Sexual Performance Anxiety

PhD Robert Filewich
03/31/2006

Millions of American men suffer with sexual performance anxiety. Below, clinical psychologist Dr. Robert J. Filewich, a specialist in anxiety disorders, and psychiatrist Dr. Ken Rosenberg, an expert in sexual disorders, give you the low down on how to keep it up.

Q: What is performance anxiety?

ROBERT J. FILEWICH, PhD: Performance anxiety, in sexual terms and with sexual problems, is when a person has an anticipation of some sort of problem occurring in the sexual act. As a consequence, they develop a sense of anxiety, which translates into an inability to become erect or an inability to have sex for a certain duration before they achieve orgasm, or premature ejaculation.

Q: Why does it happen?

KEN ROSENBERG, MD: We were not made to be anxious and have sex at the same time. When we're anxious, we're not ready to have intercourse. Our plumbing does not work when we become anxious, and therefore when we're extremely anxious we just can't perform very well sexually. ROBERT J. FILEWICH, PhD: And the anxiety is usually fear-based. It's the fear of being rejected, fear of disappointing a partner.

Q: How does performance anxiety manifest itself?

ROBERT J. FILEWICH, PhD: There are a few ways it can happen. You can get erect, and as you're about to have sex, you lose your erection, or maybe you're actually in the process of having intercourse and you lose the erection, or perhaps you don't get erect at all. Usually what happens is that the person is focusing on the orgasm, and not really focusing on all the rest of what goes on in the sexual encounter. As therapists, we try to get the person to focus more on the relationship and the sensory experiences that they're having as opposed to the final goal - focus on the process rather than the product.

Q: Are women also subject to performance anxiety?

KEN ROSENBERG, MD: Of course. It is not often called performance anxiety for women. It more characteristically is called anorgasmia, or the inability to have an orgasm, or vaginismus, the inability to allow the penis -- or the finger, for that matter -- to enter the vagina because a woman is so anxious that her vaginal muscles are contracting. So for women, anxiety certainly plays a role, and behavioral techniques and medicines and couples therapy and all sorts of therapies could be of enormous benefit for women as well as for men.