Sexual performance anxiety refers to the fear that an individual will not measure up to some preconceived expectation within the context of sexual interaction. Whether related to concerns about body image, one’s masculinity or femininity, or aspects of sexual response itself, such anxiety can disrupt normal sexual response and result in unsatisfying sex with one’s partner.
The sexual responses—erection, lubrication, orgasm, ejaculation—involve the autonomic nervous (internal) system and thus are not strictly under voluntary control. Although an individual may take steps to increase (or decrease) the likelihood of autonomic activation for arousal and orgasm, such responses cannot generally be “controlled” or “willed”.
Biological factors in sexual performance anxiety
A high level of anxiety (and stress) may interfere with the normal erectile process: anxiety typically prompts elevated sympathetic nervous system response (flight or fight), whereas the process of erection demands a predominantly parasympathetic response, which can lead to Erectile dysfunction during the sexual activity.
Furthermore, elevated cortisol (a stress hormone) has been associated with diminished erectile response and greater self-reported “worry”. As men progress through the sexual response cycle, dominance typically shifts from parasympathetic to sympathetic control necessary for ejaculation. Evidence suggests that some men show a too-rapid shift from parasympathetic to sympathetic dominance, resulting in (a premature) ejaculation before the man feels ready which is premature ejaculation.
Characteristics and Influencers of Sexual Performance Anxiety(Causes of sexual performance anxiety)
Both men and women with performance anxiety tend to focus heavily on themselves rather than on the erotic cues provided by the partner. This self-focus includes the monitoring of one’s own physical responsiveness [e.g., for men, the extent of their erection; for women, how close they are (or are not) to orgasm], a process referred to as “spectatoring” or “hypervigilance”. For most individuals, close self-monitoring has negative results: arousal due to erotic cues is either lost or never achieved because the focus on one’s own body—whether related to body image, genital pain, or sexual response itself—precludes attention to partner-generated erotic cues.
One consequence of self-focus is that it distracts from the erotic cues at hand. This shift in focus counters the typical (and somewhat reflexive) response to those cues, such that levels of psychological/physiological arousal necessary for erection or lubrication are never achieved. Although self-focus and distraction often occur concomitantly—resulting in diminished performance—the parameters may not be the same for the two sexes. While sexually dysfunctional men tend to self-focus on their erection, how aroused they are, or how incompetent they are, sexually dysfunctional women tend to self-focus on their body appearance and, surprisingly, non-sexual residuals from the day, although thoughts about incompetency also play a role.
Expectancies and Self-Assessment
Men and women with sexual problems tend to underestimate (or at least underreport) their level of subjective arousal and genital response. Two cognitive processes might explain this. (1) These individuals may set high (or even unattainable) expectations for themselves, based on what they themselves want, what they believe their partners expect, and what they assume to be a socio-cultural norm; that is, they believe that they can never live up to the expectations they have adopted. (2) These individuals are also more likely to catastrophize about their situation, believing that the situation is far worse than it really is.
Diminished Self-Efficacy and Negative Scripts
The above processes often result in a diminished “self-efficacy,” that refers to one’s perceived ability to be effective at a given task based on previous experiences. Individuals with high self-efficacy rehearse situations with positive performance strategies and visualize success even when having to overcome significant problems, whereas those with low self-efficacy dwell on the negatives of the situation and envision failed scenarios.
Men and women who have recurring sexual failures begin to view sexual situations differently—no longer as an opportunity for pleasure and intimacy but as a situation that leads to failure, shame, and embarrassment. Thus, from a cognitive/affective perspective, these individuals handicap themselves. Their self-narrative (thoughts) during sex becomes negative, with the inevitability of failure as the anticipated outcome of any encounter. Concomitantly, anxiety levels overwhelm any potential for positive affect, thereby engendering counterproductive behaviors—including avoidance of intimacy altogether—that are aimed at reducing the negative effect but which often only sustain or intensify the problem.
Role of performance anxiety on sexual response and dysfunction
Several models, two general and one focused on the role of performance anxiety have attempted to understand sexual response and dysfunction.
Inhibition-excitation models In these models, excitatory factors may be individual, relational, and contextual—they include both neurobiological and psycho-socio-cultural factors. For example, the desire and attraction to one’s partner, and the value of sexual intimacy and a satisfying relationship represent important excitatory elements. Inhibitory factors—ones that interfere with the sexual response—also involve individual and bio-psycho-socio-cultural components and may include a neurobiological predisposition for anxiety, relationship conflict that suspends sexual advances, or cognition/assessment of risk factors resulting from infectious disease, inappropriate (and sometimes illegal) objects of desire, and so on. In such models, performance anxiety assumes a role as one of any number of inhibiting factors on sexual response.
cognitive-affective model According to this widely referenced model, sexually functional men progress through stages that lead to stepwise increases in autonomic arousal, subsequent functional performance, and future approach toward similar situations. In contrast, dysfunctional men progress through similar stages, yet due to low expectancies, self-efficacy, perception of control, and attention on consequences of failure rather than on erotic cues, these variant stages lead to autonomic arousal/anxiety, dysfunctional performance, and avoidance in future situations. This descriptive model generated a quest to verify differences between dysfunctional and functional men along with a number of dimensions.
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