# Sexual Performance Anxiety: 10 steps to beat it!

Larisa Pletneva

This book is about self-therapy methods of treating such a sexual disorder as the Sexual Performance Anxiety. The one is the most common reason for men to reach out to sexologists. The book presents self-help techniques to address anxiety, self-esteem and partner relationships, and the ones applied in couples sex therapy.

© Larisa Pletneva, 2024


ISBN 978-5-0064-0350-5

Created with Ridero smart publishing system

## Preface

Thank you, dear Reader, for buying my book!


Attention: This text should not be considered a substitute for consulting a qualified medical professional. It is strongly recommended to consult a doctor before using a supplement.


My name is Larisa Pletneva, I am a psychologist majoring in sexology, Member of the Association of Sexologists of Russia.

My clients are Men suffering from sexual dysfunctions, such as sexual performance anxiety, premature ejaculation, delayed ejaculation, lack of sexual desire, and so on and so forth, as well as couples experiencing problems in their sexual life.

The idea to write a helpful book addressing such a touchy issue struck me a long time ago. I had a whole lot of failed sessions when clients were uneasy about coming. And I can understand their feelings —it is sometimes incredibly difficult to admit even to oneself that there’s a problem, much less to a stranger, though the one was a psychologist.

Sexual Performance Anxiety (SPA) has been known to the world for a good while: the SPA problem has been faced for as long as Homo sapiens has existed.

Surely, our ancestors lived in the Stone Age were not that concerned about satisfying their females, but failure to perform sexual duties was frowned upon even then.

Why do You need to read this book?

It presents the information I have collated for you from a variety of professional sources, including national masters of sexology, European experience and best practices, and personal observations based on therapy sessions given to clients.

The caveat here is that treating SPA assisted by a sexologist is dozens of times more effective than any self-therapy attempts, but if you are determined to try to overcome it by yourself, I will support you. Deciding to struggle is a major step toward getting rid of the problem.

In this book, I will tell you stories of some men struggling to cope with SPA, both successful and not quite happy ones. All the clients’ names and ages have been changed to make sure they cannot be identified and not to violate the sacred for any psychologist Code of Ethics.

After reading this book, you will learn how to influence your thoughts, control your anxiety, and manage your erection.

Don’t put it off and read it right away! Let me help you have sex back in your life!

## Chapter 1. SPA as counterpart of erectile dysfunction

Amir, 34

He was one of my first clients and, I suppose, that is why he stuck in my mind.


He was an Oriental handsome guy with thick curly hair, well made and charismatic.

Having met him on the street, You, dear Reader, would never have thought that he could have any sexual problems. As he was Walking Sex. But no. He did have problems.

He was frantic with despair when he came to me, because his problem had to be solved urgently, literally by the end of that day.

By the way, men often wait until the last moment before reaching out for help, as there is no retreat indeed.

While being a long and happily married man, Amir fell in love like a teenager. The girl was young and sexually inexperienced. He thrilled when he talked about her, but…

The time came to have their first sex and… It was Total Fiasco: he had no erection WHATSOEVER. No matter how hard his new lover tried, no matter how he did, while burning with desire, nothing came of it.

All exhausted and put to shame, Amir came home to his all-too-familiar wife and… My God, he got aroused again, had 17-year-old boy’s erection and performed several sexual acts in a row, leaving his wife speechless.

* * *

And so, You, My Reader, have just got to see an absolutely typical pattern of SPA. Amir had no idea what it was; he had only once failed years before – and that only “because he had had a drink’. Apart from that, it had never happened to him before! He was Macho and He-Man after all!

Are you surprised, my Reader? Don’t be, who the choice will fall on doesn’t make any difference to SPA, whether that be a looker who is a fixture in parties or a modest stay-at-home scholar who freaks out when he sees girls on the street.

Anyone’s hard-on can be lost! And Every man has lost his erection before or during sex at least once in their lives!


If You, dear Reader, bought this book, it means you are experiencing inability to get or keep your erection.

I want to tell you that you are not alone, quite a number of celebrities and rulers suffered from this disorder.

The outdated “Impotence” will feature in the examples given here, but it is the very dreadful word that for a very long time was used to call any men’s failure.


The problem of impotence is first mentioned in the Old Testament. God punished King David for adultery and took away his “sword of David”.


In 1486, the Church published a treatise called The Hammer of Witches, which purported men’s potency problems to stem from nothing but witchcraft.

Middle Age men experiencing virility problems took that literally and launched witch-hunts.

There was a belief that a man could regain his erection by killing a witch.

In Rus’, they also went hammer and tongs in overcoming impotence, which was called “nevastanikha”, mainly with the aid of incantations and potions.

One of the ancient recipes has survived to our days,

“Should there be a man whose mikhir won’t get hard, then you take cervine marrow from bone, grind it in water and give it to that man to drink. Therewith the man’s mikhir will get hard.”

I do not recommend trying it, it is dangerous to health.

But Russian potions and incantations pale beside the impotence treatment methods prevailing in Europe at that time.


Electroshock therapy

In the second half of the 19th century, a whole lot of “men’s health” offices operated in Europe and the United States, where the main treatment device was an electric generator.

They applied electrodes to the penis or inserted them in the urethra and released an electric discharge hoping to “invigorate” the virile member.


Irradiation

In the late 19th and early 20th centuries, pharmacies began selling pills that contained Radium, the element discovered by the Curies. At that time, no one was aware of the lethal effects of irradiation, and there were plenty of preparations that contained the trendy Radium, from potency cosmetic creams to ointments and rectal suppositories.


Transplantation of animal genitals

Frauds have always existed and, of course, they wouldn’t pass up such an opportunity as the impotence issue, as diseases can be monetized.

Thus, in the early 1900s America came to know Doctor Brinkley, who promised his patients that they would enjoy “iron-clad hard-ons’ after transplanting goat testicles into them.

There were lots of those wishing to do that, especially since Brinkley skillfully fueled the rush by spreading rumors about the first patient who had immediately became a father after the operation.

It did not last long, Brinkley was taken to court and spent all his money on lawyers.


So, which of the power holders combated with impotence and lost?


Dwight Eisenhower

The President of the United States was long and, supposedly, happily married.

But years later, information got out that his relationship with his secretary Kay had gone beyond the working one. Sex was a failure, and Dwight allegedly claimed after his nonperformance that he hadn’t thought about sex for many years and that he had failed because all his virility had been killed by his family life.

Rumor has it that he tried to treat the disease, but nothing helped. Perhaps it was too late.


Charles II of Spain

Charles ascended to the throne in 1665. His huge head and deformed lower jaw made him butt-ugly.

In addition to his ugliness, he was also very sick as he came of the Habsburgs where incest had been encouraged for generations.

Someone once said, “Charles I was a warrior and a king, Philip II was only a king, Philip III and Philip IV were only men, and Charles II was not even a man.” He suffered from fever, diarrhea, mental disability and erectile dysfunction. He did not trust any doctors and refused to take any treatment.

He died at 38, leaving no children to heir, while led to the years-long War of the Spanish Succession.


Peter III of Russia

The soon-to-be Empress Catherine waited in vain for her husband on their wedding night – he, being a drunkard, just got drunk and hit the sack.


Nor did Catherine know that Peter was unable to be her hundred-percent fulfilling husband because of phimosis (inability to retract the foreskin covering the head of the penis).

There is a speculation that Emperor Paul I was born to Catherine and her favorite Sergey Saltykov rather than her husband.


Henry IV of Castile, King of Castile and León

In vain did he pin hopes on the marriage to the Portuguese princess Joan, for his previous 13-year long one had been childless as the King’s wife had remained a virgin.


The Portuguese gave their Infanta to Henry only provided that a child be born, and should no conception occur, Joan would return home.

Henry hoped to make his potency good with the aid of some device invented by a University of Padua doctor, which was a golden tube that would help Henry’s seed get inside Joan. She did give birth to a child – a daughter who went down in history as Beltraneja, since her father was handsome Count Beltrán de Ledesma, the King’s favorite.

The civil war, which broke out as a result of the attempt to crown bastard Beltraneja queen, eventually enthroned Henry’s half-sister Isabella.


Christian VII of Denmark

In the 17th century, King Christian VII’s favorite pastime was masturbation.

The King’s self-gratification became a real state problem. Christian VII was mentally sick (according to some sources, he suffered from schizophrenia) and could masturbate for hours.

The government could not get their ruler to hike up his pants and turn his attention to the affairs of state.

At government meetings, which Christian did attend, he masturbated uncontrollably.


Henry VI of England

The modest King Henry VI took no interest in the intimate moments of life at all. In fact, he was impotent.


One day his faithful friends and members of the government decided to surprise him and sent some naked dancers to his room.

The King’s reaction was unexpected.

Henry VI ran out of the room appalled and shouting, “Ew! What a disgrace!”

When his wife Margaret of Anjou announced she was pregnant, the monarch nearly fainted. According to the court gossip, the Duke of Somerset conceived that child.


Erectile dysfunction is the man’s persistent or recurrent inability to get and/or keep an erection firm enough to have and complete successful sexual intercourse.

“Erectile dysfunction” is usually diagnosed when a man is unable to keep an erection in over 25% of the sexual intercourses he attempts to have. According to American researchers, more than 150 million men over 40 suffer from this disorder worldwide. But right now, the appointments with me are made mostly by men in their 30s.

Erectile dysfunction can be organic, psychogenic or mixed.


Sexual Performance Anxiety is a sexual phobic disorder, and it refers to psychogenic erectile dysfunctions. So, SPA is a phobia or neurosis.

Sure enough, SPA has existed since Homo sapiens evolved, but it was described and so named only in the 1980s.

Here are a few SPA definitions given by leading sex therapists:

– In Western literature, SPA is known as the “fear of sexual failure”. The main thing in this syndrome is the worries/fear of being unable to perform or failing to complete sexual intercourse. Such worries/fear manifest themselves to the utmost when and where sex is to happen, which, as a rule, impairs sexual functions due to deautomatization thereof.

– Anxiety neurosis, both as an independent disease and a syndrome in any other disorder, represents the most frequent reaction of a person to failed sexual intercourse. This primary dysfunction is based on the obsessive fear of failing sexual intercourse.

### How does SPA manifest itself?

So, what happens when one has SPA? What symptoms serve as a red flag?

It is a “failure”, meaning the erection is weak, not firm enough for penetration, or the erection dies out during or before intercourse.

Simply put, the erection gets weaker as sex nears. Certain psychosomatic manifestations may be present too, which are hot flashes, palpitations, sweating, dizziness, pain in the lower abdomen or penile region.

Below is the portrait of SPA!


SPA CYCLE


As you can see from the diagram, SPA is a cycle of anxiety or panic. It very much looks like a panic attack.


I came across the SPA signs described in Internet that have nothing to do with the one, and it drives me to cite them here so that You wouldn’t think it’s SPA:

1. Aversion to your partner. This is NOT a sign of SPA, it is rather indicative of Sexual Aversion (sexual disgust), and if it lasts more than six months, it is unfortunately incurable.

2. Premature ejaculation. It is NOT a sign of SPA, it can accompany it but is a separate problem that needs be thoroughly examined without attributing it to SPA.

3. Anejaculation. This is NOT a sign of SPA and calls for meticulous independent examination.

4. Decreased sexual desire is NOT a sign of SPA, if you have tired yourself out so much that you do not want to have sex or are afraid of it, and it is more of fear of intimacy. A person suffering from true SPA has libido, at least in the early stages thereof.

5. Pain and burning sensation during intercourse. It’s NOT a sign of SPA and must be examined individually.


Let’s continue…

To make our joint efforts effective, we need to look into the mechanism of erection.


How Erection Works

I suppose you’ve already read and seen tons of erection-related publications and pictures, but I’m going to tell you something that can be rarely found in popular literature.

What does it read everywhere?

An erection results from the blood flow into the corpora cavernosa of the penis, two muscles – ischiocavernosus and bulbospongiosus – compress the base of the penis and it erects.

That is right, but most likely you’ve never taken notice of the first part of this process, which is as follows:

Before the deep arteries of the penis dilate and their blood supply increases, the smooth muscles of the cavernous tissue relax and their resistance decreases, meaning that in order to get an inflow of blood and, as a result, an Erection, you literally need to RELAX, and that’s the whole point.


My favorite question I ask those who make appointments with me:

– Why do you need an erection?

Ponder it when you have an idle moment.


The word “erection” comes from the Latin “erigere”, which means “to be erect, firm”.

So, if the penis is filled with blood but not hard and firm, it means that the erection is incomplete.

The word “erection” has many other meanings.

“Erectus” means “lofty”, “noble”, “elevated”.

Therefore, to continue the association, we can say that an erect penis is sort of advanced and, so to speak, it lords over a vagina, and not the other way around.

It must be “erect”, that is, quite hard to penetrate into the passive, vulnerable vagina.

We find the word MUST in these earlier definitions, which imposes certain responsibilities on You as the one who has a penis, and it is the must-drive that eventually results in losing erection.

Erection is a very important element of any male’s life; for example, squirrel monkeys show an erect penis not only during courtship but also as part of aggression, greeting, and when they see their own reflection in the mirror (Ploog D.W.,1966). W. Wickler (1967) described sentinel baboons and green monkeys which use an erect penis as an alarm signal to other individuals, warning them against intrusion.

If an unfamiliar genus specimen approaches, an erection is demonstrated to the one. Hamadryas baboons demonstrate flaccid penis for the same purpose.

Some of these genera featured certain anatomical changes, when the penis became particularly brightly colored, enhancing its signaling value. R.E.Miller and J.H.Banks (1962) state that demonstration of an erect penis is aggressive, while the flaccid one is a calming reaction; various genera sometimes use both flaccid and erect penis as a warning, though.

Speaking about human beings, primitive tribes feature similar tendencies underlying some copulation rituals, which become more and more covert as the culture sophistication develops (Roper P.,1966).


Let’s first define if you have a problem at all.

People tend to catastrophize their health problems, especially when it comes to the genitals.

How will we find out that the problem does exist? A real medical questionnaire will help here.

Doctors check for erectile disorders using the IIEF-5 (International Index of Erectile Function) questionnaire, it’s on page 93 of the book.

You read a question and answer it choosing one of the given options, each of which has its score, and then add up all the scores.

If You score 21 or less in this questionnaire, then you do have a problem! But what kind of a problem is it exactly? Is it SPA or something else? That’s what we’re going to try to puzzle out together with you.

### How can you tell the difference between SPA and a disease?

First you need to make sure that you have SPA, for loss of erection can be caused by many factors being both harmless and very serious. Further work makes no sense if the diagnosis is unclear.


It is SPA if:


1. You are in good physiological shape.

2. You have morning/night erections.

3. You have erections and orgasms when masturbating.

4. You have an erection and orgasm when you have spontaneous sex or sex with a woman who “means nothing to you”.

5. You have intrusive thoughts about upcoming intercourse and your failing again.


Let’s develop each of the SPA symptoms separately:


1. You are in good physiological shape.

The first thing You should do after the first failure is to see the doctor. You need to make sure that you have no organic disorders. Erection failures are often indicative of cardiovascular system disorders.

And this is very serious!

The doctors to go to are cardiologist, andrologist/urologist.

Be sure not to take any medications to maintain erections on your own initiative.

These are prescription-only medicines that should be taken in minimum doses and for the short term.

But let’s assume that you cannot reach out to the doctor for some reason. Then the following paragraph will help you.


2. You have morning/night erections.

How does this help us? It’s very simple: a nighttime erection is indicative of your sexual function being good.

The hydraulic system of blood flow to the penis works well and erections occur. Your brain is asleep at night and does not interfere with operation of your sexual system, that is, it does not control it.

There is an important point: if SPA has been experienced for a long time, spontaneous night/morning erections may become less frequent and even disappear at all.

As you can see from this table, night/morning erections are the most indicative factor proving that you have psychogenic erectile dysfunction, which should be “treated” psychologically.


3. You have erections and orgasms when masturbating.

How does that help us? All this means that there are no physiological reasons for losing erection, i.e. the problem resides not in the body but in the head.


4. You have an erection and orgasm when you have spontaneous sex or sex with a woman who “means nothing to you”.

How does this help us? SPA is the “stage fright”, you are unconsciously or consciously afraid of being judged. You must play your part giving one, maybe even two, hundred percent.

So, if you happen to have quick sex with your partner or a girl being a perfect stranger to you, your mind is late to react in its usual way, you have no time to work yourself up into anxiety, and the sex come together perfectly well.

The case is the same when you have sex with an “unimportant” woman, for example, a prostitute (forgive me, Ladies of Easy Virtue, for saying so). You owe this woman nothing, her opinion is of little interest to you, and then everything is great and goes well.


5. You have intrusive thoughts about upcoming intercourse and your failing again.

One of my patients started thinking about sex that was to happen in the evening as early as the very morning. And all day long, while being at work, he would be flashing back to his previous inability to perform, thus programming himself to fail. Is your story the same?


Another aspect helping to distinguish SPA from an organic disorder (disease) is that it can be Situational, that is, erections fail not continually but in certain situations:

• drinking alcohol before sex;

• fear of the story to go public, if intercourse is illicit;

• no private place to stay in, fear that someone will see You having sex;

• a new partner;

• fear of your partner to conceive;

• simple physical fatigue.


And SPA can also be SELECTIVE, when erection is lost only when attempting to have sex with a certain girl, while everything goes and works well with other girls.

If it was an organic disorder, erections would be missing continually rather than occasionally.


And how do you behave?


Let’s go through the patterns of how people suffering from SPA behave. Regardless of which one You chose, the scheme of getting rid of it will be the same, but you must know absolutely everything about the problem to solve it.


Avoidance

You don’t talk about it, the topic is taboo even in a couple relationship. After experiencing a few failures, you’ve decided that sex is not your thing and you can get along just fine without it.


Devaluation

You think that sex is not the main thing in life at all, more important are the intellectual aspect and relationship, and romance.


Compensation

You throw yourself into sports, making career or money. You learn or have already learned techniques to make a woman orgasm, where the penis is not involved.


Imitation

In public, you behave like an alpha male, flirting openly, joking a lot about sex, telling how many girls you’ve had. You are the life and soul of any party, a man of her dreams, but you do not become intimate with girls, because you are supposedly a misogynist and “they are all immoral and there are no nice and honest ones today’.

### Causes of SPA

It is impossible to pinpoint the cause of SPA developed in a certain person (male or female, it doesn’t matter), but there is a combination of such ones, some of which may refer to you.

Study all the causes carefully and try to identify those that may have triggered your problem.


Trait anxiety

This is neither good nor bad, it’s just that you were born hypersensitive. This means that you not only feel anxious about sex but also experience anxiety across many situations in general.

People featuring such traits tend to catastrophize any situation, “I can’t make it! I’m going to be late! She’ll fall out of love with me! I’ll fail! The airplane will crash!” And so on and so forth.

As part of family, inherently anxious people are kind and caring, trying to avoid quarrels and conflicts.

They are prone to hypercontrol and try to monitor everything going on around them, for “you never know what might happen’.


Furthermore, such worrywarts usually feature and experience:

• low self-esteem;

• fear of the unknown;

• decision-making problems;

• second-guessing;

• dependence on other people’s opinions;

• their thoughts being focused either on the future or the past, and rarely on the here and now;

• discomfort when interacting with the opposite sex;

• fear of being rebuffed, and then preferring not to want or seek for anything at all.


Unexperienced stages of psychosexual development

One of the main causes of most of the psychological sexual dysfunctions is getting stuck at one of the stages of psychosexual development or racing through them too quickly.

Be sure to study and recognize this cause!

There are three stages of psychosexual development:


Stage One: Platonic

You were then about 7 (the age may vary, give or take a year or two at most).

At this stage, you experienced/should have experienced your first crush on someone. Those were unrequited feelings, your love object could have been not only your agemate also some adult, such as a singer or actor, anyone at all.


Your experiences at this stage were a very important milestone, nature was thus preparing you for advancing to the next level of libido development and training you to build relationships with the opposite sex.

At the Platonic stage You should have realized what friendship is, that relationships can be based on deep affection without sexual context.

You learned then to understand others, listen to them, empathize, and to love without focusing on sex.

And supposed you passed this stage very quickly?

What are the perils?

The physiological aspect predominates over the emotional one in your relationship with the opposite sex.

You don’t understand why a long courtship is needed. You’re all about enjoying physical satisfaction. You don’t know how to build long-term deep relationships. You fall in love quickly and cool off before too long.

In general, early sexual activity that lacks psychoemotional context can be frustrating and turn into a powerful source of stress and neurasthenia.

Stage Two: Erotic

This stage falls within the adolescence period and spans the ages of about 10 to 15 years.

There is an emerging interest in physical intimacy (touching, kissing), erotic movies, romance literature, descriptions of dating scenes, and pornographic content.

It is the stage when You get acquainted with masturbation and petting.


The problems I most often see in my clients refer to this stage. In men, it usually passes very quickly and goes straight into the sexual one.

Women, on the contrary, usually get “stuck” there, which in adulthood can lead to sexual problems.

Parents and their attitudes play a major role in the Erotic stage be passed successfully. If they kept their girl on a leash, making her believe that sex is dirty, then the third stage – the libido one – is postponed in a girl (and sometimes in a boy) indefinitely.

And the opposite context is if you had your first sex with an older woman when you were 13—14; it means that you passed this stage like greased lightning, which results in the sexual aspect of relationship being the main thing for you and, if there is no sex, “such a relationship will be doomed to failure’. This is the point where your hyper-responsibility for having an erection arises.