Sexual Performance Anxiety in Men

Possibly every man will suffer from sexual performance anxiety at one time or another during the course of his sexual life. Sexual performance anxiety occurs when a man anticipates having some form of difficulty, such as difficulties with, or maintaining erections, or lack of arousal, causing him to be anxious or even panicked approaching or during sex. This can lead to a lack of desire, or an avoidance of sex all together. If one is able to have normal erections at other times apart from sex, e.g. when waking in the morning, or when masturbating, one is capable of having erections firm enough for intercourse, and thus the cause is unlikely to be physiological. If this isn’t the case, it’s a good idea to get a check up rather than leave it to chance. The problems performance anxiety causes in relationships aren’t limited to simply the lack of physical sex, but the lack of mutually intimate expression, feelings a man has about himself, his partner, and sex itself.

Physiologically, anxiety is a reaction, meant to be a warning system of a threat or danger; an evolutionary remnant from when our species was potential prey to predators. For example when a saber tooth tiger preyed upon early humans on the Savannah, some the symptoms resulting from anxiety-heart beating hard, fast, or pounding, sweating, trembling or shaking, shortness of breath, nausea, vomiting, dizziness, fainting, and fears of losing control, came in handy escaping predators. Still, even in the saber tooth tiger situation many of these symptoms are not ideal-one wouldn’t necessarily want to deal with vomiting while trying to run from the saber tooth tiger. And when the situation is the prospect of having sex with a partner one is attracted to, they are not wanted at all. In fact they go counter to the immediate experience. Humans are not geared to be anxious and have sex at the same time. Further, the symptoms of anxiety cause excessive worry and give one an exaggerated view of their problems, leaving them irritable, easily scared, and even depressed. If a man is anxious that there may be a problem during sex, his warning system doesn’t differentiate between real and perceived danger, but simply does its job, releasing chemicals that interfere with his sexual performance. More often than not, the real danger around sex is emotional, or psychological, and the resulting anxiety a rather unfortunate manifestation of these. But because the warning system acts on a perceived problem, without the man’s buy-in-he certainly doesn’t want this particular response-he not only has this unwanted, or unwarranted anxiety, but a physiological response that feels out of his control. This creates a self-fulfilling fear.

Many therapists believe that a man’s anxiety about sex is related to normal underlying fears and insecurities that have never been openly expressed, such as being rejected, disappointing a partner, his masculinity, his ability to perform, or anxieties related to his sexual practices and/or orientation. Feeling inadequate in any of these areas can be especially painful, and hits a man when he is most vulnerable and insecure.

Interestingly, a general observation about relationships and sex (at least heterosexual ones) is that while women need to be close to have sex, men need to have sex in order to be close. At an initial glance this is a no-brainer. It is assumed men always want or can have sex, while women simply take a little convincing. Another no-brainer. But this sells both sexes short. While it’s true that on average men tend to want physical sex more, this may be as much a biological condition as a social, or cultural one; it isn’t simply that women arbitrarily take convincing. Rather, as a generalization, women need to access their partner’s intentions for mutual feelings, or simply assurance that he is not a creep; in the same way a man might access for his partner’s openness towards, or availability for, sex. As sexual as men are physically, sex is also a powerful physical means towards an emotional expression. The clincher here is: as a means towards closeness. Men, who are typically less emotionally verbal than women, often find that sex is the means to manifest and express their emotions. Yet for some men, even though they get a physical response, when things get “serious”, it actually may mean more to them or have greater affect than they previously anticipated. It’s no longer “just sex” in the physical sense. It’s an emotional closeness, and one that may be affecting or threatening them. As a result, things stop working without their permission. Perhaps his body is saying “I’m not ready to be this close to this person.” Or the converse, maybe the man is ambivalent about his partner, and won’t let himself fully let go for fear it will encourage her and he will ultimately hurt her. In either case, it’s not sex or their partner that he is afraid of (he may really want to be sexual with his partner), but it’s negotiating the closeness he is afraid of. He may be afraid or hesitant to set or establish boundaries with his partner, and bare his vulnerability or ambivalence to her-or worse, in his head, where it churns with anxiety. If his anxiety occurs due to his partner–from her lack of interest in sex, or mistrust, he might experience this as a rejection and close himself off from her or discontinue the relationship. But if it occurs due to himself, he is really at a loss. His emotional means is compromised, and he is left with only approximations of expression, or worse, a feeling of failure. The myth of men is that they are always supposed to be arousable, willing, and able to partake in sex. But this is only a baseline, the bare essentials, from which a man is expected to perform, and perform mightily. A man’s sexual performance is often times synonymous with his identity, if not his perceived ability to even be a man.

For example, imagine a scene in some early adult romance. The young man is surrounded by his male peers, and across the way there is a group of girls. While the young man and peers are acting in a ribald manner, one of the girls is looking over at the young man flirtatiously. Suddenly the young man’s peers become aware of this and cajole the young man to go over and talk to her. He assures them he will get somewhere with her, yet when he finally approaches her he is quite shy and insecure. The former assurance he had from his male peers has fallen away. He struggles to say something to cover this up, but it comes out foolishly. The prior assurance doesn’t hold up against his own experience of attempting to interact with this girl and, in a manner of speaking, he is small, alone. It’s similar in terms of sex. By adhering to the sexual expectations put on him as a man, and failing at these due to performance anxiety, he suddenly finds himself small and alone, facing his humanness apart from being male, a man. And while it is this expectation that has failed him, he instead feels and fears, he has failed it and, by this, failed as a man. Not so much as a lover, as one individual to another, but as a man who is supposed to successfully embody this expectation and finds that that he can’t for one who is the expectant object of this expectation. Like the young man in the above scene, he is suddenly without the assurance promised or expected of him, and facing a very weighted interaction alone, and he stumbles to cover this up.

Sexual performance anxiety is a difficult situation to reverse, and can start from a single time in which the man loses or fails to maintain an erection. This can happen in even in a very stable, emotionally healthy man. The difficulty comes when one first notices that he may be going a little soft and, noticing that, it distracts him, and the focus on his performance or state of arousal takes him away from his goal, which is mutually enjoying sex with his partner. Like quicksand, the more frantic he becomes the worse the problem will become. Once having experienced this, and given the importance of sex- biologically, emotionally, and socially for men, the fear of not being able to perform at it is always present if even to varying degrees, causing problems of confidence in and out of the bedroom. Meaning, even if a man overcomes even a single event in which he cannot perform, the possibility that he might not be able to perform again lurks for him, and in a sense, gets initially placed over his sexual experiences like a template. If it’s a common occurrence for him, the template becomes less transparent. An actual part of his sexual experiences become pre-perceived as disappointing and emotional painful. As a result, he may then tend to approach sex with uncertainty, ambivalence, or avoid it altogether.

Men who are experiencing performance anxiety may begin to perceive sex as an obligation or a job that needs to be accomplished. They don’t want to disappoint their partner or the perceived reactions of other men, including themselves, and sex is no longer fun and enjoyable because they have lost sight of the pleasures involved in sexual contact. Performance anxiety causes the man to focus on the mechanics of sex rather than the pleasure, sensations and excitement. They are “spectating,” attempting to objectively observe themselves while simultaneously experiencing themselves in the midst of it: they become an observer rather than a participant. They are thinking about how they are doing to the exclusion of how they are feeling. Sex is best when one can shut the mind off, stop thinking about one’s self, and be lead by a passionately heightened sensual or sexual intuitiveness.

Possibly the best start is for a man to understand himself physiologically in terms of sexual drive or function. It is unclear whether males have a sexual cycle per se, despite a variance in testosterone and sperm levels. There is much data that suggests that males have both daily hormone cycles and perhaps yearly hormone cycles. Numerous studies have identified a daily rhythm in testosterone, the “male” hormone, production. In one Danish study, endocrinologists kept daily records of hormones excreted in men. When analyzed, those records showed that his hormones rose and fell in roughly a thirty-day rhythm. Testosterone is what fuels sexual function and libido in males. Low levels of testosterone can lead to erection problems, as well as reduce a man’s sex drive. Erection problems become more common with age. However, they can affect men at any age. While physical causes are more common in older men, emotional causes are more common in younger men.

What appears most likely is that the male sex cycle is weekly and not so much based on biology but stress levels. Men seem to be their most sexual Saturday and Sunday, and begin diminishing again Monday through Friday, rising again for the weekend. It is much more plausible to suggest that the male sexual cycle is different to varying degrees with each individual. Some men are just more often aroused than others. Understanding and accepting this and communicating it with one’s partner may be one step in relieving the pressure to perform according to unrealistic expectations.

Another consideration is one’s frequency of masturbating and/or the use of porn. Either or both may be too much. Today’s use of porn has skyrocketed to the degree that it is a norm. But perhaps too much of a good thing has its consequences. Aside from diminishing one’s libido through satiation, pornography creates unrealistic expectations about one’s self, partner, and the sequence or acts of sex. (Not to mention, the bombardment of images of super-attractive people and perfect, youthful bodies, especially female, that we get thought television and advertising, is like a constant stream of subtle porn. It has desensitized many of us, especially men, to the more generic attractiveness of ‘normal’ people and ‘older’ women.) If one is perpetually viewing young, perfect bodies, easily able to reach pitch perfect orgasms, they may only be setting themselves up for disappointment with the imperfections of real life partners. And it isn’t like this disappointment isn’t communicated, subtly or otherwise, which in turn creates static in connection and their partner’s feeling of attractiveness and security, and can insure long-standing conflicts. Pornography also has a thrill that tapers, if not or wares off-especially with repeated exposure. One may begin to find it difficult to be aroused with any alternative or seemingly less immediate stimulation, not to mention the large chunk of psychic-sexual space it draws from and depletes. If this is the case, one might cut down on both masturbation and/or the use of porn, or use fantasy instead of porn to arouse and pleasure oneself.

An erection involves the brain, nerves, hormones, and blood vessels. Anything that affects your circulatory system can contribute to difficulties maintaining an erection, like smoking, heart problems, or diabetes. Medications such as Viagra, Cialis or LaVitra increase blood flow to the penis, which enhances sexual performance and are very effective for many men. Although these drugs can have some adverse side effects which include headache, upset stomach, flushing, vision problems and even cardiovascular problems, they can be extremely helpful in restoring a man’s confidence. While these medications don’t completely remove the anxiety or a man’s fears regarding his performance, they at least help him build from a positive, successful experience. They allow him to worry less about his erections and to focus on other areas of the sexual act, and let him be the lover he wants to be.

There are also a number of natural and holistic treatments such as nutritional supplements. Herbal remedies and acupuncture may be effective in treating impotence- yet probably less so if one is more of a Western thinker. A variety of herbs have been identified as having the ability to improve sexual functioning and overall systemic health. Herbs such as Epimedium grandiflorum, also known as Horny Goats Weed are considered natural sexual stimulators that encourage performance and testosterone production. Tribulus terristis is thought to contain aphrodisiac properties and also promotes muscle strength and prowess. One of the most well known herbs, Eleutherococcus senticosis, Siberian ginseng, promotes male or ‘yang’ energy, aids circulation, supports natural vitality and also acts as an overall systemic supporter. There are also calming herbs like lavender, lemon balm and passionflower, that can support the health of the nervous system and help maintain balanced emotions during everyday pressure, stress and common nervous tension, which can effect the ability to get and maintain an erection.

Most therapists agree, without the worries about physical performance, most men will begin to actually enjoy the experience of sex, which in turn, will more readily invite arousal. He’ll be experiencing other things like erotic sensations, sexual pleasure, or the emotional connectedness with his partner.

Learning to forget about the mechanics of sex is certainly easier said than done. The key to overcoming this problem however, is not with the man simply being completely honest with himself, but with his partner, about how he experiences himself experiencing sex, how he feels about sex, himself, and his partner.

Some tips for couples approaching Performance Anxiety:

Women need to communicate with their partner about their issues of concern. Let him know that you are aware of the problem and want to solve it collaboratively. Demonstrating that you want to work together can lessen anxiety; the reassurance a partner gives can be invaluable. Brainstorm together possible reasons for any anxiety or fears about sex. It’s hard to counsel someone out of insecurity because even addressing it is uncomfortable and usually causes a defensive reaction. Overcoming insecurity is a difficult task, and usually has established itself in many and far-reaching areas of an individual. While talking about performance anxiety is an especially difficult issue to discuss, it may perhaps be a prime, or core, place to start deepening the relationship. To open up to another individual and genuinely talk about and express feelings and insecurities can be healing-security building, more so to have this witnessed by an intimate and accepting partner who won’t abandon them to their own emotional or psychological devices.

For some men with newer partners, there can be a haunting feeling of there being many more people in the room when he’s having sex with his partner: the shadows of every person his partner has slept with (or the people he imagines his partner has slept with) before him, the ghosts of all of the men he imagines his former girlfriends left him for, the caricature people and acts he’s seen in porn or heard about in the locker room. He’s competing for his partner’s attentions with people who aren’t actually in the room, don’t actually exist, or are statistical outliers. He may feel outnumbered, overwhelmed, or not being up to snuff.

Whatever you do, don’t appear like you are trying to convince him to feel more secure… this will only prove to him that his worrying is justified. Try instead to enjoy the relationship with him, enjoy sex with him, tell him about how much you enjoy your physical relationship with him. Encourage him, by letting him know what you enjoy, and ask him to do what ever that is. Show him what you like, let him share a space with you where you are receiving pleasure but his performance isn’t on the line. Ask him to join you in doing something you enjoy but that he doesn’t ordinarily do, and thank him afterward. Take time out to relax and be intimate with him, without engaging in activities that will trigger his performance anxiety. If he brings the issue up, tell him that you’re the one receiving his affections and that you enjoy them the way they are. Let him know, through your actions and words that it is the intimacy that makes everything else so satisfying, and that you enjoy being intimate with him.

In “Passionate Marriage,” author David Snarch, says that foreplay should be considered everything that goes on between one bout of lovemaking and the next –simply hanging out, doing normal dumb things like errands, or watching TV (though this in itself can be an excruciatingly boring intimacy killer). A lot of reassurance can come from how a couple interacts during this non-sexual time. By sending him the message during these non-sexual periods that he’s attractive and appealing, perhaps he’ll be less concerned about trying to keep you through the sex.

When he has the occasional performance difficulty, encourage him to try to approach it with humor and lightheartedness. Is there some way you can have some sort of failing to make him feel a little less self-conscious, that’d take the edge off of things?

If you partner is a perfectionist, help him understand that his self worth does not ride on you loving every minute of sex with him, or that only a perfect performance every time will continue to allow him to be your boyfriend.

Focus on the enjoyment of foreplay. Make a pact with your partner that the goal at this time will strictly be the pleasure of being close together, instead of having intercourse or achieving an orgasm.

Tell him that you want him to practice being a bad lover. Tell him to try to be a bad lover in bed and to do whatever he feels a “bad lover” would. Then continue to love him even after he does his “bad lover” attempt. Repeat as needed.

Another is an improvisation, combining of an exercise called, “Hug till relaxed,” that David Snarch suggests in “Passionate Marriage,” in which couples are to hug, while allowing themselves to stay in touch with themselves. This is combined with the idea of sensate focus, in which a couple is instructed not to have intercourse or be concerned about the erection to remove the expectation and pressure of performing–so hopefully the man can begin to relax and not think of sex as a job that needs to be done, but rather a positive and pleasurable experience. In this version, couples are to just hold each other, feeling the pleasure and intimacy of the embrace. They may stroke each other, or kiss to emphasize this closeness and comfort. Again, the purpose of the exercise isn’t to have sex, but to experience the proximity and emotional desire for the other.

If sex happens, so be it; if it does and wanes, so be it too: repeat as necessary.

Find ways of pleasuring each other that do not involve intercourse especially if the problem is related to getting or maintaining an erection. Try using your hands to manually stimulate your partner, oral sex, role playing a sexual fantasy you or he has, or just hold each other while watching an erotic film. If and when he feels ready for intercourse let it come naturally. Try not to add pressure by setting a time limit as to when this should happen.

Another solution might be to either mutually masturbate, or to masturbate as you please your partner in other ways. The familiarity of his own touch, the awareness and immediate stimulation, can help produce the wanted erection or orgasm. It also relieves him of the lack of immediacy or necessary stimulation if you are touching him to no avail due to his anxiety, spectating, or being in his head. For the man, this can also be freeing, expressive and erotic, sharing something that might otherwise be private and, because of this, sensual in its own right. If this doesn’t immediately work, simply acknowledge, and allow him to continue pleasuring you. The reason for this is threefold, it might relieve getting hung up on not being able to please you, develop a further intimacy with you and your body, and provides the possibility that in the process he may become naturally aroused.

Men who have trouble talking about their feelings may find it hard to share their anxiety about sexual performance. But men need to talk openly to their partners about sex and relationship. Consider talking to a therapist if your problem does not improve with self-help techniques. Many therapists treat sexual performance anxiety and can work with you individually or as a couple to understand and overcome this issue. Couples therapy allows both partners to talk about feelings and beliefs about sex in order to learn how these affect physical intimacy. Couples who cannot talk to each other about sex are likely to have problems with sex and sexual intimacy.

If all else fails, take a break from sex. Time away will relieve the pressure and anxiety associated with performance and make you eager for the next time you do become intimate.

All responses, though professionally based, are intended as opinions, and are not a substitute for working with a therapist professionally.