Daily Life

Men, sex and performance anxiety

Sex occupies the minds of young men in more ways than the obvious. In my work as a relationship counsellor and sex therapist about 40 per cent of my clients are men, mostly between 18 and 35 years old. Their main issue is they believe they have some sort of sexual dysfunction, such as premature ejaculation, repeated erection loss, difficulties in ejaculation or an inability to ejaculate at all.  

One client, let's call him James, is a gorgeous 24-year-old young man. He had sex for the first time when he was 17 and was very excited, but ended up losing his erection. At the time he blamed it on being drunk and it took him a while to try again. But after several attempts it didn't get any better and he became convinced there was physically something wrong with him. He saw his GP who suggested he try Viagra, a well-known erectile dysfunction drug, which didn't make him feel much better.

Performance anxiety: Many men feel stressed about sex.
Performance anxiety: Many men feel stressed about sex. Photo: iStock

He had some more encounters with women who, overall, weren't very understanding when he lost his erection. One wondered if he was gay and another told everyone at work what a dud he was, the morning after they hooked up at a work function. He stopped having sex for about four years. He was traumatised and put all his energies into study and work to avoid being disappointed again. But after meeting a girl at university who he really liked, he decided to do something about it and came to see me.

Loss of erection also sometimes happens to men who have never had a previous problem when they start out on a new relationship. Even in a stable relationship, a single event can be a frightening experience and anticipating the possibility it may happen again can become a self-fulfilling fear.

Premature ejaculation or PE (coming too quickly) affects about 30 per cent of the male population. Unfortunately, many doctors often prescribe healthy young men a class of antidepressants, called selective serotonin reuptake inhibitors (SSRIs), because it's known these medications can delay ejaculation. But what about the side effects of taking daily medication when the main reason may be a psychological problem that can be treated effectively?

There is also this belief that most women like men to last a long time, a myth perpetuated by the many "lasting longer" advertisements in the media and on billboards. When a man finds it difficult to ejaculate or comes too quickly, his partner often believes that it's her fault, she must be doing something wrong or not be attractive enough, etc.

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After seeing so many men with these problems, I have come to the conclusion that most of them have acquired sexual performance anxiety. Ninety per cent of my clients are healthy individuals who are not taking any medication or drugs. When I take their sexual history I check if they lose their erections, or ejaculate very quickly or not all, when they masturbate. Most say they usually only have the problem when they attempt intercourse.

The exception is some men with premature ejaculation who may have trained themselves to be very quick. When they were boys they may have been told masturbation was evil and not allowed, and therefore they learned to do it quickly not to be discovered. As the brain is our largest sex organ it needs training to reverse this habit.

Problems usually start when these men, like James, began having sex as teenagers that may have been scary and disappointing. When I explain to clients that they don't have physical sexual dysfunction but have acquired sexual performance anxiety – a psychological condition that can be fixed – they are very relieved.

Sexual performance anxiety occurs when a man anticipates a problem during the sexual act and as a result becomes anxious or panics while attempting to be sexually active. Many men, regardless of age, relationship or orientation suffer from this condition at some time in their lives. In my opinion some men who are diagnosed with low sexual desire actually have acquired performance anxiety and are avoiding sex instead.

A man's sexual performance is often perceived as synonymous with his identity and ability to be a man. Sex should be a pleasurable experience but it's very difficult when men have performance anxiety, especially when they are not aware of it and worry and suffer in silence.

I help my clients understand the issues that cause the anxiety, discuss how to reduce or eliminate them and provide psychosexual education, tips and techniques depending on the problem. They usually don't need more than one or two sessions.

And here's some advice for any partners of men who may have sexual performance anxiety: try to understand what it's like to be a man "having to perform" all the time. Women don't need to perform – they can just lie down and don't need to do much – they can even fake an orgasm! Think about it!

Matty Silver is a relationship counsellor and sex therapist

mattysilver.com.au