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The Heartbreak of Male Performance Anxiety


I get a dozen or so messages a month on this topic. I’ve written about it in numerous postings and spoken about it in several podcasts, but still the email comes.

One of the real bugaboos for anyone, regardless of gender, is living up to our own expectations of sexual performance. So many things can get in the way, literally and figuratively, of fully enjoying ourselves and/or pleasuring our partners.

The arousal stage of our sexual response cycle is particularly vulnerable to a disruption. And when there’s trouble there, there’s no hiding it. A limp dick or a dry pussy can put the kibosh on all festivities that we may have hoped would follow.

However, performance anxiety can strike any of us, regardless of age, and at just about any point in our sexual response cycle. This is a particularly galling when it seems to come out of the blue. And regaining our composure can be more far more difficult than we imagine.

Today we will be focusing on male performance anxiety.  I’ll address female performance anxiety at a later date.

Here’s Bob, he’s 26:
Doc, this has never happened before. But I couldn’t get it up tonight, and this chick was H.O.T. Now I’m not gay at all, but I haven’t had sex in about 3 years because I was locked up…so I masturbated pretty regularly, about 3 or 4 times a week. But I can’t figure out why I was soft… the only thing I can think of is I ate clams tonight and I’ve never had them before. Could it be that or should I get checked out?

It weren’t the clams, darlin’! And I don’t think you need to get “checked out” either…at least not right away. If you could back away from the situation a bit and stop freaking out, I think you’d discover the source of your problem all on your own.

Here’s the thing—while you were out of commission there in the slammer, you relied, as you say, on jerking off. Okay, cool. We all do what we gotta do. Now the first time you try to score after your release…you go soft. This tells me you have a mild case of performance anxiety. We all get that from time to time.

There’s probably nothing wrong with you or your johnson. You just got the jitters first time you tried to get you some after being away, that’s all.

The anticipation of boning this H.O.T. chick—fueled by some predictable self-consciousness; what with just getting out of the big house and all—pulled the plug on your wood. No surprise there, right?

What I don’t want to see happen is for you to replay the incident over and over in your mind’s eye til that’s all you can think about. If you do, this proverbial molehill will become a mountain. You’ll then bring all this anxiety to your next encounter, setting yourself up for even more disappointment. You can see how this shit can snowball? If you interpret every less than satisfying encounter as a failure, your fears will become self-fulfilling. You’ll begin to avoid partnered sex and you’ll develop a full-blown sexual dysfunction. And your self-esteem will take a nosedive, too.

If you’re preoccupied with your performance, it’s less likely that you’ll be fully present during sex with a partner. This pretty much fucks up your sexual responsiveness and any hope for spontaneity. Why not just relax into the whole sex thing and not try to prove your manhood with your pecker?

Then there’s Steve with a slightly different take on this meddlesome problem:

My partner and I have been together for just over 3 years now in a monogamous relationship. I am the top and he the bottom. Our problem is not premature ejaculation on his part, but his inability to have an orgasm at all. No matter what I try and even if he masturbates, sometimes it is impossible to get him to cum. Is this a medical issue? Have you ever heard of this?

Delayed ejaculation is the difficulty one has ejaculating even with a firm erection and sufficient sexual arousal and stimulation. This problem is not uncommon. For most men, delayed ejaculation occurs during partnered sex more frequently than while masturbating. In fact, 85% of men with delayed ejaculation can usually cum by jacking off. However, in partnered sex, the guy may be unable to ejaculate at all, or only after prolonged partnered stimulation. This problem can be very frustrating and cause distress for both partners involved, as you already know.

What causes delayed ejaculation? Well, it could be a number of things. It could be something as simple as performance anxiety, or inadequate stimulation, or there could be neurological damage.

I don’t want to be too reductionist here, but most of us experts believe that the majority of instances of delayed ejaculation aren’t physical in nature, but rather are the product of psychological concerns. Simply put, there’s a difference between the psychosexual response we have when we are alone and the one we experience with a partner. There’s probably nothing wrong with your partner’s unit. It’s all in his head…or his mind, to be more exact. If I had to guess, I’d say he’s got a real bad case of performance anxiety.

When I see this sort of thing in my private practice, I always begin the therapeutic intervention by calling a moratorium on fucking of any kind. This immediately takes the pressure off the couple. From there we begin to rebuild the partnered psychosexual response one step at a time. We begin with sensate focus training (Sensate Focus is a series of specific exercises for couples that encourage each partner to take turns paying increased attention to their own sensations. More about these helpful exercises in the weeks to come.), stress reduction and relaxation exercises. These applications are designed to reduce performance pressure and instead focus on pleasure. The idea is to get them to stay in the moment; absorb the pleasure present without worrying about what is “supposed” to happen.

Finally we address as frankly and openly as possible any fears or anxieties that they may have—as individuals or as a couple. I have the greatest confidence in this method; it succeeds over 90% of the time.

Ok, let’s recap shall we?

Overcoming sexual performance anxiety is dependent on five simple things.

  • First, a guy needs to be attuned to his sexual response cycle — arousal, plateau, orgasmic and resolution phases. He should know what kind of stimulation he needs at each phase to fully enjoy himself and satisfy his partner.
  • Second, the more worried a guy is about a performance issue, the more likely that problem will present itself. A bad experience in the past can often set the stage for its recurrence.
  • Third, don’t be afraid to talk this over with your partner. Withdrawing from your partner or shying away from sex altogether will only increase the likelihood that the problem will persist.
  • Forth, be proactive! Fearing the loss of your sexual prowess or feeling sorry for yourself is counterproductive. Confront the challenge head on. Employ sensate focus training stress reduction techniques and relaxation exercises to help you push past this temporarily impasse and regain your self-confidence.
  • Fifth, free yourself from the mindset that your dick is the center of the universe. Your manhood or your capacity to be a great lover does not reside in your genitals. Expand your sexual repertoire. Remember, pleasure centers abound in your body as well as your partner’s.

Good luck!

Notching the belt

Hey Doc,

So I’ve asked you a question anonymously before and you were a huge help so here I am again.
My names Mike and I’m 17 years old. For some reason it takes me a ridiculously long time to “finish” with my girlfriend. It’s not her, because this has happened with about 4 or 5 other women before her. It’s an annoying flaw that it takes me about 90 minutes to finish, if I finish at all. My GF and I get tired and eventually just stop because it’s too tiring and just plain tiresome. Is it performance anxiety or something? My first time having sex was anal with a girl, and I have done anal with girls many times before so it was a lot tighter than vaginal intercourse, not sure if that affects anything… I am really tired of lasting so long; I just want to be done when she is, much earlier.

I’ll be glad to answer any questions or anything you might need to know,
Thank you so much in advance, Mike.

finger fuck00445Where to begin, Mike? You’re 17, you’re having performance problems with your GF and you have had with about 4 or 5 other women before her. Holy Cow! you certainly are a sexually precocious lad, aren’t you?

I can’t help but notice a bit of sexual bravado in your message. I don’t know if that’s intended or if it’s more of a subliminal message. Either way, I have a feeling that there is some belt notching goin on here and that may be the root of your problems.

Here’s why I say this. There is nothing in your message that communicates that the sex you’re having is fun, or that it’s play. All I hear is that you’re a young man on a mission. You want to get off in a timely fashion and you’re currently being frustrated in that pursuit. You sound so goal oriented and your sex sounds like a task, rather than a playful adventure.

Us men folk get like this sometimes; and we’re the poorer for it. We’re all about solving a problem instead of enjoying the moment. The curious thing about this is that enjoying the moment is often the best way to solve a sexual performance problem.bryan_tony_box

When I hear men and/or women talking about their sex life like it’s work, I know there will be problems ahead. And you, Mike, sound like your sex is way more work than fun. If you were a sex worker or a porn star, I’d understand your predicament. But I suspect that you are neither a sex worker nor a porn star. You are, however, a young man who has, for one reason or another, scuttled all the joy and wonderment from your sex play. And that, my friend, is a crying shame…and at your tender age too. How do you suppose you’ll behave when you’re an old man of 25?

This path you’re on will continue to lead you into a sexual wilderness. You will become increasingly frustrated in your efforts to cum “on time”…and I use that term in quotes, because you’re all about bangin’ something rather than pleasuring and being pleasured by someone.

The comment you make about the difference between butt sex and pussy sex also tells me a lot about the kind of tightness you need to get off. I’d be willing to guess that you have a death grip on your johnson when you wank; am I right? Obviously your average asshole is a tighter orifice than your average pussy. But, if you were really turned on and enjoying the mutual pleasure available to you and your partner, instead of worrying about busting your nut during the fuck itself, you could jettison all those “shoulds” you have when you’re supposed to be enjoying yourself in the company of your lover.

beltWhy not stop what you are doing and take a look at why and how you are doing it. You may surprise yourself with what you find. And if you are man enough, have a heart-to-heart chat with your GF and get her feedback on what she encounters when she fucks you. Again, I’d be willing to guess she’d have some timely advice to offer you on how to fuck and get fucked.

Good Luck

5 Ways to Make his Cock go from LIMP to LIVELY

Erectile Dysfunction (ED) means your man can’t get it up or keep it up during sex. Many men suffer from this condition — approximately 30 million men to be exact. To explain what causes this, let’s review the basic anatomy of the penis and what happens during an erection.


The penis has four main parts: glans (the head), corpus cavernosum and corpus spongiosum (the shaft), and the urethra (the hole that you urinate or ejaculate from). When a man is aroused from sexual thoughts or direct stimulation, nerves and hormones work to cause the muscles in the penis to relax and the corpus cavernosum and spongiosum will fill with blood causing the shaft to get hard — an erection. Another set of muscles cuts off the blood supply when the penis is erect to maintain its hardness. Once he orgasms, the blood will drain and the penis softens.

So what causes erectile dysfunction? There’s more than one answer. Taking prescribed medications to control blood pressure, allergies, anxiety, depression, peptic ulcer disease and or your appetite can lead to ED as can aging, and being depressed. Chronic illnesses such as diabetes, high blood pressure, or high cholesterol which can lead to poor blood flow to the penis can cause a penis to be limp. Drinking too much alcohol, smoking cigarettes, doing illegal drugs, even being too tired, having relationship problems, being stressed out about work or being anxious can cause this problem.

Any type of damage to the penis, nerves, and arteries that help maintain his erection can also lead to ED. The good news is that ED can be treatable. Just talk to your doc — an urologist. They will do a history and physical and order lab tests. If embarrassment has caused you to turn to the Internet for treatment options, be warned that this can be dangerous. You just don’t know what is in the medications that you get from many online sites. Before you turn to medications or even surgery to fix this problem, let’s discuss some ways to cope with a man who can’t get or maintain an erection NATURALLY.

  1. Make him do more Cardio exercises. He needs only 30 minutes a day. This will boost his testosterone. He may also lose weight, which can help the testosterone to work better. Testosterone is one of those important hormones that work to get an erection. Exercising also reduces stress and increases blood flow — all factors that can help! Read all about sex hormones HERE!
  2. Cook for him. There are nitrates in leafy greens, lycopene in tomatoes, and zinc in oysters. These essential nutrients will help keep his penis erect. Diet is so important. Read all about sex and food HERE!
  3. Have more FOREPLAY with him. Try oral sex. And remember, oral doesn’t just mean the penis. Play with his nipples or the back of his neck. KISS him more. Add sex toys in the bedroom BUT make sure they are smaller than his penis. Read all about foreplay HERE!
  4. Purchase a vacuum penis pump. This fun device will draw blood into the penis to help get it erect. If you have an increased risk of bleeding, have sickle cell anemia, or other blood disorders, this is NOT for you. And be careful — if not used correctly, this can cause bruising. Read all about penis pumps HERE!
  5.   Try using a cock ring. Once you get the penis erect, this sex toy will keep it that way.  Read all about cock rings HERE!

You should also make sure your man gets his diabetes, cholesterol, and/or high blood pressure under control. Quit smoking. Make sure he doesn’t drink alcohol or do hard drugs. Find ways to reduce his stress and anxiety. Make sure he is getting enough sleep. Get help if you are suffering from depression. Ladies (and guys) try not to be discouraging. You both will overcome this.

Good luck

Sexuality and Illness – Breaking the Silence

(This is a Companion piece to yesterday’s posting. You’ll find yesterday’s posting HERE!)

By: Anne Katz PhD

Sexuality is much more than having sex even though many people think only about sexual intercourse when they hear the word. Sexuality is sometimes equated with intimacy, but in reality, sexuality is just one way that we connect with a spouse or partner we love (the true meaning of intimacy). Our sexuality encompasses how we see ourselves as men and women, who we are attracted to emotionally and physically, what turns us on (eroticism), our thoughts and fantasies, and yes, also what we do when we are sexually active, either alone or with a partner. Our sexuality is connected to our image of ourselves and it changes over the years as we age and face threats from illness and disability and, eventually, the end of life.seniors_men

Am I still a sexual being?

Illness can affect our sexuality in many different ways. The side effects of treatments for many diseases, including cancer, can cause fatigue. This is often identified as the number one obstacle to sexual activity. Other symptoms of illness such as pain can also affect our interest in being sexually active. But there are other perhaps more subtle issues that impact how we feel about ourselves and, in turn, our desire to be sexual with a partner or alone, or if we even see ourselves as sexual beings. Think about surgery that removes a part of the body that identifies us as female or male. Many women state that after breast cancer and removal of a breast (mastectomy), they no longer feel like a woman; this affects their willingness to appear naked in front of a partner. Medications taken to control advanced prostate cancer can decrease a man’s sexual desire. Men in this situation often forget to express their love for their partner in a physical way, no longer touching them, kissing them, or even holding hands. This loss of physical contact often results in two lonely people.  Humans have a basic need for touch; without that connection, we can end up feeling very lonely.

Just talk about it!

seniors_in_bedCommunication lies at the heart of sexuality. Talk to your partner about what you are feeling, how you feel about your body, and what you want in terms of touch. Ask how you can meet your partner’s needs for touch and affection. The most important thing you can do is to express yourself in words. Non-verbal communication and not talking are open to misinterpretation and can lead to hurt feelings. Our sexuality changes with age and time and illness; we may not feel the same way about our bodies or our partner’s body that we did 20, 30 or more years ago. That does not mean we feel worse – with age comes acceptance for many of us – but we do need to let go of what was, and look at what is and what is possible.

The role of health care providers

Health care providers should be asking about changes to sexuality because of illness or treatment, but they often don’t. They may be reluctant to bring up what they see as a sensitive topic and think that if it’s important to the patient, then he or she will ask about it. This is not good. Patients often wait to see if their health care provider asks about something and if they don’t, they think that it’s not important. This results in a silence and leaves the impression that sexuality is a taboo topic.senior intimacy02

Some health care providers are afraid that they won’t know the answer to a question about sexuality because nursing and medical schools don’t provide much in the way of education on this topic. And some health care providers appear to be too busy to talk about the more emotional aspects of living with illness. This is a great pity as sexuality is important to all of us – patients, partners, health care providers. It’s an important aspect of quality of life from adolescence to old age, in health and at the end of life when touch and love are so important.

Ask for a referral

If you want to talk about this, just do it! Tell your health care provider that you want to talk about changes in your body or your relationship or your sex life! Ask for a referral to a counselor or sexuality counselor or therapist or social worker. It may take a bit of work to get the help you need, but there is help.

Complete Article HERE!

Sexuality at the End of Life

By Anne Katz RN, PhD

In the terminal stages of the cancer trajectory, sexuality is often regarded as not important by health care providers. The need or ability to participate in sexual activity may wane in the terminal stages of illness, but the need for touch, intimacy, and how one views oneself don’t necessarily wane in tandem. Individuals may in fact suffer from the absence of loving and intimate touch in the final months, weeks, or days of life.head:heart

It is often assumed that when life nears its end, individuals and couples are not concerned about sexual issues and so this is not talked about. This attitude is borne out by the paucity of information about this topic.

Communicating About Sexuality with the Terminally Ill

Attitudes of health care professionals may act as a barrier to the discussion and assessment of sexuality at the end of life.

  • We bring to our practice a set of attitudes, beliefs and knowledge that we assume applies equally to our patients.
  • We may also be uncomfortable with talking about sexuality with patients or with the idea that very ill patients and/or their partners may have sexual needs at this time.
  • Our experience during our training and practice may lead us to believe that patients at the end of life are not interested in what we commonly perceive as sexual. How often do we see a patient and their partner in bed together or in an intimate embrace?
  • We may never have seen this because the circumstances of hospitals and even hospice may be such that privacy for the couple can never be assured and so couples do not attempt to lie together.

intimacy-320x320For the patient who remains at home during the final stages of illness the scenario is not that different. Often the patient is moved to a central location, such as a family or living room in the house and no longer has privacy.

  • While this may be more convenient for providing care, it precludes the expression of sexuality, as the patient is always in view.
  • Professional and volunteer helpers are frequently in the house and there may never be a time when the patient is alone or alone with his/her partner, and so is not afforded an opportunity for sexual expression.

Health care providers may not ever talk about sexual functioning at the end of life, assuming that this does not matter at this stage of the illness trajectory.

  • This sends a very clear message to the patient and his/her partner that this is something that is either taboo or of no importance. This in turn makes it more difficult for the patient and/or partner to ask questions or bring up the topic if they think that the subject is not to be talked about.

Sexual Functioning At The End Of Life

Factors affecting sexual functioning at the end of life are essentially the same as those affecting the individual with cancer at any stage of the disease trajectory. These include:go deeper

  • Psychosocial issues such as change in roles, changes in body- and self-image, depression, anxiety, and poor communication.
  • Side effects of treatment may also alter sexual functioning; fatigue, nausea, pain, edema and scarring all play a role in how the patient feels and sees him/herself and how the partner views the patient.
  • Fear of pain may be a major factor in the cessation of sexual activity; the partner may be equally fearful of hurting the patient.

The needs of the couple

Couples may find that in the final stages of illness, emotional connection to the loved one becomes an important part of sexual expression. Verbal communication and physical touching that is non-genital may take the place of previous sexual activity.

  • Many people note that the cessation of sexual activity is one of the many losses that result from the illness, and this has a negative impact on quality of life.
  • Some partners may find it difficult to be sexual when they have taken on much of the day-to-day care of the patient and see their role as caregiver rather than lover.
  • The physical and emotional toll of providing care may be exhausting and may impact on the desire for sexual contact.
  • In addition, some partners find that as the end nears for the ill partner, they need to begin to distance themselves. Part of this may be to avoid intimate touch. This is not wrong but can make the partner feel guilty and more liable to avoid physical interactions.

Addressing sexual needs

senior intimacyCouples may need to be given permission to touch each other at this stage of the illness and health care providers may need to consciously address the physical and attitudinal barriers that prevent this from happening.

  • Privacy issues need to be dealt with. This includes encouraging patients to close their door when private time is desired and having all levels of staff respect this. A sign on the door indicating that the patient is not to be disturbed should be enough to prevent staff from walking in and all staff and visitors should abide by this.
  • Partners should be given explicit permission to lie with the patient in the bed. In an ideal world, double beds could be provided but there are obvious challenges to this in terms of moving beds into and out of rooms, and challenges also for staff who may need to move or turn patients. Kissing, stroking, massaging, and holding the patient is unlikely to cause physical harm and may actually facilitate relaxation and decrease pain.
  • The partner may also be encouraged to participate in the routine care of the patient. Assisting in bathing and applying body lotion may be a non-threatening way of encouraging touch when there is fear of hurting the patient.

Specific strategies for couples who want to continue their usual sexual activities can be suggested depending on what physical or emotional barriers exist. Giving a patient permission to think about their self as sexual in the face of terminal illness is the first step. Offering the patient/couple the opportunity to discuss sexual concerns or needs validates their feelings and may normalize their experience, which in itself may bring comfort.

More specific strategies for symptoms include the following suggestions. senior lesbians

  • Timing of analgesia may need to altered to maximize pain relief and avoid sedation when the couple wants to be sexual. Narcotics, however, can interfere with arousal which may be counterproductive.
  • Fatigue is a common experience in the end stages of cancer and couples/individuals can be encouraged to set realistic goals for what is possible, and to try to use the time of day when they are most rested to be sexual either alone or with their partner.
  • Using a bronchodilator or inhaler before sexual activity may be helpful for patients who are short of breath. Using additional pillows or wedges will allow the patient to be more upright and make breathing easier.
  • Couples may find information about alternative positions for sexual activity very useful.
  • Incontinence or the presence of an indwelling catheter may represent a loss of control and dignity and may be seen as an insurmountable barrier to genital touching.

footprints-leftIt is important to emphasize that there is no right or wrong way of being sexual in the face of terminal illness; whatever the couple or individual chooses to do is appropriate and right for them. It is also not uncommon for couples to find that impending death draws them much closer and they are able to express themselves in ways that they had not for many years.

Complete Article HERE!

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