Can Performance Anxiety Cause Erectile Dysfunction? - Healthline

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Key takeaways

Performance anxiety and erectile dysfunction (ED) share a connection, as anxiety can decrease testosterone and constrict blood vessels, potentially leading to ED.
While both have psychological components, ED can stem from physical causes like high blood pressure or diabetes, whereas performance anxiety is primarily a psychological issue related to situational pressure.
Treatments for both conditions include relaxation techniques, online therapy, and, in the case of ED, medications to stimulate blood flow. It’s important to speak with a healthcare professional for proper diagnosis and treatment.

Anxiety is a typical part of life. It’s normal to experience anxieties about work, your future, your partner, or other life events. Even if it’s not as apparent as you may think, any fear, stress, or anxiety-provoking situation can change your body and how it functions.

Performance anxiety is no different. When you’re anxious or in a stressful environment, your body reacts to these situations by increasing your stress hormone cortisol and decreasing testosterone. Your blood vessels also become smaller, making it more difficult for blood to flow throughout your body.

And that is where erectile dysfunction (ED) comes in.

A quick recap on ED…

Erectile dysfunction is the inability to get or keep an erection firm enough for penetrative sex. Or, when there is not enough blood flow to the penis. When the person is anxious, scared, nervous, or otherwise stressed during a sexual encounter it could make it more difficult to maintain or get an erection.

There are other causes of ED, but conditions that affect blood flow, your nervous system, or your hormones can impact ED more greatly.

…and performance anxiety

Performance anxiety, or sexual performance anxiety, is similar to ED only physiologically. Performance anxiety is more of a psychological issue than it is physical (like ED can be).

Performance anxiety, whether it’s sex-related, sport-related, or public speaking-related, is a worry or fear that you won’t be able to accomplish something the way you’d like it to happen. This can lead to physical and emotional distress, and it can manifest physical symptoms, such as:

ED
inability to climax or orgasm
increased heart rate
sweating
vaginal dryness (for those with vaginas)
premature (or delayed) ejaculation (for those with penises)

The link between ED and performance anxiety

Both ED and sexual performance anxiety may start from worries and fears about how you may perform, the anticipation of a sexual encounter, or another psychological factor. These thought processes often repeat themselves until you’re only thinking about your worries instead of your partner, the situation, or otherwise.

Sometimes the fears are short-lived and go away after the moment is gone. However, often the thoughts continue to circulate and may even grow. This keeps the anxiety in a loop and may keep the performance anxiety active for a while.

The longer the anxiety presents itself, the more the cortisol levels in your body continue to rise. This constant exposure to cortisol can increase your risk of a range of health issues, including erectile dysfunction.

Having a mental health problem, especially one that is managed with medication, could affect libido. Depression and anxiety are two of the most common mental illnesses, and both are known to affect sexual desire, energy levels, self-esteem, and more.

If you or your partner takes medications for these mental health conditions, research indicates that these medications may also affect libido and increase the likelihood of erectile dysfunction, vaginal dryness, and more.

So while both ED and sexual performance anxiety can be a psychological worry that affects your body, any medications you may be taking could be additionally affecting your body in a way that makes it more difficult for you to feel pleasure, give pleasure, or receive pleasure.

The differences between performance anxiety and ED

Where performance anxiety is mostly focused on the psychological effects of situational pressure, erectile dysfunction can be due to many more factors including performance anxiety.

It’s important to note that occasional ED is fairly common. Many people experience it during stressful situations, lifestyle changes, or nutritional shifts. However, if ED becomes frequent, occurring longer than a few weeks, it may be time to talk with a healthcare professional to see if there are any underlying issues.

Some physical causes of erectile dysfunction can include high blood pressure, cardiovascular disease, diabetes, obesity, kidney disease, substance use, and more. It’s important to note any symptoms, including trouble getting an erection, to help a healthcare professional rule out and treat any underlying medical conditions.

How to treat ED and sexual performance anxiety

It’s important to note that ED and sexual performance anxiety are common. Disappointing and unsatisfying sexual encounters do happen. Being unable to perform an in-the-moment sexual act does not mean you are unable to have sex. It could be due to another reason such as a stressful situation that happened earlier in the day or an anxiety flare-up.

If you feel anxious or fearful about the potential for sexual disappointment, keep in mind that these thoughts could present themselves in your next sexual encounter. However, treating ED and sexual performance anxiety can help reduce the chances of this happening.

Reframe and relax

If you’re feeling anxiety surrounding sex, whether it’s sex with your partner or masturbation, creating a relaxing atmosphere for yourself may be helpful. Trying breathing exercises or asking your partner for a massage may also be beneficial. The more relaxed you feel, the more likely you can be pulled into the present situation instead of focusing on challenging thoughts about what might occur in the moment.

You can also try talking with your partner about the anxieties or worries you’re feeling, whether it’s about keeping an erection or a new sexual experience you’ve been wanting to try. Asking for help, or even just venting, can help you feel mentally lighter.

Online therapy

Having performance anxiety or ED can be isolating and may induce even more anxiety. And sometimes, speaking with a loved one or your partner may seem even more daunting.

Resources are available to help with sexual insecurities.

Online sex therapy, or even regular online therapy, may help. Therapy sessions can give you a safe space to discuss your insecurities while receiving guidance and support where necessary. You can engage in therapy with or without your partner.

Sex therapists are certified and go through rigorous training and experience before obtaining a sex therapy certification. Sex therapy never requires any sexual acts to be performed during your session. Ever.

Here are a few options to consider that can make it easier to talk about your sexual anxieties.

Cost: session costs vary by professional
Accepts insurance: varies by professional
Services offered: varies

GET STARTED WITH AASECT

Healthline's review

Why we chose it: Because sex therapy is a field not all therapists are certified for, it may be best to find someone who you know for sure is qualified for discussing your anxieties. The American Association of Sexuality Educators, Counselors, and Therapists (AASECT) is a directory of all the sex therapists available to you by state.

Though this isn’t a platform, the AASECT can be a helpful tool in searching for certified sex therapists and educators. You can find sex therapists that offer individual or couples therapy, online therapy, in-person therapy, and some that may take insurance.

If you’re looking for a therapist, using the AASECT as a guide is a great place to understand the baseline of what you can be looking for in another mental health professional.

Product details

Privacy: varies by professional

Services offered: talk therapy, couples therapy, sex therapy, individual therapy, psychiatry, teen therapy, therapy for LGBTQIA+ persons, therapy for veterans
Accepts insurance: yes
Cost: $25 copay or less; starts at $69 per week for messaging; $99 per week for video and messaging; and $109 for video, messaging, and workshops

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4.5out of 5healthline scoreHealthline’s review

Why Talkspace: Since sex can be a delicate topic, talking out loud to someone over video or audio could be even more anxiety-inducing. Talkspace offers a messaging-based therapy platform so you can message your therapist about your issues without ever having to see them.

Talkspace is a subscription-based site that offers several types of plans for individuals and couples. You can get matched with a therapist, or you can search for one on your own. Since not all therapists are certified in sex therapy, Talkspace recommends choosing your own therapist.

Talkspace also takes insurance. Copays can be $25 or less. The plans start at $69 per week for messaging, $99 per week for video and messaging, and $109 for video, messaging, and workshops.

Our score breakdownMental Health Professionals4.5Payment & Insurance5Privacy & Security5Communication4.5Quality Indicators3.3

Product details

Privacy: HIPAA compliant and NCQA accredited

Payment model: subscription-based

Women-Founded

Privacy: HIPAA compliant and NCQA accredited
Payment model: subscription-based

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Treatments for ED

As previously mentioned, ED can have many underlying causes. After talking with a healthcare professional about your symptoms, they may prescribe medications that could help stimulate blood flow to your penis.

Note that these medications do come with side effects, especially if you have cardiac issues or are taking heart medications. Make sure to always consult a healthcare professional before starting any erectile dysfunction treatments so they’re aware of what could be best considering your current health.

brand name meds = generic name meds

There is no clinical difference between the brand-name and the generic medications. Generics are the active ingredients in brand-name medications. The only differences between the two are the pill manufacturer and the price.

There are four main types of ED medications. All four are approved by the Food and Drug Administration (FDA), and all four require a prescription to receive them. Viagra (sildenafil), Cialis (tadalafil), and Levitra or Staxyn (vardenafil) are four FDA-approved medications that are available as a brand name or its generic formula.

Stendra, or avanafil, is the only medication that is currently not available as a generic medication.

These medications are classified as phosphodiesterase type 5 inhibitors, or PDE5 inhibitors. When you have too much PDE5 in your system, blood flow to your penis could be more constricted (reduced or limited), which can lead to ED.

PDE5 inhibitors help improve blood flow to the penis by creating a natural chemical called nitric oxide that can help relax your penis muscles and allow blood to flow more efficiently.

There are also natural ways to relieve ED symptoms, but be mindful that all vitamins and supplements are not approved by the Food and Drug Administration (FDA) or regulated. Also, some medications you take may have a negative interaction with some alternative treatments. Always make sure to consult a healthcare professional before you start any new prescribed or over-the-counter treatment or medication

You can purchase ED pills online, but make sure that you check for FDA-approved formulas and check that they require a prescription to receive them.

Here are some Healthline-approved online sites that can prescribe ED medications to you after a brief telehealth visit with web-based healthcare professionals.

Treatments offered: Viagra, sildenafil, Cialis, tadalafil, Hard Mints
Prescription needed: yes
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Takeaways

Sexual performance anxiety and erectile dysfunction can typically occur due to life stressors or other events. Though sexual performance anxiety and ED are very closely related and can form a challenging cycle, they are different diagnoses.

If you have performance anxiety or erectile dysfunction for more than 3 months — or something doesn’t feel right to you — talk with a healthcare professional to schedule an appointment. They can rule out any other underlying causes, provide a proper diagnosis, and help create the right treatment plan for managing your symptoms.

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Dhaliwal A, et al. (2023) PDE5 Inhibitors.https://www.ncbi.nlm.nih.gov/books/NBK549843/
Kane L, et al. (2019). A review of experimental research on anxiety and sexual arousal: Implications for the treatment of sexual dysfunction using cognitive behavioral therapy.https://journals.sagepub.com/doi/10.1177/2043808719847371
Malhi Gin S, et al. (2022). Questions in psychiatry: Psychological basis for sexual dysfunction in psychiatry.https://onlinelibrary.wiley.com/doi/10.1111/bdi.13273
McCabe M, et al. (2016). Risk factors for sexual dysfunction among women and men: a consensus statement from the Fourth International Consultation on Sexual Medicine 2015.https://academic.oup.com/jsm/article-abstract/13/2/153/6940095?redirectedFrom=fulltext&login=false
Montejo A, et al. (2018). The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management.https://onlinelibrary.wiley.com/doi/10.1002/wps.20509
National Health Service. (2024). Erectile dysfunction (impotence).https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/erectile-dysfunction-impotence/
Pyke RE. (2020). Sexual performance anxiety.https://academic.oup.com/smr/article-abstract/8/2/183/6880285
Rowland DL, et al. (2019). Anxiety and performance in sex, sport, and stage: Identifying common ground.https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2019.01615/full
Rowland DL, et al. (2021). Remediation strategies for performance anxiety across sex, sport, and stage: Identifying common approaches and a unified cognitive model.https://www.mdpi.com/1660-4601/18/19/10160
Sexual dysfunction in men and women. (2024).https://familydoctor.org/condition/sexual-dysfunction/
Simopoulous EF, et al. (2013). Male erectile dysfunction: Integrating psychopharmacology and psychotherapy.https://www.sciencedirect.com/science/article/abs/pii/S016383431200271X
Stress effects on the body. (2024).https://www.apa.org/topics/stress/body
Treatment for sexual problems. (2010).https://www.apa.org/topics/sex-sexuality/treatment
Velurajah R, et al. (2022). Erectile dysfunction in patients with anxiety disorders: A systematic review.https://www.nature.com/articles/s41443-020-00405-4

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Medically reviewed by Alana Biggers, M.D., MPH — Written by Parisa Syed — Updated on February 20, 2025

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Key takeaways

A quick recap on ED…

…and performance anxiety

The link between ED and performance anxiety

The differences between performance anxiety and ED

How to treat ED and sexual performance anxiety

Reframe and relax

Online therapy

Healthline's review

Product details

Product details

Treatments for ED

Product details

Product details

Takeaways

How we reviewed this article:

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