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Stage Fright: How sexual performance anxiety affects men's mental health

Updated: Jul 31, 2023


Man and woman upset at each other

First Step Men's Therapy helps men across Ontario, Canada develop healthier relationships with themselves and others. We offer individual, couples, and group counselling to men and their families online using our secure telehealth platform.


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An increasing amount of men we see at the clinic come to us after noticing or experiencing sexual performance anxiety or after finding it difficult to achieve an erection or orgasm during sex. For many men, this might cause shame, embarrassment, anxiety, fear, and anger.


It is estimated that almost 1 out of every 3 men will experience some dysfunction with sexual performance in their lifetime, leading many to wonder how and why these challenges exist. For many men, they often first seek assistance with their family doctor, and, after a battery of tests, discover that there is no biological or physiological issues that would cause them to experience sexual anxiety or dysfunction.


How does sexual performance issues happen?


So why do some men have difficulty performing in the bedroom? Here are some potential explanations:

  • body image or low self-esteem which affects sex drive or ability to stay present during sex

  • past trauma with a partner where they felt embarrassed, ashamed, invalidated, or anxious

  • depression that may lead one to not feel sexual or avoid sex with partner

  • a lack of sexual experience, which may cause one to feel inexperienced or not good enough

  • increased stress which may lead to difficulty feeling sexual or aroused

  • increased or compulsive porn use, which could lead to porn-induced erectile dysfunction, which leads men to choose porn over their partners

How does performance anxiety or erectile dysfunction impact men's mental health?

  • Men may feel less than or not masculine based off of their lack of performance or anxiety in the bedroom

  • Men may feel shame or embarrassment and may avoid sex as a way to reduce the feelings of not being good enough or feeling ashamed for their lack of performance/ability to pleasure their partner

  • Men may feel anxious or depressed, which may lead to feelings of low mood, self-worth, or self-esteem

  • Men may avoid dating or getting into a relationship as a result of their fears around performing or being good enough for a partner

  • Men may compulsively use porn as a way to feel empowered, manly, or to get pleasure without having to experience shame, rejection, or anxiety with a partner

So how can one treat sexual anxiety or erectile dysfunction?


First, it may be important to rule out any biological or physiological factors that may have led to a lack of arousal, erection, or sexual anxiety.


If physiological or biological factors are removed or treated, therapy can be helpful to:

  • understand the root cause of the anxiety or lack of sexual arousal or desire

  • treat any comorbid issues such as depression or porn addiction that may impact one's sexual performance/experience

  • work through feelings of shame, low self-worth, or fear that may be associated with sexual anxiety or erectile dysfunction

  • improve one's emotional intimacy and physical intimacy with their partner as a way to improve communication, safety, and healing between partners

  • work on any trauma that may be associated with sexual dysfunction including sexual abuse, abandonment, rejection, or neglect

What is sensate focus and how can it help?

Additionally, helping to confront or challenge unhealthy or unrealistic standards or beliefs around sex might also be helpful. One common example we see is that sex has to be perfect. Sensate Focus, and an increase in presence and mindfulness during sex, can also help to allow one to be more present and less distracted during sex with a partner. Sensate focus challenges one to use all the senses to explore and experience sex as more than just a physical event. It allows one to be immersed in sex through a series of events and experience, taking in all of another rather than focusing on the end goal: the orgasm.


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Low Self-Esteem Therapy: Click here

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Porn Addiction Therapy: Click here



First Step Men's Therapy works with men across Ontario on sexual performance anxiety, erectile dysfunction, and sexual impairment. We offer individual therapy via our secure telehealth platform, JaneApp. We offer sexual performance anxiety therapy to men in Toronto, Ottawa, Brampton, Mississauga, Guelph, St. Catherine's, Barrie, Kingston, Peterborough, Sudbury, Windsor, London, Hamilton, Burlington, Oakville, Oshawa, Pickering, Kitchener-Waterloo - and everywhere in between.

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