Sex is supposed to be pleasurable, right?

But for many people, sex doesn’t feel free, confident, or connected; it feels pressured, stressful, and full of second-guessing. If you've ever found yourself overthinking your performance in the bedroom, worrying about how your body is responding, or feeling frozen in moments that are supposed to feel intimate, you’re not alone.

Sexual performance anxiety is incredibly common, but it’s rarely talked about even in therapy spaces. And unfortunately, the silence often makes things worse. The good news? Therapy can help, and not just in a surface-level way. It can address the deeper emotional and relational patterns that keep performance anxiety in place and help you (and your partner) move toward real, connected intimacy.

Let’s break it down.

What Is Sexual Performance Anxiety?

Sexual performance anxiety is a form of anxiety that shows up in sexual situations whether you're about to have sex, thinking about sex, or trying to be intimate with a partner. It can affect people of all genders, sexual orientations, and relationship types.

It often sounds like this:

“What if I can’t keep it up?”
“What if I don’t finish?”
“What if I don’t feel anything?”
“What if they think I’m bad in bed?”
“What if my body doesn’t respond the way it’s supposed to?”
“What if I disappoint them?”

For some, performance anxiety leads to avoidance (e.g., avoiding sex, closeness, or even conversations about intimacy). For others, it shows up during sex as intrusive thoughts, tension, or a sense of being disconnected from your body. This can be frustrating, isolating, and, let’s be honest, deeply painful, especially if it’s affecting your relationship.

Common Causes of Sexual Performance Anxiety

Sexual performance anxiety rarely shows up out of nowhere. It's often connected to one or more of the following:

1. Cultural or religious shame about sex

Messages you received growing up about sex being "bad," "dirty," or only for reproduction can linger in the body and mind, even years later. These messages about sex can lead us to think we are ‘wrong’ for wanting to be intimate or thinking about engaging in sex with our partners.

2. High pressure to perform

Especially for men, there's often pressure to “initiate,” “stay hard,” “last long,” or “satisfy your partner” all while being relaxed and confident. That's a lot of pressure for something that's supposed to be mutually enjoyable.

3. Body image concerns

If you're worried about how your body looks or functions during sex, it's hard to be present.

4. Past sexual trauma or negative experiences

Unresolved trauma or even one awkward, painful, or embarrassing sexual encounter can shape how you feel about intimacy moving forward.

5. Relationship issues

Ongoing conflict, lack of trust, or emotional disconnection can make sex feel like a performance instead of a shared experience.

6. Stress, anxiety, and mental health

Generalized anxiety, depression, and chronic stress (especially from work, parenting, or caregiving roles) can impact desire, arousal, and confidence.

So, Can Therapy Really Help?

Yes, and here’s how. At Embrace Sexual Wellness, we work with individuals and couples who are dealing with the emotional, relational, and physical challenges of sexual performance anxiety.

Therapy can help you:

1. Understand what’s really going on

Performance anxiety is rarely just about what’s happening in the moment. Therapy helps uncover what’s fueling the anxiety, whether it’s past experiences, shame, fear of failure, or relational dynamics. You get to explore your story in a safe, supportive space.

2. Interrupt the anxiety-thought cycle

In therapy, you’ll learn how to identify and challenge anxious thoughts before they spiral into shutdown or panic. This might involve CBT techniques, mindfulness practices, or somatic awareness, all aimed at helping you stay present and grounded during intimacy.

3. Reconnect with your body

Performance anxiety pulls you out of your body and into your head. Therapy helps you rebuild a relationship with your body that feels safe, attuned, and responsive, not judgmental or critical. This can be especially healing for people who’ve experienced dissociation or discomfort during sex.

4. Communicate with your partner more openly

If you're in a relationship, therapy can support both of you in having honest, shame-free conversations about sex. You’ll learn to express needs, set boundaries, and understand each other’s triggers so sex becomes a space of trust, not pressure.

5. Heal from past experiences

Whether you’ve been through trauma, rejection, or simply years of sexual avoidance, therapy offers a chance to heal. You don’t have to carry the weight of old experiences into every intimate moment.

6. Create a new sexual narrative

Instead of sex being about performance, pressure, or expectation, therapy helps you define what you want sex to mean. Perhaps it’s connection, pleasure, playfulness or safety or a combination. You get to rewrite the script.

What to Expect in Sex Therapy

You don’t have to show up with all the answers. You don’t need to be in crisis. You just need to be willing to be curious and honest with yourself and your therapist.

We’ll create a space that’s affirming, nonjudgmental, and tailored to you. Some clients come for individual therapy; others come as a couple. Either way, therapy is always consent-based, collaborative, and deeply respectful of where you are in your journey.

We often hear clients say things like:

“I wish I’d started this sooner.”
“I am so relieved I found you to help us.”
“I thought I was broken, but I just needed someone to help me understand what was really going on.”

You’re not broken. You’re human. And you don’t have to figure this out alone.

Sex Therapy in Chicago

At Embrace Sexual Wellness, we offer specialized comprehensive care in sex therapy that targets your goals. While we are based in Chicago, Illinois, we’re also licensed to support clients in Idaho, Indiana, Kansas, and Louisiana. Whether you're local or working with us virtually, you’ll receive compassionate, expert care grounded in science and rooted in human connection.

TLDR

Sexual performance anxiety can make intimacy feel like a test you’re always failing, but it doesn’t have to stay that way. Therapy can help you understand your anxiety, shift your mindset, reconnect with your body, and build a sex life that actually feels good for you and your partner. You don’t need to power through, shut down, or pretend everything’s fine. You can talk about it. You can work on it and find new strategies to approach intimacy with more ease.

Have you ever found yourself running on autopilot? Waking up and going through the motions, each day without really thinking about the task at hand. If this sounds like you, don’t be alarmed, almost half of the population is “mentally checked out”. We all have the potential to be more present in the moment, the hard part is remembering to do it.

Maybe you have heard of mindfulness but never understood exactly what it meant or how to even be mindful, and that's okay. Mindfulness has been in practice for centuries and was originally a Buddhist concept brought to the Western mainstream by Jon Kabat-Zinn. In his book, Meditation Is Not What You Think: Mindfulness and Why It Is So Important, Kabat-Zinn states that we can no longer ignore the new possibilities that emerge out of our yearnings when we are true to ourselves. This cultivation of mindfulness can contribute to our lives in so many ways including our health and sexual wellbeing. Researcher Lori Brotto defines mindfulness as “present moment nonjudgmental awareness”, and participating in the moment versus being a spectator judging your performance.

Judgment of your body can contribute to sexual dysfunction and dissatisfaction. By incorporating a daily mindfulness practice into your routine you can begin to calm the chatter in your mind. According to the Journal of Sex & Marital Therapy, being mindful may contribute to sexual wellness by allowing for intentional behavior, emtoional regulation, reduction in anxiety, and an increase in self esteem. Performance anxiety can affect people of all genders throughout their lifespan. When being intimate with yourself or a partner(s), thinking about your body in a negative way can be a real mood killer. For penis-having individuals the inability to be present can cause erectile dysfunction. By being a spectator in erotic situations you can diminish your ability to maintain an erection. Spectatoring refers to shifting your focus from the present moment, and evaluating yourself and sexual activity in a third person perspective. Focusing your attention on sexual performance instead of the present sensory experience can interfere with your sexual functioning and lead to erectile dysfunction.

When you instead focus your thoughts on the here and now, your primary attention is on your body and physical sensations and pleasure. The muscles that surround the penis need to relax in order for dilation of the arteries to occur, which promotes an erection. By being mindful during sex you can alleviate “cognitive interference,” which is associated with a decrease in anxiety related to sex. Attending to physical sensations can enhance your sexual and romantic relationship.

For individuals with vulvas, mindfulness has been shown to decrease genital pain and sexual distress and bridge the mind-body disconnect. When the central nervous system is disregulated by stress, central sensitization, and hormonal changes in the neuroendocrine system, this can cause the vulvar skin to change increasing sensitivity to pain. According to Brotto, interest and motivation for sex can all be impacted by negative body image, sense of self, comfort in partnership, and violation to your sense of safety. By practicing mindfulness, participants in Brotto’s study reported an increase in “sexual function, including desire, arousal, orgasm,” and overall psychological well being. Through increasing attention to the here and now, it may be possible to redirect any negative thoughts or judgments that may arise when in an intimate situation.

Regardless of your gender identity or relationship status, mindfulness can benefit your sexual wellbeing. We encourage you to experiment with different modalities of mindfulness. One of our favorite partnered mindfulness practices is sensate focus. This activity encourages you to actively focus on and communicate with your partner(s) about the sensation you are experiencing. By being fully present with your partner free from judgment, you can dive deeper into a state of erotic pleasure. Mindfulness is also something that you can practice on your own, by simply paying attention to your breath and any thoughts that may arise. There are a variety of apps available that can help guide you through this process. We are linking our favorites below:

Headspace - Great for the whole family with hundreds of meditations to choose from
Calm - Focus in on what you want to meditate on with guided sessions between 3-25 minutes
Insight Timer - Chart your progress and earn badges on your mindfulness journey
Aura - Personalized meditations based on your mood
Sattva - Drawing its meditations from ancient Vedic principles, this app is perfect for anyone looking to get more in touch with the origin of mediation
Buddhify - Perfect for those on the go (meditations for travel, dining, and more)
Simple Habit - Traditional guided meditation mixed with coaching

Breathing techniques are something you can do anywhere and at any time. By mindfully slowing the breath we engage the parasympathetic nervous system, which signals to our body it is time to calm down. Next time you are getting intimate with yourself or your partner(s) try taking a few minutes to intentionally slow your breath and practice mindfulness.

Can Therapy Really Help with Sexual Performance Anxiety?