Performance Anxiety Has Physical Consequences

Dear Dr. Dave and Dr. Dee,

I'm a 22-year-old male, who hasn't had a sexual relationship in about 4 years. About a year ago, I was seeing a girl, and we tried to have sex but I did not maintain an erection. I have no problem getting an erection, and having orgasm, with masturbation. But the last four times I've attempted intercourse I have failed. I'm at the point that I'm afraid to try to have sex. This is all I can think about, it's destroying my life. What is wrong with me?

Signed,

Can you help?

Dear Can you help,

Since you are able to achieve normal erection and orgasm with masturbation, it's less likely that you have a physical problem, and more apt to be performance anxiety. Unfortunately, performance anxiety can escalate, since the initial episode creates concern that it will happen again, thus establishing a vicious cycle, or self-fulfilling prophecy.

Remember, performance anxiety can have very real physical consequences. When we're anxious, our body releases chemical mediators (catecholamines) into the blood stream, which activate the involuntary "fight or flight" response. Blood vessels supplying less vital areas, such as the genitalia, constrict, in order to shunt blood flow to areas crucial to immediate survival, such as the heart, lungs and skeletal muscles. It's a primitive reflex that, when fully triggered, is highly effective at maximizing the ability to fight or run, in order to protect one's life. But it does so at the expense of more sedentary functions such as penile erection, which depends on the relaxation and dilation of blood vessels to the genitalia.

Try to take some of the pressure off of yourself. It should help to realize that the problem is performance anxiety, rather than impotence. Don't rush into things. Have meaningful conversations with your significant other. With patience, and a comfortable relationship, you'll break out of the vicious cycle and have normal intercourse again. Don't forget, if problems do persist, make sure and get a medical checkup.