Sexual performance anxiety is the fear that an erection will not occur, will not last, or that ejaculation will come too soon. It is one of the most common sexual complaints, and it can sustain itself: a single difficult experience leads to worry, and the worry makes the next experience more difficult.
How common it is
A review of population-representative surveys estimated that sexual performance anxiety affects 9 to 25% of men, and found that it contributes to both premature ejaculation and psychogenic erectile dysfunction.1
Why attention matters
Laboratory studies of sexual arousal, beginning with work by Barlow, suggest that anxiety alone does not explain the loss of erection. The decisive factor appears to be attention. When a man shifts his attention from the sensations of sexual activity to monitoring his own performance, arousal falls.2,3 Many men describe exactly this: checking whether the erection is holding, at which point it begins to fade.
Cognitive behavioral therapy
In a randomized placebo-controlled trial of 137 young men with non-organic erectile dysfunction, cognitive behavioral sex therapy improved erectile function compared with placebo, and the improvement did not differ significantly from that achieved with sildenafil. Therapy also reduced depression scores more than medication did.4
Therapy can also be delivered remotely. In a randomized trial of 78 men, a seven-week internet-delivered cognitive behavioral program with therapist support by email improved erectile function compared with a control group, and the difference between the groups increased at six-month follow-up.5
Mindfulness
Mindfulness training directs attention back to present sensation. A meta-analysis of mindfulness-based interventions found a moderate improvement in sexual function, with an effect size of 0.65 in controlled trials.6
In the Andro-Somatic Method
The Method's work on the mind includes attention training, work with automatic thoughts, mindfulness and graded exposure. It begins after the initial assessment has indicated whether a psychological factor is involved.
References
- Pyke RE. Sexual performance anxiety. Sex Med Rev, 2020. Source
- Barlow DH. Causes of sexual dysfunction: the role of anxiety and cognitive interference. J Consult Clin Psychol, 1986. Source
- Review of attention and arousal in sexual function. Kane et al., 2019. Source
- Bilal A, Abbasi NH. Randomized placebo controlled trial of sildenafil citrate, cognitive behavior sex therapy and integrated treatment in men diagnosed with non organic erectile dysfunction. Sex Med, 2022. Source
- Andersson E et al. A randomized controlled trial of guided Internet-delivered cognitive behavioral therapy for erectile dysfunction. J Sex Med, 2011. Source
- Banbury S et al. Meta-analysis of mindfulness-based interventions for sexual function, 2021. Source
This article is educational and does not replace medical advice. Published by The Andro-Somatic Method.