At our clinic, we see a ton of guys struggling with performance anxiety and erection difficulties. It’s a really common problem, and almost always is rooted in anxiety.
Difficulties with erections during sex are usually the consequence of what’s called spectatoring, or the negative self-perceptions and emotions that flood a guy’s attention while he’s trying to have sex (usually intercourse). Self-critical and embarrassing thoughts become overwhelming, drawing focus away from what would otherwise be pleasurable and arousing. When that happens, anxiety spikes, and arousal goes down. Because there isn’t sufficient arousal, a guy won’t be able to get an erection, or alternatively will lose his erection. This then creates a nasty cycle of anxiety about future experiences, which will then lead to self-fulfilling prophecies (i.e., the problem will only get worse).
Penis concerns (appearance, particularly size) are one source of anxiety and embarrassment. And because many men attribute a lot of meaning to their penises in terms of their identities as men, this type of worry can become really upsetting, resulting in anxiety, depression, shame, and avoidance of sex.
In one study, researchers examined the effects of anxiety and distractibility as traits (rather than states) that could make the effect of penis appearance concerns on sexual difficulties even worse.
The researchers discovered that trait anxiety was associated with increased difficulties with sexual functioning through increased embarrassment about penis appearance. In other words, if a guy is more anxious in general (i.e., trait anxiety), the more he will feel embarrassed and anxious about the appearance of his penis, and this will result in more problems with sexual functioning. This is made even worse by a tendency to be distracted, in this case by embarrassing and anxious thoughts.
The good news is that the problem is treatable. Most guys who come see us for erections difficulties will see significant improvements. We do our best to help them challenge their negative/embarrassing thoughts to improve their mindsets, and learn to focus on what feels good and is arousing.