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How does sexual performance anxiety affect older people?

Jan L. Shifren, MD
Reproductive Endocrinology
Defined as an overwhelming concern about sexual performance that obscures pleasure and leads to sexual dysfunction, performance anxiety is a particularly insidious issue affecting aging couples.

In men, it's the most common psychological contributor to erectile dysfunction. Here's how the problem often develops. The natural effects of aging dictate that a man needs more time and direct penile stimulation for an erection. Medications and cardiovascular disease may also contribute to erection difficulties. If a man continues to expect the instantaneous rock-hard erections of his 20s, he may equate this change in his physical response with the end of his virility. Once he makes this erroneous leap in his thinking, the problem often snowballs. After a few incidences of erection failure, embarrassment and feelings of defeat leave him unwilling to try again. He may withdraw from all forms of physical intimacy to avoid failure or his fear of not performing. In turn, his partner feels rejected and fears that she or he is no longer attractive enough to sexually excite him. She or he may also suspect him of having an affair.

If this happens, the partner may shy away from touching his penis directly, out of fear that he will feel pressured to perform. Paradoxically, any reticence denies the man just the type of direct stimulation that he needs to achieve an erection. The result is that an addressable physical issue becomes a morass of anger, resentment, and frustration.

Women experience performance anxiety in different ways. Performance anxiety is common in women who have experienced pain during sex (dyspareunia) in the past. They may be worried that sex will be uncomfortable again, and this anxiety can decrease lubrication or cause involuntary tightening of the vaginal muscles. In turn, this makes sex painful, which heightens anxiety and further interferes with lubrication. Women also worry about how long it might take to reach orgasm, which may interfere with experiencing maximum pleasure during sex and make orgasm more difficult. Ultimately, some women decide to avoid sex entirely.

The frank discussion of sexuality that has become commonplace in women's magazines and on daytime television can also contribute to performance anxiety. This openness has had the unintended consequence of making some women worry that they do not respond quickly or intensely enough to be considered a "good lover."

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.