The broader aim is to reduce the pressure surrounding sex, understand what may be maintaining the anxiety and help you develop a more flexible relationship with yourself and intimacy.
When should you speak to your GP?
Sexual difficulties aren't always psychological.
The NHS identifies stress, tiredness and anxiety among factors that can affect erections, but persistent erectile difficulties can also be associated with physical health conditions, medication and hormonal factors (NHS, 2023).
If erection difficulties are persistent, new or causing concern, speaking with your GP or another appropriate healthcare professional is an important first step.
Counselling and psychotherapy can work alongside medical assessment, supporting the emotional and psychological aspects of what you're experiencing.
Counselling and Psychotherapy for men’s sexual performance anxiety in Oxfordshire and online
If sexual performance anxiety is affecting your confidence, relationship or enjoyment of intimacy, you don't need to understand exactly why before coming to therapy.
I offer integrative counselling and psychotherapy from my private practice in Upper Heyford, near Bicester, Oxfordshire, as well as online across the UK.
Therapy provides a confidential and non-judgemental space to understand what's happening, reduce some of the pressure you've been carrying and begin finding a way forward that works for you.
References
NHS (2023) Erectile dysfunction (impotence). NHS. Available at: NHS website. Last reviewed 28 July 2023.
Pyke, R.E. (2020) ‘Sexual Performance Anxiety’, Sexual Medicine Reviews, 8(2), pp. 183–190. doi:10.1016/j.sxmr.2019.07.001.
Stefanou, C. and McCabe, M.P. (2012) ‘Adult Attachment and Sexual Functioning: A Review of Past Research’, The Journal of Sexual Medicine, 9(10), pp. 2499–2507. doi:10.1111/j.1743-6109.2012.02843.x.
Frequently asked questions
Is sexual performance anxiety common in men?
Yes. Sexual performance anxiety can affect men at different ages and stages of life. It may develop following a difficult sexual experience, during periods of increased stress or alongside worries about confidence, relationships or sexual functioning. For some men, worrying about whether something will happen again can become part of what keeps the anxiety going.
Can anxiety cause erection difficulties?
Anxiety can contribute to erection difficulties. When you're focused on whether you'll get or maintain an erection, attention can shift away from intimacy and towards monitoring your body's response. However, erection difficulties can also have physical or medication-related causes, so persistent or new difficulties should be discussed with your GP.
How do I stop overthinking during sex?
Trying to force yourself to stop thinking can sometimes create even more pressure. Counselling & Psychotherapy can help you understand what you're monitoring or worrying about, why those concerns have become important and how you might respond differently. The aim isn't to achieve a completely anxiety-free mind, but to become less caught up in monitoring yourself and more able to remain present.
Can counselling and psychotherapy help with sexual performance anxiety?
Counselling and psychotherapy can provide a confidential space to explore the anxiety, confidence, self-esteem or relationship patterns that may be contributing to sexual performance concerns. As an integrative therapist, I can draw on different approaches depending on your individual needs, including Solution-Focused approaches and, where appropriate and agreed together, clinical hypnotherapy.
About the Author
Andrew Selway is a qualified integrative counsellor, psychotherapist and clinical solution-focused hypnotherapist based in Upper Heyford, near Bicester, Oxfordshire.
He supports adults with anxiety, workplace stress, burnout, confidence, perfectionism, relationship difficulties and life transitions through counselling, psychotherapy and solution-focused hypnotherapy, both in person and online across the UK.
Before retraining as a therapist, Andrew spent over 20 years working in senior HR, recruitment and business leadership, giving him a particular understanding of the pressures faced by professionals, managers and business owners.