Under Pressure: Men’s and Women’s Sexual Performance Anxiety in the Sexual Interactions of Adult Couples

ABSTRACT

Most research on sexual performance anxiety has focused on men’s experiences and links to erectile functioning and premature ejaculation, with little research attention given to women’s experiences or to relationship dynamics. At times, sexual performance anxiety has been examined in the context of dysfunction, but rarely as a focus in its own right. Study 1 asked 51 participants reporting sexual performance anxiety to describe the cognitive and affective components of their experiences, coping strategies, and perceived impact on their relationship using open-ended responses from online surveys. Through directed content analysis, Study 1 revealed that men and women experience a range of cognitive and affective processes with predominant feelings of inadequacy, and overall promoting more approach coping strategies. Study 2 used quantitative surveys to examine whether sexual performance anxiety was associated with higher sexual distress and lower sexual and relationship satisfaction in a sample of 228 community-based couples. Guided by the Actor-Partner Interdependence Model, multilevel modeling analyses indicated that higher sexual performance anxiety was linked to higher sexual distress and lower sexual and relationship satisfaction in both individuals and their partners. This work advances knowledge of sexual performance anxiety to women’s experiences, not just men’s, and to couples’ experiences. Effective treatment for those suffering from this anxiety may incorporate education around sexual beliefs and expectations.

Introduction

There is a wealth of research on problems in sexual function and its link to personal and interpersonal outcomes, such as associations with sexual and relationship dissatisfaction (Byers, 2005; Impett et al., 2014; O’Sullivan et al., 2016; N. O. Rosen et al., 2015, 2019; Sprecher, 2002). Yet relatively little is known about sexual performance anxiety, despite it being widely recognized for over 50 years as a sexual complaint. Indeed, a recent review of all related literature indicates that sexual performance anxiety possibly affects 9–25% of men and 6–16% of women, yet has received very little research attention, especially with regard to treatment (Pyke, 2020). Sexual performance anxiety refers to an individual’s excessive concerns about their ability to satisfy a partner during a sexual interaction (Masters & Johnson, 1970; McCabe, 2005). Most research has shown that sexual performance anxiety is integrally connected to experiences of sexual dysfunction among men (Cranston-Cuebas & Barlow, 1990; Hawton, 1993; McCabe & Connaughton, 2014), but relatively little research attention has been given to links between sexual performance anxiety and women’s sexual function despite known associations with arousal difficulties (Dang et al., 2018; McCabe, 2005). In this research, we explored both men’s and women’s experiences of sexual performance anxiety and how it may be linked to couples’ well-being.

Sexual Performance Anxiety among Men

Research on male experiences with sexual performance anxiety has focused heavily on erectile dysfunction (ED) (Both, 2016; McCabe, 2005, 2014; R. C. Rosen et al., 2007, 1994; Telch & Pujols, 2013). Liu (2002) found in a comparative study of 44 men diagnosed with ED that sexual performance anxiety, deficient sexual sensitivity, and poor communication were major psychological factors contributing to ED when compared to men without ED. In some of the earliest work on sexual performance anxiety, LoPiccolo (1992) conducted a treatment study for men with ED using sensate focus (i.e., exercises requiring focus on touch and pleasure senses rather than performance) and noted that these exercises did not alleviate performance anxiety as expected but in fact exacerbated them because of increased focus on the sexual interaction. This formative work demonstrated how some men may experience heightened performance anxiety over the maintenance of an erection during sexual intercourse. This anxiety can lead to a loss of erection – which reinforces performance anxiety – creating a cycle of performance anxiety and erectile dysfunction. Causal direction is not known and may be bidirectional (e.g., a man experiences erectile difficulties once and becomes anxious during his next sexual interaction in fear that he may experience erectile issues again), but the association between sexual performance anxiety and erectile dysfunction has been reliably established and replicated (Liu, 2002; R. C. Rosen, 2007).

Another line of research reveals links between men’s sexual performance anxiety and other sexual function (Hawton, 1993; McCabe, 2005). Online studies with a sample of over 12,000 men found links between sexual performance anxiety and premature ejaculation (McCabe & Connaughton, 2014; Porst et al., 2007). In a study of 157 men, McCabe (2005) showed that men reporting erectile dysfunction, premature ejaculation, or lack of desire reported higher levels of sexual performance anxiety compared to men who did not experience any sexual difficulties. Indeed, even when accounting for stress/fatigue levels, communication, and sexual attitudes, performance anxiety was the only unique predictor of sexual dysfunction. Thus, sexual performance anxiety is clearly implicated in men’s sexual function.

Sexual Performance Anxiety among Women

Far less research has addressed women’s experiences of sexual performance anxiety despite 6% to 16% of women reporting to medical professionals with this concern (Pyke, 2020). In fact, most of the research focuses on anxiety more generally, such as trait versus state anxiety, or on anxiety disorders (i.e., generalized anxiety disorder) and their links to sexual function, rather than anxiety around sexual performance specifically. The few studies that have focused on women revealed links to problems in sexual function, including lack of vaginal lubrication and inability to reach orgasm. For example, McCabe (2005) found in a comparison of clinic-recruited and community-based women that women reporting low arousal, low desire, or inability to orgasm had higher levels of sexual performance anxiety compared to women without sexual function problems. Sexual performance anxiety was a unique predictor of sexual dysfunction among women recruited from a clinic and a university sample (Dang et al., 2018; McCabe, 2005). These findings indicate that women also experience sexual performance anxiety, like their men counterparts, and that sexual performance anxiety is linked to experiences of sexual problems.

Aspects of the cognitive distraction literature might shed some light on women’s experiences with sexual performance anxiety. Cognitive distraction originally focused on attention to non-erotic rather than erotic stimuli in a sexual interaction (e.g., mathematic problems within a laboratory study, or thinking of “to-do” lists during sex) (Adams et al., 1985; Lazarus, 1963). However, in more recent years, researchers have included sexual distractions, among which are negative sexual thoughts (e.g., sexual abuse, lack of affection, sexual beliefs, and self-schemas) and, notably, performance anxiety. Although there is some overlap between these concepts, sexual performance anxiety focuses on the intense feelings and thoughts of failure to meet a partner’s sexual needs and can include negative self-body image (Dove & Wiederman, 2000; Masters & Johnson, 1970). Women who reported higher levels of distraction during sexual activity – specifically fear of failing to satisfy their partner sexually – tended to report less consistent orgasms and higher incidence of faking an orgasm (Dove & Wiederman, 2000). Similar results were found in a study focusing on female orgasm and distraction by negative automatic thoughts (Cuntim & Nobre, 2011). Negative automatic thoughts included any indication of worrying about potential failure to adequately perform sexually for one’s partner (i.e., sexual performance anxiety).

More work is needed, and in particular, what is needed is far richer detail about these experiences from those who suffer from it, ideally in their own words, to gain some understanding of those operating with this problem and its role in sexual dysfunction. Overall, sexual performance anxiety has been linked broadly to sexual function, but are men’s experiences similar to women’s? What thoughts and feelings characterize what they go through? A more in-depth investigation is needed regarding the cognitive and affective components of both men’s and women’s experiences, as well as strategies used to cope, and what they see as the impact of it in their lives. Such information will be of use for clinicians working with individuals and couples dealing with sexual performance anxiety by providing valuable points of intervention and possible ways to tailor one’s approach.

Individual and Relationship Factors Linked to Sexual Performance Anxiety

Relatively little is known about the sexual and relationship well-being (i.e., relationship satisfaction, sexual satisfaction, and sexual distress) of those coping with sexual performance anxiety. One exception is a study using a Canadian university sample of 1,023 students (n = 307 men and n = 716 women). Dang et al. (2018) found that both men and women who reported higher levels of sexual performance anxiety tended to have elevated sexual distress compared to those with lower sexual performance anxiety.

Dove and Wiederman (2000) found that women who experienced higher levels of performance anxiety tended to report lower self-esteem and lower sexual satisfaction. Going even further and providing one of the only published comparisons of men’s and women’s experiences, McCabe (2005) examined links between sexual performance anxiety and personal and relational outcomes in both men and women (25–68 years). Those who reported higher levels of sexual performance anxiety reported more negative sexual attitudes. Men also reported more conflict within their relationship, and women reported poorer quality relationships and lower sexual satisfaction. This study significantly adds to the literature by demonstrating the importance of examining both personal and relational outcomes associated with sexual performance anxiety. However, it did not incorporate information from both members of a couple, which is the only means of determining how one partner’s sexual performance anxiety is linked to their own and their partner’s personal and relational outcomes.

Conceptual Framework

Sexual script theory (Gagnon & Simon, 2005; Simon & Gagnon, 1986) has guided this current research as a way to capture how individuals establish beliefs about what is expected of them in terms of sexual performance. Scripts are cultural norms that guide our understanding of how events will unfold, are acquired through social learning, and involve modeling and reinforcement to learn how to appropriately react during sexual cues and situations (Simon & Gagnon, 1986). Script theory posits that we are socialized to adopt traditional, complementary, gender roles for sexual interactions, which provide a common context for sexual performance. Specifically, men are expected and socialized to be agentic, to initiate and pursue all opportunities for sex, and to demonstrate prowess in their sexual interactions (Messerschmidt, 2000). The social construction of femininity, by contrast, in sexual interactions has placed considerable emphasis on maintaining physical attractiveness, being acquiescent in ways that maximally please their partner, and being responsive to their partner’s needs (Kim et al., 2007; Vannier & O’Sullivan, 2012). Men and women in mixed-sex and same-sex relationships report responding to socialization along traditional script lines (Klinkenberg & Rose, 1994; Rose & Frieze, 1993).

Greater insights into the beliefs (i.e., scripts) about how they are expected to behave in partnered sexual interactions likely will inform what we know about how sexual performance develops. Key to effectively capturing these scripts is generating data that represents men’s and women’s own views to investigate whether endorsing these beliefs adds pressure to perform, which ultimately might interfere with the quality of their sexual interactions. Lower sexual satisfaction and decreased sexual desire was linked to stronger endorsement of traditional sexual scripts (Kiefer & Sanchez, 2007; Rubin et al., 2019). Individuals who report greater flexibility in sexual script beliefs (i.e., less traditional beliefs) tend to report greater sexual desire and lower sexual distress, and partners report greater sexual satisfaction compared to those who endorse traditional forms (Bouchard et al., 2023). Thus, script theory might provide a useful framework for understanding how expectations acquired through socialization guide beliefs about how one should behave or perform sexually with a partner, with consequences for sexual function and well-being for individuals and their partners.

The Current Research

In this research, we explored the cognitive and affective experiences of those reporting sexual performance anxiety, strategies that they report using to cope with it, as well as how this type of performance anxiety might be linked to relationship dynamics among community-based couples, notably romantic and sexual satisfaction. We expected, in line with our conceptual framework, that these experiences would correspond to traditional scripts. Our primary objective was to explore experiences of sexual performance anxiety among men, women, and other genders, extending the literature in this way.

Study 1 was designed to explore in individuals’ own words their perceptions of how sexual performance anxiety is linked to personal and relational outcomes. This addresses the need for richer detail about these experiences. The following research questions guided this work:

Q1:

How do individuals across genders describe their own experiences of sexual performance anxiety and its perceived impact on themselves and their relationship?

Q2:

Are there patterns in reports of experiences that correspond to traditional expectations about men’s and women’s roles in sexual interactions?

From Study 1, we gathered valuable insights as to how sexual performance anxiety is linked to an individual’s sexual functioning, coping strategies, and how both may influence the individual’s relationship. This led us to our second objective which was to gain some understanding of how sexual performance anxiety may be affecting both partners in a relationship. To that end, we investigated personal and relationship outcomes among a sample of community-based couples. Studying both partners is challenging but provides much-needed information about the dyadic processes involved – information necessary for effective treatment and management of sexual performance anxiety. Community-based couples were chosen because sexual performance anxiety is not a clinical diagnosis, and like general subclinical anxiety, anyone can experience this sexual problem; therefore, these couples could give us additional insights into how sexual performance anxiety is experienced among people not necessarily seen in clinical settings at any point.

In Study 2, we examined dyadic experiences of sexual performance anxiety by surveying couples from a large community sample and assessed links to personal and partner outcomes, including sexual distress, relationship satisfaction and sexual satisfaction. The following research question and hypotheses guided this work:

Q3:

Is sexual performance anxiety associated with sexual distress, relationship satisfaction, and sexual satisfaction for one or both members of a couple?

H1:

Individuals reporting higher levels of sexual performance anxiety were expected to report higher levels of sexual distress and lower levels of relationship and sexual satisfaction.

H2:

Individuals reporting higher levels of sexual performance anxiety were expected to have partners who reported higher sexual distress and lower sexual and relationship satisfaction.

Study 1

The goal of Study 1 was to obtain a better understanding of the experience of sexual performance anxiety in individuals’ own words regarding corresponding thoughts and feelings, how they try to cope with this anxiety, as well as their perceptions regarding whether and how it might be affecting their relationship.

Method

Participants

Individuals were recruited using a crowdsourcing site (Prolific®). Interested individuals completed an eligibility screening survey in which eligibility criteria were embedded among filler items to disguise criteria for entry. Eligibility criteria included being fluent in English, in a committed relationship of at least three months’ duration, at least 19 years of age, and experiencing frequent sexual performance anxiety (using a Likert scale; 1 (no, I have not), 2 (yes, but rarely), 3 (yes, often), where participants were eligible if they selected 3). Three hundred and twenty-five interested individuals completed the eligibility screener. Of those who completed the screener, one individual did not complete the sexual performance anxiety question and therefore did not meet the criteria. Of the remaining screened, 30% indicated never having experienced sexual performance anxiety before (n = 97), 46% indicated experiencing sexual performance anxiety but rarely (n = 149), and 24% initially reported experiencing sexual performance anxiety often (n = 78), but once completing the survey, some individuals changed their responses, leaving 16% (n = 52) of all participants who reported often experiencing sexual performance anxiety. The 26 individuals who changed their responses to rarely experiencing sexual performance anxiety were no longer eligible and were removed without completing the survey. One participant who indicated experiencing sexual performance anxiety often did not complete any open-ended questions and so was removed from analyses, leaving 51 completed surveys.

Participants identified as either cisgender men (n = 17), cisgender women (n = 33), or as nonbinary (n = 1). The majority resided in the United Kingdom (45%) or the United States (18%), with the remaining residing across Europe (France, Germany, Italy, Poland, Portugal, Spain, and Ireland), Canada, and South Africa. The mean age of participants was 34.29 (SD = 10.47; range 21–61 years). Most (78%) reported being heterosexual, 18% were bisexual, 2% were gay, and 2% were questioning. The average total number of past intimate relationships was five (SD = 4), with a median relationship duration of four years. Over half of the sample (57%) indicated they had children.

Measures

Experiences of Sexual Performance Anxiety

Participants were asked a series of open-ended questions to describe scenarios when they experienced sexual performance anxiety during sexual activity along a number of dimensions. These questions were developed and refined in consultation with experts in sexual relationship research and piloted on a small number of participants prior to use with the larger sample. In relation to the most recent experience of sexual performance anxiety, participants were asked: (1) What thoughts were going through your head? (2) What were you feeling in that moment (e.g., shame, guilt, indifferent)? (3) How did you cope with this type of anxiety? (4) Has your sexual performance anxiety affected your sex life and/or your relationship with your partner? If so, how? Participants were encouraged and reminded to elaborate upon their responses as much as possible.

Procedure

Individuals were recruited as part of a larger study on intimate relationships. Eligible participants were provided with a link to the online consent form, which explained the research in detail. Once consent was obtained, a separate link was provided to access the online survey. There were four attention checks embedded in the survey (e.g., “Pick the answer that is not a food” and “What is 5 + 5?”); all accurately completed these attention checks and were retained. The average length of time for participants to complete the survey was 16.42 minutes. Participants were compensated for their time in line with the crowdsourcing payment guidelines, which amounted to £3.00 per half hour. All procedures were approved in full by our institution’s research ethics board prior to the initiation of the study.

Data Analysis

Participants’ open-ended responses were analyzed using directed content analysis (Krippendorff, 2004). Content analysis is systematic and replicable, and distills written material into content categories (Stemler, 2000). Because of the exploratory nature of this study, we adopted a conventional content analysis approach, which involves five interrelated steps to organize and code the data (Elo & Kyngäs, 2008): (a) open coding, (b) the development of a categorical coding protocol, (c) grouping, (d) categorization, and (e) abstraction. Each response was treated as a single text segment for coding. Analysis continued in an iterative process, with categories added or removed to efficiently capture all dimensions of the data, until saturation was reached. Reports were categorized into groups based on the situation and outcome between the two partners involved. Two independent raters trained in qualitative research individually analyzed all open-ended responses. The interrater reliability was shown to be within the excellent range (Kappa = .81), and any discrepancies were discussed as a group to clarify category identification. All responses that were uninterpretable or too general to interpret were not included in the analyses. These were discussed and eliminated prior to onset of the coding. The researchers were able to assess the frequencies of all categorical data and any sex/gender differences using SPSS 28.0.

Results

Primary categories were analyzed for each of the areas of interest addressed in the survey: cognitive and affective components, coping with the anxiety, and perceived impact on self and relationship. Responses could fall into more than one category depending on the details provided.

Cognitive and Affective Components

When participants were asked to describe the thoughts and feelings that occur when experiencing sexual performance anxiety, three primary themes emerged: Feelings of inadequacy as a sexual partner, physiological/low arousal, and distraction. Each of these is described below using illustrative quotes.

Feelings of Inadequacy

The most common response (n = 38 total, 75%) regarding corresponding thoughts and feelings was descriptions of feeling inadequate as a sexual partner and was noted more often in the women’s responses than the men’s (28/33; 85% women and 9/17; 53% men, with the non-binary participant reporting these feelings as well). Participants described feeling unattractive, not sexually skilled, worried and embarrassed, and having thoughts of comparing poorly to their partner’s past lovers, of not living up to their partner’s expectations of them as a sexual partner, and overall self-consciousness. One man wrote, “I lose my erection as I am anxious that I am not giving my partner any pleasure” (gender: man; age: 53 years old). Other illustrative responses include the following:

I went along with [sex] and pretended to enjoy it but was concerned my weight/unattractiveness would be putting him off, I faked an orgasm to get it done quicker. I was wanting to do it with the lights off to hide my unattractiveness and worrying about how I looked was the main reason for me feeling I wasn’t doing a good job at it. (gender: woman; 42 years old)

I was trying to read from my partner’s expressions if I was performing well and meeting his needs, but I couldn’t tell for sure. So, after that, I started getting anxious and my head filled with worries that I wasn’t doing a good job. I was wondering if I was doing “things right” and if I wasn’t good enough. (gender: woman; 21 years old)

These descriptions indicate that thoughts of sexual inadequacy, feelings of shame and worry are common fears among individuals with sexual performance anxiety. Although appearance and one’s perceived attractiveness were mentioned in many women’s responses (corresponding to the traditional sexual script), the overarching theme of not being able to please one’s partner underscores the thought and emotional processes in these descriptions of sexual performance anxiety. Just over 50% of men described having these thoughts as well during episodes of sexual performance anxiety. In addition, almost one-third (n = 12, 32%) of the participants who described thoughts of inadequacy also described physiological or low arousal responses. This association noted in their reports may show an important link between critical self-talk and sexual function (i.e., arousal) for a person struggling with sexual performance anxiety.

Physiological and Low Arousal

The second most common response was physiological or low arousal issues (n = 24; 47%) and was somewhat more common among the men (12/17; 71%) – in line with the traditional sexual script emphasizing physical ability in sex for men – than among the women (12/33; 36%). This category included descriptions of anxious thoughts before or during sex about the physiological aspects of performance, including the ability to maintain arousal, match their partner’s level of arousal, and reach climax. One man wrote, “I was worried that I would not be able to perform for long enough as I was getting a bit excited too early. I was worried that I would ejaculate too early” (gender: man, 36 years old), whereas another reported “[I was] worrying about size and both getting and maintaining an erection, constant worry, and embarrassment. [I felt like] I was a failure” (gender: man, 53 years old). From a woman:

I was not opening up down there enough, so it was difficult for him to penetrate me. I felt like I needed to hurry up my arousal level to be on the same page as him because he was ready to go. I felt disappointed with myself for not getting physically aroused quick enough. (45 years old)

These responses revealed that their sexual experiences were often physiologically and emotionally uncomfortable and occasionally dreaded, surrounded by worries that they were not meeting expectations and their partner would be frustrated, disappointed, angry, or dissatisfied.

Distraction

The third primary category was distraction and was relatively infrequent among participants with only eight (16%) reporting this component (2/17; 12% of the men and 6/33; 18% of the women). This category captured all responses that described racing or off-base thoughts, difficulty focusing on the sexual interaction taking place, or feeling agitated by other stresses, such as home or personal concerns, all indicators of general anxiety but arising in sexual contexts. Some illustrative examples of these responses were:

The children were all out on various activities with friends and my partner wanted to have sex. There was a short amount of time before the first child was going to be dropped back. I felt under time pressure to perform. I had to satisfy my partner but was aware of time constraints and of a list of chores I needed to get done that weekend. (gender: man, 56 years old)

I felt that my mind was in another place, I wasn’t enjoying the sex. Also, my vagina wasn’t wet, or my body was feeling that heat that it usually feels. Any kind of thought was bad and negative about the next movement, and I wanted to stop the sexual activity, but I was challenging myself to take out that thought but I failed so I had to stop and that happened at least four times. (gender: woman, 24 years old)

These responses reveal how individuals can feel overwhelmed by other thoughts unrelated to sexual activity, such as their children, chores, or even stresses within their lives that make it challenging for them to be in the sexual moment. Many of these responses also fell into other categories because being made anxious by distractions seemed to heighten felt pressure to function sexually and be responsive to their partner, which ultimately impeded their physiological response (i.e., arousal) altogether.

Coping with Sexual Performance Anxiety

Two primary categories (approach and avoidance motives) best captured participants’ reports of how they coped with sexual performance anxiety. Approach strategies included the pursuit of positive outcomes in one’s relationships (e.g., enhanced intimacy), whereas avoidant strategies included efforts to avert negative outcomes in the relationship (e.g., avoid a fight or disappointing a partner) (Cooper et al., 2008). All responses were effectively categorized into these domains.

Approach Strategies

Approach strategies as a way to cope were reported by 61% of participants (n = 7; 41% men, 23; 70% women, and 1 non-binary) and included descriptions of continuing to engage in sexual activity for their own pleasure and/or their partner’s pleasure, trying to stay in the mood, positive forms of communication (i.e., communicate thoughts and needs with their partner and/or gain partner’s reassurance), or engaging in other intimate activities (e.g., cuddling, other sexual activities aside from penetrative sex) as a way to reduce pressure. Some examples illustrating participants’ responses are as follows. One man said, “I kept on with foreplay with my partner, but I asked her to slow down with touching my genitals, this allowed me to continue to pleasure her and then we had sexual intercourse. I tried to think about other events to take my mind off of ejaculating too early” (gender: man, 36 years old).

One woman explained, “We continued having sex but after my partner relaxed me so I wasn’t as tense and could enjoy more, he gives me a massage or tries to arouse me and then switch positions” (gender: woman, 34 years old). Another woman reported “I let my partner know how I was feeling, and they offered me reassurance and let me know there was no rush. They were extremely understanding and comforting towards me, so the sexual interaction continued” (gender: woman, 24 years old). These responses centered on the importance of pleasure and the connection that comes from sexual intimacy with their partner. Many of these responses indicated that the partner understood and was responsive in these situations, occasionally working together in efforts to alleviate the individual’s performance anxiety.

Avoidance Strategies

Almost half of the participants (n = 23; 71% men, 33% women) revealed coping with sexual performance anxiety via avoidance in some form. [Three of the 51 participants (6%) reported both approach and avoidant motivations]. Avoidance responses involved finding a way to not have sex altogether, stopping part way, or engaging in or continuing a sexual activity to prevent an argument with a partner from occurring or escalating, or to circumvent partner dissatisfaction or disappointment. Some also reported concealing their performance anxiety as much as possible. One example of this type of response was:

My partner got frustrated and asked what was wrong. I didn’t want her to think it was her fault, so I kept going until I eventually pulled out and apologised. My partner was unsympathetic and silent. When this has happened previously, I sometimes switch to oral on her to leave her satisfied but this time I didn’t for some reason. (gender: man, 40 years old)

A woman reported “I continue with it. I go through the motions. I don’t tell my partner how I feel because I know that would upset him and he would think it is his fault” (gender: woman, 37 years old), and another wrote “I just kept going until my partner finished. I don’t let them know how I’m feeling” (gender: woman, 36 years old). These responses indicate significant pressure to meet their partners’ expectations and the goals of passively avoiding disappointment or arguments by continuing in sexual interactions without displaying or communicating one’s concerns in some way, or else avoiding sex completely. Many of these responses revealed discord between partners where blame and frustration are expressed. These participants often indicated that the negative responses that they received from their partners made their sexual performance anxiety worse going forward.

Perceived Impact of Sexual Performance Anxiety

Participants described whether and how they viewed their sexual performance anxiety as affecting their sex life and relationship with their partner. Three central themes emerged from their responses: negative impact, positive impact, and no perceived impact.

Negative Impact

As might be expected, the majority of responses (n = 35; 69%) could be classified as capturing a negative impact of some type (n = 13/17; 77% men and 22/33; 67% women). Descriptions that entailed no or poor communication about the performance anxiety issues, and/or indication of no or very little sexual activity or sexual satisfaction fell within this category. Some examples of these responses were: “Yes, we have sex much less often than we would both like and I have noticed my wife very rarely initiates sex anymore, I think because of fear of rejection. I would often reject sex due to the fear of not being able to complete the deed” (gender: man, 40 years old). Another man wrote, “We do not have spontaneous sex anymore and sex has become a distant part of our relationship. Four times in the last year” (gender: man, 50 years old). These responses show how sexual performance anxiety can be perceived as affecting the frequency of sexual activity and how it may impede both partners’ well-being in the form of lowered self-esteem (i.e., feeling rejected or inadequate) and poor relationship connection.

Tension and frustration between partners appeared to increase when there was little to no communication about the performance issues. This response then seemed to lead to doubts and suspicions about one or both partners’ commitment, exacerbating concerns and needs further. One example along this line was: “When I had to stop sometimes my wife gets angry and wouldn´t talk to me in a couple of days” (gender: man, 41 years old).

Positive Impact

A small portion of responses were coded as describing some form of positive impact resulting from sexual performance anxiety (n = 8; 16%; 1 man, 6 women, 1 non-binary). This category highlights responses indicating healthy, supportive communication and sexual intimacy between couples who were working together to deal with sexual performance anxiety. Examples of these responses were as follows:

So, as much as I think I am failing him or feel guilty for not pleasuring him enough, I know that he will always say it is ok and no pressure. So, it is mainly me and my head telling me otherwise. But the older we get the more relaxed and getting better at just communicating more to help solve it. (gender: woman, 34 years old)

Sometimes I’m afraid that it has effects on our relationship, but my partner is very comprehensive, so I think he is ok with it, at least he never said anything bad about it. He only tries to encourage me to be more comfortable so our sex life can be better … We are satisfied with it but we are still working on it to make it as we desire. (gender: woman, 21 years old)

We try and mitigate my mental state and get me calmer when we do things. It is a sort of maintenance. But my anxiety means I get to focus less on that goal, specifically performance anxiety, because I think I am giving him less than he deserves. If anything, it’s not helping our sex life together, but the understanding about it is making us stronger in the long run. (gender: woman, 34 years old)

No Perceived Impact

Responses indicating there was no perceived impact were relatively uncommon overall (n = 6—2 men, 4 women; 12%). In five cases (83%), the impact was unclear. One woman wrote, “It’s stressed me out in the bedroom but hasn’t necessarily put a dent into the relationships” (gender: woman, 24 years old) and another reported “We are less intimate but there are so many variables at play. I still initiate and engage even when I don’t really feel like it as I know I am not a great partner at the moment” (gender: woman, 32 years old). Although some of these responses may imply that the individual’s sexual performance anxiety had some impact on their sex life and/or their relationship, the details were not clear enough to determine if the impact was perceived as positive or negative. Overall, sexual performance anxiety clearly can be challenging to manage; and these experiences illustrate how individuals and couples vary in their responses to it.

Discussion

This exploratory study generated detailed descriptions of experiences of sexual performance anxiety among individuals in committed intimate relationships, including thoughts, feelings, how they coped, and perceived impacts. This work comprises one of the first to provide a comprehensive perspective to our knowledge. Of particular note perhaps, it adds insights into women’s perspectives about sexual performance anxiety as there has been so little research on women’s experiences overall.

Participants reported a range of cognitive and affective processes during their experiences, indicating considerable disruption, distraction, and distress. Feelings of inadequacy predominated, with participants referring to expectations shared explicitly, implicitly or assumed with their partner about how they should be performing sexually, corresponding in some ways to traditional sexual scripts. Although we cannot generalize beyond our sample and likely have not captured trends effectively, we did note that a higher proportion of women than men endorsed feelings of inadequacy relating to their physical appearance, including thoughts that compared themselves unfavorably to a partner’s previous lover or zeroed in on particular insecurities about their body. Women also tended to report focusing on their abilities to please their partner, such as how effectively they were pleasuring a partner in a sexual position.

Men tended to endorse sexual function and low arousal concerns more than women but with so few men we are not confident how well this pattern characterizes them. We did perceive a pattern whereby a third of the participants endorsed both feelings of inadequacy and physiological low arousal. Women showed a pattern of identifying thoughts about being an inadequate sexual partner which seemed to be followed by low physiological arousal, whereas men identified physiological arousal issues first, followed by feelings of inadequacy – both patterns of which correspond to traditional sexual scripts. In this way, sexual scripts may have been operating. Men are socialized to always be ready for sex (i.e., get and maintain an erection); when these men experienced anxiety about maintaining an erection, they berated themselves with negative thoughts about being an inadequate sexual partner. By contrast, women are socialized to be valued in terms of their physical appearance, their sex appeal, and willingness to please and appease male sexual partners (in committed relationship contexts). When the women in this study experienced negative thoughts about their appearance, they described such thoughts as leading to feelings of inadequacy as a sexual partner and eventually lowered arousal. With such a small exploratory sample, we are not establishing causal links here. However, these findings align with cognitive distraction research, for instance, addressing women’s negative automatic thoughts, including fear of failure or sexual inadequacy, and the association with sexual functioning difficulties (Cuntim & Nobre, 2011; Dove & Wiederman, 2000). Overall, this study indicates that those suffering from sexual performance anxiety could benefit from clinical intervention that addresses the origins of expectations learned via socialization, challenges the validity of these messages, and draws links to the anxiety experienced with their partner.

In terms of other directions for helping individuals deal with sexual performance anxiety, the participants described more approach than avoidance strategies when interacting with their partners. Approach strategies emphasized communication, whereas avoidance strategies highlighted shame, the common fear of disappointing their partner, efforts to avoid conflict, and avoiding sex altogether. Participants expected or experienced negative reactions (in the past) from their partners. There is no literature to our knowledge that we can draw upon that addresses coping strategies for individuals struggling with sexual performance anxiety. We expect that this initial effort to capture individuals’ views about how to best address these problems will help spur other investigations along this line.

Although this study did not incorporate couples’ views, participants were prompted to discuss the impact on self and their relationship. In line with previous research (McCabe, 2005), sexual performance anxiety is often perceived as being problematic and distressing and aligned with partner frustration with participants avoiding sex as a result. Positive impacts were reported by a minority but typically entailed healthy, supportive communication with their partner. These descriptions underscore the importance of couples working together to overcome or manage the difficulties they face in partnered sexual lives rather than becoming conflictual, resentful, or antagonistic.

Study 2

The findings from Study 1 provided richer detail than acquired to date about individuals’ experiences of sexual performance anxiety – using their own words – and revealed the considerable distress for many around this type of sexual problem and ways it might be compromising sexual relationships. What is needed next is a more formal assessment of the links between sexual performance anxiety and associated distress, and whether these expectations are associated with decreases in sexual and relationship satisfaction. Such information would advance work to date that uses individual perspectives by instead examining dyadic processes. Sexual performance anxiety arises in partnered contexts, so partners’ perspectives are needed to capture these dynamics. In addition, this assessment allows a comparison of men’s and women’s experiences, which we anticipated to vary on the basis of differential socialization in part, in line with our conceptual approach. These aims comprised the primary objective of Study 2.

Method

Participants

The community-based sample was recruited online through advertisements (Kijiji, Facebook, Twitter, and Instagram) and comprised 228 couples (456 participants). Both members of a couple were screened via a telephone interview with a trained research assistant, who explained study procedures and determined whether they met eligibility criteria (i.e., fluent in English, at least 18 years of age; currently in a committed, monogamous sexual relationship of at least three months; and residents of the US or Canada). Both partners needed to provide consent to enter the study and complete a survey about their experiences with sexual performance anxiety. As in Study 1, study criteria were disguised among a wider set of screening items. Initially, 486 participants were eligible and completed the online survey. Three participants were removed because their partner did not complete the survey, and nine participants (plus their nine partners) were removed due to failed attention checks (i.e., more than one incorrect out of four checks). Nine duplicate entries were deleted from participants who had restarted the survey once exiting, leaving a final count of 228 couples. The majority of these couples were in mixed-sex relationships (n = 213), with 11 couples in same-sex relationships, and four couples in mixed-sex relationships that included gender diversity (i.e., non-binary and questioning).

Measures

The survey consisted of measures assessing demographics, experiences of sexual performance anxiety, sexual distress, and sexual and relationship satisfaction. Descriptive statistics for participant demographics are shown in Table 1.

Table 1. Descriptive Statistics for Couples Study (Study 2).

	M ± SD or N (%)
Age (years)	28.14 ± 5.05
Gender
Woman	233 (51%)
Man	218 (48%)
Other gender	5 (1%)
Sexual Orientation
Heterosexual	347 (76%)
Mostly heterosexual	46 (10%)
Bisexual	37 (8%)
Lesbian	14 (3%)
Gay	9 (2%)
Questioning	1 (<1%)
No labels preferred	2 (<1%)
Ethnicity/Culture
White	376 (83%)
Biracial/Multiracial	15 (3%)
African American/Black	14 (3%)
Chinese	12 (3%)
Aboriginal/Metis/Native American	8 (2%)
South Asian	9 (2%)
Southwest Asian	4 (1%)
Hispanic/Latino/Latina	4 (1%)
West Asian	4 (<1%)
Arab	2 (<1%)
Japanese	1 (<1%)
Filipino	1 (<1%)
Relationship Status
Committed relationship (e.g., living together, engaged, married)	357 (78%)
Dating, one person exclusively	96 (21%)
Other	3 (1%)
Relationship Length (years)	4.5 ± 4.35

Note.  = 456 individuals.

Demographics

A standard experimenter-derived measure was used to assess age, gender, sexual orientation, race/ethnicity and relationship characteristics.

Sexual Performance Anxiety

Four gender neutral items were selected from the Erectile Performance Anxiety Index (EPAI; Telch & Pujols, 2013) to capture experiences of sexual performance anxiety. These items were selected to use for all genders and were measured using a 5-point Likert scale ranging from “Not at all like me” to “Very much like me.” A sample item is “I feel tense or nervous in sexual situations with my partner.” The Cronbach alpha score was acceptable; α = .72.

Sexual Distress

Sexual distress was assessed using the 12-item Female Sexual Distress Scale (FSDS; Derogatis et al., 2002). This scale was originally created for women but has been validated for men (Santos-Iglesias et al., 2018). Participants rated 12 items on a 5-point Likert scale to indicate how frequently they experienced distress within the past 30 days about their sex life. The scale ranged from 0 (never) to 4 (always); higher total scores indicated higher levels of sexual distress. The reliability among this study’s participants yielded good internal consistency (α = .81).

Sexual Satisfaction

Sexual satisfaction was measured using the Global Measure of Sexual Satisfaction scale (GMSEX; Lawrance & Byers, 1998). The GMSEX consists of five items in which participants rate their sexual relationship with their partner using bipolar scales (e.g., bad – good, unpleasant – pleasant). Participants respond to each item on a 7-point scale, with higher ratings indicating greater sexual satisfaction. The scale yielded excellent internal consistency (α = .96).

Relationship Satisfaction

The Global Measure of Relationship Satisfaction scale (GMREL; Lawrance & Byers, 1995) was used to measure overall relationship satisfaction. Similar to the sexual satisfaction scale, respondents rated their relationship satisfaction using a bipolar 7-point scale (e.g., bad-good, unpleasant-pleasant). Higher scores indicate greater relationship satisfaction. The Cronbach alpha for the current study was excellent (α = .95).

Procedure

Couple surveys were collected as part of a larger study on committed relationship maintenance that involved recruiting community-based couples in committed relationships. Couples were then told that the study included questions about attraction, intimacy, and sexuality. Each partner received an individualized link to the online consent form and survey, distributed by Qualtrics® survey software. Partners were instructed to complete the survey privately and separately from one another. The survey took about 30–45 minutes to complete, and each partner received a $20 gift card. All procedures were approved in full by our institution’s research ethics board prior to the onset of the research.

Data Analysis

The deidentified data for this study can be made available upon request. Statistical analyses were conducted using SPSS 28.0. Analysis of variance was first computed to assess gender differences in reports of sexual performance anxiety. For our key predictions about the associations between sexual performance anxiety and personal and interpersonal well-being, we conducted a multilevel modeling analysis using indistinguishable models to include all couples (i.e., mixed gender/sex and same gender/sex couples) from our sample; therefore, gender was not used as a distinguishing factor between partners. Partners were nested within couples to account for any non-independence of couple data (Kenny et al., 2006). These analyses were guided by the Actor-Partner Interdependence Model (APIM). Both partners’ sexual performance anxiety scores were simultaneously entered as predictors to test for both actor effects (i.e., how an individual’s own sexual performance anxiety is associated with their own satisfaction and sexual distress) and partner effects (i.e., how an individual’s own sexual performance anxiety is associated with their partner’s satisfaction and sexual distress) (Cook & Kenny, 2005). Sexual performance anxiety scores were grand mean centered. Separate indistinguishable models were conducted for each outcome. The coefficients presented are unstandardized coefficients so that they can be interpreted as the change in the outcome variable for every one unit increase in the predictor. Finally, gender was tested as a moderator between sexual performance anxiety and sexual and relationship well-being outcomes.

Results

Levels of Sexual Performance Anxiety

Overall, the sample reported a mean score of 1.92 (SD = .85) on a scale of 1 to 5, indicating low to moderate levels of sexual performance anxiety. When examining frequencies, 86% of participants scored within the low to moderate range (i.e., 1–3 SPA mean), leaving 14% of participants experiencing moderate to high levels of SPA (i.e., 3–5 SPA mean). The analysis of variance testing for gender differences in mean levels of sexual performance anxiety was not significant, F_{4, 451} = 1.54, p = .19. Men reported a mean of 1.84 (SD = .79), and women reported a mean of 2.01 (SD = .90). Therefore, gender was not controlled or entered as a covariate; however, moderation analyses were run to determine if the associations between sexual performance anxiety and the outcome variables differed based on gender.

Links Between Sexual Performance Anxiety, Distress, Sexual and Relationship Satisfaction

When individuals reported higher levels of sexual performance anxiety, they reported higher sexual distress (b = 7.20, 95% CI = 6.42, 7.98, t(427.49) = 18.22, p = <.001), and their partner also reported higher sexual distress (b = 1.64, 95% CI = .86, 2.42, t(427.49) = 4.15, p = <.001). Also as predicted, when individuals reported higher levels of sexual performance anxiety, they reported lower sexual satisfaction (b = −2.86, 95% CI = −3.38, −2.33, t(409.91) = −10.76, p = <.001), and their partner tended to be less sexually satisfied as well (b = −1.56, 95% CI = −2.08, −1.03, t(409.91) = −5.86, p = <.001). Further, when one person reported higher levels of sexual performance anxiety, they reported significantly lower relationship satisfaction (b = −1.18, 95% CI = −1.54, −.82, t(430.70) = −6.44, p = <.001), as did their partner (b = −.65, 95% CI = −1.01, −.29, t(430.70) = −3.57, p = <.001). Of note, gender did not moderate these associations. In sum, sexual performance anxiety was positively associated with sexual distress and negatively associated with sexual and relationship satisfaction among community-based couples, and the strength of these associations did not differ across men and women.

Discussion

Experiencing sexual performance anxiety clearly is associated with sexual distress and is linked to reduced sexual and relationship satisfaction. What is notable about this study is that these experiences do not appear to be different for men and women. Caution should be exercised in interpreting these findings because overall this was not a clinical sample, and their level of sexual performance anxiety was not generally high enough to prompt them to seek clinical help. It may well differ for men and women in clinical samples and future research should examine that possibility. We have a long history in this field of equating men’s and women’s sexual experiences without appropriate investigation, and this has been challenged on the basis of simplifying or ignoring important distinctions between men and women in brain anatomy, physiology, neurochemistry, susceptibility to selected disorders and response to therapy (Szadvári et al., 2023). We can add to the list gender and sexual socialization, social, cultural, and economic factors as well (Peplau, 2003).

Our use of a community-based sample compared to a clinical sample is a strength here because it has the potential to provide insights most pertinent to those possibly unlikely to ever seek clinical care. We know women may be more likely to seek help for sexual concerns given that traditionally men are more reluctant than are women to seek care, especially psychological care (Booth et al., 2019). Sexual and gender minority individuals face systemic biases and considerable discrimination in healthcare contexts (Gioia & Rosenberger, 2022; Sherman et al., 2020) that undoubtedly work against seeking support or treatment for this sexual problem. A more representative community sample would inform prevalence and provide better insights; from our sample alone, their averages indicated that 14% of individuals experience a moderate to high level of sexual performance anxiety.

Finding no notable gender differences in reports highlights how this is an issue not characteristic of men alone and might not be primarily a binary gender-based experience. It also suggests that traditional sexual scripts may be more useful for understanding how cognitions linked to the anxiety operate once activated in the intimate context for either partner, not necessarily proscribed on the basis of gender. As predicted, when an individual reported higher levels of sexual performance anxiety, both they and their partner experienced lower sexual and relationship satisfaction, as well as higher sexual distress. Sexual performance anxiety may reflect an overall inability to be present in the sexual moment, to trust that one’s partner is enjoying themselves, to reveal genuine responses as they occur, to truly enjoy sex as a way to create intimacy, and to have fun. Such anxiety would undoubtedly detract from a partner’s experience. It is important to bear in mind that we cannot clarify the direction of effects. It may be that if a relationship is of poor quality, as reflected in lowered sexual and relationship satisfaction, this strain might add considerable pressure to their sexual interactions, helping to generate performance anxiety and leaving both partners distressed. Longitudinal research with couples would help to clarify how sexual performance anxiety, distress, and satisfaction unfold.

Even though we cannot clarify the direction of associations, these findings are valuable as they are the first dyadic reports to our knowledge to reveal that sexual performance anxiety not only is linked to the individual’s experiences but also to their romantic partner and relationship dynamics generally as well. Our findings add to research demonstrating links between sexual performance anxiety and poorer personal sexual function (e.g., low arousal, pain during sex) (Dang et al., 2018; McCabe, 2005) and to poorer relational (i.e., dyadic) well-being (McCabe, 2005).

General Discussion

These two studies were designed to obtain a better understanding of individuals’ and couples’ experiences of sexual performance anxiety. These studies investigated gender differences among sexual performance anxiety experiences, links between sexual performance anxiety and sexual distress, and sexual and relationship satisfaction. Overall, our findings were replicated by demonstrating in both studies the distress that individuals experience from this form of anxiety and how sexual performance anxiety can affect experiences within a relationship. This work goes further by making clear that this anxiety is linked to dynamics between partners, a finding that verifies what we learned from participants’ open-ended descriptions in Study 1. Sexual performance anxiety plays a role in personal and relational well-being, and relationship functioning more broadly – impacts that have not been explored or acknowledged in full in previous research.

Rather than rely solely on structured items, our approach allowed us to generate the words of those experiencing sexual performance anxiety in the course of their lives in a way that may prove useful to clinicians working with individuals and couples in distress. These insights might help clinicians tailor their approaches to the unique treatment needs presented. In addition, these findings clarified in part the cognitive and affective components of this type of sex-related anxiety, for instance, that some men perseverate on whether their body will respond as desired, such as getting and maintaining an erection. Quite a few of the women seemed to focus on thoughts of sexual inadequacy and not being sufficiently attractive or responsive enough. It should be noted, however, that there was not a clear bifurcation along traditional sexual script lines that could be discerned with the small sample overall. Further research on the sexual performance anxiety processes may be beneficial, especially research that examines the role of sexual scripts, sexual motivations, and sexual beliefs (e.g., sexual dysfunction beliefs or myths).

In addition, there was an exploratory component to this study in which participants explained in their own words how they cope with sexual performance anxiety and how it affects their relationships. Overall, participants endorsed more approach (versus avoidance) strategies when coping (i.e., engaging in healthy communication and trying to stay in the sexual moment), which might reflect potential responsivity to education and prevention efforts that those supporting individuals in distress could develop.

However, they also expressed notable discord, distress, and avoidance patterns reinforced in our analysis using couples. Individuals described communication issues (i.e., not discussing issues at all or reporting frustrated partners), that may be linked to poorer partners’ well-being due to uncertainty or lack of understanding of the sexual problem itself. They also heavily endorsed expectations, some of which are proscribed by traditional sexual scripts, about what they should be like as a sexual partner, shame for not living up to these expectations, as well as discomfort around discussing them in fear of their partner’s rejection (Wiederman, 2005). Challenging these scripts and beliefs could be a target within individual or couples therapy to foster new sexual behaviors and a wider range of potential options in their interactions.

These couple findings confirmed the personal narratives of individual participants, in line with the work of others before us (Dang et al., 2018; McCabe, 2005). However, we extended this work by examining pathways between these components and how partners are tied into the dynamics by experiencing negative outcomes (i.e., sexual distress and low sexual and relationship satisfaction) associated with sexual performance anxiety. Additionally, there were no differences between men or women reporting higher levels of sexual performance anxiety or their partners reporting lower sexual and relationship satisfaction and higher sexual distress. The over-emphasis both on men’s experiences and individual reports alone needs to be corrected going forward.

Limitations & Future Directions

There are a number of limitations among both studies that must be kept in mind. Both studies were designed to examine gender differences in the experiences of sexual performance anxiety; however, we did not have an especially wide range of individuals with gender and sexual minority identities for meaningful analysis [20% (Study 1) and 14% (Study 2); only 1–2% identified as non-binary]. Researchers could employ a targeted recruitment strategy to generate a more diverse sample. Crowdsourcing samples are more representative and have more conscientious responding than most convenience samples of community participants, student, or other online samples (Behrend et al., 2011; Casler et al., 2013). But exploring how sexual performance anxiety is experienced across diverse partnerships would provide researchers and clinicians with a better understanding of the maintenance of this type of sexual problem and how best to approach the challenges within therapy.

Both studies used cross-sectional data rather than longitudinal or daily diary data. Longitudinal and dyadic daily diary studies could help determine the directionality of some of the associations uncovered here when considering thought and emotion processes and links to sexual function and well-being outcomes. Although there are benefits to open-ended written responses, such as reduced participant burden, opportunities to clarify, frequent anonymity, and little constraints or limits on participant responses, one of the limitations is that some adults may have difficulty expressing themselves in writing. Future researchers could consider collecting open-ended data through interviews, which would add richer detail of people’s experience of sexual performance anxiety.

Another limitation is that couples were recruited from community sources and intentionally were not identified beforehand as having high levels of anxiety via clinical assessment. However, a dyadic prospective study using a clinical sample would be valuable to ascertain whether the same patterns emerge and whether different issues arise altogether. In doing so, we would generate a far clearer picture of the impact of sexual performance anxiety as well as a sharper evaluation and possible confirmation of the associations between performance anxiety and personal and interpersonal factors.

Future studies could examine treatment options for individuals, and couples coping with sexual performance anxiety. Given the response patterns from Study 1, negative thoughts about inadequacy relating to one’s appearance, sexual skills, and the maintenance of arousal could be addressed within therapy aided with the lens of sexual script theory. Specifically, therapists may focus on the individual’s belief systems about sexual function, myths or lessons acquired through sexual and gender socialization, providing psychoeducation about sexual health to counter maladaptive beliefs. Focusing on breaking down sexual myths and replacing them with accurate information, teaching individuals to be more mindful in the sexual context (putting aside concerns about appearance, competence, achievement, completion, etc.) may help alleviate or attenuate performance anxiety. Research shows significant promise in mindfulness-based work (focusing on the present moment and keeping an open, accepting, and non-judgmental attitude) for women with clinically low sexual desire and/or arousal as they began to experience increases in sexual arousal, desire, and sexual satisfaction (Brotto & Basson, 2014; Stephenson, 2017).

Implications and Conclusions

By analyzing open-ended responses that captured first-hand experiences with sexual performance anxiety and supplementing this work with more structured assessments using a dyadic approach, we provide a more comprehensive understanding of how sexual performance anxiety is associated with personal and relational well-being than has been offered to date. Our studies advance the small but notable body of work that precedes them (Dang et al., 2018; Masters & Johnson, 1970; McCabe, 2005) by exploring both men’s and women’s reports. Participants revealed guiding beliefs about sexual performance that may have stemmed from learned sexual scripts, such as how adequate lovers perform and how their bodies should respond to sexual cues. This insight is especially important as it appeared that anxiety among our participants arose and performance was affected when these sexual beliefs were not met, possibly having an impact on the sexual well-being of both partners. Although we cannot clarify causal links here, challenging the source of individuals’ and couples’ sexual beliefs and expectations through sexual education would likely be a highly effective component in the delivery of treatment to those suffering from sexual performance anxiety.

Acknowledgments

The authors would like to thank Kendra Wasson and Morgan Richard for helping to coordinate this study and all of the individuals and couples who participated and shared their personal experiences.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was funded by the Social Sciences and Humanities Research Council [435-2017-1166; O’Sullivan, Principal Investigator].