How performance anxiety leads to erectile dysfunction


Editorial Team


February 3, 2021

man in bed smiling overcoming erectile dysfunction caused by sexual performance anxiety
Medical review by Dr. Davis LiuAnxiety is one of the most common causes of ED. Why? In the midst of a stress response, your body cuts off blood flow to your penis.

Sexual performance anxiety, an aspect of male erectile dysfunction (ED), can be a common source of distress and shame. It raises questions about masculinity and sexual abilities.

Due to the taboo nature of sex and the lack of comprehensive sex education, it can be a very secretive and confusing source of pain. Learning why performance anxiety happens and how to work with it can empower you and make it possible to enjoy your sex life fully.

For people with anxiety and depression, purposefully engaging in pleasurable activities can improve mental health.
Anxiety is one of the most common causes of ED. Why? In the midst of a stress response, your body cuts off blood flow to your penis. Fortunately, there are many treatments for anxiety such as medication, therapy or coaching.

What is sexual anxiety?

Sexual anxiety, also called sexual performance anxiety, is the inability to achieve or maintain an erection due to worry, stress, anxiety, or other difficult emotions or experiences – some of which may not have anything to do with sex itself

For many men, performance anxiety & ED can lead to doubt around issues like masculinity, virility, and sexual prowess.

If you’re experiencing erectile dysfunction, you might have thoughts like these: “Is something wrong with me? If I can’t get hard, am I a real man? Can I ever be in a fulfilling sexual relationship?”

What can cause ED?

Sorting out the cause of erectile dysfunction can be a difficult task given the prevalence of myths and stereotypes about male sexuality. In reality, the etiology of erectile dysfunction can be broken down into both physiological and psychological explanations.

Common physiological causes of erectile dysfunction include:

  • Vascular, neurological, or hormonal conditions
  • Medication side effects
  • Health habits (such as smoking, excessive drinking, or unhealthy eating)

There are several psychological causes of erectile dysfunction.

  • Depression
  • Anxiety, especially about sexual performance
  • Relationship issues
  • Guilt and shame
  • Stress
  • Low confidence and self-esteem
  • Sexual abuse or repression
  • Unrealistic expectations about sex

Among these psychological causes, sexual performance anxiety is the most prevalent complaint. While many men can recognize when their erectile difficulties are “emotional” or “psychological” in nature, few can explain the role of anxiety.

If you’re experiencing performance anxiety, a clear understanding of the effects of anxiety on the body, including sexual functioning, can help move you towards a more satisfying sex life. Plus, anxiety & erectile dysfunction are both treatable.

Learn how to deal with erectile dysfunction in a relationship.

Anxiety and sex

Let’s start with a simple definition of anxiety: Anxiety is your body’s natural reaction to a stressor, either real or perceived, that threatens your emotional, psychological, or physical well-being. 

You’ve probably heard of the fight, flight, or freeze response. Performance anxiety triggers this same physiological mechanism.

When you experience a threat, part of the brain called the amygdala activates the sympathetic nervous system, sending signals throughout the body, preparing it to fight, flight or, freeze.

This process is an evolutionary response dating back to caveman days that helps protect you from existential threats. While the human brain has evolved over time, the threat response system still works the same way it did back then. And the amygdala isn’t always discriminating.

Whether it’s a wild animal, the embarrassment of public speaking, or sexual performance concerns, the body’s anxiety response is pretty consistent. When it’s activated, you’ll likely experience tightness in your chest, shallow breathing, tense muscles, tunnel vision, and a racing heart.

Elevated heart rate plays a significant role in erectile issues. When the sympathetic nervous system is activated, your heart races to pump blood from the core of your body to your arms and legs, better enabling you to fight or flee. However, it inhibits blood flow to your penis.

If there’s no blood flowing to your penis, you won’t be able to get erect. After all, the last thing your body needs when confronted by a mortal threat is to be ready for sex.

Find out how erectile dysfunction relates to age.

Listen to your anxiety

Often, feelings of anxiety are adaptive. Even if your brain mistakenly triggers a disproportionate life-or-death stress response, the feelings of anxiety might be trying to communicate useful information.

Even though it’s so uncomfortable, anxiety may be pointing to something that needs and deserves your attention.

If you experience erectile dysfunction due to anxiety, it may be your body’s way of telling you to pay attention. Learn to ask yourself questions like these to assess the situation.

  • Are you preoccupied with rejection, judgment, or failure?
  • Do you feel pressured to be the primary source of pleasure?
  • Are you confident in your safe-sex practices?
  • Do you have consent?
  • Are your sexual behaviors congruent with your values?

Sometimes anxiety is “free-floating,” that is, not readily associated with a specific cause. But many times, there’s something about the situation you’re in that doesn’t feel right.

If you train yourself to look at what’s underneath a circumstance or situation that triggers anxiety, you’ll learn more about how to take care of both your mental and sexual health.

Erectile Dysfunction as a sign of general anxiety

For many men, erectile dysfunction may be just one of many symptoms indicating an anxiety-related issue like generalized anxiety disorder (GAD). It’s not uncommon for anxiety symptoms in men to cause difficulty around sexual functioning, issues with orgasm, or erectile dysfunction.

In addition to sexual performance anxiety, some common symptoms of GAD include the following.

  • Persistent worry that gets in the way of functioning
  • Inability to control or manage worry
  • Feeling on-edge and agitated
  • A tendency to see situations or circumstances as dangerous or threatening
  • Irritability and anger
  • Difficulty making decisions and feeling paralyzed by indecision

If you’re experiencing symptoms like these in addition to erectile difficulties, you may have an underlying anxiety disorder.

Talk to a medical professional about the best ways to treat your anxiety. A healthcare professional will be better able to help you understand and manage the symptoms of anxiety, including erectile dysfunction.

Get treatment for ED right now.

How to overcome sexual performance anxiety

The good news is that there are multiple ways to work with sexual performance anxiety. The solutions below can help reduce anxiety related to sex, enabling you to get the most out of your sex life and sexual relationships.

You may find that these interventions work best when appropriately combined.

  • Learn to communicate with your partner regarding desire, turn-ons, and expectations.
  • Shift from performance-based sex to pleasure-based sex.
  • Try relaxing exercises to calm anxiety, such as mindful breathing and muscle relaxation.
  • Make use of cognitive interventions like cognitive restructuring, refocusing, and reframing.
  • Work with a  therapist to uncover the psychological roadblocks causing sexual anxiety.
  • Work with a coach trained in cognitive behavioral techniques to discuss which of the above behavioral changes might be a fit for you, and create ap lan to practice these skills in a way that works for your lifestyle.
  • Use ED medications, like Viagra (sildenafil), Cialis (tadalafil), or Levitra (vardenafil).

More about ED medication

ED medications, such as ViagraCialis, and Levitra, are often helpful. They work by increasing blood flow to the penis. You can learn more about prescription ED pills to see if this is an option you’d like to pursue. For some men, prescription meds are just the little boost needed to improve confidence.

However, the body’s anxiety response can often be stronger than the effects of the medication. Therefore, it’s advisable to address the issues that may be causing anxiety, even if you’re currently using or want to start using prescription medication to treat ED.

If you have concerns about male erectile dysfunction, orgasm anxiety, or other sexual functioning issues, consult with a medical or mental health professional.


  • Anxiety is the most common non-physiological cause of erectile dysfunction.
  • When your body experiences a chemical stress response, blood stops flowing to your penis, so you can’t get an erection.
  • Sexual performance anxiety treatments include psychological therapy, behavioral health coaching, cognitive strategies, and prescription medications.
  1. Metz & McCarthy (2004). Coping with Erectile Dysfunction. Oakland, CA, U.S.A.: New Harbinger Publications.
  2. Öhman (2005). The role of the amygdala in human fear: Automatic detection of threat.
  3. Pyke (2019). Sexual Performance Anxiety


Editorial Team


February 3, 2021

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment or medication.