Improve Sexual Wellbeing & Intimacy
Manage Sexual Performance Anxiety
Worry about how you will 'perform' in bed is common, and it can take the ease and enjoyment out of intimacy for people of any gender, orientation or age. This page is about the worry itself and the habits, conversations and therapies that can loosen its grip; the physical side of erections, desire, arousal, orgasm and pain each have their own pages.
General information, not medical advice. Last updated November 1, 2026. Written by the AlternativeMed editorial team. Not medically reviewed.
Start here
- Tell yourself plainly that this worry is common and can be eased. Then choose one person to talk to: a partner you trust, a doctor or a therapist.
- Take the pressure off for a while. Spend intimate time on touch, closeness and sensation rather than on a result, and agree with a partner that nothing has to 'work' during that time.
- If the problem keeps happening, see a doctor or sexual health clinic. Anxiety can be the whole story, but erection, arousal, orgasm and pain problems can also have medical or medicine-related causes that are worth ruling out.
Be careful with
- Do not use alcohol or drugs to calm your nerves. They can make sexual problems worse and can worsen anxiety over time.
- Be wary of 'male-enhancement' pills and online sellers of prescription sexual-function medicines. The FDA warns that many such products are contaminated with hidden drug ingredients, even when labelled as natural.
- Never stop or change a prescribed medicine on your own because of a sexual side effect. Talk to the prescriber, who can review your options.
Get help when
- Sexual problems that keep happening or keep getting worse, because they may point to a treatable physical, hormonal or medicine-related cause (the NHS and NIDDK both make this point about erection problems).
- Low mood, constant worry, loss of interest in things you used to enjoy, or any thoughts of harming yourself: speak to a doctor or local emergency services now.
- A painful erection lasting more than 3 to 4 hours is an emergency (NHS: call 999 or go to A&E). Sudden severe pain, pain with bleeding, fever or pelvic pain also need prompt care.
- Sexual difficulty that began after an assault or abuse, or after childbirth or cancer treatment: a clinician or a specialist support service can help, and you do not have to manage it alone.
About Manage Sexual Performance Anxiety
What this goal means
Sexual performance anxiety means worry, self-doubt or fear about whether you will be able to enjoy sex, satisfy a partner, or respond the way you expect your body to. It can show up before sex, during it, or as a reason to avoid it.
It is not a diagnosis and it is not a character flaw. NIDDK lists anxiety, stress, low self-esteem, lack of confidence and negative body image among the emotional issues that can cause erection problems or make them worse, and the same kinds of worry can affect anyone of any gender.
1What it can feel like
Common experiences are a racing mind, watching and judging yourself during sex, dread beforehand, a tense body, losing arousal when you notice you are worried, or finding reasons to avoid intimacy. Worry about a difficulty can become a trigger for the next one, so the pattern can feed itself.
Many people feel embarrassed and say nothing, which tends to make the worry bigger. Mindfulness research on sexual problems describes fear linked with sexual activity and negative thought patterns as targets for treatment.
2,1What can contribute
Stress, tiredness, drinking too much alcohol, depression and anxiety are listed by the NHS as common reasons for erection problems. For low sex drive the NHS also lists relationship problems, and some medicines or hormonal contraception.
NIDDK lists a range of medicines that can contribute to erection problems and says erection problems may be a symptom of another health problem. Where a sexual difficulty first appeared after starting a medicine, that is worth raising with the prescriber.
3,4,1Conditions that can sit behind it
Anxiety disorders, depression, past trauma, relationship strain, and physical conditions that affect blood vessels, nerves or hormones can all be involved, sometimes together. A clinician can help sort out how much is worry and how much is something else, and the answer is often a mix.
If your worry reaches beyond the bedroom, see the pages on anxiety disorders and panic attacks.
1,5Realistic expectations
Anxiety about performance usually eases gradually. In a Cochrane review of psychological treatments for erection problems, group psychotherapy was more effective than no treatment in the trials pooled, but the trials were small and old. For women, a 2026 network meta-analysis of 45 studies (4,726 women) found cognitive behavioral therapy, mindfulness-based interventions and sex education improved sexual function scores compared with usual care.
The NHS says CBT usually involves between 5 and 15 sessions. Expect progress over weeks, with good days and bad days, rather than a single fix.
5,6,7Who this applies to
Adults of any gender, orientation or age who feel anxious about sex, whether or not they have a long-term partner. Disabled people and people living with illness or after cancer treatment may face extra worries and can ask a clinician for tailored advice.
Specific problems have their own pages: erection problems, changes in desire, arousal difficulties, orgasm concerns, discomfort during sex and medicine side effects. This page covers the worry that surrounds them.
8,9Related conditions and symptoms
Anxiety disorders → Panic attacks and panic disorder → Trauma-related stress and PTSD → Erectile dysfunction →
A manageable starting plan
An educational starting point, not a personal prescription. Adjust it to your own situation and any advice from your clinician.
Your first actions
- Choose one person to tell this week: a partner, a doctor or a therapist.
- Take performance off the table for a few weeks: agree on touch and closeness without a goal.
- Cut back on alcohol before intimacy and protect sleep.
- Book a medical check if the difficulty keeps happening or began after a new medicine.
Optional additions
- Practise slow breathing daily so it is familiar when needed.
- Try a mindfulness course or guided practice.
- Look into CBT or sex therapy, including online programmes from a trusted health service.
- Read the linked pages on communication and connection with a partner.
What to track
- When the worry shows up (before, during, after) and how strong it is on a 0 to 10 scale.
- What helps: sleep, less alcohol, a slower start, a certain kind of conversation.
- Any new medicine, supplement or change in health, and whether the difficulty also happens when you are alone.
When to reassess
Give gentle steps four to six weeks. If the worry is not easing, is spreading into daily life, or is damaging a relationship, move on to talking therapy and a medical check.
When to seek professional support
- See a doctor or sexual health clinic for persistent sexual difficulty.
- Ask about talking therapy; many adults can refer themselves for anxiety.
- If sex has become linked to an assault or abuse, contact a clinician or a specialist support service. The NHS sexual health pages include a link to help after rape and sexual assault.
What helps
Ordered by how well the research supports each step. Evidence strength is shown on every card; precautions sit next to the advice.
Start here
Naming the worry and talking about it
Low certaintyAddresses: Takes away secrecy and some of the pressure
Why it may help: NIDDK says counselors can help lower anxiety and stress about sex, and may ask you to bring your partner to sessions. The NHS says counselling and therapy can help when erection problems are linked to emotional or mental health problems. Keeping the worry hidden tends to add to it, though no study read for this page tested that directly.
How to apply it: Start with one sentence to a partner you trust, such as 'I have been feeling anxious about sex and I want us to take the pressure off.' If you have no partner or would rather not, a doctor, nurse or therapist is a good first listener.
Who it may suit: Almost everyone with performance worry.
Precautions: If talking about sex has been unsafe or painful because of past abuse or a controlling partner, choose a trained professional rather than raising it alone.
9,3Shifting attention from results to sensation and connection (mindfulness-based approaches)
Low certaintyAddresses: May reduce fear around sex and improve satisfaction
Why it may help: A systematic review of 15 studies of mindfulness-based therapies for sexual problems found improvement in self-rated arousal and desire, sexual satisfaction and a reduction of fear linked with sexual activity, mostly in women. The authors note small studies and methodological limits, and that only one study looked at erectile dysfunction in men.
How to apply it: Practise paying gentle attention to touch, breath and body sensation, in everyday life first and then during intimacy. Treat thoughts about performance as passing noise and return to sensation. A structured course or guided programme gives more support than trying alone.
Who it may suit: Adults whose minds race or who watch and judge themselves during sex.
Precautions: Mindfulness did not reduce pain during sex in the review. If you have a trauma history, choose a trained teacher or therapist.
2,6Talking therapy, including CBT and sex therapy
Moderate certaintyAddresses: Changes unhelpful thoughts and rebuilds confidence step by step
Why it may help: The NHS describes CBT as a talking therapy that helps you question unhelpful beliefs and gradually return to activities you have been avoiding, usually over 5 to 15 sessions. In a 2026 network meta-analysis of 45 studies in women, CBT, mindfulness-based interventions and sex education all improved sexual function and reduced sexual distress compared with usual care. A Cochrane review found group psychotherapy more effective than no treatment for erection problems, though the trials were small.
How to apply it: Ask a doctor or sexual health clinic about a referral, or look for a therapist with sex-therapy training. Many areas allow adults to refer themselves to talking therapy for anxiety.
Who it may suit: Adults whose worry keeps coming back, is affecting a relationship, or has lasted for weeks or months.
Precautions: Waiting lists for NHS services can be long. Check a private therapist's professional registration. CBT can stir up uncomfortable feelings at first; tell the therapist if it feels like too much.
7,10,6,5,3Facing the situation gradually instead of avoiding it
Low certaintyAddresses: Stops avoidance from confirming the fear
Why it may help: The NHS advises people with anxiety not to avoid situations that provoke it, because gradually building up exposure can reduce anxiety. Applied to intimacy, that means small, low-pressure steps (cuddling, kissing, touch without a goal) rather than all-or-nothing attempts or complete avoidance.
How to apply it: Agree a few steps with a partner, move on only when the current step feels comfortable, and treat stopping at any point as fine. Without a partner, the same idea applies to dating, flirting or self-touch at your own pace.
Who it may suit: People who have started to dodge intimacy because of past difficulties.
Precautions: Never pressure yourself or anyone else. Consent and comfort come first, and either person can pause at any time.
11,7Everyday habits: less alcohol, regular activity, good sleep, no smoking
Low certaintyAddresses: Supports mood, energy and general sexual function
Why it may help: For erection problems the NHS suggests stopping smoking, a healthy diet, regular exercise, losing weight if overweight, and keeping alcohol to no more than 14 units a week. NIDDK lists similar changes, including limiting or stopping alcohol and stopping recreational drugs. The NHS adds that regular exercise and enough sleep help with anxiety.
How to apply it: Choose one habit to change at a time. Plan sex for times when you are rested rather than at the end of an exhausting day.
Who it may suit: Most adults.
Precautions: Check with a doctor before starting vigorous exercise if you have a heart condition or have been inactive. Do not cut alcohol suddenly if you drink heavily; ask a doctor.
3,9,11A check-up for lasting or recurring problems
Moderate certaintyAddresses: Rules in or out physical and medicine-related causes
Why it may help: The NHS advises seeing a GP or sexual health clinic if erection problems keep happening, because this may signal a treatable health condition. NIDDK says erection problems may be a symptom of another health problem and lists blood-vessel disease, high blood pressure and a number of medicines among the possible causes.
How to apply it: Book an appointment and describe when the difficulty happens (for example, only with a partner, or also when alone, in the morning). A clinician may check blood pressure, general health and medicines.
Who it may suit: Anyone whose sexual difficulty is persistent, new, or came after a medicine, illness or procedure.
Precautions: Do not stop or change a prescribed medicine yourself. Ask the prescriber to review it.
3,1Understand How Medicines Affect Sexual Wellbeing → Support Healthy Erectile Function →
Additional options
Slow breathing and relaxation before intimacy
Low certaintyAddresses: Calms the body's stress response
Why it may help: The NHS lists calming breathing exercises, yoga and pilates among self-help steps for anxiety. No study read for this page tested breathing specifically for sexual performance anxiety, so this is general anxiety advice applied here.
How to apply it: Practise slow breathing with a longer out-breath for a few minutes each day, so it feels familiar when you need it. Use it before intimacy or whenever you notice tension rising.
Who it may suit: People who feel physically tense, shaky or breathless with worry.
Precautions: If breathing exercises make you dizzy or more anxious, ease off and ask a clinician.
11Breathing exercises for stress → Relaxation techniques → Breathwork →
Online and self-guided programmes
Low certaintyAddresses: Private, low-cost access when therapy is hard to reach
Why it may help: A 2026 systematic review of 21 studies of internet-based CBT and web-based education for male sexual dysfunction found improved erectile function and sexual satisfaction compared with controls, and some studies reported less performance anxiety and more confidence, with no serious adverse effects. Adherence was often below 60%. A separate 2026 review of 8 online-intervention studies (961 people, mostly people with cancer) also found measurable improvement in sexual function. Both note limited and varied evidence.
How to apply it: Choose a programme from a recognised health service or university. Programmes in the studies lasted about 6 to 12 weeks and often included feedback from a therapist.
Who it may suit: Adults who feel embarrassed to start in person or live far from services.
Precautions: Studies used specific programmes; a general website or app has not been tested. Seek in-person help if your mood is low or the problem persists.
12,8Relationship or couples counselling
Low certaintyAddresses: Addresses strain that feeds anxiety
Why it may help: The NHS names relationship problems as a main cause of low sex drive and suggests relationship counselling. Worry about performance can both cause and result from tension between partners.
How to apply it: Look for a counsellor registered with a recognised professional body, and go together if you can.
Who it may suit: Couples where the worry has led to silence, blame or avoidance.
Precautions: Counselling is not suitable for abusive relationships; seek individual support in that situation.
4Still being studied
Mindfulness-based programmes (studied mainly in women)
Low certaintyAddresses: Possible gains in arousal, satisfaction and less sex-related fear
Why it may help: The 2019 systematic review of 15 studies found promising results for women's desire and arousal and for sexual anxiety, but the studies were small and had methodological limits. A 2026 network meta-analysis ranked mindfulness-based interventions highest for reducing sexual distress in women. Evidence for men is much thinner.
How to apply it: Used in the studies as structured group or individual programmes lasting several weeks.
Who it may suit: Women especially; men may also try it, with less research behind it.
Precautions: Not a substitute for a medical check when a physical cause is possible.
2,6Behavioural and psychosocial approaches for early ejaculation concerns
Low certaintyAddresses: Some gain in time to ejaculation and couples' satisfaction
Why it may help: A Cochrane review found behavioural therapy better than a waiting list in one trial for duration of intercourse and couples' satisfaction, and a combined behavioural-and-medicine approach did better than medicine alone in another. The review stressed that most research was not randomised and lacked long-term follow-up. A 2019 overview of reviews found evidence on behavioural and psychological interventions to be insufficient compared with drug trials.
How to apply it: A sex therapist or doctor can explain what the studied methods involve; this is better done with guidance than from a website.
Who it may suit: People worried about early ejaculation, with a partner or alone.
Precautions: Worry about early ejaculation can itself feed anxiety. See the page on orgasm concerns for the wider picture.
13,14Food & nutrition
Eating and drinking around intimacy
No food has been shown to treat sexual performance anxiety. The NHS suggests a healthy diet as part of general advice for erection problems and keeping alcohol to no more than 14 units a week.
For anxiety in general, the NHS advises limiting coffee, tea, cola and energy drinks, because caffeine can disrupt sleep and make anxiety harder to control, and eating regular, balanced meals. Large amounts of alcohol before sex are best avoided.
3,11'Aphrodisiac' foods
No food read for this page has good human trial evidence for easing performance anxiety. Foods with a reputation as aphrodisiacs are best treated as part of a shared meal and a relaxed evening rather than as a remedy. If you take medicines, check with a pharmacist before adding concentrated food extracts or supplements.
9Remedies & supplements
Traditional use, laboratory findings and human trials are kept apart. "Natural" does not mean safe.
Ginseng
Low certaintyStudied form and route: Root extracts and supplements
Intended outcome: Erectile function (not performance anxiety itself)
Human evidence: A Cochrane review of 9 trials (587 men with mild to moderate erection problems, followed up to 12 weeks) found ginseng probably has a trivial effect on erectile function compared with placebo, with low-certainty evidence that it may improve self-reported ability to have intercourse. Adverse events did not clearly differ from placebo. No trial tested performance anxiety.
Traditional use: Widely used in Asian traditional medicine as a general tonic.
Limits: Short follow-up, small trials of uneven quality, and none addressed anxiety about sex.
Interactions and precautions: Ginseng products vary and can interact with some medicines; ask a pharmacist, especially if you take blood thinners or diabetes medicines, or if you are pregnant or breastfeeding.
15L-arginine
Low certaintyStudied form and route: Amino acid supplement
Intended outcome: Erectile function in mild to moderate erection problems
Human evidence: A meta-analysis of 10 randomised trials (540 men with mild to moderate erection problems) found arginine supplements improved erection problems compared with placebo or no treatment. The adverse effect rate was 8.3% against 2.3% with placebo, none severe. Doses and durations varied between trials. None of the trials were about anxiety.
Limits: Trials varied in dose and length; the benefit measured is erection function, not worry about performance.
Interactions and precautions: Ask a doctor first if you take blood pressure medicines or other prescribed treatments for sexual function, if you have heart or kidney disease, or are pregnant or breastfeeding. Do not combine with online products of unknown content.
16Yohimbine (yohimbe bark extract)
Low certaintyStudied form and route: Bark extracts and supplements
Intended outcome: Erectile function
Human evidence: A 2021 meta-analysis of 8 randomised trials found yohimbine alone and in combination with other supplements was more likely than placebo to improve erectile function. The authors noted that earlier studies suggested the effect might be placebo or due to blood-vessel changes. The review did not test performance anxiety.
Traditional use: Used traditionally in West Africa as an aphrodisiac bark.
Limits: Small trials; products and preparations differ widely, and the content of over-the-counter extracts is not guaranteed.
Interactions and precautions: Can affect heart rate and blood pressure; this is a general caution rather than a finding of the review, so ask a doctor before use, particularly with heart, blood pressure or anxiety conditions. Avoid in pregnancy and breastfeeding unless advised.
17'Male-enhancement' pills sold as natural or herbal
Evidence againstStudied form and route: Capsules, tablets, drinks and shots
Intended outcome: None advised
Human evidence: The FDA says many such products are likely to be contaminated with dangerous hidden ingredients and are not guaranteed to work. A review of 2007 to 2016 FDA warnings found that nearly half (47%) of the adulterated sexual-enhancement supplements contained a hidden prescription erection-medicine ingredient.
Limits: The label cannot be trusted to show what is inside, and the FDA list covers only a small fraction of contaminated products.
Interactions and precautions: Avoid. Hidden drug ingredients can cause harm through overuse or interaction with other medicines and health conditions. Report suspected reactions.
18,19Therapies & care
Established professional care for sexual performance anxiety starts with talking: a doctor or nurse to check for physical and medicine-related causes, and a therapist for the worry itself. Doctors may also discuss prescription treatments for a specific sexual problem; those are decided with a clinician and are not recommended here. Never stop or change a prescribed medicine on your own.
Cognitive behavioural therapy (CBT)
Moderate certaintyPsychological therapy A therapist helps you notice and question unhelpful thoughts and gradually return to activities you have been avoiding. The NHS says CBT usually takes 5 to 15 sessions and can be delivered one-to-one, in a group, online or by phone. In women, a 2026 network meta-analysis found CBT improved sexual function and reduced sexual distress compared with usual care.
Who it may suit: Adults with persistent worry, avoidance or low confidence.
Precautions: Waiting times vary. Work with a trained therapist or an evidence-based programme.
7,6,10Sex therapy and psychosexual counselling
Low certaintySpecialist talking therapy A trained therapist works on sexual worries with you or as a couple. The NHS says counselling and therapy can help when erection problems are linked to emotional or mental health problems, and lists professional bodies for sex therapists. A Cochrane review found group sex therapy more effective than no treatment in small trials of men with erection problems.
Who it may suit: People whose worry is centred on sex, or couples who want guided exercises.
Precautions: Check professional registration. Tell the therapist about any history of abuse, assault or pain with sex.
3,5,9Mindfulness-based therapy
Low certaintyPsychological therapy Structured training in non-judging attention to the body and thoughts, used in studies for desire, arousal and sexual distress, mostly in women.
Who it may suit: People who get lost in worry or self-monitoring.
Precautions: Evidence for men is limited. People with trauma should choose a trained teacher.
2,6Medical assessment
Moderate certaintyClinical assessment A doctor or sexual health clinic can check general health, blood pressure and medicines, and look for physical causes of persistent sexual problems. A 2019 overview of reviews found that for male sexual problems a range of treatment options, including drug, behavioural and combined approaches, should be put to each person so they can weigh risks and benefits.
Who it may suit: Anyone with a lasting, new or worsening problem.
Precautions: Be open about all medicines and supplements you take, and about alcohol and drug use.
3,1,14Online therapy programmes
Low certaintyDigital self-help with or without therapist support Internet-based CBT and education programmes improved sexual function in two 2026 reviews, though research is limited and many people did not finish the programmes.
Who it may suit: People who prefer privacy or live far from services.
Precautions: Choose programmes backed by a health service or university.
12,8What to avoid
Habits, products and claims that can get in the way. Never stop a prescribed medicine without talking to the professional who prescribed it.
Risks that apply to most people
Alcohol or drugs as a way to calm nerves
Low certaintyWhy: The NHS says occasional erection problems are usually linked to stress, tiredness or drinking too much alcohol, and advises against using alcohol, cigarettes or drugs to relieve anxiety because they can worsen mental health. NIDDK advises limiting or stopping alcohol and recreational drugs.
Who it applies to: Anyone who relies on a drink 'to take the edge off' before sex.
Try instead: Try breathing, a slower start to the evening, or talking to your partner. If you find it hard to cut down, ask a doctor or support service for help.
3,11,9Avoiding all intimacy
Low certaintyWhy: The NHS advises against avoiding anxiety-provoking situations, because avoidance keeps the fear alive and gradual exposure reduces it. Stepping back from touch and closeness can also leave a partner confused or hurt.
Who it applies to: People who have begun to dodge touch, flirting or dating after a difficult experience.
Try instead: Keep affection going in low-pressure ways and let sex return at a pace you both choose.
11,7Personal triggers to check
Stress, tiredness and poor sleep around intimate time
Low certaintyWhy: The NHS lists stress and tiredness among the usual reasons for occasional erection problems and stress, anxiety or depression among the causes of low sex drive.
Who it applies to: People juggling work, caring or money worries.
Try instead: Pick times when you are rested and unhurried, and work on the stress itself.
3,4Medicines that can affect sexual function
Moderate certaintyWhy: NIDDK lists several groups of medicines that can contribute to erection problems, including some antidepressants, blood pressure medicines, sedatives and pain relievers. The NHS says to see a GP if you think a medicine or hormonal contraception is affecting your sex drive.
Who it applies to: Anyone whose difficulty began soon after starting or changing a medicine.
Try instead: Tell the prescriber or a pharmacist. Do not stop or reduce a prescribed medicine without their advice.
1,4Understand How Medicines Affect Sexual Wellbeing → Medicines, sleep, mood and memory →
Low mood and long-running anxiety
Moderate certaintyWhy: The NHS links frequent erection problems with depression or anxiety, and lists low mood among the causes of low sex drive. These conditions respond to talking therapy and other care.
Who it applies to: Anyone whose worry is not limited to sex.
Try instead: Seek care for the mood or anxiety itself; sexual wellbeing often improves alongside.
3,11Anxiety disorders → Stress, anxiety, burnout and depression compared →
Products that need caution
'Male-enhancement', 'stamina' and 'natural' sexual-performance pills
Evidence againstWhy: The FDA warns that many products sold for sexual enhancement are likely to be contaminated with dangerous hidden ingredients, may be marketed as dietary supplements or all-natural, can cause severe health problems and hospitalisation, and are not guaranteed to work. A study of FDA warnings from 2007 to 2016 found 353 sexual-enhancement supplements with hidden unapproved drug ingredients, and noted risks from overuse and interactions with other medicines and conditions.
Who it applies to: Anyone tempted by online adverts, social media or shop-counter products.
Try instead: Talk to a doctor before trying any product. Report a suspected reaction to your national health regulator.
18,19Buying prescription sexual-function medicines online without a consultation
Moderate certaintyWhy: NIDDK says not to order erection medicine online before talking with a health care professional, because interactions can cause serious side effects. The NHS notes that many websites sell fake medicines and that ingredients can vary between packs.
Who it applies to: People embarrassed to see a doctor in person.
Try instead: Use a regulated service with a real clinical consultation, or see a doctor or sexual health clinic.
9,3Unsupported claims
"It is all in your head, so there is nothing to check"
Moderate certaintyWhy: Worry is often involved, but NIDDK says erection problems may be a symptom of another health problem, and the NHS advises seeing a GP when they keep happening. Both anxiety and physical causes can be present together.
Who it applies to: Anyone told to 'just relax'.
Try instead: Treat the worry and have the physical side checked if the problem persists.
1,3"Natural supplements are a safe shortcut"
Evidence againstWhy: Safety depends on what is in the product. The FDA says products promoted as natural can contain hidden drug ingredients, and NIDDK advises talking with a health care professional before using dietary supplements.
Who it applies to: Product labels, reviews and social media.
Try instead: Check with a doctor or pharmacist first, particularly if you take other medicines or have heart or blood pressure problems.
18,9Common mistakes
Watching and judging yourself during sex
Low certaintyWhy: Mindfulness-based research targets anxiety and negative thought patterns during sex, and found less sex-related fear after training attention on sensation. This is an interpretation of that research rather than a result any study tested directly.
Who it applies to: People who mentally monitor their body, timing or a partner's reaction.
Try instead: Practise returning attention gently to touch, breath and your partner.
2Pressure, blame or comparison
Low certaintyWhy: NIDDK lists low self-esteem, lack of confidence, negative body image, feeling lonely and stress as emotional factors. Blaming yourself or a partner, or comparing yourself with what you see in media, adds to those factors.
Who it applies to: Both partners.
Try instead: Agree that sex is about enjoyment and closeness, not a test, and be kind in how you talk about difficulties.
1Stopping a prescribed medicine on your own
Moderate certaintyWhy: A medicine can affect sexual function, but stopping it suddenly can harm your health. NIDDK and the NHS direct people to health professionals for review.
Who it applies to: Anyone taking prescribed medicine who notices a sexual side effect.
Try instead: Ask the prescriber whether the dose, timing or choice of medicine can be reviewed.
1,4Evidence & safety
What the research shows
Health agencies agree that stress, anxiety, tiredness and alcohol commonly contribute to sexual difficulties, and that persistent problems deserve a medical check because physical and medicine-related causes are possible. For the worry itself, talking therapies (CBT, sex therapy) and mindfulness-based approaches have the best support, but trials are often small and the strongest recent evidence is in women. Supplements have thin evidence for erection problems and none for performance anxiety, and 'male-enhancement' products carry a risk of hidden drugs.
Limits of the evidence
- Most trials of psychological treatments are small, and the Cochrane reviews of erection problems and early ejaculation draw on older trials.
- Mindfulness research is mainly in women; very little is in men.
- Online-programme reviews include few LGBTQ+ participants and many participants with cancer, so results may not apply to everyone.
- No supplement trial read for this page measured performance anxiety.
- Sexual function is measured with questionnaires that rely on self-report.
Precautions and interactions
- Ask a pharmacist or doctor before any supplement, especially with heart, blood pressure or other medicines.
- Do not order prescription sexual-function medicines online without a consultation.
- Never stop or change a prescribed medicine on your own.
Life-stage considerations
- Young adults: worry is common and usually eases with support; see a doctor if erection problems are frequent.
- Older adults: physical causes and medicines become more likely; ask for a medical check and a medicine review.
- After childbirth, cancer treatment or surgery: difficulties are common; ask a clinician rather than waiting.
- Pregnancy and breastfeeding: avoid supplements and herbal products unless a clinician agrees.
- People with disability or long-term illness: ask for tailored advice from a clinician or specialist service.
Warning signs
- An erection lasting more than 3 to 4 hours (NHS: call 999 or go to A&E).
- Sudden severe pain, pain with bleeding, fever or pelvic pain.
- Persistent low mood, hopelessness or thoughts of self-harm: seek help from a doctor or local emergency services.
- Sexual difficulty after an assault or abuse.
- Signs of a sexually transmitted infection, such as unusual discharge, sores or pain passing urine: attend a sexual health clinic.
Claim checks
Male-enhancement pills are a safe natural fix
Evidence againstThe FDA warns that many are contaminated with hidden drug ingredients and can cause severe harm.
18,19Ginseng cures erection problems
Low certaintyA Cochrane review found a trivial effect on erectile function compared with placebo, from short, small trials.
15Performance anxiety is always just psychological
Moderate certaintyWorry is common, but NIDDK says erection problems can be a symptom of another health problem, and the NHS advises seeing a GP if they keep happening.
1,3Mindfulness is a proven treatment for performance anxiety
Low certaintyResults are promising, mainly in women, but the studies are few and small, and the 2019 review calls for more research, especially in men.
2,6A drink beforehand helps you relax
Low certaintyThe NHS lists drinking too much alcohol as a common reason for erection problems and advises against alcohol to relieve anxiety.
3,11Questions people ask
Is sexual performance anxiety common?
Worry about sex is widely reported. NIDDK lists anxiety, stress, low confidence and negative body image among the emotional factors behind erection problems, and the NHS says occasional erection problems are usually linked to stress, tiredness or alcohol. We did not find a reliable prevalence figure in the sources read, so we do not quote one.
Can anxiety alone cause erection or arousal problems?
It can contribute strongly, and NIDDK says emotional issues can cause erection problems or make them worse. Physical causes and medicines can also be involved, and often several factors overlap, so a lasting problem is worth a medical check.
What can I do right now?
Take the pressure off by focusing on touch and closeness rather than a result, talk to a partner or someone you trust, and avoid using alcohol to calm nerves. If it keeps happening, see a doctor or sexual health clinic.
Does talking therapy help?
The NHS says counselling and therapy can help when erection problems are linked to emotional or mental health problems. A 2026 meta-analysis in women found CBT and mindfulness-based therapy improved sexual function and reduced distress, and a Cochrane review found group psychotherapy helped men with erection problems in small trials.
How long does CBT take?
The NHS says it usually involves between 5 and 15 sessions, depending on the reason for treatment, with practice between sessions.
Do herbs or supplements help?
For erection function, the evidence for ginseng is trivial and for L-arginine and yohimbine it is low certainty. None was tested for performance anxiety. The FDA warns that many 'male-enhancement' products contain hidden drug ingredients.
Is it safe to buy sexual-function medicine online?
NIDDK says to talk with a health care professional first, because interactions can cause serious side effects, and the NHS notes that many websites sell fake medicines.
Could my medicine be the cause?
Possibly. NIDDK lists several groups of medicines that can contribute to erection problems, and the NHS suggests seeing a GP if you think a medicine or hormonal contraception is affecting your sex drive. Do not stop it yourself; ask the prescriber.
Does this apply to women and non-binary people?
Yes. Worry about sex is not limited to men. Research on mindfulness and psychological therapy is mostly in women, and talking therapies are suitable for anyone. Pain, dryness and arousal have their own pages.
When should I get urgent help?
A painful erection lasting more than 3 to 4 hours, sudden severe pain, pain with bleeding, fever, or any thoughts of harming yourself need urgent care. The NHS says to call 999 or go to A&E for a prolonged painful erection.
References
- NIDDK. Symptoms and Causes of Erectile Dysfunction. Last reviewed October 2024. Read 2026-11-01. source
- Jaderek I, Lew-Starowicz M. A Systematic Review on Mindfulness Meditation-Based Interventions for Sexual Dysfunctions. J Sex Med. 2019. PMID 31570137. source
- NHS. Erectile dysfunction (impotence). Last reviewed 28 July 2023. Read 2026-11-01. source
- NHS. Low sex drive (loss of libido). Last reviewed 26 May 2026. Read 2026-11-01. source
- Melnik T, et al. Psychosocial interventions for erectile dysfunction. Cochrane Database Syst Rev. 2007. PMID 17636774. source
- Qiangzhao L, et al. Psychological therapies for female sexual function: a systematic review and network meta-analysis. J Sex Med. 2026. PMID 41718740. source
- NHS. Cognitive behavioural therapy (CBT). Last reviewed 28 March 2025. Read 2026-11-01. source
- Ghannam Ferreira B, et al. Online interventions for the treatment of sexual dysfunctions: systematic review and meta-analysis. J Sex Med. 2026. PMID 42224497. source
- NIDDK. Treatment for Erectile Dysfunction. Last reviewed October 2024. Read 2026-11-01. source
- NHS. Talking therapies. Last reviewed 5 November 2025. Read 2026-11-01. source
- NHS. Generalised anxiety disorder (GAD). Last reviewed 22 October 2024. Read 2026-11-01. source
- Srisadono A, et al. Internet-based cognitive behavioral therapy, web-based counseling, and online/digital psychoeducation for male sexual dysfunction: a systematic review. Sex Med Rev. 2026. PMID 41926207. source
- Melnik T, et al. Psychosocial interventions for premature ejaculation. Cochrane Database Syst Rev. 2011. PMID 21833964. source
- Ciocanel O, Power K, Eriksen A. Interventions to Treat Erectile Dysfunction and Premature Ejaculation: An Overview of Systematic Reviews. Sex Med. 2019. PMID 31300388. source
- Lee HW, et al. Ginseng for erectile dysfunction. Cochrane Database Syst Rev. 2021. PMID 33871063. source
- Rhim HC, et al. The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systemic Review and Meta-Analysis. J Sex Med. 2019. PMID 30770070. source
- Wibowo DNSA, et al. Yohimbine as a treatment for erectile dysfunction: A systematic review and meta-analysis. Turk J Urol. 2021. PMID 35118966. source
- U.S. Food and Drug Administration. Sexual Enhancement and Energy Product Notifications (page current as of 15 October 2026). Read 2026-11-01. source
- Tucker J, et al. Unapproved Pharmaceutical Ingredients Included in Dietary Supplements Associated With US Food and Drug Administration Warnings. JAMA Netw Open. 2018. PMID 30646238. source
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Support Healthy Erectile Function → Understand Changes in Sexual Desire → Address Arousal Difficulties → Understand Orgasm Concerns → Address Discomfort During Sex → Communicate More Comfortably About Intimacy → Build Emotional & Physical Connection → Understand How Medicines Affect Sexual Wellbeing → Calm a Busy Mind → Feel Calmer During the Day →
Ingredients, foods and supplements
Research, safety and claim-check resources
Therapy for anxiety and stress → Breathing exercises for stress → Relaxation techniques → Mindfulness and meditation for stress → Stress and anxiety: safety and when to get help → Supplements, teas and adaptogens for stress compared → Men's health: when to get help → Testosterone boosters and male-enhancement claims → Medicine interactions → Meditation → Breathwork →