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Sexual Performance Anxiety: Symptoms, Causes, Treatment

Article By Ashley Olivine, Ph.D., MPH

~ October 2021 ~ Sexual performance anxiety is a type of performance anxiety that involves a fear or worry related to sexual activity. This can happen during sex, or even before sex. The term sexual performance anxiety is sometimes shortened to just performance anxiety.

Sexual performance anxiety is sometimes confused with erectile dysfunction. However, while sexual performance anxiety can sometimes lead to erectile dysfunction, they are two different conditions.

Erectile dysfunction is the physical inability to get or keep an erection, and sexual performance anxiety is sexual worry or fear of not being able to satisfy a partner, get or keep an erection, or other factors.


Like other types of performance anxiety, symptoms of sexual performance anxiety include both physical and mental effects. These symptoms can range in severity and may be frequent or occur only occasionally.

Men and women can both experience sexual performance anxiety, but some of the symptoms may be different.

Sexual Performance Anxiety Symptoms

Symptoms of sexual performance anxiety include:

  • Negative thoughts before or during sex
  • Negative thoughts or feelings associated with sex
  • Worry or fear before or during sex
  • Worry or fear when thinking about sex
  • Inability to climax or orgasm during sex
  • Premature ejaculation (men)
  • Delayed ejaculation (men)
  • Erectile dysfunction (men)
  • Vaginal dryness (women)
  • Pain during sex (women)
  • Decreased interest in sex
  • Increased heart rate
  • Sweating
  • Unsettled stomach


Sexual performance anxiety can be diagnosed by your primary care provider or an expert mental health professional, such as a psychiatrist, psychologist, or therapist.

These healthcare providers are able to assess physical and mental symptoms, along with associated thoughts or circumstances, to provide a diagnosis. Further, they are able to help develop a treatment plan.


There are many causes of sexual performance anxiety that involve fears or worries related to sex.

Some people may be concerned by body image insecurities such as weight or worry about their ability to satisfy a partner. Others may have had previous negative sexual experiences or relationship challenges.

General stress or anxiety, societal or other pressure to perform, alcohol, smoking, and illegal drugs are also possible causes. Sexual performance anxiety can even be a side effect of certain medications.

Regardless of the cause, treatment options are available to address the issue.


Sexual performance anxiety is a mental health condition. It can occur along with and be linked to other mental health conditions, such as depression.

Further, these conditions can intensify one another, with depression increasing sexual performance anxiety symptoms and sexual performance anxiety increasing depression symptoms.

Fortunately, sexual performance anxiety can be treated. Common treatment approaches include medications, psychotherapy, or both.


Psychotherapy, or talk therapy, is the primary treatment for sexual performance anxiety.

Cognitive behavioral therapy (CBT) is the most common type of talk therapy used to treat sexual performance anxiety in men and women. This option has been found effective in treating sexual performance anxiety related to a variety of different causes.

Exposure therapy and systematic desensitization may also be used to help reduce the feelings of fear related to sex.

Exposure therapy is a process that allows the person with sexual performance anxiety to face the fear in a safe and controlled setting as a way to overcome that fear. Systematic desensitization is a process that involves both relaxation and gradual exposure.


If erectile dysfunction is part of the cause of sexual performance anxiety, medications may be prescribed to address the erectile dysfunction and alleviate the associated anxiety.

These medications include oral pills called phosphodiesterase type-5 inhibitors, penile injections, and intraurethral medications. If there is an issue with low libido and finding of low testosterone levels, then testosterone replacement therapy can occur with gels or injections.

Erectile Dysfunction Medicinal Treatments

Medications used to treat erectile dysfunction include:

  • Viagra (sildenafil)
  • Cialis (tadalafil)
  • Levitra (vardenafil)
  • Stendra (avanafil)
  • Caverject, Trimix, Bimix, and QuadMix (intracavernous injection)
  • Muse (alprostadil urethral suppository)


Beyond talk therapy and medications for treatment, there are other ways to cope with sexual performance anxiety.

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Mindfulness meditation, yoga, and talking with partners are all possible coping strategies. These options can be used alone, in combination with one another, or along with psychotherapy or medication treatment options.

Mindfulness Meditation

Mindfulness meditation training has been found effective in treating sexual performance anxiety.

This process is often used to cope with different types of anxiety, among other challenges, including physical and mental health and general life challenges. It involves learning how to get into a relaxed state, often with eyes closed and resting comfortably.

Some of the goals of the practice are to calm a mind with many thoughts, replace negative thoughts with more neutral or positive thoughts, and gain more awareness and control of the body and mind together.

Mindfulness practices can also be used without meditation.


Yoga is another practice that is often used to cope with different types of anxiety and many other physical and mental health challenges. It has been used to address sexual performance anxiety and erectile dysfunction.

There are even bedroom yoga practices specifically for overcoming sexual challenges and improving sexual satisfaction. This is a practice that can be used by a person struggling with sexual performance anxiety as a daily wellness habit or together with a partner.


Talking with sexual partners can help a person cope with sexual performance anxiety. This is beneficial because it facilitates understanding between sexual partners of the performance anxiety challenges, builds stronger relationships, and can lead to determining practical solutions together.

Communication with partners can also be used as part of mindfulness meditation or yoga practices.

Sexual performance anxiety can be challenging both mentally and socially, and can negatively impact romantic relationships.

If you are struggling with this condition, help is available. Reach out to your primary care physician, mental health professional, or a member of your healthcare team for support.

With a variety of medicinal and psychotherapy treatment options available, plus coping techniques, sexual performance anxiety is a condition that can be overcome.

Mental Health Resources

If you or a loved one is struggling with sexual performance anxiety, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

A version of this article originally appeared here on


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