Breaking the Cycle of Sexual Performance Anxiety

The Mind-Body Connection in Anxiety

An erection requires the parasympathetic nervous system (the "rest and digest" system) to be dominant. When you feel anxious, your body activates the sympathetic nervous system (the "fight or flight" response). This releases stress hormones like adrenaline, which constrict blood vessels and are the direct physiological opposite of what's needed for an erection. You cannot be both highly anxious and highly aroused at the same time.

This cycle often involves "spectatoring," where you're mentally observing and judging your own performance instead of being present and enjoying the moment. This self-monitoring only fuels the anxiety.

Therapeutic Approaches to Break the Cycle

Our counseling for performance anxiety is practical and skills-based. We use evidence-based approaches to give you the tools to manage your mind and body.

• Cognitive Behavioral Therapy (CBT): This approach helps you identify, challenge, and reframe the negative automatic thoughts that trigger your anxiety. For example, changing the thought "What if I lose my erection?" to "It's normal for erections to wax and wane; I can just focus on other forms of pleasure."
• Mindfulness and Sensate Focus: This is the direct antidote to "spectatoring." We teach you mindfulness exercises to bring your attention out of your anxious head and into the physical sensations of the present moment. Sensate focus is a series of touch-based exercises for couples that removes the pressure of intercourse and helps you rediscover pleasure and connection.
• Relaxation and Breathing Techniques: Learning diaphragmatic breathing and other relaxation techniques can give you an in-the-moment tool to calm your sympathetic nervous system if you start to feel anxious during intimacy.