It’s common knowledge that feeling unusually nervous or inhibited in bed can make sex turn out to be a bit of a flop. For men, this might literally be the case if their anxiety is responsible for a disappointing time in the bedroom. There’s a known link between the emotional and physical symptoms of anxiety and erectile dysfunction (ED).
Feeling so anxious that you are unable to have a satisfactory sexual experience is sometimes down to performance anxiety, whereby worrying about being able to get and maintain an erection leads to a vicious circle that is difficult to break out of.
This situation can also be a source of confusion because sometimes it might be referred to as ED, while another time you might see it described purely as performance anxiety.
This can make dealing with the problem a bit of a dilemma. Do you treat the ED with a medication such as Viagra (the trade name for sildenafil), or do you attempt to tackle the underlying anxiety? Breaking the cycle of performance anxiety is not impossible, but it is first important to pinpoint the exact causes.
From a medical point of view, sexual performance anxiety and ED are two distinct but interrelated conditions. To complicate matters further, sexual performance anxiety is not an officially recognised medical condition, and any treatment may be prescribed as part of more generalised treatments for anxiety.
So what is the best way to determine whether you have ED or sexual performance anxiety? The first step is to rule out any physical underlying causes of ED by visiting a doctor. This is especially important for men over the age of 40, because in middle-aged men, ED is far more likely to be caused by a physical health problem.
For example, ED can be a sign of heart disease, high blood pressure, type 2 diabetes, high cholesterol, nerve damage, low testosterone, obesity, or the result of an injury, or the side effects of medication or surgery. It’s really important to get checked out to ensure that there are no red flags signalling the need for prompt medical intervention.
However, sexual arousal is a complicated process that involves not just the physical responses of the body, but also our brain and emotional wellbeing. If you are feeling more tired, stressed, or depressed than usual, you may have noticed that your sexual desire falls off a cliff, or even if the heart is willing, it is impossible to rise to the occasion.
Even one negative experience in bed, particularly with a new partner, can trigger an anxiety response that creates a self-fulfilling fear around performing. This can in turn damage self-confidence and self-esteem, and make the problem continue or become more acute over time.
Once any physical causes for ED have been identified or ruled out, men who continue to experience problems in the bedroom may benefit from counselling or behavioural therapy to help them identify and overcome their issues.
Performance anxiety might be caused by a poor body image or low self-esteem; worries about appearing too inexperienced with a new partner; past traumatic sexual experiences; tension or emotional distance in a relationship; or an overreliance on pornographic material to become aroused.
It may also be related to a wider mental health problem such as chronic stress, depression, or generalised anxiety disorder. It can take some courage and a degree of self-knowledge and honesty to admit that any of these issues might be affecting you, even to yourself, let alone a partner, friend, or medical professional.
However, battling with the problem alone is only likely to perpetuate it and make it more entrenched and difficult to treat. This can eventually lead to more serious problems such as social isolation or withdrawal, depression, anger, or even suicidal thoughts.
A doctor may recommend therapy or counselling alongside a medical treatment such as Viagra on a temporary basis. Medicalising emotional problems may not be a long-term solution, but it can help to break the negative cycle that can trap men with sexual performance anxiety and leave them in despair of finding an effective solution.
Drugs such as Viagra have proven to be effective for over 80 per cent of men with ED, and are available without prescription after a short consultation with a pharmacist. They can provide a quick confidence boost and be used as a platform to rebuild relationships or repair damaged self-esteem.
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