Sexual performance anxiety and erectile dysfunction (ED) are both troublesome issues, and it’s possible for a man to have both. But they do have some clear differences.
A man with sexual performance anxiety occurs worries about his sexual function or his ability to please his partner sexually. He might have questions like these:
- Will I be able to get a firm erection?
- Will I ejaculate too quickly?
- Will I have an orgasm?
- Does my partner find me attractive?
- Is my penis big enough?
- Am I sexually skilled enough?
- Will my partner reach orgasm?
- What will happen if my partner is not sexually satisfied?
Men who use pornography can develop sexual performance anxiety if they compare their real life experiences to what they see in adult films and videos. Usually, such depictions are not realistic, but men may feel nervous or inadequate if they don’t perform the same way.
Sometimes, a man may become so concerned about his performance that he develops erectile dysfunction (ED). The anxiety triggers the production of stress hormones (such as epinephrine and norepinephrine) which can narrow blood vessels in the penis and make it difficult for blood to flow in and form an erection.
Erectile dysfunction (ED) occurs when a man cannot get and maintain an erection firm enough for sex. As noted earlier, ED can be a result of performance anxiety. But health situations can affect erections, too. Here are some examples:
- Heart disease
- High cholesterol
- High blood pressure
- Nerve damage
- Cancer treatment (such as prostatectomy – removal of the prostate gland)
- Thyroid disorders
- Low testosterone
- Medication side effects
- Attention deficit (especially in young men)
[Please click here for more information on ED, its causes, and its treatments.]
Sometimes, ED leads to performance anxiety. A man who has had trouble with erections in the past may become anxious about his ability to perform sexually in the future.
While it’s possible to have both sexual performance anxiety and ED, it doesn’t always happen this way. Men who feel confident in the bedroom and in their relationships can still develop ED.
Fortunately, both ED and sexual performance anxiety can be treated.
Men with performance anxiety may consider sex therapy. A therapist can help men work through their concerns, adjust their expectations, and become more focused on the pleasure of sex. For example, a man who is concerned about a small penis might be relieved to learn that his length is in the average range. Or a man who worries about his partner’s orgasm may learn ways to ask his partner what he or she likes.
If the man is in a relationship, it’s often a good idea for his partner to come to therapy with him. Sometimes, partners are the source of pressure and anxiety due to their own worries, sexual problems, or lack of knowledge. Attending therapy together can help a couple with relationship tension, too.
Men with ED have a variety of treatment options, including medications, self-injections, vacuum devices, and penile implants. Learn more about them here. (You can also find more details on our Erectile Dysfunction Q & A page.)
International Society for Sexual Medicine
“What are sex therapists? What do they do?”
“What is erectile dysfunction (ED)? What causes ED? How is ED treated?”
Journal of Sexual Medicine
Telch, Michael J., PhD and Yasisca Pujols, MA
“The Erectile Performance Anxiety Index: Scale Development and Psychometric Properties”
(Full-text. December 2013)
Veale, David, MD, FRCPsych, et al.
“Sexual Functioning and Behavior of Men with Body Dysmorphic Disorder Concerning Penis Size Compared with Men Anxious about Penis Size and with Controls: A Cohort Study”
(Full-text. September 2015)
Cohen, Elliot D., Ph.D.
“Some Tips on Overcoming Sexual Performance Anxiety”
(May 29, 2011)
“Sexual Performance Anxiety”
(November 25, 2017)