Performance anxiety in men: the worry loop, and how to deal with it

This page is about the mental side of things. For the muscle side, see our guide to Kegel exercises for men. Here you'll find the worry loop explained in plain words, a breathing practice you can start today, and a clear line for when a GP or a therapist should take over.

What performance anxiety is

It's worry about sex itself: will your body do what you want it to, and what will a partner think if it doesn't? It isn't a formal diagnosis. The review above notes that "no diagnosis is recognized" for it, and that "research into treatment has been minimal".¹

The NHS lists "anxiety about sexual performance" among the common psychological causes of finishing early. It says this is particularly likely at the start of a new relationship, or when a man has had problems before.² It also lists anxiety, alongside depression, among the conditions that can cause erection problems that happen often.³

Stress plays a part on its own. The NHS lists "sexual problems" among the physical symptoms of stress, next to muscle tension or pain.⁴

So if this is you, you're in very ordinary company. That doesn't make it pleasant, and it doesn't mean you should ignore it.

The worry loop, in plain words

Put those NHS points side by side and you can see how a loop forms.

1. An off night. Most men sometimes fail to get or keep an erection, usually because of stress, tiredness or alcohol.³ Finishing sooner than you'd like now and then is common and isn't a cause for concern.²
2. Worry about next time. The NHS says anxiety about performance is particularly likely after earlier problems.²
3. Worry in the moment. Anxiety is on the NHS list of causes for finishing early and for erection problems that happen often.^2,3 So the worry can help bring on the very thing you were worried about, and the loop goes round again.

Researchers describe something similar, carefully. A 2022 review of erection problems in men with anxiety disorders says "it is proposed that anxiety contributes to a vicious cycle", one that strains things between partners and makes talking harder. The same review says the role of anxiety "has not been clearly established".⁵ So think of the loop as a useful map, not a proven mechanism.

What you can do at each point

None of these is a quick trick, and we can't promise any of them will end the loop for you.

How to deal with performance anxiety: where to start

1. Check the usual suspects. Were stress, tiredness or alcohol part of the night? They're the usual reasons for an occasional miss.³
2. Practise slow breathing when you're calm, so it feels familiar when you need it. The steps are in the next section.
3. Look after the stress around it. The NHS suggestions for stress include talking about your feelings to a friend, family member or health professional, and breathing exercises. It also advises against using alcohol, cigarettes, gambling or drugs to relieve stress.⁴
4. Decide whether to tell a partner. You don't have to do this alone. The NHS describes psychosexual counselling as help for "you, and a partner if you have one".²
5. See a GP if it keeps happening. The section after next explains why it matters, even if you're sure it's nerves.

Finishing early is part of it for you? Finishing sooner than you'd like now and then is common and isn't a cause for concern. Lifelong early ejaculation is much less common.^2,6 Our guide to the stop-start technique covers one method sex therapists teach.

A slow-breathing practice for anxious moments

Slow breathing, under 10 breaths a minute, is linked to feeling more relaxed and less anxious.⁷ That finding comes from small studies in healthy adults, not from studies of sexual performance anxiety, so think of it as a way to calm down and nothing more. The NHS offers its own breathing technique "for stress, anxiety and panic".⁸

1. Get comfortable. Sit with your back supported, or lie down with your knees bent. Rest one hand on your belly.
2. Breathe in through your nose for about 4 seconds. Let your belly rise under your hand.
3. Breathe out slowly for about 6 seconds. Let your shoulders drop and your jaw go loose.
4. Repeat for 12 breaths. At 10 seconds a breath that's 2 minutes, at 6 breaths a minute.
5. If counting winds you up, drop it. Just make each out-breath longer than the in-breath.

Practise once a day when nothing is at stake. Once it's familiar, a few slow breaths are something you can reach for whenever the worry starts.

For a voice to lead you, try the free pelvic floor relaxation session: 5 minutes at the same pace, with no squeezing. Our guide to breathing and your pelvic floor has more on belly breathing. And if you train your pelvic floor too, every session on the free Kegel timer ends with a slow release.

When to see a GP

See a GP if erection problems keep happening, or if early ejaculation keeps happening and bothers you.^3,2

Don't assume it's nerves. Erection problems that keep happening can be an early warning of heart or blood-vessel disease, sometimes before any other symptom, and the link is stronger in younger men. If it keeps happening, see a doctor.^3,9 Our guide to exercises for erectile dysfunction explains why the doctor comes first.

A good appointment covers your head as well as your body. The NHS says the doctor or nurse may ask about your lifestyle and relationships, and do basic checks such as taking your blood pressure.³ The European urology guideline asks doctors to consider a man's psychosexual development, "including life stressors".⁹ So say what's been going on. It's part of what they're meant to ask about.

Both erection problems and early ejaculation have medical treatments, and a doctor can talk you through them. We don't give advice on medicines.

If the anxiety reaches well beyond sex, that deserves help in its own right. The NHS says to see a GP if you're struggling to cope with stress. In England, if you're 18 or over, you can also refer yourself to NHS talking therapies without seeing a GP first.⁴

Psychosexual therapy: what it is and how to find it

A psychosexual therapist, or sex therapist, is a counsellor who works with sexual problems. The NHS describes psychosexual counselling as a therapist helping "you, and a partner if you have one, with sex related problems".² The NHS is also clear that you should "never be asked to take part in any sexual activities" during a session.²

How to find one:

• Ask your doctor for a referral. In the UK, the NHS says some areas provide a sex therapy service, and that availability "can vary widely".²
• UK, privately. The NHS says sex therapists should be a member of the College of Sexual and Relationship Therapists (COSRT) or the Institute of Psychosexual Medicine.³ COSRT has a find a therapist directory.¹⁰
• US and some other countries. The American Association of Sexuality Educators, Counselors and Therapists (AASECT) has a referral directory of its certified members, searchable by state or country.¹¹

When to get help now

How GoBeast helps

We can't promise GoBeast will ease your anxiety, and nothing has tested it. This is what it does.

• Lessons on the anxiety loop, how erections work and when it's medical. Health information links to its sources.
• Paced breathing and body-scan practices to help you relax.
• Stamina and Confidence lessons you can take in your own time.
• A voice-guided, eyes-free player, a discreet icon and an app lock.
• It works alongside medical care, not instead of it.

Comparing apps first? See how the main Kegel apps for men compare, or read how the GoBeast app works.

Questions