Male Performance Anxiety Solutions: 5 practical effective ways to overcome it

Introduction 

Male Performance Anxiety (M.P.A.)  is characterised by intense anxiety about the ability to attain and maintain an erection during sex. Consequences may include disruption in sexual satisfaction and even  avoidance of sex in anticipation of failure. 

M.P.A. may affect one in four men suffering from premature ejaculation and psychogenic erectile dysfunction,[1] while adversely impacting partners sexual functioning or sexual satisfaction too.[2]  

Male Performance Anxiety Solutions 

Identifying precipitating factors for M.P.A. is vital in recognising the correct solution.  The duration of complaints; whether partner specific or happened in previous relationships or during self-stimulation offer important cues. Often partner interview may provide additional insights. An overall holistic approach to understanding M.P.A combining individual, sociocultural and situational factors likely causing sexual distress is beneficial. [3] 

Apprising the couple about stages of normal sexual response cycle [desire, excitement, orgasm and resolution], signs of sexual excitement and potential turn-on and turn-offs can aid in dispelling myths and managing expectations. Possibility of shifting focus away from orgasm focused on-demand penetrative intercourse  towards a more planned pleasure focussed one with impetus on pleasure giving can help reduce the pressure greatly.   

Use of C.B.T., Sex therapy techniques, Kegels exercises and Mindfulness techniques can help lessen the burden of M.P.A. Role of medications supervised by a doctor for on demand use or as continuous treatment regime is valuable. 

Common causes of Male performance Anxiety 

1. Psychological stress: Fear of negative evaluation or anticipated humiliation by the partner due to unsatisfactory intercourse is a common cause.Distress in daily life arising from financial concerns, work pressure and familial discord can precipitate M.P.A.
2. Relationship difficulties: Relationship concerns ranging from marital disharmony to apprehensions about partner health can trigger M.P.A.
3. Lifestyle factors: Such as lack of physical fitness, substance abuse disorders especially alcohol abuse can have a major impact on the performance.
4. Lack of awareness:  Myths and misconceptions about stages of the physiological sexual response cycle are common and lead to unrealistic expectations from intercourse. Stigma and taboo associated with discussion around this topic further intensifies the sense of isolation and helplessness.
5. Biological causes: Medical conditions such as Diabetes, Hypertension, Thyroid disorders, Prolactinomas and low Testosterone levels or local genital pathology like penile lesions can adversely affect the sexual response cycle resulting in sexual dysfunctions which may in-turn precipitate M.P.A.

How does Male performance Anxiety affect daily life and relationships 

1. Individual effects:  A constant preoccupation with intrusive ruminative thoughts about inability to perform sexually can occur leading to difficulties in focusing on daily responsibilities. It may also impar his body image and self-confidence, sometimes leading to almost phobic avoidance of sex. Precipitation of other sexual dysfunctions such as Erectile dysfunction and Premature ejaculation is likely. 
2.  Impact on Mental Health: Performance anxiety can be responsible for precipitating Major depressive disorders, Substance abuse disorders like alcohol abuse, worsening of preexisting anxiety disorders like social phobia and sometimes even conjugal paranoia.
3. Relationship discord: Inability as a couple to enjoy the expected sexual gratification combined with lack of open communication can irrevocably damage their relationship. This often sows seeds of marital disharmony. Faliure to properly address this and indulging in blame games or harsh criticism can often strain ties between the couple resulting in total breakdown of the relationship.

 5 effective practical solutions to Overcome Male performance

1. Proper evaluation & psychoeducation: Cornerstone of successful management is a thorough evaluation about cause and duration of the anxiety. It is necessary to address any myths and misconceptions regarding sex harboured by the couple, along with imparting requisite information about the proper sexual techniques.Use of telemedicine services to reach people with sexual problems has been shown to result in better understanding of their issues, decrease in complaints, and reduced barriers to communicating with a partner or physician.
2. Supervised medications: Supervised medications by your doctor is quick and effective treatment option available for M.P.A. Commonly prescribed ones include Phosphodiesterase5 inhibitors on  s.o.s. basis , appropriate nutrachemical supplements for enhancing sexual well-bieng and the indicated anti-depressants where co-morbid anxiety disorder or depression is present. Any comorbid medical illness also needs to be addressed by the appropriate specialist.
3. Couple interventions: A conscious decision to focus on more pleasure focused rather then penetration focused one is beneficial in reducing the impact on anticipatory anxiety. It is also worth considering a shift from immediate on demand sex to a more planned tranquil approach. 

An open minded and non-judgmental conversation with your partner regarding the concern can help facilitate this discussion. 

1.   Behavioural techniques: Sex therapy exercises, Kegels exercises and CBT when done with the proper guidance help alleviate M.P.A. 
2. Lifestyle alterations: Improving your stamina by exercise, appropriate weight control avoiding  alcohol and smoking in addition to practicing relaxation techniques like mindfulness exercises are some lifestyle interventions that will help.   

Conclusion

Physical intimacy forms an important pillar on which the relationship between two consenting partners rests.

M.P.A. is a common and silent stream of anxiety that can erode this pillar often precipitating major breakdown in the relationship or triggering psychological and sexual distress in the patient.  

Psychoeducation, thorough assessment, supervised medicines, appropriate therapy and lifestyle interventions can provide effective solutions.

References 

[1] Pyke RE. Sexual Performance Anxiety. Sex Med Rev. 2020 Apr;8(2):183-190. doi: 10.1016/j.sxmr.2019.07.001. Epub 2019 Aug 22. PMID: 31447414. 

[2] Brotto L, Atallah S, Johnson-Agbakwu C, Rosenbaum T, Abdo C, Byers ES, Graham C, Nobre P, Wylie K. Psychological and Interpersonal Dimensions of Sexual Function and Dysfunction. J Sex Med. 2016 Apr;13(4):538-71. doi: 10.1016/j.jsxm.2016.01.019. Epub 2016 Mar 25. PMID: 27045257. 

[3] Raposo CF, Nobre PJ, Manão AA, Pascoal PM. Understanding sexual distress related to sexual function (SDRSF): A preliminary framework based on a qualitative study with clinical sexologists. Int J Clin Health Psychol. 2024 Jul-Sep;24(3):100473. doi: 10.1016/j.ijchp.2024.100473. Epub 2024 Jun 24. PMID: 39021678; PMCID: PMC467054. 

[4] Zimbile F, Beek T, David S, Crutzen R. An Implementation Pilot of Web-Based Self-Training Programs on Sexual Dysfunctions in the Dutch Public Sexual Health Setting: Mixed Methods Study. JMIR Form Res. 2023 Oct 26;7:e49009. doi: 10.2196/49009. PMID: 37883172; PMCID: PMC10636612.