When I was still learning to control when I orgasm, sex was always a trial. Failure was my constant companion. Initially, I felt absolutely overwhelmed and helpless. I was hurting and my gut was filled with shame. I never told anyone about how I struggled to push the boulder up that fucking hill until I succeeded. Despite all the pain, I was determined to push through.

In hindsight, things could have been much, much easier. It took me years to understand that a huge part of why I wasn’t making progress was that I never resolved my anxiety around sexual relationships. With this piece, I want to put you in the fast lane to overcome any sexual dysfunction. It’s not a shortcut, it’s simply the right way.

Cognitive Behavioral Therapy's effectiveness in treating general anxiety and anxiety disorders has inspired me to write this guide for this common issue (Borkovec & Costello, 1993; Stewart & Chambless, 2009).

 

Step 1: Understand the role of anxiety

Let’s start and see what the textbook says about anxiety:

Definition of Anxiety on Google according to Oxford Dictionary
Definition of Anxiety on Google according to Oxford Dictionary

This feeling of worry leads us to avoid the underlying reason. Our mind, our ego prefers the comforting hug of safety. It quickly learns that we stay in the shelter if the fear is just strong enough. So every time we avoid the feared situation, our mind dials up our fear even more as if we would have made more bad experiences. The graph below shows exactly how your anxiety grows as you avoid it. 

A graph showing that anxiety becomes stronger if a person avoids the anxiety-inducing situation
Graph showing performance anxiety development over time. Adapted from Therapy Aid (n.d.).

Whenever you are feeling anxious about sex and then avoid the situation that caused you to feel anxious then you are feeding your anxiety. 

 

Anxiety motivates you to do become better

According to the Yerkes-Dodson law, there is a sweet spot of moderate anxiety where we humans do our best.

A graph showing that moderate levels of anxiety yield the highest chances to get better at sex.
Moderate levels of anxiety are useful to be motivated to improve your sexual prowess (I adapted the model to fit the topic)

If we had no anxiety at all, we wouldn't be motivated to tackle our issues. At the end of the day, anxiety is a form of physiological arousal and without it, we'd simply ignore our problems and live with it. We need a certain level of anxiety so that we invest resources to learn the required skills to overcome our sexual challenges.

In a way, having a high level of anxiety makes it super important for us to resolve our current issues and to find a solution because our current experience is painful. Unfortunately, when we are very anxious, we tend to have such a high stress level that we are unable to function constructively. This leaves us stuck in a place where we rather avoid the issue because we don't feel like we are capable of improving ourselves to a point where we are skillful enough to not feel anxious anymore.

Let's take a closer look at this dynamic. 

 

Step 2: Understand how our thoughts, physiological state, emotions, and behavior influence each other.

Before we can learn to regulate our sexual anxiety so that we stay at the sweet spot for improvement, we need to understand the cognitive-behavioral relationship between mind, body, emotions, and behavior. 

A graph showing that thoughts, behavior, physiological state and feelings all influence each other.
All dimensions are interdependent and thus influence each other

Your conscious experience is a complex system where the different domains Mind, Emotions, Body, and Behavior are always influencing each other. For instance, when are smiling (behavior) your body is providing feedback and you feel happier (emotion) (Tsujita & Rekimoto,2011). Or, when you are feeling relaxed (emotion), it's more likely that your heart rate is slow (physiological state). 

Now, an external event such as going to the bedroom with your partner can trigger a sudden shift in this equilibrium. If you suffer performance anxiety, your mind is programmed to interpret the situation as a threat. You will notice that your thoughts become negative, and with that your physiological state, and emotions match this anxious belief system. Now that your heart is racing, your breathing accelerated and you are feeling anxious, your thoughts become even more negative. This undermines your confidence and you withdraw from your partner to defuse the sexual threat. Your cognitive system might even invent nausea or a headache to get out of the situation. 

If you manage to push through your anxiety and have sex regardless, you are likely to feel immense pressure and nervousness. You are focused on not fucking up and thus have no capacity to pay attention to your partner. 

How do we break this vicious cycle? 

 

 Step 3: Recognize when you experience performance anxiety

Unless you realize when you are experiencing performance anxiety, there is no way you can do something about it. Luckily, it's quite easy to spot if you know what to look for. You will most likely realize one or multiple of these common symptoms of sexual (performance) anxiety:

The most common symptoms of sexual performance anxiety
Most common effects of performance anxiety

Take a moment to reflect on the last time when you were in a sexual situation. What kind of symptoms do you remember? By vividly memorizing a particularly frustrating sexual experience, it's likely that you will be able to trigger some of these symptoms as well. 

 

Recognize Unhelpful Thinking Styles

Psychologists have observed that unpleasant emotions are often caused by unhelpful thoughts. Especially when we humans are anxious in a certain context we often tend to develop these unhelpful thinking styles. These thought patterns are unconstructive because they blow things out of proportion, draw premature conclusions or portray reality as highly biased.

 

Magnification & Minimization

You believe that what you have achieved is invalid or unimportant. At the same time when things go wrong like you come early or can't get it up, you put a lot of value on these situations.

 

Jumping to Conclusions

You are taking evidence such as a feeling of nervousness and conclude that everything is going to turn out bad automatically because of it.

 

Overgeneralization

You make broad interpretations from a small number of events. You believe that because you had a few times with premature ejaculation or erectile dysfunction that you are doomed and it will always be like that.

Disqualifying the Positive ("Mental Filter")

You only recognize the negative aspects of a situation or feedback and ignore anything positive. Your partner might make you a compliment that they find you hot or that something feels great but you think they are lying or saying this to be nice. If your body works as intended you find reasons why this time doesn't count. 

Mindreading

You are interpreting the thoughts and beliefs of your partner without hearing directly from them. You assume that your partner thinks you suck in bed or are not a real man even though they never said that.  

 

Fortune Telling (Predicting the Future)

You already expecting a certain outcome (like, your partner will not enjoy themselves) without reliable evidence.

Catastrophizing

You can only see the worst possible outcome of a sexual encounter. You label sex as something huge, or overwhelming. When you are coming quickly or can't get it up it's the worst thing ever.

"Should" Statements

You make unreasonable demands or put pressure on yourself. You might think things such as: "I should not feel anxious", "I should last one hour at least", or "I should have a rock hard penis right now" 

Labeling

You describe yourself by making global statements that you based on limited evidence. You might call yourself inadequate or pathetic even though there are many reasons that speak against this conclusion.

Black & White/All-or-Nothing Thinking

You think in absolutes and see only one extreme or the other. You are either amazing or a total loser. You tend to use words like "always", "never" or "every time". For example, "I will always come quickly.", "I will never please my wife."

These thinking styles are inspired by this article.

 

Step 4: Write a Thought Log

You now know what to look out for. It's time to write your thoughts down in a thought diary - seriously. Do it. With each time you are getting better at spotting when anxiety creeps up on you. Keeping a thought log will grow your self-awareness and provide you with the foundation to break the cycle. 

A thought log for performance anxiety showing event (trigger), thought, consequences and alternate response
Example of a thought log for performance anxiety related to premature ejaculation

Try to be aware when a situation occurs where you feel anxious. For instance, experiencing sexual arousal could already be a trigger. After such an event, write down what happened and describe your thoughts associated with that event. Then you describe your emotions and your actions that resulted from the situation. As the last step, you reflect on how you could frame that event differently and how you could have handled it better. 

By keeping a thought log, you will become more aware of your anxiety and how it affects you emotionally and alters your behavior. Now we have the chance to not let those moments slip by unnoticed but to constantly improve how we deal with our anxiety. 

 

Step 5: Break the cycle and challenge your unhelpful thoughts

After a week or so of doing the thought log, it's time to go a step further. You are now proficient at recognizing your unhelpful thoughts. You are ready for battle.  

Once you recognize that a thought contributes to your anxiety, challenge it by asking questions like: "Do I have evidence that supports this thought or am I jumping to conclusions? Do I have good reasons to feel like this?"

Example of how to break through unhelpful thoughts when anxiety comes up
Example of how to reframe an unhelpful thought pattern

In reality, challenging your long-held beliefs is often extremely difficult. You can try to ask yourself this serious of questions to slowly chip away the power of your limiting beliefs. 

 

Worksheet to challenge unhelpful thoughts
Challenge your thoughts with the questions from this worksheet

 

Step 6: Replace the unhelpful thoughts with more useful ones

Once you have successfully challenged your beliefs, it’s time to replace them with something more positive. This is an iterative process. You can’t go from

“I will never solve my erectile dysfunction” to “I don’t have erectile dysfunction”

all at once. In the beginning, it’s already a victory to replace super negative beliefs with beliefs that are less negative. Try to go from: 

"I will never solve my erectile dysfunction" to "I may solve my erectile dysfunction"

first. If you do this persistently you will eventually renew your belief system with positive beliefs. This will take time because a belief is not just an affirmation it reflects your genuine conviction. 

 

Step 7: Learn and practice relaxation techniques

Anxiety reduction techniques are useful because they help you with managing your anxiety. These methods calm you down and balance your emotions. I’ve written a dedicated guide for relaxation techniques which you can find here

You want to practice staying calm inside and outside of sexual situations. This step is vital before going to the last one. 

Step 8: Expose yourself

Now comes the hardest part. Psychologists call this step exposure therapy (Kaczkurkin & Foa, 2022). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience.. The idea is to face what you fear over and over again until you don’t fear it anymore. This works because fear is often irrational and the consequences are not nearly as bad as our mind wants to make us believe. Now, we begin this process of systematic desensitization by creating an exposure hierarchy. This is a list of situations that cause performance anxiety of increasing severity. Here is an example related to premature ejaculation-based performance anxiety. 

Example of a fear hierarchy for a patient suffering from premature ejaculation
Exposure therapy typically relies on a fear hierarchy

 Now it’s time to expose yourself to a situation that is mildly anxiety-induced while using the relaxation techniques that you’ve learned. You can gradually increase the fear level of the event while learning to manage your anxiety. 

In some situations, this might not be possible. If you go straight for sex, this is called flooding and it can also work. However, it's safer to work yourself up.

 

For coupled humans 

In a partnership, where sex is happening more or less frequently, you sometimes don’t have full control over when you have sex. So for your own sake, growth, and the integrity of your relationship you want to talk to your partner about this. It's normal that relationship issues arise if one partner experiences distress from sexual intercourse. More often than not, your partner will be understanding and happy to help. If you are having doubts about sharing this with your partner think about it like that: Would you be happy if your partner told you about something that they are really struggling with so that you can support them to get better?

See, it’s okay to receive support. 

 

Trust the process

Overcoming any type of anxiety isn't exactly a walk in the park. It's freaking uncomfortable and it takes time. Sexual satisfaction and safety don't come to you overnight. So be patient with yourself. If you are feeling you are stuck or can't handle the anxiety by yourself please seek professional help. Self-help can only do so much and it's possible that you won't get the results that you desire. Your mental health should be your priority. It's okay to ask for help when you need it. I know how hard it is to make that step as a man and seek sex therapy. 

As you tackle your performance anxiety, life and especially sex will become more and more beautiful. You will notice how sex becomes a space where you feel safe to express yourself freely. I wish that you come to witness what I mean for yourself. 

 

References

Borkovec, T. D., & Costello, E. (1993). Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 61(4), 611-619.

Kaczkurkin, A. N., & Foa, E. B. (2022). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience.

Stewart, R. E., & Chambless, D. L. (2009). Cognitive-behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies. Journal of Consulting and Clinical Psychology, 77(4), 595-606.

Therapist Aid. (n.d.). Treating Anxiety with CBT. Retrieved: 04.04.2022, from: URL.

Tsujita, H., & Rekimoto, J. (2011, September). Smiling makes us happier: enhancing positive mood and communication with smile-encouraging digital appliances. In Proceedings of the 13th international conference on Ubiquitous computing (pp. 1-10).