When clients complain about sexual anxiety, whether it is the inability to achieve erection or rapid ejaculation, they often find themselves dwelling on everything that could possibly go wrong in a future sexual encounter.  That kind of anxiety starts building up much earlier than the actual event itself and can feel crippling and paralyzing in other aspects of daily life. We call this anxiety “performance anxiety” because it reflects the fears of being unable to perform adequately in front of other people.

In this case, “other people” refers to a sexual partner, but performance anxiety rears its ugly head in other areas, ranging from public speaking to interviews. In all of these situations, the person struggling with performance anxiety is preoccupied with the thoughts and judgments of others. “What will these people in the audience think of me if I mess up?” “If I don’t perform well, my interviewer won’t like me, and I won’t get the job.” These are common thoughts that go through someone’s head when they are stressed about an upcoming performance. You see, the most important aspect of the anxiety is the fear of social disapproval. Someone who can practice their speech alone in the privacy of their room can suddenly start shaking uncontrollably in front of an audience. Same speech. The difference is other people.

Sexual anxiety works the same way. Someone may have absolutely no anxiety masturbating alone in a room, but bring in a sexual partner, and all of a sudden Mr. Happy goes to sleep and can’t wake up. This is why so many people who struggle with ED are not helped with medicines like Viagra– Viagra does nothing to ease the anxiety about other people.  Individuals who struggle with these issues often worry, “What will she think of me if I can’t perform? Oh God, this will be so embarrassing.” In this way, sexual dysfunction is often linked to fears of social embarrassment.  This is why often sexual dysfunction is just another form of social anxiety.

So what causes social anxiety? The difference between people who have social anxiety and those that do not often comes down to our expectations of others. If we feel like others won’t like us or will judge us harshly or are unsupportive, we are more likely to feel anxious about our social interactions. Often it comes down to our worldview based on previous life experiences. If we’ve had the experience of being judged, bullied, let down, abandoned, or misunderstood growing up, we are far more likely to experience anxiety again in social situations. Our own self-esteem may feel low, so we may spend our social lives waiting for the other shoe to drop, waiting for people to let us down or judge us as they have done in the past. Or if people trust us well, we may feel fake, as if their opinion would change if only they truly knew us.

In my experience, individuals who suffer from sexual anxiety have grown up internalizing many of these kinds of experiences. It’s hard to let go and enjoy yourself with another person if you are terrified of what they are thinking. This is another example of how often, sexual difficulties have nothing to do with the sex, and everything to do with the deeper emotional life of the individual.