Performance Anxiety - Emotional And Social Issues: Womens Sexual Health

Content provided by the Faculty of the Harvard Medical School

Performance anxiety

Defined as an overwhelming concern about sexual performance that obscures pleasure and leads to sexual dysfunction, performance anxiety is a particularly insidious issue affecting aging couples. Performance anxiety becomes a problem for both men and women as they move into their 50s.

In men, it's the most common psychological contributor to erectile dysfunction. Here's how the problem often develops. The natural effects of aging dictate that a man needs more time and direct penile stimulation for an erection. Medications and cardiovascular disease may also contribute to erection difficulties. If a man continues to expect the instantaneous rock-hard erections of his 20s, he may equate this change in his physical response with the end of his virility. Once he makes this erroneous leap, the problem snowballs. After a few incidences of erection failure, embarrassment and feelings of defeat leave him unwilling to try again. He may withdraw from all forms of physical intimacy to avoid having to perform. In turn, his partner feels rejected and fears that she's no longer attractive enough to sexually excite him. She may also suspect him of having an affair.

If this happens, the woman may shy away from touching her partner sexually out of fear that another failure will occur. Paradoxically, her reticence denies the man just the type of direct stimulation that he needs to achieve an erection. The result is that an addressable physical issue becomes a morass of anger, resentment, and frustration.

Women experience performance anxiety in different ways. Performance anxiety is common in women who have experienced pain during sex (dyspareunia) in the past. They may be worried that sex will be uncomfortable again, and this anxiety can decrease lubrication. In turn, this makes sex painful, which heightens their anxiety and further interferes with lubrication. Ultimately, some women decide to avoid sex entirely.

The frank discussion of sexuality that has become commonplace in women's magazines and on daytime television can also contribute to performance anxiety. This openness has had the unintended consequence of making some women worry that they do not respond quickly or intensely enough to be considered a "good lover."

Last updated:	January 23, 2007