Sexual performance anxiety in men: causes and what helps

Sexual performance anxiety is one of the most common sexual complaints. A 2020 review in Sexual Medicine Reviews estimated that it affects between 9% and 25% of men, and said it contributes to premature ejaculation and to erection problems with a psychological cause.

It can bring on the very thing you're worried about. As the International Society for Sexual Medicine (ISSM) explains, a man may become so anxious about getting an erection and pleasing his partner that, during sex, he has erection difficulties.

What is sexual performance anxiety?

Sexual performance anxiety is worry or fear about how sex will go: whether you'll get or keep an erection, finish too soon or satisfy your partner. A 2020 review notes that no diagnosis is recognised for it in either men or women, and that research into treatment has therefore been minimal.

How common is sexual performance anxiety?

Estimates vary. The 2020 review, which drew on population surveys, put sexual performance anxiety at 9% to 25% of men and 6% to 16% of women. In Britain, sexual difficulties in general are common, but distress about them is much less so.

Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) interviewed 15,162 people aged 16 to 74 between 2010 and 2012. Among men who'd had sex in the past year, 41.6% reported at least one problem with sexual function lasting 3 months or more, but only 9.9% reported distress or worry about their sex life.

What causes performance anxiety in bed?

NHS and NICE guidance list stress, low mood and relationship difficulties among the psychological causes of premature ejaculation and erection problems, and the NHS lists anxiety about sexual performance too. These are the situations the sources describe:

• A new relationship, or a past problem. The NHS lists anxiety about sexual performance among the common psychological causes of premature ejaculation, particularly at the start of a new relationship or when a man has had previous problems with sexual performance.
• Stress, low mood and relationship problems. NICE's guidance for GPs lists performance-related issues, relationship problems (including a new relationship), stress, depression and anxiety among the psychological causes of erection problems.
• Mixed feelings about sex. The ISSM says men who feel conflicted about sex because of religious or cultural beliefs may also have erection problems with a psychological cause.
• An off night. The NHS says most men occasionally fail to get or keep an erection, usually because of stress, tiredness or drinking too much alcohol, and that it's nothing to worry about.

How does performance anxiety affect erections?

Anxiety can get in the way of erections. When erection problems have emotional or psychological causes, they're called psychogenic erectile dysfunction, the ISSM explains. They may happen when a man is feeling depressed or anxious, has problems in his relationship or is dealing with stress, and for many men they then lead to performance anxiety.

Erection problems that happen often can also have physical causes, such as high blood pressure, diabetes or hormone problems, the NHS says, or be a side effect of some medicines. Our guide to erectile dysfunction covers them.

The NHS also notes that, depending on the cause, you may still be able to get an erection at other times, such as when you wake up (see our guide to morning wood).

Can performance anxiety make you come too quickly?

Performance anxiety can play a part in coming too quickly. The NHS lists anxiety about sexual performance among the common psychological causes of premature ejaculation, and the 2026 European Association of Urology (EAU) guidelines say acquired premature ejaculation (a bothersome drop from the time you used to last) may be caused by psychological problems such as sexual performance anxiety.

Sources don't all agree on how big a part it plays. The BAUS patient page lists anxiety about sexual performance among the psychological causes, yet it also says most cases of premature ejaculation have no clear cause and that the cause appears unrelated to performance anxiety.

It can work as a loop. The ISSM's 2014 guidelines say performance anxiety may lead to premature ejaculation, which then makes the original anxiety worse, though they add that there has been limited research on causality. They also say one in three men with premature ejaculation report anxiety connected to sexual situations.

Erection worries can drive it too. The EAU says many men with erection problems develop premature ejaculation because of the anxiety of getting and keeping an erection, and the ISSM notes that some men rush sex so they finish before losing their erection. Our guides to premature ejaculation and how to last longer in bed go into the options.

How do you get over sexual performance anxiety?

The ISSM suggests starting with a medical check, then talking to your partner, remembering there's more to intimacy than penetration, focusing on the moment and, if you need more help, seeing a sex therapist. A 2020 review says no treatment for sexual performance anxiety itself is well proven yet, though several have potential.

Get a medical check first

The ISSM advises starting with your doctor, because erection problems sometimes have both psychological and physical causes; if physical problems are found, they can be addressed. At an NHS appointment, the doctor or nurse may ask about your lifestyle and relationships, do basic health checks such as taking your blood pressure, and examine your genitals to rule out an obvious physical cause.

Talk to your partner

Talking about sex can be awkward, but the ISSM says it's worth the effort: if you're worried about your partner's satisfaction, they can reassure you, or they might tell you more about what they need and enjoy. The NHS says communicating your concerns can often go a long way to helping to resolve them.

In Natsal-3, people who couldn't talk easily about sex with a partner were more likely to report low sexual function.

Take the pressure off

The ISSM points out that erection problems are common: most men have erection difficulties from time to time, and having them isn't a reflection of your masculinity or your sexual skills. It also says there's more to intimacy than penetration: even without a firm erection, couples can enjoy closeness through hugging, kissing and touching.

Focus on the moment

During sex, the ISSM suggests focusing on the "here and now": the sensations of touch, taste, smell, sight and sound, and what you're feeling at the moment. This is a form of mindfulness. The 2020 review says mindfulness meditation training and cognitive behavioural therapy (CBT) have been proven effective for non-sexual performance anxiety and social anxiety, and are recommended for sexual performance anxiety, but controlled studies of them in sexual performance anxiety are lacking.

Can therapy help with sexual performance anxiety?

The NHS says counselling and therapy can help if erection problems are linked to emotional or mental health problems, although there can be a long wait for these services on the NHS. NICE's guidance tells GPs to arrange referral to mental health services, or psychosexual or relationship counselling, depending on clinical judgement, when a psychological or relationship cause is suspected.

• NHS Talking Therapies. For anxiety, you can refer yourself without speaking to a GP, as long as you're registered with a GP and aged 18 or over (16 or over in some areas). The therapies include cognitive behavioural therapy (CBT), counselling, couples therapy and mindfulness-based cognitive therapy. You can find NHS talking therapies for anxiety and depression on the NHS website.
• Psychosexual (sex) therapy. A therapist helps you, and a partner if you have one, with sex-related problems. The NHS says some areas provide a sex therapy service on the NHS, but availability varies widely. If you pay privately, the NHS says sex therapists should be members of the College of Sexual and Relationship Therapists (COSRT) or the Institute of Psychosexual Medicine, and Relate offers sex therapy for a fee.

A 2007 Cochrane review of psychological treatments for erection problems found evidence that group therapy may improve erectile function, and that group therapy plus sildenafil led to more successful intercourse than sildenafil alone. The British Society for Sexual Medicine, quoted in NICE's guidance, says that when psychological issues are likely to be contributing to erection problems, combining psychosexual counselling with medicine may be more effective than either one alone or one after the other.

What is sensate focus?

Sensate focus is a sex therapy technique developed by Masters and Johnson in the 1960s: a series of touching exercises that a couple works through in order. The Sexual Medicine Society of North America (SMSNA) says it aims to improve intimacy and communication, reduce sexual performance anxiety and move away from goal-focused sex, with partners focusing on the sensations of touch rather than on what "should" happen.

A leaflet from Leicestershire Partnership NHS Trust's medical psychology department says the programme can help overcome fear of failure. In the first phase, couples avoid touching the genitals and breasts, and sex and orgasm are off the table; they move on to the next stage only when both partners agree. Sessions typically last 20 to 60 minutes, two to three times a week, over six or more weeks. SMSNA suggests a medical check to rule out physical causes before starting, and a sex therapist for guidance.

Can sildenafil (Viagra) help with performance anxiety?

Medicines for erection problems can help some men whose anxiety centres on erections. The NHS names medicines that increase blood flow to the penis, called PDE-5 inhibitors, as the main treatments for erectile dysfunction: sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra). NICE's guidance tells GPs to consider them for men who aren't at high risk from heart problems during sex, whatever the suspected cause.

BAUS, the British Association of Urological Surgeons, says the exact role of these medicines in premature ejaculation is uncertain, but that if poor erections are a problem, they can improve sexual confidence and reduce performance anxiety by producing better erections. You can get sildenafil on prescription or buy it from a pharmacy after speaking with a pharmacist; the others need a prescription.

The NHS says sildenafil isn't usually prescribed with nitrates, such as GTN for chest pain, and advises a check-up with your doctor within 6 months if you buy it without a prescription, because erection problems can be a sign of conditions such as diabetes or heart problems. Call 999 if you're taking sildenafil and think you might be having anaphylaxis (a serious allergic reaction), a heart attack or a seizure; call NHS 111 for any other serious side effect, such as a painful erection lasting longer than 4 hours. There's more in Viagra (sildenafil): how it works and safety and does Viagra make you last longer?

When should you see a GP?

See a GP or go to a sexual health clinic if erection problems keep happening: the NHS says it might be a sign of a health condition that can be treated. Sexual health clinics are free and confidential, and many offer a walk-in service; you can find one with the NHS sexual health clinic finder.

See a GP, too, if finishing too quickly is a persistent problem for you. If anxiety is affecting the rest of your life, you can refer yourself to NHS Talking Therapies, or speak to a GP if you're not sure about referring yourself.

If you need urgent help for your mental health, the NHS says to get help from NHS 111 online or call 111 and select the mental health option, or ask for an urgent GP appointment. Call 999 or go to A&E now if someone's life is at risk, or if you don't feel you can keep yourself or someone else safe.