No erection due to performance anxiety: how do you break the tension?

Any man can experience an erection problem during sex from time to time. But if it happens more often, something dangerous creeps in: the pressure to get it right next time, no matter what. A lack of erection due to performance anxiety is one of the most common forms of erectile dysfunction in men under 50. The good news is: you’re not powerless against it.

What exactly is performance pressure?

Performance pressure arises when, during sex, you focus more on how you’re doing it than on what you’re feeling. This focus on ‘performance’ can stem from a previous disappointing experience, insecurity about your body, or the fear of letting your partner down.  Research shows that sexual performance anxiety is one of the most commonly cited psychological causes of erectile problems in men of all ages. It says nothing about your attractiveness, your relationship or your masculinity. It simply means that your mind is working harder than your body can cope with.

How does performance anxiety lead to erectile problems?

The mechanism is physiological in nature. When you are tense, your body switches to the sympathetic nervous system, the so-called fight-or-flight response. According to a review study, however, an erection depends precisely on the parasympathetic nervous system, which signals relaxation. As soon as stress or anxiety take over, the blood vessels constrict and blood flow to the penis decreases. An erection is then literally blocked by your own nervous system. This isn’t a character flaw; it’s biology.

It differs from stress-induced erectile dysfunction in the conventional sense, even though the causes are closely related. With performance pressure, the source of stress is sex itself.

Why does performance pressure often return?

This is where the vicious circle lies. Failing to get an erection once leads to insecurity; this insecurity leads to more pressure the next time, and this additional pressure causes tension once again. Studies show that men experiencing performance pressure consistently report higher levels of anxiety beforehand when thinking about sex, which increases the likelihood of failure. The more you try to control what happens in bed, the further you are from relaxation.

What can you do to reduce performance pressure?

It starts with shifting your focus. Concentrate on touch and sensations rather than the outcome. Consciously take more time for foreplay so that sexual arousal builds gradually, rather than you having to ‘perform’ straight away. Alcohol is counterproductive: it feels like relaxation, but it directly impairs erectile function. Open communication with your partner also helps, even if this is a hurdle in itself for many men. A partner who understands what is going on is less of a threat and more of an ally.

Can medication help with performance anxiety?

Yes, temporarily and specifically. PDE5 inhibitors such as sildenafil and tadalafil relax the smooth muscle in the blood vessels of the penis, making it easier for blood flow to get going during sexual stimulation. They only work if you are already aroused: it is not a magic bullet, but a form of support that lowers the inhibition threshold.

The key finding is: clinical studies show that short-term treatment with PDE5 inhibitors can break the cycle of negative expectations in cases of psychogenic erectile problems. One or more successful sexual experiences, even if medication was involved, restore self-confidence and reduce the compulsion to control. For a comparison of the options, read more about sildenafil vs. tadalafil. If you would like to find out more about Tadalafil as a treatment option straight away, you will find all the practical information there.

Both medicines are contraindicated if you are taking nitrates or poppers. Always discuss your situation with a doctor.

When is it advisable to seek help?

If performance anxiety is affecting your relationship or your self-confidence, that is the right time. Not as a last resort, but as a sensible first step. Studies show that men with sexual dysfunction are significantly more likely to suffer from anxiety and low mood, and that seeking help usually alleviates these symptoms. You don’t have to live with this for years.

Treatment for erectile dysfunction is made easily accessible at Fellos, precisely because we understand that the barrier to discussing such issues is high.

How does Fellos help with erectile problems caused by performance anxiety?

Fellos offers a three-minute online initial consultation. A Dutch doctor assesses your situation and draws up a personalised treatment plan. If medication is suitable for your situation, it is delivered discreetly to your home. There is no waiting room, no awkward conversation with your GP. Find out how Fellos works and what you can expect.

What do men say about their experiences with Fellos?

Men who sought help from Fellos for performance-related erectile problems report that they received quick and professional help without it feeling like a major medical process. Read the experiences of men who have already taken this step.

Regain your peace of mind and self-confidence with the help of Fellos

Performance anxiety rarely resolves itself. But it can be resolved. Whether you decide to adjust your approach in the bedroom, have a conversation with your partner, seek medication, or a combination of these: the first step is to recognise that it is your mind causing the blockage, not your body. Fellos helps you break this cycle – quickly, discreetly and at your own pace.

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