How To Manage ED And Sexual Performance Anxiety

Updated May 10, 2024by Regain Editorial Team

If you struggle with sexual performance anxiety or ED, you may know firsthand how challenging it can be, particularly when you’re in a relationship. Performance anxiety is often referred to as “stage fright” because it refers to a fear of doing something in front of people. It can be important to recognize that you’re not alone; many people experience sexual performance anxiety and ED. Each of these conditions can have underlying medical or psychological causes, which is why it can be vital to see a professional if you’re struggling with either one. Read on to learn about the techniques you can use to help manage your performance anxiety and ED, which may allow you to enjoy a more fulfilling sex life.

Is performance anxiety affecting your sex life?

What is sexual performance anxiety?

Sexual performance anxiety is the fear and anxiety that arises when a person performs sexually for their partner. Research shows that sexual performance anxiety impacts more men than women, mainly because mature males tend to have a higher risk of developing other sexual issues, such as erectile dysfunction (ED) and the inability to obtain or maintain an erection. If you have ED, you are far from alone. Roughly fifty percent of men over 40 are impacted by ED, a condition that can make anxiety levels soar.

In addition, premature ejaculation is another issue that can contribute to performance anxiety. Typically, men want their partners to think of them as virile. However, when you have difficulty with maintaining an erection, or you ejaculate prematurely, you may experience performance anxiety and erectile dysfunction, which can commonly hurt your sex life.

Sexual performance anxiety symptoms

People respond in different ways to sexual performance anxiety, just as they do to generalized stress and anxiety. Performance anxiety can produce various symptoms in the body, including increased heart rate, difficulty with or the inability to orgasm, premature ejaculation, or a lack of interest in sex. Physical symptoms of ED include not having or keeping an erection, which can eventually lead to a loss of sexual desire.

Causes of sexual performance anxiety

It can be natural to want to perform well during sexual activity, but negative thoughts about one’s ability to please a partner can cause sexual performance anxiety. An anxiety disorder may prevent you from experiencing sex joyfully. Perhaps you are having feelings of sexual inadequacy. You may be self-conscious about your body or your penis size. Negative thoughts about your life in general may also contribute to sexual performance anxiety. Moreover, money, work, or family-related stressors can influence your mental state and lead to performance anxiety. If you can relate to any of these issues, it can be important to remember that you are human; you are not lacking in any way, and there are ways to overcome these obstacles you’re facing. 

Managing performance anxiety

Many doctors treat erectile dysfunction using medication. Although these medications can help a person get and maintain an erection, taking them doesn’t necessarily solve the root of the problem. Instead, you may want to consider the following ways to cope with performance anxiety and ED.

Break the cycle

Lots of people get trapped in a cycle of performance anxiety. It can be normal to experience disappointing sexual experiences occasionally and having ED occasionally can also be natural. However, dwelling on these events and telling yourself that you are a failure may make you anxious about future sexual activities, and this anxiety alone could bring on ED or premature ejaculation the next time you have sex.

Try not to see your experiences as sexual failings, but rather acknowledge that having sexual performance anxiety and erectile dysfunction is the norm for many individuals. Shifting the focus from the symptoms to the cause of the stress or worry can help.  Causes can be as varied and straightforward as anticipating an upcoming work project, dealing with a family illness, or planning a vacation. Cut yourself some slack; there’s no need to feel pressure to perform well sexually every time, particularly if you are experiencing an episode of increased stress in your life.


Focus on the senses

It is normal for those with sexual performance anxiety to beat themselves up over their perceived sexual failures. You may be wondering or worrying continuously about what your sexual partner thinks or how they might perceive you during sex. It may help to focus your mind on sensory experiences instead of analyzing each sexual event. Block out performance anxiety by focusing on what your hands are feeling or your eyes are seeing. Choose candlelight and romantic music if you would like to increase your sensory enjoyment and lessen your anxiety.


Researchers have noted that a lack of physical exercise can exacerbate ED and performance anxiety symptoms. Exercising regularly for just 20 to 30 minutes a few times per week has been found beneficial in reducing levels of stress. Adding Kegel exercises can also help; these pelvic exercises strengthen the muscle that pumps blood to the penis during an erection. To perform a Kegel exercise, pretend you are stopping the stream of urine by clenching the appropriate muscles, hold for as long as possible, release, and repeat for several minutes as part of a daily or weekly routine.

Guided meditations

Guided meditation can help you achieve a state of relaxed concentration, which challenges the mindset that contributes to performance anxiety. One of the goals of guided meditation for anxiety and stress is emotional and mental healing and stress relief. Guides can include yoga instructors, religious guides, sound recordings, or YouTube videos. During meditation, the guide makes you comfortable by instructing you to relax certain muscles in the body and then leads you through visualizations and mental images that comfort and heal you. Guided meditation can take just a few minutes or up to several hours.

Couples counseling

Sexual performance anxiety can negatively impact relationships. Couples counseling is a type of therapy that can benefit those who experience performance anxiety as well as their partners. During counseling, a therapist assists those in a romantic relationship to gain insight into their relationship. They can help to resolve any conflicts that may have arisen from sexual performance anxiety and support you in improving the relationship. You can find a couple’s counselor in your geographic area and meet face to face or seek counseling online. 

Sex therapy

Sex therapy is a practice that focuses on aiding couples who have intimacy issues. It can be a potent tool for couples who are striving to connect intimately. A sex therapist’s main job is to listen to each person in the relationship without judgment to determine what may be needed to improve the relationship.  It may be awkward at first to discuss performance anxiety and erectile dysfunction. Still, in the long run, it may be worth it as the therapist puts a treatment plan in place that can help with overcoming sexual performance anxiety.

Stress reduction

Keep in mind that controlling your stress can be critical to overcoming sexual performance anxiety. Learning different types of breathing exercises can be a powerful step in reducing your stress levels. Find a quiet, comfortable spot where you can put stress and anxiety aside. Breathe in slowly through your nose, feeling your chest and lower belly rise as your lungs fill with air. Once your abdomen has expanded sufficiently, breathe out slowly through your mouth. Once you’ve mastered the practice of breath focus, you can progress to a regular practice of controlled, deep breathing. The following techniques can be combined with breath focus to further dial down your response to stress:

Working with a therapist may also help with stress reduction. Research shows that a certain type of therapy, called cognitive behavioral therapy, is effective in stress reduction. Cognitive behavioral therapy helps clients identify thought patterns that may contribute to stress, anxiety, or performance anxiety.

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Is performance anxiety affecting your sex life?

Online counseling with Regain

If you continue to experience ED or sexual performance anxiety, it can be important to seek advice from a professional. Seeing a doctor can help you understand whether a medical condition may be contributing to your condition, while a therapist could help you explore any mental or emotional concerns that could be causing your symptoms. Thanks to Regain, it is both easy and convenient to get the care you need at an affordable price. Regain is an online counseling platform that can connect you with a therapist via in-app messaging, video chats, or phone calls. Therapists are specialized in a variety of areas so that you can get support regardless of what you’re facing. Anxiety doesn’t have to hold you back in life; reach out when you feel ready to begin your healing journey. 

The efficacy of online counseling 

ED and sexual performance anxiety may be successfully treated through online counseling interventions. In one study, researchers compared the efficacy of an internet-based cognitive behavioral therapy intervention to a face-to-face CBT program and found that they had similar overall effects in the treatment of anxiety disorders. CBT is a framework that teaches people how to reframe their unhelpful thoughts into more helpful ones, thereby altering their beliefs and behavior. 


Learning how to manage ED or sexual performance anxiety can be challenging, but it is possible with the right resources. In some cases, there may be an underlying medical condition that could be contributing to your symptoms. Other times, there might be an undiagnosed mental health disorder. Talking to your doctor can help you get to the root of your ED or performance anxiety. As you go through this process, online counseling could be a valuable tool. Regain can connect you with a therapist who can offer support and help you find healthy coping mechanisms while you heal. With time, patience, and treatment, you can move forward.

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