The PGspot - In Your Head, Not in Your Bed: Understanding Sexual Performance Anxiety

In this episode, we dive into the physical and psychological factors that can impact male sexual performance, from medical conditions and stress to unrealistic expectations and complex relationship dynamics. Whether you're personally navigating these concerns or supporting someone who is, we’ll share practical strategies to help.

We’re also busting some of the most common myths around male sexual performance, because let’s face it, there's a lot of misinformation out there. This is a stigma-free, honest conversation about an issue that affects more people than you might think. Tune in for insight, support, and maybe even a little relief.

If you want to learn more about sexual health, sexual dysfunction, or how to improve your sex life, follow me on Instagram at @thepgspot or check out my website at doctorpattyj.com for blogs and resources related to sex positivity and real talk about sexuality.  As as always, stay curious, stay empowered, and stay you.

Transcript

Speaker 0:08

Welcome to the PG spot, where our goal is to take the X out of sex by breaking down the barriers that prevent open communication about sexual health. I'm Dr. Patty Jalomo, a dual certified nurse practitioner, pelvic floor therapist, and certified sexual counselor. I'm here to provide expert insights, debunk myths, and empower you to embrace your sexual wellbeing. Whether you're looking for answers or simply curious, join us as we open up the conversation around sex, intimacy and everything in between. I want to take this opportunity to acknowledge that some content may not be appropriate for all listeners. I'm a huge proponent of honest and accurate information regarding sexuality. But I'm also mindful that this should be age appropriate. Therefore, if you are under 18, this may not be the podcast for you. Additionally, some of the language used in this podcast may be offensive to some listeners. Please take these things into consideration before going forward with your consensual participation in this podcast. The opinions expressed by myself or my guests are just that, and these opinions are neither expected or required to be shared by all listeners. The information that is provided is for educational and entertainment purposes only, and should not be mistaken for individual medical advice if you do find the information that we cover in the PG spot. Helpful. Interesting or informative. Please rate and review the podcast wherever you're listening from. If you think this information is important, I would love for you to share it with your friends or family. This is a great way to get the information out to more people. So thank you for listening and let's get on with the show.

Patty 1:46

Hey everybody. Welcome back to the PG spot. I'm your host, Dr. Patty Jalomo, and I'm so glad you're here today. Over the past few episodes, we've spent a lot of time exploring female sexual dysfunction, from desire discrepancies to challenges with arousal orgasms. Today we're going to shift the focus. In this episode, we're talking specifically about male sexual performance anxiety, a topic that's misunderstood, stigmatized, or just not talked about enough. We'll explore both the physical and psychological factors that can contribute to performance, concerns from medical conditions and stress to unrealistic expectations and relationship dynamics. We'll also share some practical ways to address them, whether you're personally experiencing them or supporting someone who is. And of course, we'll bust some of the most common myths about male sexual performance because let's be real, there's a lot of misinformation out there. So whether you're tuning in out of curiosity, concern, or support, this episode is here to open up honest Stigma free conversation about a topic that affects far more people than we often realize. So let's get into it. First off, we need to define the term. Sexual performance anxiety is the fear or worry about one's ability to perform sexually, which can interfere with desire, arousal, and satisfaction. This isn't just a male problem. Sexual performance anxiety can affect people of all genders, ages, and sexual orientations. The International Society for Sexual Medicine found that the prevalence of sexual performance anxiety can be anywhere from nine to 25% for men, and six to 16% for women When referring to experiences of anxiety about sexual performance for at least one month in the past year. Similarly, the Cleveland Clinic estimates that up to 25% of men and 16% of women are affected by sexual performance anxiety. And a 2019 study published in the Journal of Sexual Medicine, found sexual performance anxiety effects 14 to 19% of men, and can contribute to issues like premature ejaculation and psychogenic erectile dysfunction, which is a term that we'll discuss in more detail later. But first, let's talk about some of the common experiences that relate to or might cause someone to experience sexual performance anxiety, especially penis owners. One common cause of this anxiety is worrying about pleasing a partner. Men may worry about sexually pleasing their partner for a variety of personal, psychological, social, and even cultural reasons. These worries often stem from deep concerns about performance, masculinity, and emotional connection. This might be caused by past trauma or rejection from a partner body image, low self-esteem, Or even physical concerns such as erectile dysfunction or premature ejaculation insecurity, or jealousy of their partner's. Past experiences may create competitive thinking about sexual worthiness and link pleasure to performance instead of experiencing an intimate connection. This is why the body count question that often comes up in new relationships can be so damaging. Just because someone has had a lot of sexual partners, it doesn't mean that they're skilled sexually or that they're better lovers fixating on how many past experiences your partner has had. It's not going to add anything positive to the relationship or sexual experiences that you have now. So if you're entering a new relationship, just don't even go there. body image is something else that can cause anxiety and affect sexual performance. There's such a societal pressure to look a certain way. We see it not only in porn, but even on mainstream and social media. We often think that body image is just something that women struggle with, but many men worry about this too. It may be that they don't feel comfortable taking their shirt off. Um, maybe they have a little dad bod going on, but probably more often they're worried about their dick size. I know you've probably all heard it's not the size of the boat, it's the motion of the ocean or something like that. And for most women, that's true. Granted, there's going to be some women that are definitely size queens, but for the majority of women, it really doesn't matter that much. Remember, 80% of women don't get off from penetration alone, so it really doesn't matter how big your dick is. If you can be skilled with touch and connection, you're going to be in a much better position to satisfy your vulva owning partner, Kissing, light touch, oral sex, clitoral stimulation. These are the things that are the most important for female pleasure. So don't put so much focus on penis size. And this brings up another concern that might cause a man to have some performance anxiety, and that is, what if I can't make my partner orgasm? So to this first, I have to say. It's not your job to make your partner orgasm. That's their job. It's their job to know what works for them, what kind of touch they need, the pressure, the speed, all of that is their responsibility to figure out and communicate that with you. We get so many unrealistic expectations from porn and social media. But just know that sexual success does not have to be tied to orgasm. There can be so much fun and pleasure just in the journey. You know, if you think about sexual experience with curiosity and playfulness, it can be so much more fun regardless of if it ends in orgasm for either party. So speaking of orgasm, this is another area that can cause significant anxiety in men. They may be concerned about, what if I can't stay hard long enough, or what if I come too soon? The fear of not being able to maintain an erection throughout intercourse can really have a negative impact on a man's self-worth. So many people equate erections with masculinity or capability, but as we discussed earlier, there are so many other ways to have pleasure sexually. It's really something that both parties need to be open to exploring. I like to use the analogy of a playground because when you really think about it, sex is supposed to be fun. It should be like an adult playground. Easy, fun, lighthearted, you know, all of those things that we felt as children when we engaged in play. So think about it like this. When you go to the playground, you don't always have to go down the slide. Maybe some days you just want to swing or play on the monkey bars, or maybe you want to do those things first and then go down the slide. and then what happens at the playground that you go to doesn't even have a slide. That doesn't mean that you can't have a lot of fun playing on other things, right? So guys, don't put so much pressure on yourselves to immediately get hard or stay hard. It doesn't have to equate to being a disappointing experience for your partner or for you. The same is true for premature ejaculation. If this is something that you struggle with, play on the swings first before you go down the slide. by taking away the pressure to perform for a certain length of time. Many of these physical concerns may resolve on their own. Now sometimes these physical concerns like erectile dysfunction or premature ejaculation can be related to other health concerns. I want to first talk about erectile dysfunction because this can be the first sign of a much more serious concern like cardiovascular disease, Erectile dysfunction and cardiovascular disease are strongly linked, not just coincidentally, but biologically. Erectile dysfunction is often an early warning sign of cardiovascular problems, especially in men over 40. To understand this better, let's look at the shared underlying cause, which is endothelial dysfunction. The endothelium is the inner lining of the blood vessels, and when it's not working well, which is what we consider endothelial dysfunction, it can't properly regulate blood flow. This contributes to both erectile dysfunction. because the penis needs strong fast blood flow for an erection and cardiovascular disease because poor blood flow affects the heart, arteries and brain. So in short, erectile dysfunction and cardiovascular disease are both signs of damaged blood vessels. Because blood vessels in the penis are smaller, about one to two millimeters in diameter than those in the coronary arteries, which are three to four millimeters Blockages or restricted blood flow show up earlier in the penis than in the heart. this is why erectile dysfunction can be an early symptom of heart disease. Studies show that erectile dysfunction can appear three to five years before a cardiovascular event like a heart attack. Therefore, a man with new onset erectile dysfunction may be at a higher risk for silent heart disease. In a 2010 meta-analysis published in the Journal of the American College of Cardiology, it was determined that men with erectile dysfunction have a 44% increased risk of cardiovascular disease, a 62% higher risk of heart attack or myocardial infarction, and a 25% increased risk of dying from all causes. This risk is independent of traditional factors like age, smoking or diabetes. therefore, erectile dysfunction is a significant marker for underlying vascular health and not just a performance issue. Another important thing to consider is that erectile dysfunction and cardiovascular disease often have the same contributors, such as high blood pressure or hypertension, high cholesterol, obesity, smoking, diabetes, and a sedentary lifestyle. Also, poor diet and psychological stress can relate to both of these. So treating one can help the other. This can be done by improving cardiovascular health through exercise diet, such as the Mediterranean diet, quitting smoking, and managing stress and weight. So guys, if you're noticing difficulties with getting or maintaining an erection, please see your healthcare provider and get a cardiovascular workup Because as we mentioned, the erectile dysfunction can appear three to five years earlier than an actual cardiovascular event. So let's take a look at premature ejaculation. In many cases, premature ejaculation is psychological or situational, especially in younger men or those without a history of ongoing sexual issues. Common psychological contributors include worrying about pleasing a partner or maintaining an erection. This can actually speed up ejaculation. Early sexual conditioning can also be a cause of premature ejaculation. Consider this rushed or secretive. Masturbation during adolescence can create a pattern of rapid ejaculation. Our bodies have muscle memory, so when something is always done in a certain way, we have to retrain those muscles and neurotransmitters to perform in a different way. This can be done by learning how to feel sensations in a different way. For example, it may be helpful to masturbate with your non-dominant hand. Another suggestion is to use edging, which is when you masturbate until you're at the point where you're close to ejaculation, but not past that point of no return, and then stop letting the arousal subside a bit and then starting again. So by playing in this way, many penis owners have been able to resolve the issue of premature ejaculation. Other psychological causes of premature ejaculation include guilt or shame around sex, especially if it's tied to cultural, religious, or personal beliefs. Relationship stress, including a lack of trust, emotional disconnect, or unresolved conflict and depression or anxiety disorders, which make it difficult to stay present or relaxed during sex. S, while psychological reasons are more common, some men do experience premature ejaculation due to medical or physiological factors Such as neurochemical imbalances, where low serotonin levels are associated with reduced ejaculatory control, hormonal issues including abnormal levels of testosterone, thyroid hormones, or prolactin. Prostatitis or UR arthritis, which are related to infections or inflammation. This can increase sensitivity and lead to quicker ejaculation. Additionally, medication side effects or withdrawal from substances can impact ejaculatory timing, and there may also be a genetic predisposition or hereditary component in some men. Finally, erectile dysfunction may be related as some men feel that they need to rush to climax before losing their erection, creating a secondary premature ejaculation issue Depending on the root cause, treatment may include things like cognitive behavioral therapy, mindfulness and breathing techniques. SSRIs, which are selective serotonin, re-uptake inhibitors or antidepressants like peroxetine or sertraline. They can delay ejaculations as a side effect. So sometimes those are prescribed. Also topical anesthetic creams or sprays can be used ideally, ones that don't also kind of numb your partner. Erectile dysfunction medications, um, can be helpful in some cases. And also couples counseling if there are relationship dynamics that are involved. So while premature ejaculation is often psychological, especially in younger or otherwise healthy men, it can also have medical or neurological causes. As with erectile dysfunction, a full medical evaluation really is the best way to find the right treatment path. Okay. Now that we've identified some of the causes of sexual performance anxiety, let's take a few moments to discuss some of the tools that are available to overcome these issues. For help with the psychological causes that were mentioned, therapy, especially sex therapy or cognitive behavioral therapy, can be extremely helpful by learning mindfulness and grounding techniques. Or even journaling and identifying thought distortions. Sex therapists and counselors can really help clients to overcome these barriers. Communication is key, even if it's not with a mental health provider or sex counselor. Talking with your partner about fears and expectations, practicing vulnerability and empathy, and establishing emotional safety and trust in your relationships will lead to decreased anxiety and improved sexual satisfaction. Additionally, lifestyle changes such as reducing alcohol or substance use, exercising regularly and prioritizing sleep and self-care will lead to improved health and decreased stress overall. Finally, seeking medical support to evaluate for possible physical causes and explore treatment options for erectile dysfunction or hormonal imbalances may be necessary. Before we wrap up, I want to debunk some common myths that are associated with sexual function and performance anxiety. So myth number one, great sex is supposed to be long and intense every time. While in truth, the average time for penetrative sex is five to seven minutes. Good sex is about connection and pleasure, not duration, so quality over quantity. Myth number two, A real man is always in the mood and can get or maintain an erection on command. Well, the truth is arousal fluctuates. Stress fatigue, medications and emotions can all affect performance. This myth is a major cause of sexual performance anxiety in men. Myth number three, only men worry about their sexual performance. In truth, women also experience anxiety about orgasming body image being good in bed or pleasing their partner. It just manifests differently. Myth number four, if you or your partner don't climax, the sex wasn't successful. Truth orgasms aren't the only goal. Pleasure, intimacy, and connection matter more. As we mentioned, many women don't orgasm from penetration alone. Myth number five, being in love equals perfect sexual chemistry. Every time the truth, even loving couples can face mismatched libidos stress, or off days Myth number six. What you see in adult film reflects normal sex. The truth porn is performative. It rarely shows consent, communication, emotional connection or realistic bodies or stamina. porn is for our entertainment. It's done by actors. It's not real life. Myth number seven. Penis size is key to satisfying sex. the truth. Most people care more about emotional intimacy, attentiveness and mutual pleasure than size. Plus, many nerve endings are located near the vaginal entrance, not deep inside. Myth number eight, if a woman needs lube, she's not aroused the truth. Lubrication is affected by hormones, medications, hydration and more. Lube is a tool, not a sign of failure. Lots of people use it to make sex better, and I certainly recommend it for any kind of sex. One of my favorite lubes is Uber Lube, which is a nice smooth silicone lube. It doesn't get tacky, it doesn't dry up. It's great. Myth number nine, if you're truly compatible, you won't need to talk about sex the truth, open communication improves sex. Talking about likes, boundaries, and feelings is a sign of maturity, not dysfunction. Myth number 10, struggles with performance or desire mean you're flawed In truth, sexual difficulties are common and often temporary. They're not a reflection of your worth or your relationship. Sexual performance anxiety is more common than you think, and is treatable with the right support, communication, and self-compassion. It doesn't have to define your intimate life. While these concerns often reflect good intentions like wanting to be a giving responsive partner, they can become overwhelming when tied to rigid ideas of masculinity or performance. When unspoken, these words can lead to avoidance of intimacy, increased anxiety and physical symptoms such as erectile dysfunction and emotional distance in a relationship. Hopefully, by talking about this issue, you are able to learn something or at least gain some insight into some of the struggles around sexual performance anxiety. So until next time, stay curious, stay empowered, and stay you.

Speaker 20:36

That's it for today's episode. Thanks for listening, and be sure to rate and review the podcast on whatever platform you're listening from and share it with your friends. That's a great way to help reach new listeners and make this a more sex positive world. Also, I'd love your feedback and questions, so send me a message. It's at email@doctorpattyj.com, and that's doctor spelled out, D-O-C-T-O-R-P-A-T-T-Y j.com. Until next time, stay curious, stay empowered, and stay you.