Overcoming Performance Anxiety and Erectile Dysfunction With a Paradise Valley Sex Therapist (in training)
Erectile dysfunction (ED) and performance anxiety are related, but they’re not quite the same thing. ED is the physical experience of difficulty getting or keeping an erection. Performance anxiety is psychological and is more about the worry or fear of not being able to perform sexually, which can lead to ED.
The link between Performance Anxiety and Erectile dysfunction
Performance anxiety or sexual stage fright can stem from all sorts of things like past sexual experiences, religious backgrounds, body image concerns, stress, childhood sexual abuse, childhood abandonment, rejection or neglect, relationship factors, and unhealthy societal ideals about men’s sexuality. The pressure to perform can create a cycle where worry leads to being unable to obtain or sustain an erection, which creates a cycle that continues to get in the way of maintaining an erection.
Performance anxiety can cause ED because the stress and worry that comes with it can interfere with sexual arousal. When someone feels anxious, their body can go into “fight or flight” mode, which isn’t helpful for sexual response. We need to be relaxed to get aroused and experience pleasure. This cycle can then make ED worse, especially if someone begins to expect it to happen each time they’re intimate.
On the other hand, ED can sometimes have physical causes that aren’t connected to performance anxiety, such as health conditions like diabetes, heart disease, or the effects of certain medications. In these cases, ED can still lead to performance anxiety as someone may begin to worry about their ability to perform, which can add a layer of stress to sexual intimacy.
So, while they are different, ED and performance anxiety often go hand in hand. Erectile issues are frustrating, and they can lead to feelings of embarrassment, anxiety, shame, or self-doubt. The good news is that understanding this relationship can make it easier to find the appropriate solution and support to address the underlying cause of the erectile issue.
What impacts how erections are sustained?
Getting and maintaining an erection is a process that involves your body, mind, and nervous system working together in harmony. Sustained erections depend on many factors, such as:
Diet
Trying to have sex after a big meal can impact your body’s ability to sustain an erection. This is because after eating, blood is diverted to your intestines, away from the penis to help with the food digestion process.
Alcohol
Alcohol can dampen the brain’s ability to send clear signals to the body, including the signals needed to allow blood flow to the penis. Alcohol widens blood vessels temporarily, which makes it harder for the blood to stay trapped in the penis long enough to maintain an erection.
Hydration
If you are dehydrated, your heart has to work harder to pump blood to your penis, which makes it more challenging to maintain an erection.
Sleep
Sleep also helps regulate stress levels. When we are well-rested, we’re usually more relaxed and able to focus, feel connected, and get aroused.
Mood/Emotions
Positive emotions like happiness, love, and excitement create a sense of ease, which helps the brain send clear signals to the body for arousal and blood flow. On the other hand, feelings of stress, anxiety, sadness, guilt, or shame can make it challenging for these signals to come through. If you are anxious, depressed, have OCD, ADHD, PTSD, or substance abuse issues, on top of erectile issues–I encourage you to seek support from a mental health professional who specializes in treating sexual problems as well. SSRIs can significantly impact men’s sexual health.
Attraction to Our Partner
When we feel emotionally and physically drawn to someone, it sparks a sense of desire, excitement, and connection. This positive feeling creates a flow of signals between the brain and body that supports arousal, the physical response needed for an erection.
Relationship Issues
If the relationship is challenged, there are feelings of disconnection, or there is a lack of emotional intimacy, these can affect how we feel toward our partner, which might influence our body's physical response to arousal and desire. If a partner feels rejected by their partner’s inability to maintain an erection, this can also perpetuate the cycle of performance anxiety. Trust the wisdom of your body and have the courage to do the work and fix your relationship issues.
Hormones
Hormones regulate many processes that drive sexual arousal and function. One of the key hormones involved is testosterone, which is crucial for sexual desire and the ability to get and maintain an erection. Healthy levels of testosterone help keep libido strong and support the body’s physical response to arousal.
Cardiovascular System
The cardiovascular system plays a vital role in sustaining erections, as it is responsible for the flow of blood throughout the body, including the penis. Good circulation means that blood can flow freely and quickly into the penis when needed, helping to create and maintain an erection. If there are issues with the cardiovascular system–such as high blood pressure, clogged arteries, or poor circulation–it can affect how easily and how long blood flows into the penis.
Blood Pressure
Healthy blood pressure helps ensure blood flows freely and in the right amounts to create and sustain an erection. Blood pressure medications can impact men’s sexual health.
Pelvic Floor Health
Pelvic floor muscles are directly involved with sexual function. The pelvic floor muscles surround the base of the penis and are responsible for helping trap blood inside the penis during an erection, which keeps it firm. These muscles also help control the release of blood, allowing for a steady and sustained erection.
Erectile issues are like check engine lights. They mean something is going on under the hood, and we need to do additional digging to determine the issue's root cause.
physical causes of erectile issues
As we are learning, there can be many causes for erectile difficulties, and it can be overwhelming to know where to go for answers and solutions. The first step is to get a complete physical from your primary care doctor to rule out physical causes such as diabetes, cardiovascular problems, or hormonal issues. An important thing to note about testosterone replacement therapy (TRT) is that it can have long-term consequences, such as shrinking the testicles, and can ruin our body's ability to generate testosterone naturally on its own. So, consider obtaining a second endocrinologist's opinion before starting TRT.
methods to rule out physical causes of erectile issues
Another way to rule out physical causes is to purchase a Firmtech cock ring. Firmtech’s technology allows penis owners to track their body’s nocturnal erections. Suppose you have two or fewer erections during the night. In that case, it’s likely your erectile issues have a medical cause, and it’s time to see your primary care doctor so they can refer you to a urologist, cardiologist, or endocrinologist. Otherwise, if your nocturnal erections are in the normal range, the root cause is most likely occurring psychologically or in your relationship.
One other way to decipher if the origin of your erectile issues is physical or psychological is by asking yourself if you can get an erection when you are home alone, masturbating, getting down with yourself, or me՜nage a՜ moi ing it. This can give you a good indication of what needs to be addressed.
Psychological causes of erectile issues
You’ve done the work, gone through the process of elimination, and have determined with your primary care doctor that the root of your erectile issues is psychological or relational. The wonderful news is that erectile problems do not determine whether you can give pleasure to your lover. You have fingers, a mouth, sex toys, and, more importantly, your presence and heart to make love with. Your value as a lover cannot be reduced to your penis. The more heart and vulnerability you bring to your sex life, the depth of your intimacy will grow within your relationship.
how Shame and Fear Can Lead to erectile issues
Our societal norms and expectations of men paint a picture that they should always be able to perform effortlessly in bed. Men should never have any problems getting aroused or obtaining an erection, much less sustaining it throughout the entire sexual experience.
The idea that men should always be able to take charge and perform sexually can lead to a negative cycle of feeling embarrassed, inadequate, personal failure, sexual shame, anxiety, and avoidance of sex entirely. A penis owner can have difficulty with an erection one time, then worries that the next time it will happen again, then attempt to have sex and can't be present due to worry and is unable to get an erection. He worries that something is wrong with him and his penis, and the cycle continues over and over again.
Trauma is stored throughout the body. If a penis owner has a history of relationship trauma, it can impact their ability to be intimate and vulnerable in a long-term relationship. Childhood experiences of abandonment, neglect, and rejection can unconsciously make a person feel like getting into a long-term committed relationship is unsafe, even dangerous, and can affect a man’s ability to obtain and maintain an erection. Pay attention to what you are feeling and experiencing in your body.
Best therapies for treating erectile dysfunction
Sex Therapy
Sex therapy is a type of psychotherapy that focuses specifically on sexual issues. It can help individuals or couples address both the emotional and physical aspects of ED. Sex therapists work with clients to improve communication, resolve relationship problems, reduce sexual anxiety, and explore any emotional or psychological blockages related to sex. This therapy is beneficial for ED who have relational or emotional roots, such as performance anxiety or trauma-related issues.
Mindfulness-Based Stress Reduction (MBSR)
Mindfulness practices, including meditation and body awareness exercises, can help reduce anxiety and increase relaxation, which may improve sexual function. Mindfulness encourages non-judgmental awareness of the present moment, which can help reduce stress and performance pressure during sex. By focusing on the sensations of intimacy rather than on specific outcomes (such as achieving an erection), individuals may experience less anxiety and more satisfaction in sexual encounters. Mindfulness has been found to reduce symptoms of anxiety and improve overall sexual functioning in some people.
Couples Therapy
ED can sometimes result from relational issues, such as lack of communication, unresolved conflicts, or emotional distance. Couples therapy addresses these issues directly. A trained therapist can help partners communicate more openly about their needs, fears, and desires, which can reduce stress around intimacy. It also helps improve emotional connection, which can enhance sexual desire and function. Couples therapy can be beneficial if ED is affecting a relationship or if there is a lack of intimacy or emotional closeness.
EMDR
EMDR (Eye Movement Desensitization and Reprocessing) can be a deeply transformative therapy for people who experience erectile issues rooted in emotional trauma or unresolved psychological distress. While it’s often associated with trauma recovery, it has also shown promise in helping individuals with sexual dysfunction, mainly when emotional or psychological factors play a role. EMDR can help remedy erectile issues by releasing emotional baggage, alleviating performance anxiety, and healing negative beliefs.
Other solutions for erectile dysfunction
If you find yourself caught in a negative cycle of anxiety about your erections, come into the present moment. Pay attention to your five senses. What does your lover's skin feel like? What do their lips taste like? Draw your awareness to your breath and focus on deep belly breathing. Talking during sex can be another effective way to keep your mind focused on the present moment. Talking can be as red hot, dirty, or vanilla as you and your partner like.
What kinds of stories were you told about erections? Are they bad? Dangerous? Something to be ashamed of? What is your spiritual relationship to your eroticism and sensuality? Erotic meditations and Lingam massages are a way to practice healing touch and love instead of expectation and desire for the penis to behave in a performative way–getting hard and getting off.
Building a Pleasure-Centered Approach to Sex
Communicate with your partner about switching the focus to pleasure rather than performance during sexual intimacy. Prioritizing pleasure above all else during sex is the foundation for a successful sexual experience. In a long-term relationship, sex will be great, something in between, and disappointing at times. Practicing acceptance of each other and the situation for what it is without blame or shame will minimize anxiety and the pressure to perform over time.
Cock rings can be a surprisingly handy–and fun–tool for dealing with erectile issues. They work by gently restricting blood flow out of the penis, which helps maintain a firmer erection for longer. Firmtech is a company that uses science to design cock rings that are safe and comfortable to use. Don’t be afraid to incorporate more toys into your sex life!
One of the most effective and, by far, my favorite way to enhance sexual pleasure and blood flow to the penis is THC-infused topicals during intercourse. THC topicals create an effect called vasodilation, which means they increase blood flow, swelling, and heightened sensation in the penis. If applied topically, it will not have the high effect that would occur if you ate, drank, or smoked it. My favorite brand to purchase THC topicals from is Kush Queen.
Pros and cons of using Viagra for erectile difficulties
Taking Viagra for erectile difficulties can be a helpful option for many men, and it comes with its own set of pros and cons. Here’s a balanced look at what it can offer and some things to consider.
Pros:
Improved Blood Flow and Responsiveness
Viagra helps increase blood flow to the penis, making it easier to get and keep an erection when sexually aroused. For many people, it’s a reliable way to support a more natural sexual experience.
Boosts Confidence
Viagra can relieve some of the worries around performance, allowing some people to focus more on connection and enjoyment without the added stress of whether or not their body will respond as they hope.
Quick Acting
Viagra starts working within 30 minutes to an hour, making it easy to plan for intimate moments without a long wait. The effects can last several hours, allowing for some flexibility in timing.
Widely Tested and Trusted
As one of the most commonly prescribed medications for erectile difficulties, Viagra has been studied extensively, so its effects and side effects are well-understood by healthcare providers.
Cons:
Temporary Solution
Viagra doesn’t treat underlying causes of erectile difficulties. It’s a “quick fix” that helps at the moment but doesn’t address deeper causes.
Possible Side Effects
Some people experience side effects like headaches, facial flushing, upset stomach, or vision changes. In rare cases, men can get Priapism, which is an erection that lasts more than four hours. It is painful but not very common.
Not Suitable for Everyone
Certain health conditions–like severe heart problems, low blood pressure, or interactions with specific medications, can make Viagra very unsafe.
It’s always best to check with your healthcare provider to ensure using Viagra is a safe option for you.
Closing thoughts from a sex therapist in AZ
Erectile difficulties are a shared experience and nothing to feel alone or ashamed about. From lifestyle changes and relaxation techniques to medical options and communication skills with your partner, there are many ways to support your sexual health and confidence.
Remember, you do not have to navigate this journey alone. If you’re facing erectile difficulties, reaching out to a healthcare provider or a trusted professional can open doors to personalized support and guidance. At The Connection Couch, we are qualified to help you embrace this conversation with yourself and your partner. Reach out for additional support if you are ready to take the next step toward greater intimacy, connection, and peace of mind.
Overcome Performance Anxiety & ED with Sex Therapy in Scottsdale, AZ
We know how challenging it can be to discuss concerns like performance anxiety and erectile dysfunction. These struggles can impact not only your confidence but also your relationships and overall well-being. As experienced sex therapists in Paradise Valley, we are dedicated to providing compassionate, evidence-based care in a safe and supportive environment. Begin your journey with The Connection Couch by following these steps:
Schedule your first sex therapy appointment and begin the healing process
Uncover the life-changing benefits of sex therapy for individuals struggling with performance anxiety and erectile dysfunction.
Other Therapy Services Offered In The Scottsdale Area
As a sex therapist in Paradise Valley, I provide therapy for couples and individuals seeking to improve their intimacy. I also specialize in helping partners navigate betrayal and heal from infidelity. Additionally, I offer support for those recovering from sexual trauma.
Sources Related To Sex Therapy:
McCaffrey, K. (2019). Merry Jane: The CBD solution. Greenleaf Book Group Press.
McCarthy, B. W., & Metz, M. E. (2004). Coping with erectile dysfunction: How to regain confidence and enjoy great sex. New Harbinger Publication.
Watter, D. N. (2022). The existential importance of the penis: A guide to understanding male sexual health and masculinity. Springer.
Resources Provided by a Sex Therapist:
Pelvic Floor Therapists in AZ:
https://pelvicwellnessaz.com/
www.shept.co
Topicals and Toys:
https://myfirmtech.com/
https://kushqueen.shop/
Erotic Meditation and Lingam Massage:
https://www.youtube.com/watch?v=p0e2AKwvj7g
https://www.youtube.com/watch?v=zYyhs3Whjqo