Can a Sex Therapist help with ED?

Jul 23, 2021

Therapist doing online therapy Telehealth

Erectile dysfunction and sexual performance anxiety are two prevailing sexual problems today. Personal worries and partner’s expectations are the major contributing factors.

Can a sex therapist help with ED? The answer is YES! Stress around sex can lead to performance anxiety. Approximately 20% of men in the U.S. experience performance anxiety in the form of erectile dysfunction (ED) which is the inability to maintain an erection before or during a sexual encounter.

Some simple coping methods may help people deal with ED when it’s the result of performance anxiety.

What is the correlation between performance anxiety and ED?

Stress and anxiety about performing sexually or pleasing a partner can cause sexual dysfunction in anyone, regardless of their sex, gender, or sexual orientation. When we start feeling or believing that we are incapable of meeting our partner’s sexual needs, we often begin to believe that we are unworthy and that we will never be able to be “up-to-par” with others.

These feelings of inadequacy and low self-esteem often lead to physical symptoms, such as ED.

What are the factors that could lead to performance anxiety?

Most often the factors that lead to the negative view of ourselves or our partners are:

  • Body image
  • Relationship issues
  • Penis size
  • Porn use/addiction
  • Gender role identity
  • Work stressors
  • “Every day” stressors
  • Financial concerns
  • Couple/family issues

Erectile dysfunction and Mental Health

Although ED can be the result of physical problems, such as cancer, diabetes, hypertension, medication side effects, or low testosterone, just to cite a few, it is instead most often the result of an uncontrolled psychological problem that is affecting personal relationships, social lives, and sexual expression.

Research shows that people who experience or have experienced:

  • Anxiety
  • Depression
  • Sexual Trauma
  • Shame around sex
  • Stress
  • Sleeping issues

Are more susceptible to develop performance anxiety, which then leads to more complicated pathologies such as ED, premature ejaculation, inability to orgasm, or to someone even avoiding sexual activities altogether.

“If a person has an erection waking up in the morning but not during sexual activity, there may be an emotional or psychological cause.”

How can I cope?

There are various facets that can help people cope with performance anxiety and ED and enable them to have positive sexual experiences. The most common one is sex therapy.

Sex Therapy

 The interventions used to treat ED include:

  • Psychoeducation about healthy erectile functioning
  • Reduction in performance anxiety
  • Promotion of mindfulness during sex
  • Increase in the couple’s communication about the effectiveness of sexual techniques
  • Ensuring the use of appropriate sexual stimulation
  • Promotion of a more flexible sexual repertoire

Most people have a disappointing sexual experience from time to time, but this does not mean that you have sexual performance anxiety. However, if negative experiences lead to fear and anxiety, and these feelings persist, they can affect sexual activities in the future.

Shifting the focus to the cause, rather than the symptoms, may help a person reduce the pressure that they place on themselves to perform well every time, especially during times of increased stress.

Lifestyle Changes

Lifestyle changes could also assist in improving sexual functioning, especially if you are younger. For instance, you could attempt the following:

  • Limit alcohol consumption
  • Exercise regularly
  • Quit smoking
  • Maintain healthy weight
  • Practice self-soothing activities (e.g., yoga, meditation, etc.)

Performance anxiety and erectile dysfunction can be disruptive and have a negative impact on mental health, self-esteem, and relationships. Regardless of the origin of the problem, all men and couples who experience erectile problems may benefit from combined treatment interventions that include sex therapy.

Filippo M. Forni, LMFT is a sex and couples therapist in Los Angeles, CA. His goal is to provide high-quality and effective goal-oriented sex and couples psychotherapy to the Los Angeles and Century City community. He has extensive training in sexuality and multiculturalism and serves as an adjunct professor at Pepperdine University Graduate School of Education and Psychology.


Hall, K. S. K., Binik, Y. M., Kalogeropoulos, D., & Larouche, J. (2020). Ch. 4 / An Integrative Biopsychosocial Approach to the Conceptualization and Treatment of Erectile Dysfunction. In Principles and practice of sex therapy (pp. 87–103). essay, The Guilford Press.

MediLexicon International. (n.d.). Performance anxiety and erectile dysfunction: Causes and how to cope. Medical News Today.