Overcoming Male Performance Anxiety

The one issue that I see time and time again in my sex therapy practice is male performance anxiety. It usually manifests as psychogenic erectile dysfunction and/or inhibited sexual desire. Although every story is unique to the client and his life, there is often a common thread or pattern running through these narratives.

 A typical scenario goes something like this. The male is sexually attracted to his partner but engages in sex with a lot of anxiety because he is fearful of letting the other person down by not getting an erection. There usually have been past episodes of failure to achieve an erection with a sexual partner. He becomes preoccupied by the sexual dysfunction and tries to mentally ‘will’ himself to get an erection during sexual activity. This strategy doesn’t work so he disengages from his partner (sometimes quite abruptly) and doesn’t want to talk about it because he feels terrible about himself. This experience often results in him gradually losing interest in sex altogether and over time avoiding sexual encounters. Despite functioning well in other areas of his life, at the back of his mind, he wonders what’s wrong with him. After all, everyone else can do it but him.

The partner (usually female) takes the lack of erection personally and usually gets angry, accusing him of not finding her attractive, being in love with someone else, having an affair etc. In her mind, any man who finds her attractive would have no problems getting aroused and erect. Her sense of self depends on his ability to function sexually so she starts to blame the male who (at this point in time) may have lost his interest in having sex. Other partners may not be so overtly reactive but feel hurt by the male’s emotional withdrawal which they don’t openly address. The relationship becomes tense and fraught with conflict, distance and discontent.

Although each of them may be in different places emotionally by the time they come to see me, both are convinced that there is something wrong with the male and that he needs help to get “fixed”.

Assumptions about masculinity

If a man is not interested in sex or turned on regardless of what has happened, or might be happening to him in his life, it is automatically assumed by him and his partner that there is something wrong with him. This is because in our culture, there are long-standing assumptions about what men are suppose to be, and suppose to feel when it comes to sex – untiring, masterful, dominant, can go all night, hard as steel etc.  It is assumed men are always up for sex and anything short of that makes him (and his partner) question his masculinity. In this way of thinking, the male sexual drive is a biological force in constant pursuit of an outlet and ready to go at any moment.

This limited model of male sexuality reduces men to just their biological drives and is frankly de-humanising. It’s high time we stop viewing men in this highly over-simplified and unhelpful way and start seeing them as just human beings.

Psychotherapist and author, Esther Perel points out that there are some really important things to understand about men and male sexuality. Here is what she had to say:

1.     Men are no different from any other human being. They are affected by their inner state and this in turn, impacts on their level of sexual desire and their sexual interest. If a man is depressed, anxious, worried and/or struggles with his self-esteem, then all of these inner states will influence how he experiences his sexuality. There is always an interconnection between what is going on in a man’s inner life, his sense of desirability and actual level of desire and arousability.

2.     There are three central male vulnerabilities that really capture what many men grapple with.

-  First, it’s the fear of rejection. Throughout history men have been placed in the free position but also burdensome position of having to be the initiator. If you are constantly the initiator, you deal with worries about rejection.

- Second is the fear of inadequacy. “Am I competent enough?”,Do I know what I’m doing?

 - Third, “How do I know that my partner (especially if it is a female partner), really enjoys it”.

These three masculine doubts around sexuality deeply affect many men and is what accompanies them into the bedroom.

Addressing the real issue/s

So, as a man, how can you help yourself manage sexual performance anxiety? Again Perel has some valuable advice to offer:

1.     Stop buying into unhelpful assumptions based on an outdated model of male sexuality.

2.     Check inside yourself, what’s going on? – is your mood down? Are you anxious? Are you worried? Are you unsure about her interest in you? What are the internal conversations that directly affect your excitement and your arousal state?

3.     What’s going on in your relationship? Do you talk with your partner? Does she know what’s going on? Do you get turned on enough? Are there things between the two of you that turn you off? Do you want her to initiate so you don’t have to make all the effort?  

4.     Bring your partner into the conversation. No partner is happy at being kept out of the loop. When you don’t share your inner life with her, it makes her wonder about her desirability and attractiveness and doubts set in about whether you still care for her. If having an honest and open conversation with your partner fills you with anxiety, seek couples counselling to help with communication.

5.     Get out of your head and more into your body.  Work on easing your anxious thoughts so you’re not asking yourself the whole time “Am I turned on enough?” “Am I manly enough?” This will constantly take you out of the experience. Rather, find ways to ground yourself in your body and in the moment.

6.     Don’t think about having to do the entire experience called ‘sex’, that is, the act of intercourse.  Work on increasing eroticism (see my previous post on Sexual Playfulness for ideas) and on decreasing the focus on intercourse.

Again, if you find that it is all too hard to communicate this to your partner and to gain her cooperation, please consider enlisting the help of a couples counsellor or sex therapist.

Esther Perel is a Belgian psychotherapist and author. Recognised as one of the important voices in modern love, marriage and human relationships, she is known for her work on sexual desire and infidelity.

In this Youtube video, Perel addresses the issue of Male Performance Anxiety https://www.youtube.com/watch?v=wd4oVg0pAv4