Sexual performance anxiety: can hypnotherapy help?

Sex is probably one of the few areas of life where trying harder doesn't necessarily make us better at it. In fact, sometimes the opposite happens.

Perhaps you've had an experience where your body didn't respond in quite the way you expected. You lost an erection, climaxed sooner than you wanted to, found it difficult to reach orgasm, or simply didn't feel as relaxed and engaged as you normally would.

Initially, it might not have seemed particularly significant. Bodies aren't machines, after all. But then comes the thought: What if it happens again? And suddenly, the next intimate experience feels slightly different.

Rather than simply being in the moment, part of your attention is elsewhere. You're checking. Monitoring. Waiting. Am I responding properly? Do they notice? What if it happens again? Before long, something that previously felt spontaneous can begin to feel like a test you need to pass.

When anticipation becomes part of the problem

Sexual performance anxiety can create a frustrating cycle. An experience causes concern. That concern creates anticipation about the next time. Anticipation increases anxiety, and anxiety makes us more likely to monitor what is happening.

The more closely we monitor ourselves, the harder it can become to remain absorbed in the experience. Research into sexual performance anxiety has identified this kind of cognitive interference and self-focused attention as potentially important factors in sexual difficulties (Pyke, 2020).

It can feel rather like trying to fall asleep while repeatedly asking yourself whether you're asleep yet. Something that ordinarily happens without much conscious effort has suddenly become something you're trying to control. And when it doesn't happen exactly as hoped, it can reinforce the original worry: There you go. I knew it would happen again.

It can quickly become about confidence

One of the difficulties with sexual performance anxiety is that it doesn't necessarily remain confined to sex. People can begin questioning their attractiveness, masculinity, femininity or desirability. They may worry about disappointing their partner or wonder whether something has fundamentally changed about them.

Others begin avoiding intimacy. Not necessarily because they don't want sex or closeness, but because avoiding the situation also avoids the possibility of experiencing the anxiety again.

Sometimes people seek reassurance from their partner. Others might begin relying on particular circumstances, routines or behaviours because these feel safer or more predictable. The original difficulty can gradually become less important than the fear surrounding it.

Why anxiety can interfere with being present

Anxiety is designed to make us pay attention. If your brain believes something important might go wrong, it becomes very good at looking for evidence of it. That's useful when we're dealing with genuine danger. It's considerably less helpful when we're trying to relax with another person.

Instead of attention being directed towards touch, connection, pleasure and the person we're with, it can become directed inwards:

• What's my body doing?
• Is this going to work?
• How long has it been?
• What are they thinking?

The bedroom can inadvertently become another place where we're evaluating our performance.

And this doesn't necessarily mean somebody is generally an anxious person. They may feel confident and capable in most areas of their life while experiencing anxiety specifically around intimacy.

So where does hypnotherapy fit?

When sexual difficulties have a significant psychological or anxiety-related component, hypnotherapy may form part of the support someone chooses to explore.

Solution-focused hypnotherapy combines elements of solution-focused therapeutic approaches with hypnosis. Rather than focusing exclusively on the problem or repeatedly analysing what went wrong, the work generally focuses on what someone would like to experience instead.

That might mean feeling calmer. Being more present. Thinking less during intimacy. Feeling more confident in their body. Being able to enjoy closeness without constantly checking what's happening. Or simply reaching a point where sex no longer feels like something they have to get right.

Importantly, the aim isn't to force a particular physical response. Trying to consciously command the body to behave in a particular way can sometimes become part of the pressure in the first place.

Instead, the therapeutic focus may be on reducing the anxiety and excessive self-monitoring surrounding the experience and helping someone develop a different response to situations that have previously triggered worry.

The role of hypnosis

There are plenty of misconceptions about hypnosis. Clinical hypnosis isn't about being unconscious or surrendering control. It's more accurately understood as a state of focused attention in which someone can remain aware of what is happening and choose whether to engage with suggestions.

Within solution-focused hypnotherapy, hypnosis is generally used alongside therapeutic conversation rather than as a standalone treatment performed on somebody. For someone experiencing performance anxiety, this may involve strengthening experiences of calm and confidence, encouraging a less analytical response and mentally rehearsing situations in which they respond differently.

Rather than repeatedly imagining the feared outcome – something anxious minds can become remarkably good at doing – attention can begin shifting towards how the person would prefer to feel and respond. That might mean imagining being relaxed, connected and comfortable with uncertainty rather than attempting to guarantee a particular sexual outcome.

Moving away from the idea of performance

Even the phrase sexual performance can tell us something about the pressure people sometimes experience. Performance suggests there is a standard to meet. Something to achieve. Something another person might judge. But intimacy doesn't need to be an examination.

For some people, progress therefore isn't initially measured by whether a particular sexual difficulty disappears completely. It might begin with noticing that they're worrying less beforehand. That they don't immediately panic if their body responds differently. That they can communicate more with their partner. That they're enjoying physical closeness again, or that one difficult experience no longer shapes what they expect next time.

As the pressure begins to reduce, there can be more room for curiosity, connection and enjoyment.

Don't overlook physical causes

It is important not to assume that a sexual difficulty is psychological.

Erection difficulties, changes in ejaculation or orgasm, reduced desire and other changes in sexual functioning can have physical causes. Medication, hormonal changes, cardiovascular health and other medical conditions can also influence sexual functioning. 

If a sexual difficulty is new, persistent, unexplained or worsening, speaking with your GP or another appropriate healthcare professional is an important first step. Hypnotherapy should not be used as a substitute for appropriate medical assessment or treatment.

Where physical causes have been considered and anxiety, stress, confidence or performance pressure appear to be contributing, psychological support may help address that part of the picture.

Sometimes the most useful change isn't learning how to perform better. It's learning that you don't need to perform at all.

References

NHS (2023) Ejaculation problems. NHS.

Pyke, R.E. (2020) 'Sexual performance anxiety: A review of the literature', Sexual Medicine Reviews, 8(2), pp. 183–190.