14 Minutes

Edited & medically reviewed by THE BALANCE Team
Fact checked

Sexual performance anxiety is a remarkably common challenge that affects individuals in intimate moments. It’s a complex interplay of psychological and physiological factors, causing persistent worry, fear, or nervousness about one’s sexual performance. 

Fixing sexual performance anxiety isn’t just about enhancing physical abilities; it’s about addressing the mental and emotional aspects that can hinder a satisfying sexual experience. Performance anxiety sexually can lead to difficulties such as erectile dysfunction, premature ejaculation, or difficulty reaching orgasm, creating a self-perpetuating cycle of fear and frustration. 

Contrary to popular belief, sexual performance anxiety is not solely a male problem; it can impact people of all sexes and sexual orientations. Let’s educate ourselves and know more about this common yet unrecognized issue, make informed decisions, and enjoy sex life to the fullest.

Sexual performance anxiety is a psychological condition characterized by excessive worry, fear, or nervousness about one’s sexual performance during intimate activities. 

It can affect anyone, regardless of gender or sexual orientation, and often arises when an individual places immense pressure on themselves to perform perfectly in the bedroom. This pressure can stem from various sources, including societal expectations, past experiences, or self-esteem issues.

Key Facts About Sexual Performance Anxiety

To understand this issue better, let’s explore some key facts:

Physical and Psychological Aspects: Sexual performance anxiety can manifest physically, causing difficulties in achieving or maintaining an erection in men (commonly known as erectile dysfunction) or leading to vaginal dryness and difficulty reaching orgasm in women. It’s essential to recognize that it also has a significant psychological component, influencing how individuals perceive their sexual prowess. 

Common Among All Ages: Sexual performance anxiety can affect people of all ages, although it’s more common among younger individuals who may feel the pressure to meet unrealistic sexual expectations.

Temporary or Chronic: It can be a temporary issue that arises in specific situations or a chronic concern that affects a person’s overall sexual well-being.

Cycle of Anxiety: One of the vicious cycles of sexual performance anxiety is that the fear of not performing well can lead to the very problem an individual is anxious about, creating a self-fulfilling prophecy.

Impact on Relationships: This anxiety can strain relationships and lead to communication problems, as individuals often find it challenging to discuss their fears and concerns openly.

How Sexual Performance Anxiety Develops

Understanding how sexual performance anxiety develops can shed light on its underlying causes. Several biological mechanisms and psychological factors contribute to its development:

Hormones play a crucial role in sexual function. Stress hormones like cortisol can interfere with the body’s natural sexual response, potentially leading to difficulties in achieving or maintaining an erection. Additionally, conditions like heart disease, diabetes, and obesity can contribute to sexual performance issues.

Worries about what a partner may think or fear of being judged can contribute to anxiety during sexual activities. This fear can be especially potent in new relationships or when there is a lack of emotional intimacy.

How Common Is Sexual Performance Anxiety?

Sexual performance anxiety is more common than you might think. Here are some statistics to give you a better perspective:

Approximately 9% to 25% of men experience erectile dysfunction at some point in their lives, which often has psychological components, including performance anxiety [1].

Women can also experience sexual performance anxiety, with varying degrees of difficulty reaching orgasm or experiencing sexual pleasure.

While specific statistics on the prevalence of sexual performance anxiety can vary, it’s clear that it affects a significant portion of the population.

Who Is Likely To Get Sexual Performance Anxiety?

Sexual performance anxiety can affect anyone, but certain demographics may be more susceptible to it:

Younger Individuals: Young adults and those in their twenties often face societal pressures to meet unrealistic sexual expectations. The fear of not living up to these expectations can lead to performance anxiety.

New Relationships: Individuals in the early stages of a romantic relationship may feel more pressure to perform perfectly, as they are still getting to know each other sexually.

History of Trauma: People with a history of sexual trauma or negative sexual experiences may be more susceptible to sexual performance anxiety.

Low Self-Esteem: Individuals with low self-esteem or body image issues may be more prone to anxiety during intimate moments.

Lack of Sexual Education: Those who haven’t received comprehensive sexual education may feel unprepared and anxious about sexual encounters.

When sexual anxiety rears its head, it often brings along some unwelcome companions. Let’s explore what sexual anxiety is and the common issues that tend to co-occur with it.

Depression and Anxiety Disorders: Sexual anxiety often goes hand in hand with mood disorders like depression and generalized anxiety. These conditions create a cycle where anxiety can lead to sexual issues, and sexual issues can worsen anxiety and depression.

Relationship Problems: Sexual anxiety can strain relationships, leading to communication breakdowns, emotional distance, and conflicts with partners.

Substance Abuse: Some individuals turn to drugs or alcohol as a way to cope with sexual anxiety, which can lead to substance abuse issues.

Erectile Dysfunction: For men, sexual performance anxiety can contribute to erectile dysfunction, creating a vicious cycle of anxiety and sexual issues.

Vaginismus and Pain During Sex: Women may experience conditions like vaginismus, which causes involuntary muscle contractions, making intercourse painful.

Avoidance of Sex: To cope with anxiety, some individuals avoid sexual encounters altogether, which can strain relationships and hinder personal growth.

Infidelity Concerns: Worries about a partner seeking sexual satisfaction elsewhere can further exacerbate anxiety.

Lack of Sexual Desire: Sexual anxiety can lead to a decrease in sexual desire, making it challenging to engage in intimate activities.

Sexual performance anxiety can cast a shadow over your intimate moments, but the first step in overcoming it is recognizing the symptoms. 

Let’s explore how to identify if you have sexual performance anxiety and what sex anxiety symptoms to look out for.

Common Sex Anxiety Symptoms

Difficulty Achieving or Maintaining Erection: In men, this is one of the most noticeable signs. Anxiety can interfere with the physiological processes necessary for a strong erection.

Premature Ejaculation: Rapid climaxing due to anxiety is another common symptom. It can lead to dissatisfaction for both partners.

Delayed Ejaculation: Some men may experience difficulty reaching orgasm, or it may take an extended period. This can create frustration and anxiety.

Difficulty Lubricating: Women may struggle with vaginal dryness, making intercourse uncomfortable or painful.

Inability to Relax: Feeling tense, nervous, or on edge during sexual encounters is a hallmark of sexual performance anxiety.

Negative Self-Talk: Persistent self-doubt and negative thoughts about one’s sexual abilities can contribute to anxiety.

Racing Thoughts: An overactive mind during sex, with worries about performance and judgment, is common.

Avoidance of Sexual Situations: Individuals with sexual performance anxiety may start avoiding sexual activities altogether to prevent anxiety triggers.

Relationship Strain: Frequent arguments, emotional distance, or dissatisfaction in a relationship can be a sign that sexual performance anxiety is affecting the partnership.

How to Know If You Have Sexual Performance Anxiety

Self-Reflection: Start by examining your feelings and behaviors during sexual encounters. Do you often feel nervous, worried, or self-conscious? Are these feelings interfering with your ability to enjoy sex?

Persistent Issues: If you consistently experience difficulties like erectile dysfunction, premature ejaculation, or pain during sex, and these issues are causing distress, sexual performance anxiety could be at play.

Relationship Struggles: If your intimate relationship is strained, with frequent conflicts or a lack of emotional connection, it’s essential to consider the impact of sexual performance anxiety.

Avoidance Behavior: Do you find yourself avoiding sexual situations or making excuses to evade intimacy? This avoidance can be a red flag.

Negative Self-Talk: Pay attention to your inner dialogue. If you often berate yourself or doubt your sexual abilities, it may be a sign of anxiety.

Sexual performance anxiety is like a pesky shadow that can haunt anyone during intimate moments. It’s that unsettling feeling that makes you question your abilities in the bedroom. But what causes sexual performance anxiety? Let’s dig into the various categories of causes that contribute to this common issue.

Psychological Factors

Psychological factors play a significant role in the development of sexual performance anxiety. These factors can include:

  • Past Negative Experiences
  • Fear of Rejection or Judgment
  • Low Self-esteem and Body Image Issues
  • Relationship Problems
  • Unrealistic Expectations
  • Stress and Anxiety
  • Lack of Sexual Education
  • Traumatic Events

These psychological factors can create a whirlwind of thoughts and emotions that interfere with the ability to relax and enjoy sexual encounters.

Biological Factors

Biological factors can also contribute to sexual performance anxiety. These include:

  • Hormonal Imbalances 
  • Health Conditions
  • Medications 
  • Age 
  • Physical Fitness
  • Substance Abuse
  • Fatigue 
  • Fear of Physical Dysfunction

Biological factors may affect the body’s physical response during sex, leading to anxiety about performance.

Societal And Cultural Pressures

Societal and cultural pressures can create an environment ripe for sexual performance anxiety. These pressures can include:

  • Media and Pornographic Influence
  • Social Comparisons
  • Stereotypes and Gender Expectations
  • Peer Pressure
  • Fear of Not Meeting Expectations

Relationship Dynamics

The dynamics within a relationship can play a significant role in causing sexual performance anxiety. These dynamics may involve:

  • Lack of Communication
  • Relationship Conflicts
  • Trust Issues
  • Emotional Intimacy Concerns
  • Fear of Displeasing Partner

When partners don’t feel safe or comfortable discussing their needs and desires, it can lead to performance anxiety.

Lack Of Sexual Knowledge

A lack of sexual education can contribute to sexual performance anxiety. When individuals aren’t informed about their own bodies or sexual health, they may feel unprepared and anxious about sexual encounters.

Personal Beliefs And Values

Individual beliefs and values about sex and intimacy can also be a cause of sexual performance anxiety. If someone’s personal beliefs clash with their sexual desires or behaviors, it can lead to anxiety.

Fear of Pregnancy or STIs

Fear of unintended pregnancy or sexually transmitted infections (STIs) can add an extra layer of anxiety during sexual encounters. Worries about contraception or the risk of infection can make it difficult to relax and enjoy sex.

Sexual performance anxiety can cast a dark shadow over intimate moments, but fear not – there are ways to overcome it and enjoy a fulfilling sex life. Let’s explore various tips and strategies to help you conquer sexual performance anxiety.

Communication is Key: One of the most effective tools in overcoming sexual performance anxiety is open and honest communication with your partner. Discuss your fears, desires, and expectations. Knowing that your partner understands and supports you can relieve a significant portion of anxiety.

Manage Stress: Stress and anxiety often contribute to sexual performance issues. Engage in stress-reduction techniques like deep breathing, meditation, or yoga. Regular exercise can also help lower stress levels.

Challenge Negative Thoughts: Identify and challenge negative thoughts related to sexual performance. Replace them with positive affirmations. Remember, no one is perfect, and there’s no such thing as a flawless sexual encounter.

Sensate Focus: Sensate focus exercises involve exploring your partner’s body without the goal of sexual performance. This can help you become more comfortable with touch and intimacy, reducing anxiety.

Masturbation: Masturbation can be a helpful tool in managing sexual performance anxiety. It allows you to become more familiar with your body’s responses and can boost your confidence.

Relaxation Techniques: Practice relaxation techniques like progressive muscle relaxation before sexual encounters. This can help reduce physical tension and anxiety.

Set Realistic Expectations: Don’t put undue pressure on yourself to meet unrealistic sexual expectations. Remember that sex is a shared experience, and it’s okay to have imperfections.

Focus on Pleasure, Not Performance: Shift your focus from performance to pleasure. Explore your partner’s body, savor the sensations, and prioritize intimacy over achieving a specific outcome.

Sensate-Focused Touch: Engaging in sensual, non-demanding touch with your partner can help you become more comfortable with physical intimacy.

Gradual Exposure: Gradual exposure to sexual situations can desensitize you to anxiety triggers. Start with less anxiety-inducing situations and work your way up to more challenging ones.

Self-Care: Prioritize self-care in your daily life. Ensure you get enough sleep, eat well, exercise regularly, and engage in activities that bring you joy and relaxation.

Avoid Alcohol and Drugs: While some may use alcohol or drugs to cope with sexual anxiety, these substances can worsen the problem. They can impair sexual function and lead to dependency.

Apart from the self-help strategies discussed above, there are various effective treatments and strategies to help you overcome this issue and regain your confidence in the bedroom.

Medications For Sexual Anxiety

Anti-Anxiety Medications: In some cases, doctors may prescribe anti-anxiety medications like benzodiazepines to help alleviate anxiety symptoms related to sexual performance [2]. 

These medications can help you relax and reduce the anxiety associated with intimacy. However, they should only be taken under the guidance of a healthcare professional due to potential side effects and the risk of dependence.

Erectile Dysfunction (ED) Medications: For men who also struggle with ED as a result of sexual performance anxiety, medications like Viagra, Cialis, or Levitra can be helpful [3]. 

These drugs increase blood flow to the penis, making it easier to achieve and maintain an erection. However, they won’t address the root cause of anxiety and are not suitable for everyone.

Therapies For Sexual Performance Anxiety

Cognitive-Behavioral Therapy (CBT): CBT is one of the most effective therapies for sexual performance anxiety. It helps you identify and change negative thought patterns and behaviors that contribute to anxiety. Through CBT, you can learn relaxation techniques, boost your self-esteem, and improve communication with your partner [1].

Sex Therapy: Sex therapists specialize in addressing sexual concerns. They can provide a safe and non-judgmental space to discuss your fears and work on improving sexual performance. Couples therapy may also be beneficial if relationship issues are a contributing factor.

Mindfulness and Meditation: These practices can help you stay present and reduce performance-related worries. By learning to focus on the sensations and emotions in the moment, you can decrease anxiety and enhance your overall sexual experience.

When To Seek Professional Help

If sexual performance anxiety is significantly affecting your quality of life or relationships, it’s essential to seek professional help. Seeking treatment at inpatient treatment centers may be necessary in severe cases where anxiety is deeply ingrained or co-occurring with other serious mental health disorders [4]. A more advanced form of these centers is luxury inpatient treatment centers that offer intensive therapy and support in a controlled environment with upscale amenities and services.

Inpatient treatment can be beneficial when:

Symptoms are Severe: If your anxiety is causing severe distress or interfering with daily functioning, inpatient care can provide a higher level of support and monitoring.

Co-Occurring Disorders: When sexual performance anxiety co-occurs with other mental health issues like severe depression or substance abuse, inpatient treatment can address these complex issues simultaneously.

Safety Concerns: If your anxiety has led to self-harming behaviors or suicidal thoughts, an inpatient facility can provide a safe and secure environment where you can receive immediate help.

1. Very Well Mind. What Is Sexual Performance Anxiety?

2. Web MD. Sexual Performance Anxiety.

3. Choosing Therapy. Sexual Performance Anxiety: Causes, Treatments, & How to Cope.

4. Very Well Health. Overcoming Sexual Performance Anxiety.



The Balance RehabClinic is a leading provider of luxury addiction and mental health treatment for affluent individuals and their families, offering a blend of innovative science and holistic methods with unparalleled individualised care.


a successful and proven concept focusing on underlying causes


0 Before

Send Admission Request

0 Before

Define Treatment Goals

1 week

Assessments & Detox

1-4 week

Psychological & Holistic Therapy

4 week

Family Therapy

5-8 week


12+ week

Refresher Visit

Anxiety Insights

latest news & research on Anxiety
Anxiety and Memory Loss
A Mindful Recall: How are Anxiety and Memory Loss Connected?

While anxiety can trigger memory loss or contribute to it, it doesn’t always mean your memory will be affected

read more
panic attack hangover
Panic Attack Hangover

A panic attack hangover is the state of affairs after a panic attack but before the individual fully recovers from the effects of the episode

read more
Selective Mutism
Selective Mutism

Selective mutism (SM) is a childhood anxiety disorder that prevents a child from speaking within certain contexts and social environments

read more
Panic Attack vs. Anxiety Attack
Panic Attack vs. Anxiety Attack

Panic attacks vs. anxiety attacks are being used interchangeably in the light of certain similar symptoms, risk factors, and causes, including rapid heartbeat, dizziness, and shortness of breath.

read more


British Psychology Society
Institute de terapia neural
pro mesotherapie
Somatic Experience


Woman & Home
National World
American Banker
Marie Claire
La Nacion
Metro UK
General Anzeiger
Live Science
Mallorca Magazin
Apartment Therapy
Express UK
Manager Magazin
Entrepreneur ME
Khaleej Times
Business Leader
The Guardian
Daily Mail
Mallorca Zeitung
Mirror Uk
The Times
The Standard
The Stylist