Ask a Cleveland Sex Therapist: Pre-Sex Anxiety is Ruining Sex for Me!

Matt Lachman Credit: Photo by Kristine Borns

Welcome to Ask a Cleveland Sex Therapist. Want to ask Matt a question that could be tackled in a future column? Click here. Now, onto this week’s topic.

Matt,
I’ve been struggling to get intimate with new partners as I have pre-sex anxiety. I get very uncomfortable and lose any erection I had. Obviously a shameful and embarrassing experience. How can I combat this? Thanks!

-Anonymous

Howdy, Anonymous! Thank you for bringing up a phenomenon that happens to MANY penis-owners. As much as society, media, and your friends may have you believe, losing erections is quite common when it comes to intimacy. In fact, research shows about 50% of men will experience an “erectile disappointment” at least once in their lives, with the chances of it happening only increasing as they get older. I prefer to call it this because disappointment and shame tend to be the main feelings expressed. I did not coin this term, but I first heard it in Chris Donaghue’s Medium article entitled It’s No Dysfunction, Your Penis is Fine. Understanding “Erectile Disappointment.” Unfortunately, toxic masculine beliefs and a lack of vulnerability tend to keep men in this cycle of disappointment. Fortunately, there are a ton of ways to help decrease the likelihood of experiencing this in the future, but they will require you to unlearn some pretty common myths. Are you ready to do that? If so, buckle up, because we have a lot to unpack.

The first thing we want to do is check your testosterone levels. Testosterone is crucial for sexual desire. A decrease in testosterone can lead to reduced libido, which might make it harder to become aroused and achieve an erection. So, if you have been putting off that doctor’s appointment, this may be a good reason to schedule it. If you discover that your testosterone levels are within the normal range, which is considered to be around 300 to 1,000 nanograms per deciliter, this is great news, as we can tackle what we both think is the main culprit here: anxiety.
Pre-sex anxiety can feel so consuming. There are so many things we have to worry about as humans, so why should how our penis performs be one of them? This brings up a question I have for you: Are you looking at sex as a performance? If so, that is something we are going to have to change. Let’s talk a little bit about toxic masculinity and how it can play a role in male-identifying individuals’ sexuality. In general, toxic masculinity can be defined as a set of culturally driven attitudes that promote behaviors stereotypically associated with or expected of men. Basically, men must behave a certain way to be considered “men.” Examples of toxic masculinity include domination, homophobia, aggression, lack of emotions, and arrogance.

When it comes to sex, toxic masculinity is easily combined with sex negativity to set penis-owners up for failure. Toxic masculinity teaches men that they need to have a 14-inch penis, know what they are doing in the bedroom at all times, be confident, make their partner orgasm, and have an orgasm themselves. This, along with the sex-negative messaging that promotes the idea that to be successful in sex, there needs to be penetration and an orgasm every single time, can really put a ton of pressure on men to fit certain expectations and overlook the main reason why we have sex: to feel pleasure. The number of penis-owners who worry about their penis size or feel as though their sole duty is to “be a good lover” can have a damaging impact that causes so much fear and anxiety that they lose their erections. I am curious, Anonymous, does any of what I just mentioned contribute to your pre-sex anxiety? My assumption would be that if not all of it, then the pressure of “being a good lover” and “giving your partner an orgasm” can usually feel universal.

One way to combat the discomfort you may be experiencing is through mindfulness and visualization. I want to talk about masturbation. I can feel people’s buttholes clenching, so do me a favor, take a deep breath, and know that it is going to be okay. Masturbation is one of the purest forms of sex we can have. If you are reading this and feel shame associated with the act of solo sex play, I get it. This article may not be enough to change your mind, but remember, there is absolutely no reason to feel shame around self-love. For men, some studies suggest that frequent ejaculation, including through masturbation, may be linked to a lower risk of prostate cancer, potentially by helping clear harmful substances from the prostate. So, to all the “bros” out there who think not masturbating makes you more “manly,” you may actually be causing more harm to your body.

What I talk to people about is a technique called mindful masturbation. I have linked a free resource I created here. Essentially, as much as we may want to watch porn and have some visual help, instead, we want to solely focus on our mind and body. It is okay to fantasize, but get connected to your body the way you did before you found visual aids like porn or, if you are a millennial or older, pornographic magazines. Explore your body and feel the different sensations you can elicit. Mindful masturbation can help you become more confident in your sexual self. Be sure to add in the skill of mimicking, which is when you mimic the positions you have sex in. Most guys plop on their back for solo sex play. Unless you are constantly having partnered sex on your back, which I hope you are not and are engaging in more variety, stand up or get on your knees and mimic the positions you can have sex.

Visualization is key to success. Do you think Serena Williams just showed up one day and became the greatest athlete of all time? We have to visualize successful sexual experiences so that when it comes time to have partnered sex, we have already practiced. Oh, and use lube. For the love of God, use lube. Partnered sex is usually a lot wetter, no matter who you are having sex with, so we want to make sure the penis is experiencing the same stimulations. A dry hand can lead to putting more physical pressure on the penis that no orifice could ever mimic.
As I wrap up, do not forget the importance of communication and vulnerability in relationships. No matter if it is someone you have had sex with a thousand times or just once, make sure you are communicating your wants and desires and that the other person, or people, are doing the same so that everyone enjoys the experience. Sex is for pleasure, not performance. If you lose your erection, it is not the end of the world. Take a deep breath, calm your mind, and tune inward. It will come back, and when it does, have at it.

Matt Lachman is a Licensed Professional Clinical Counselor and Supervisor, AASECT Certified Sex Therapist, and owner of Cleveland Sex Therapy, located in the heart of Gordon Square. Since opening Cleveland Sex Therapy in 2019, Matt has been dedicated to promoting sex positivity and inclusivity in his work with individuals, couples, and polyamorous relationships. When he’s not helping clients navigate their sexual and relational journeys, you can find him enjoying a cold brew at Gypsy Beans, sipping a cocktail at Luxe, or relaxing on his couch watching reruns of Happy Endings. Ask a question of your own here.

Disclaimer: The advice provided in this column is intended for general informational purposes only and should not be considered a substitute for professional therapy or mental health treatment. Each individual’s situation is unique, and the insights offered here may not address the complexities of your specific circumstances. If you’re experiencing challenges related to your mental health, relationships, or sexuality, I strongly encourage you to reach out to a licensed therapist or mental health professional for personalized support. You’re not alone—help is available.

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