Every week, patients want to talk with me about “performance anxiety.” It’s one of those terms that everyone now uses, so people expect that I know exactly what they mean.
But as with most things that patients say, I usually respond by asking “what do you mean?” And that’s when patients start disclosing the ugly details.
“Ugly” because we often end up talking about power. Or unspoken threats. Or unrealistic expectations. Or conflict that has no obvious purpose.
WHAT IF I…?
When people say “performance anxiety,” they mean “I get anxious about being able to deliver a particular thing that someone else values.”
In the sexual realm, that starts with erections: what if I don’t get hard enough for intercourse? But it also extends to orgasms, a concern for people of every gender: what if I don’t climax? Or I climax too quickly, or too slowly?
And finally, even enjoyment can be a commodity delivered insufficiently: what if I’m not enthusiastic enough, or satisfied enough, or moan enough?
So that’s the what. Now let’s unpack the why: Why are people concerned with their sexual “performance?”
WHY?
The innocent answer begins “because I want my partner to have pleasure. I want to share closeness with them. I want us to have a good experience.” This sounds both reasonable and wholesome—except for the anxiety part, which we’ll get to below.
Some people do feel anxious out of altruistic concern about a partner’s pleasure (which isn’t necessary, although I understand it). But the dark side of this involves efforts to prevent a partner from feeling bad—and apparently that can take many shapes.
Some people create anxiety by imagining their partner being sexually frustrated (even if they swear they aren’t). Sometimes the anxiety results from a partner explicitly complaining “If you loved me, you’d [get hard, stay hard, climax, moan, etc.].” Or “If you found me attractive, or if you really desired me…”
Some people stake their own sense of sexual adequacy on their partner’s “performance”: “If I were a good lover, you’d be hard/climaxing/get wet quickly—and since you aren’t, I guess I’m not.” In this situation, people have sex defensively—wanting to protect themselves from the pain of causing their partner pain. And again, that creates pressure.
Pressure can even come in benign-sounding language: “Oh honey, I just want things to be fair. You give me so much pleasure, you deserve the same for yourself.” The result is still pressure—the sense that someone has to experience pleasure (or at least adequate function) to validate their partner. When one person’s pleasure becomes a commodity that they have to deliver to their partner, it’s easy to feel anxious.
RESPONSES
Responses to performance anxiety vary.
One is being terribly self-conscious before and during sex, undermining much chance of enjoying the sexual experience. Another is to simply ignore a partner’s experience altogether, which is the opposite of intimacy.
Another is to lose interest in sex–not as a conscious decision, but as an understandable consequence. When sex (or anything else) is emotionally dangerous, of course people back away from it. This is a common reason that people come in to see me. People often don’t realize that their performance anxiety can have such a large impact on them.
SO WHAT TO DO ABOUT THE PRESSURE?
Whether the pressure comes from one’s partner or from within, anxiety is a choice (yes, even if a person has a disorder or feels previously traumatized). If so, what are other options?
Talking is better than isolation. Having preferences is better than trying to be “normal.” Calibrating expectations is better than failing. Curiosity is better than anxiety.
Of course you’d prefer that your body behave in certain ways during sex. But this is only a problem if you can’t manage when it doesn’t—which is what we do in the rest of life. We’re continually facing disappointment, surprise, and alternative scenarios. Most healthy people accept them, maybe massage the results a bit, and get on with life. “Anxiety” makes that almost impossible. So realizing that you have choices is a valuable first step.
I help patients walk through “so what if…” scenarios of sexual disappointment. What if she won’t believe you’re attracted to her? What if she insists that you create an unrealistic experience for her? What if another guy would get an erection in a situation that you don’t? What if you’re the first guy your boyfriend couldn’t make climax?
I also help people describe what’s important about sex to them. Sexual “function” isn’t an end in itself, it’s just a means. A means to what? Pleasure. Closeness. Playfulness. Self-expression. When people pursue these things with an open mind (and a partner they trust), they can have them regardless of how each others’ genitalia behave. In that situation, there are always alternative erotic behaviors if your body (or your partner’s) doesn’t do exactly what you want.
I encourage people to discuss these things with every person they have sex with—and what kinds of experiences they would therefore enjoy regardless of how their genitalia behave. For straight people, understanding that intercourse is not “real” sex, but rather just one kind of sex, is crucial.
UNREALISTIC EXPECTATIONS
Much performance anxiety is a response to the unrealistic expectations of one or both partners. Porn, of course, portrays behavior that only exists because it’s been edited (and these people are playing fictional characters, not recording a documentary).
But some dumb-ass sexual ideas have been floating around our culture for decades, independent of porn: that women should climax from intercourse; that sex should happen spontaneously, without planning; that penises should get erect from a single moment of visual stimulation; that women are thrilled to suck a penis for hours on end; that people should have youthful, flexible bodies at every age.
When patients disclose that they have some of these ideas, I ask them to explain why they think ordinary bodies and people would behave in these ways. That’s the first step in eventually saying “What you expect of yourself, or what your partner expects of you, is simply not realistic. So quit being surprised or dismayed when your body doesn’t do that.”
Ultimately, people need to believe that anxiety doesn’t live in sexual situations—that people create anxiety. And that they can rewire themselves to enjoy a wider range of experiences, and to take disappointment more lightly. And that you can replace the identity of Anxious Lover with something, well, sexier.
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