• Therapy for Sexual Performance Anxiety

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    Is sex a source of stress rather than pleasure?

    Do you experience sexual difficulties, such as painful intercourse or erectile dysfunction but doctors tell you there is no physiological cause?

    Are you more focused on whether you are having sex right than you are on your experience of pleasure?

    Do racing thoughts, persistent self-doubt, and fear of disappointment keep you up at night?

    If these experiences sound familiar, you may be experiencing sexual performance anxiety.

    What is Sexual Performance Anxiety?

    Sexual performance anxiety is a common psychological issue affecting individuals of all ages, genders and sexual orientations. At the core of sexual performance anxiety, is the fear of not being able to perform sexually to one’s own or one’s partner’s satisfaction. This fear can lead to a cycle of stress and worry, ultimately affecting one’s overall sexual well-being and sexual functioning.

    Individuals experiencing sexual performance anxiety often view sex as a performance based activity that needs to be done right, rather than a shared experience of pleasure.

    Who is at risk of sexual performance anxiety?

    Sexual performance anxiety can impact anyone at anytime. Some risk factors include:

    • Co-occurring anxiety or depression 
    • Body image concerns 
    • Stress and pressure from societal expectations 
    • Past negative sexual experiences 
    • Relationship difficulties such as feeling undervalued or unappreciated by your partner
    • History of trauma 
    • Being highly critical of self 
    • Unrealistic expectations and lack of knowledge about sexual performance

    Common Symptoms of Sexual Performance Anxiety.

    Psychological Symptoms

    Fear of Failure: Preoccupation with the concern that you will not be able to perform adequately or satisfy your partner. Eg. “What if I can’t perform well enough?” “What if I lose my erection”

    Negative Self-Talk: Engaging in self-criticism and self-doubt. “I’m not good enough” “I’ll disappoint my partner”

    Ruminating on Past Failures: In your mind, replaying previous, sub-optimal, sexual encounters.

    Concerns About Judgment: Concern that a partner will judge, criticize, or reject you based on your sexual performance, such as, “They will think I’m such a loser if I lose my erection” “He’s going to think his ex was better”

    Negative Self-Image: Feeling self-conscious about your body and appearance. Strong beliefs that you are not attractive or desirable, affecting your confidence and sexual performance. Eg. “I’m not sexy” “They will see my belly fat”

    Performance Pressure: Experiencing pressure to meet unrealistic expectations, often influenced by unrealistic societal standards and outdated understanding of sexual performance. Eg. “I need to squirt” “I need to last for hours”

    Loss of Control: Feeling like you have no control over your sexual response or orgasm, which can lead to anxiety during sex. Eg. “If I let myself have an orgasm I will be too loud” “I don’t like losing control” “If I have an orgasm I will ___ and be judged for it”

    Anticipatory Anxiety: Experiencing worry and anxiety before a sexual encounter including thoughts and visualizations about all the things that can go wrong. Eg. “What if they don’t like how I kiss?” “What if I lose my erection?”

    Catastrophizing: Assuming the worst possible outcomes, like imagining a sexual encounter turning into a disaster. 

    Overanalyzing: Obsessively analyzing your partner’s reactions and body language for signs of disappointment or dissatisfaction. Eg. “Was that moan real?” “Are they faking it?” “Why are they so quiet?”

    Comparisons: Comparing yourself to others or to idealized (and unrealistic) images of sexual performance, which can lead to feelings of inadequacy. Eg. “I don’t look like porn stars” “I’m supposed to last for hours” “My partner doesn’t moan like ___ so they must not like it”

    All of these thoughts pull you out of the experience of pleasure which is essential for fulfilling sexual experiences. They are part of the cycle of anxiety which continues to feed anxiety.

    Addressing sexual performance anxiety often involves challenging and reframing these negative thought patterns through therapy and developing healthier attitudes towards sex, self-esteem, and relationships. Psychotherapy, including cognitive-behavioral therapy (CBT) and Mindfulness can be a powerful approach to staying present and managing thoughts contributing to sexual performance anxiety.

    Sexual Dysfunction

    Sexual performance anxiety can lead to sexual dysfunctions through a complex interplay of psychological and physiological factors. Here’s how it can result in various sexual dysfunctions:

    Erectile Dysfunction (ED): Anxiety and stress can trigger the release of adrenaline, which constricts blood vessels. This constriction can reduce blood flow to the penis, making it difficult to achieve or maintain an erection.

    Premature Ejaculation: Anxiety can lead to heightened arousal and a hypersensitive ejaculatory response. This can result in ejaculating sooner than desired, causing premature ejaculation.

    Delayed Ejaculation or Anorgasmia: Some individuals with sexual performance anxiety may experience difficulty reaching orgasm. The heightened anxiety can interfere with the ability to relax and experience sexual pleasure.

    Low Desire:  None of us want to do things that cause us distress! The constant worry and pressure associated with sexual performance anxiety can lead to a decrease in sexual desire or interest, affecting the overall sexual experience. 

    Vaginismus: People with vulvas who experience sexual performance anxiety may experience involuntary vaginal muscle contractions, making penetration painful or impossible. 

    Dyspareunia (painful intercourse): The stress and tension associated with sexual performance anxiety can result in painful intercourse due to increased muscle tension and reduced arousal impacting lubrication.

    Cycle of Worry: A cycle of anxiety can develop, where past experiences of anxiety or sexual dysfunction during sexual encounters lead to future anxiety, creating a self-fulfilling prophecy of sexual dysfunction.

    Sexual dysfunctions caused by performance anxiety are often temporary and can be effectively treated with the right support and interventions. Psychotherapy and sex therapy are valuable approaches to address the root causes of sexual performance anxiety, helping individuals manage their anxiety, enhance their self-esteem, and develop healthier attitudes towards sex and relationships, ultimately leading to improved sexual experiences.

    * It is important to note that sexual dysfunctions can be caused by various psychological, medical, and physiological factors. Any time you experience sexual dysfunction it is important to be assessed by a doctor to rule out any medical or physiological causes. Medical assessment typically includes a physical exam, blood work, and a visit with a specialist such as a gynecologist (if you have a vulva) or urologist (if you have a penis). Once medical and physiological causes are ruled out or identified, we can treat the psychological causes.

    Relationship Issues

    Sexual performance anxiety can strain relationships, leading to communication problems, decreased intimacy, and emotional distance between partners, all of which can contribute to sexual dysfunctions. Over time, these difficulties can have a profound impact on your overall quality of life.


    As a result of anxiety, some individuals may begin to avoid talking about sex or sexual encounters altogether to escape the fear of performance issues. This avoidance can reinforce the anxiety and lead to sexual dysfunction over time.

    Imagine a life in which you can approach intimacy with confidence, knowing you have the tools to manage sexual performance anxiety. 

    If you’re ready to take the first step towards a more fulfilling and worry-free sex life, schedule a free consultation to see how we can help.

    How Can Psychotherapy/Sex Therapy Help?

    Psychotherapy for sexual difficulties is often referred to as sex therapy. Sex therapy consists of various psychotherapeutic approaches that can be used to address sexual performance anxiety.

    Therapy is a safe and supportive space for individuals to work through their anxiety, build confidence, and develop a healthier attitude towards sex and relationships. It empowers individuals to regain control over their sexual well-being and improve their overall quality of life. 

    At New Moon Psychotherapy our experienced and trained therapists offer a safe and supportive space, free from judgmental for you to openly discuss your concerns, work through anxiety, build confidence, and develop a healthier attitude towards sex and relationships. 

    Our goal is to empower you to regain control over your sexual wellbeing and improve your overall quality of life. 

    If you’re experiencing sexual performance anxiety, seeking professional therapy can be a crucial step toward a more fulfilling and satisfying sex life. 

    Common Focus of Sex Therapy for Sexual Performance Anxiety involves:

    Identification and Understanding: Therapy provides a safe and non-judgmental environment to openly discuss concerns and fears related to sexual performance. Therapists can help clients identify the specific thoughts, beliefs, and triggers that contribute to their anxiety.

    Challenging Negative Thought Patterns: Cognitive-behavioral therapy (CBT) is a common approach in which individuals learn to identify and challenge negative thought patterns associated with sexual performance anxiety. This helps them replace irrational fears and self-doubt with more realistic and positive beliefs.

    Anxiety Reduction: Therapy equips individuals with coping strategies to manage anxiety. Relaxation techniques, mindfulness, and breathing exercises are taught to help calm the nervous system and reduce the physical symptoms of anxiety.

    Rebuilding Self-Esteem and Body Confidence: Therapy can address self-esteem and body image issues that often contribute to sexual performance anxiety. Clients work on building a more positive self-image and self-worth.

    Enhancing Communication Skills: In the context of couples therapy or sex therapy, therapy can improve communication between partners. Effective communication is important because you can’t be a good lover without first understanding what your lover likes. Communication can also reduce misunderstandings, enhance emotional intimacy, and alleviate the pressure associated with performance.

    Identify the Root Cause: Therapists can help clients explore the underlying causes of their anxiety, which may include past trauma, relationship issues, or other emotional factors. Understanding the root causes can be essential for long-term resolution.

    Behavioral Techniques: Sex therapy often incorporates behavioral techniques and homework assignments to gradually desensitize individuals to anxiety-provoking situations, helping them regain their sexual confidence.

    Education and Information to Develop Healthier Attitudes Towards Sex: A key component in the treatment of sexual performance anxiety is education about sexuality and sexual function with the goal of dispelling misconceptions and reducing performance related anxiety.

    Normalization and Validation: Understanding that sexual performance anxiety is a common issue can help individuals feel less isolated and “broken.” Therapists normalize these experiences and provide validation, reducing shame and stigma.

    Just as each individual is unique, so is each treatment plan. You and your therapist will work closely to develop a personalized treatment plan, addressing your specific goals and needs related to sexual performance anxiety.

    Imagine a future where you can fully embrace your sexuality without fear or self-doubt.

    Are you ready to rediscover the joy of intimacy and pleasure?
    Reach out to us today!

    Reach out to us today to schedule a free 15-minute consultation with a therapist to learn how we might be able to help.

    Call, text, or email using the information/form below. Our administrative team will answer any questions you might have and learn how we can help you. 

    Prefer to book on your own? Don’t want to wait for the office to open? Click the link below to schedule a consultation.

    If you’re specifically interested in therapy for sexual performance anxiety, please tell us at this time so that we can connect you with a therapist trained in it. 

    You will then be connected with a therapist for a free 15-minute consultation. 

    This is a chance for us to meet the therapist, ask questions and learn about their approach so that you can determine if they’re the right fit for you. 

    Schedule your first therapy appointment and begin your healing journey! 

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