The Psychology Of Performance Anxiety

**This post is sponsored by Rugiet**

In the bedroom, performance anxiety is a classic problem people face. One bad night in bed creates worries about the next time. And when it comes time to “perform” again, all of that anxiety can make it harder to get or maintain an erection. This is one reason why erectile dysfunction (ED) is so common and isn’t always a purely physical issue. [1]  

In this post, we’re going to consider how the relationship between the brain and body influences erectile dysfunction. We’ll discuss how performance anxiety may become a self-fulfilling prophecy, why ED is surprisingly common in younger men, and what some modern treatment options might look like for people who are struggling. 

The Anxiety-Erection Feedback Loop

The arousal response, which is largely supported by our parasympathetic nervous system, is what leads to many of the physical changes we experience due to sexual arousal. For example, when this system is activated, blood flow to the penis increases, helping to produce an erection. 

By contrast, the sympathetic nervous system helps drive our stress response. When you’re worried, tense, or feeling pressure to perform, that stress response can interfere with the physiological processes that support an erection. In other words, the more you try to force arousal to happen, the harder it can become.

Here lies the anxiety-erection feedback loop. Spectatoring, or monitoring yourself during sex, can fuel anxiety about one’s own sexual performance. This worry triggers our stress response, which can interfere with sexual arousal. As a result, performance anxiety can become a self-fulfilling prophecy, making it more difficult to get or maintain an erection, which then creates even more anxiety the next time. 

ED Isn’t Just an Older Man’s Problem

Traditionally, ED has been understood as a sexual difficulty that primarily affects older men. However, research has increasingly documented ED among younger men and highlighted the role that psychological factors (such as anxiety and worry about sexual performance) can play. [2]

Per data from the 2021 National Survey of Sexual Wellbeing, 17.9% of young men aged 18-24 meet the diagnostic criteria for ED, as do 13.3% of young men aged 25-34. [3] Although these percentages are lower than those observed among men aged 45 and above, these results make clear that ED is not exclusively an older man’s issue. 

Why might this be the case? Although some studies like to connect these findings to increased access to online porn, we don’t have much data to back that claim up. Instead, ED in younger men appears to have many potential contributors, including stress, anxiety, depression, sleep problems, relationship difficulties, and performance pressure. [4] 

Further, we learned from Tom Bruett back in Episode 354 that gay men may be at a higher risk of ED compared to heterosexual men due to multiple factors, including heightened performance-based sexual expectations. 

When performance anxiety is part of the problem, one potential way to interrupt the cycle is to make erectile response feel less uncertain. If someone becomes more confident that their body will respond when they want it to, there may be less reason to monitor their erection or worry about whether they’ll be able to perform. In other words, treatment can address the physical side of the equation while increased confidence may help reduce some of the psychological pressure.

What Modern ED Treatment Looks Like 

One example of how ED treatment has evolved is Rugiet Ready, a sublingual ED treatment that dissolves under the tongue rather than being swallowed like a traditional tablet. Rugiet Ready is designed for faster onset than traditional oral ED tablets, which can mean less advance planning, and potentially less of the scheduling pressure than can feed performance anxiety.  

Rugiet Ready can combine Sildenafil (Generic for Viagra®) and Tadalafil (Generic for Cialis®) in one dose, and can be prescribed by a licensed provider after a free five-minute online visit. There’s no in-person appointment required, and the treatment is shipped discreetly. 

What Treatment Can (and Can’t) Do

Importantly, ED medication addresses the physical side of erectile function. It isn’t a treatment for anxiety itself. For some men, however, feeling more confident in their ability to get and maintain an erection may help reduce the worry that was fueling the cycle in the first place. 

But if performance anxiety persists (or if anxiety is affecting your sex life more broadly), it may be worth talking with a therapist or sex therapist.

Key Takeaways

Erectile dysfunction is an extremely common sexual difficulty that men experience. And while we often think of ED as a purely physical problem, the mind and body can both play important roles. Fortunately, ED is treatable, and there are more options available today than ever before.

Rugiet Ready is one option for men looking for a fast-acting ED treatment. If you’re interested in learning more or trying it for yourself, you can visit rugiet.com/lehmiller and use coupon code Lehmiller for 15% off your first order.  

Image credit: Rugiet.

References

[1] Capogrosso, P., Albersen, M., Burnett, A. L., Cakir, O. O., Dehó, F., Morgado, L. A., Mulhall, J., Salonia, A., Sarikaya, A. F., Satchi, M., Serefoglu, E. C., Shabbir, M., Sokolakis, I., Yap, T., & Castiglione, F. (2025). Erectile dysfunction: Update on clinical management. European Urology, 88(4), 388–399. https://doi.org/10.1016/j.eururo.2025.05.004

[2] Rastrelli, G., & Maggi, M. (2017). Erectile dysfunction in fit and healthy young men: Psychological or pathological? Translational Andrology and Urology, 6(1), 79–90. https://doi.org/10.21037/tau.2016.09.06

[3] Mark, K. P., Arenella, K., Girard, A., Herbenick, D., Fu, J., & Coleman, E. (2024). Erectile dysfunction prevalence in the United States: Report from the 2021 National Survey of Sexual Wellbeing. The Journal of Sexual Medicine, 21(4), 296–303. https://doi.org/10.1093/jsxmed/qdae008

[4] Safa, A., & Waked, C. (2025). Erectile dysfunction in young adults: A narrative review. Cureus, 17(8), e89918. https://doi.org/10.7759/cureus.89918