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Last updated October 11, 2019. 6 minute read

Premature ejaculation (PE) and sexual performance anxiety

Sexual performance anxiety is very common. Most of us have experienced it at some point, and it affects young men and older men alike. It’s when negative feelings about your sexuality cause you to become self-conscious and worry that you won’t satisfy your sexual partner.

Self Written by Michael Martin
Reviewed by Mike Bohl, MD, MPH

Quoth Captain Obvious: Sex is supposed to be fun. But sometimes we get stuck in our own heads and the prospect of having sex seems as appealing as starring in the latest Final Destination sequel—you might not literally fear getting impaled on a bedspring in the last act, but you’re certain something bad is going to happen in that bed.

The fear of how you’ll do when you’re doing it can put a serious damper on your sex life and preclude intimacy with a partner. That’s when it becomes a problem. Luckily, it’s one that has some easy solutions.


  • Sexual performance anxiety happens when you fear you’re not “good enough” to please your partner.
  • Common causes of performance anxiety include self-esteem, body image, and insecurity about sexual experience.
  • Performance anxiety can cause premature ejaculation, erectile dysfunction, or an avoidance of sex altogether.
  • There are several effective therapies for performance anxiety, including cognitive-behavioral therapy (CBT), a.k.a. changing negative thoughts about sex.

What is performance anxiety?

Sexual performance anxiety is very common. Most of us have experienced it at some point, and it affects young men and older men alike. It’s when negative feelings about your sexuality cause you to become self-conscious and worry that you won’t satisfy your sexual partner.


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“Anxiety is a future-oriented emotion in which you catastrophize about the consequences of a possible future event,” said psychologist Elliot Cohen, MD, in Psychology Today. “In the case of sexual performance anxiety, the event in question is a failure to perform sexually, and the perceived catastrophic consequences are loss of self-respect and fear of how you think others—especially your sex partner—would view you.”

What causes performance anxiety?

You might develop sexual performance anxiety for a number of reasons, including:

  • Fear that you’re not “good enough” at sex or lack sexual experience 
  • Fear your penis isn’t big enough
  • Embarrassment over bad experiences (e.g., erectile dysfunction or premature ejaculation)
  • Insecurity about your body (e.g., body image issues)
  • Relationship problems
  • Anxiety or guilt about sexuality in general

Sexual performance anxiety can have a number of side effects: You might not be able to get an erection (ED), or you might ejaculate too quickly (PE). You might have difficulty having an orgasm, or you might avoid sex altogether.

Erectile dysfunction

Sexual performance anxiety can affect your erection during sex, causing ED. You might have softer erections, erections that don’t last as long, or not be able to get one at all. Scientists estimate that fear of sexual failure and other psychological factors might cause between 10% and 20% of erectile dysfunction cases (VA, 2013).

But ED isn’t just about an ability to get hard—it’s really about how you and your partner feel about your sex life. And if you’re experiencing performance anxiety, that feeling is not great.

They say that 90% of sex is mental, and in the case of sexual performance anxiety, that’s definitely true. But performance anxiety causes physical reactions, too: When you’re anxious, your body releases the stress hormones adrenaline and norepinephrine. These constrict blood vessels, keeping blood flow from getting where it needs to go—in the moment, your penis. This makes it difficult to get and keep an erection. If you fixate on a past episode of ED and worry you’ll lose your erection this time too, it can become a self-fulfilling prophecy.

Premature ejaculation (PE)

Sexual performance anxiety can also cause you to come too fast, also known as rapid ejaculation, premature climax, or early ejaculation. This sexual dysfunction is basically your body saying, “Get me out of here.” One study found “a significant correlation” between performance anxiety and ejaculating prematurely (Rajkumar, 2014).

Orgasm difficulties

Performance anxiety can make it difficult for you to reach orgasm. It’s probably no surprise: Worrying about whether you’re having bad sex can make the experience feel less good than it should.

Fear of sex

Sexual performance anxiety might cause you to develop an aversion to sex all together, shutting down sexual desire and avoiding situations that might lead to intimacy.

How to overcome performance anxiety

Try mindfulness

An effective technique for combating anxiety of any kind is mindfulness. And staying mindful is especially important during sex. Mindfulness means staying in the present moment and concentrate on what you’re doing instead of what you’re thinking. For example, a person who feels anxious about a healthcare provider’s visit while sitting in the waiting room might concentrate on their breathing and the smallest things they’re doing, like turning the page of a magazine, sipping coffee, or tying his/her shoe.

This can be effective in taking us out of our heads, quieting negative self-judgments, and the anxious messages our brains are sending us about something bad we imagine will happen in the future. “Mindfulness means focusing our attention on any or all of the pleasurable sensations we are experiencing in the moment–touch, sight, sound, smell, taste—as well as focusing on any pleasant emotions we may be experiencing—excitement, affection, enjoyment,” says the National Social Anxiety Center (NSAC). “Mindfulness, when being sexual, also means distancing—defusing—from any evaluative or worrying thoughts and feelings we may be having, treating them like unimportant background noise.”

As you can imagine, practicing mindfulness during sexual activity can be great for enhancing the experience and overcoming performance anxiety. Concentrating on what you’re doing during sex—the sensations of touch and what you’re feeling physically and emotionally—can help shift your focus from how you’re doing.

Change your thoughts

In addition to mindfulness with a partner, experts at the NSAC also recommends practicing mindfulness when you masturbate, along with cognitive behavioral therapy, a.k.a. changing your thoughts. “Identify your belief about the sexual problem you are having,” the NSAC says. “Typically, it’s something like ‘My partner and I won’t enjoy sex if I don’t perform really well (don’t get erect or lose an erection, ejaculate too soon, or never have an orgasm).’ Then write down a constructive alternative attitude that you believe, at least intellectually, such as: ‘My partner and I can greatly enjoy being sexual together if I focus on the pleasant sensations, feelings, and experiences we are having, regardless of what my penis is doing.'”

Stop comparing yourself to porn

There’s nothing wrong with watching porn. But if you’re spending too much time with adult entertainment, you could experience erection problems. You might believe that you don’t “measure up” in terms of penis size and performance skills. Know the facts: The average penis is 5.16 inches long, and 90% of men have penises within one inch of the average.

The sex in porn is, quite literally, fake. The industry is filled with idealized versions of people’s bodies and genitals. And if we start having negative feelings about our own genitals, as one study published in the Journal of Sexual Medicine found, that can be a distraction in bed, leading to sexual anxiety and dysfunction, including ED or PE (Wilcox, 2015). And it can be a vicious cycle: You’re anxious about your body, so you have an instance of ED or PE with your new partner; the next time you’re in bed, you’re anxious about your body and the ED/PE episode, so you experience ED or PE again.

Manage your mental health

If you find that you’re feeling anxious about life in general, it might be a good idea to get professional help. Your PE and sexual performance anxiety could be part of generalized anxiety disorder, which has several treatment options, including talk therapy and anxiety medication.

Believe you’re good enough

There are days in which you might feel like a walking hormone, but guess what: You are not your dick, or how it performs on any given day. “You are not identical to an orgasm,” said Cohen. “You are not a mere mechanism. You are a being who can think, reason, act, feel, desire, and sense. So respect yourself—good sex, after all, begins with self-respect.”

Be aware of your overall health

In some cases, recurrent sexual dysfunction like frequent ED (or worsening ED symptoms) can be an early warning sign of more serious health problems like heart disease, high blood pressure, diabetes, or depression. If you’re experiencing PE, ED, or other sexual issues, it’s a good idea to check in with your healthcare provider.