Performance Anxiety and Erectile Dysfunction

Performance Anxiety and Erectile Dysfunction

Many men wonder if erectile dysfunction (ED) is all in their head. The answer is complex.

Listen to Performance Anxiety and Erectile Dysfunction through our podcast player above or read the podcast transcript here [PDF].

By: Mark Goldberg, LCMFT, CST

Many men wonder if erectile dysfunction (ED) is all in their head. The answer is complex.

Mental causes of ED can be difficult to detect and understand. They can be unique and specific to each man.

Performance anxiety and ED go together like thunder and lightning. Performance anxiety can be a component of any sexual dysfunction but it has a particular habit of causing erection problems.

What you think and feel can and will directly impact erections. The more you worry about your performance the less likely your erections will work.

What is Anxiety?

Anxiety is the experience of worry or fear. It is often expressed though always thinking about the same negative thoughts over and over. This is a normal part of life. We all experience stress and anxiety at various times in our lives.

Anxiety can be your friend. It motivates us to change and grow and it is not always a bad thing. When anxiety remains intense for extended periods of time or is widespread at the wrong times it can interfere with productivity, relationships, and sexual function.

Performance anxiety is a deep worry or fear about taking on a specific task. This can happen in a wide range of areas of life, including:

  • School
  • Work
  • Sports
  • Public performances

Performance anxiety is almost always in the context of being in front of another person or people. Performance anxiety, when it comes to sex and erections, is most likely to happen when you are trying to engage with a partner.

Where Erections Start

We have to look at where and how erections start to address performance anxiety and erectile dysfunction. For some men, erections can just happen. When it’s time to have sex, the erection is easily gained and maintained.

For most guys, it does not work that way. Erections need some form of desire or arousal to get started. Desire and arousal are processes that start in the brain. If your mind is clear and you are open to stimulation and pleasure your erections will be better. If you are not, ED can persist.

How Anxiety Impacts Erectile Dysfunction

Erections needs the mind to be somewhat clear and able to focus on pleasure. Anxiety is mind occupying and creates emotions like fear and worry. The most common response to anxiety is avoidance and that can include a physiological avoidance of erection problems.

Men may be quick to dismiss the notion that they have anxiety. For many men, anxiety is more commonly thought of as stress. Stress can cause erectile dysfunction.

What Does Anxiety Feel Like?

Anxiety feels different for each person. There are physiological signs such as:

  • Headaches
  • Sweaty palms
  • Pit in the stomach
  • Palpitations

Cognitive symptoms include racing or ruminating thoughts and emotional symptoms include worry and fear. Ruminating thoughts are a common feature of anxiety. Some men have an almost unnoticeable pattern of thoughts while others will experience pronounced thought intrusion that is distressing and unescapable. Common anxious thoughts contributing to erectile dysfunction include:


Fear is the most common emotion experienced with anxiety and erectile dysfunction.

Fear of rejection, fear of being shamed and the fear of being embarrassed can all lead to ED. Fear can make a man nervous in the moment and cause him to become overwhelmed. A man may also feel helpless to improve the situation which can make the erectile dysfunction worse.

Performance Anxiety Leading to Erectile Dysfunction

A common cause of performance anxiety induced erectile dysfunction is a negative sexual experience. This can happen when a man is alone, but most often it happens when a man is sexually engaged with a partner.

A partner may have a really negative reaction to a sexual encounter, but in actuality it’s not likely. Often, performance anxiety starts with what a guy thinks about himself, his own performance and in what he imagines his partner is thinking about his performance. Most of the time he is wrong though, and all of this is simply “in his head.”

Another cause of performance anxiety induced erectile dysfunction is misinformation.

The less a man knows about what to expect of himself and to expect of his partner, the more likely he is to misread sexual encounters. He will become nervous or fearful. He can overthink what he is doing and what is happening.

High expectations lead to increased performance concerns. Most men underestimate their ability, and this makes performance anxiety worse.

Another problem is when a man doesn’t trust his erection process. Like anything in the body, if you are worried something is wrong, you will notice and feel things in a more pronounced way.

There is a high likelihood that those things are happening in your body quite often. You just don’t realize it. As an example, if you stand and pay attention to what you are feeling in your feet, you will probably notice things that you have not noticed before.

That’s normal, and it’s not a sign of anything you need to worry about.

Your erections are the same. If you pay attention, you notice things that you were simply not aware of before.

It does not mean you have discovered a problem. Erections wax and wane. They shift, pulsate, and fluctuate in rigidity. It was like that before your ED. It just didn’t matter, and you did not pay any attention to it.

If you do not trust that process and you’re paying attention, natural movements and fluctuations will contribute to performance concerns and erectile dysfunction.

A Pill for Performance Anxiety Erectile Dysfunction Issues?

Taking a pill may help, but remember: the distress, fear, worry and concern that your erection will not last long enough or be hard enough may not go away. If these thoughts and feelings are present leading up to and during sex, they can interfere with the usefulness of taking a pill.

Our eCourse: "The Thinking Man’s Guide to Understanding and Addressing ED"

Five Ways to Address Performance Anxiety and Erectile Dysfunction

If you think performance anxiety might be contributing to your erectile dysfunction there are a number of things that you can do to improve erections.

  1. Establish goals. This is important because you have to know what you are aiming to do before starting. Many men make the mistake of trying to never feel anxious. Not all anxiety has to be eliminated and this may not be a realistic goal. Anxiety and performance anxiety have to be managed to the point that it is not overly distressing and that your mind can focus on desire and pleasure.
  2. Develop realistic expectations. Too many men believe their erections should be like machines. It’s simply not true. Erections are a complex process and it probably will not be perfect every time. It needs to be good enough. When things do not work as expected, understand many factors are involved and the next time can be different. (Listen to our podcast on unrealistic expectations and ED.)
  3. Build trust. Anxiety gets worse when there are more unknowns. If a man doesn’t know what might go wrong or what he can do its difficult to trust the erection process. Trust decreases anxiety by limiting the unknowns or helping to make them less daunting. The process of building trust tends to be unique to each man and takes some reflection and tracking.
  4. Address Relationships. If you are in a relationship this can be a source of your performance anxiety that impacts erectile dysfunction, but it can also be a part of the solution. We are not saying that your partner is responsible for your erectile dysfunction. Open communication and honest talks about each of your expectations can help make performance anxiety go away. If you are unsure of how to get this started, consider working with an expert.
  5. Work with Experts. Working with a performance anxiety and erectile dysfunction expert can help you make major progress toward better erections. Often there are factors that contribute to erectile dysfunction that are hard to readily identify.

Ready to Learn More?

To start your in-depth approach to resolving ED, try our online learning course called BEYOND THE LITTLE BLUE PILL, The Thinking Man’s Guide to Understanding and Addressing ED.


Erection IQ founder Mark Goldberg helps men resolve erectile dysfunction. He offers individual, one-on-one services to men throughout the world through a secure, telehealth platform. It’s 100% confidential. You can visit his website — The Center for Intimacy, Connection and Change — to schedule a free consult.

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Article Updated – March 2021