“Butterflies” In Your Penis: What You Need To Know About Performance Anxiety/E.D.

Andrew Siegel MD   4/14/18

“It is like a firstborn son—you spend your life working for him, sacrificing everything for him, and at the moment of truth he does just as he pleases.”

Gabriel Garcia Marquez, Love In the Time of Cholera

“The penis does not obey the order of its master, who tries to erect or shrink it at will. Instead, the penis erects freely while its master is asleep. The penis must be said to have its own mind, by any stretch of the imagination.”

Leonardo da Vinci



The brain is the biggest and most important sex organ, the “conductor of the orchestra

( Thank you, Pixabay, for image above)


Every man at one time or another may experience a situational erection problem due to  circumstances. As intoxicating and exciting as a new relationship can be, situational erection problems are not uncommonly experienced because of the anxiety and concerns that can surface when encountering a new sexual partner.  Additional contributing factors can be other life stresses, fatigue, too much alcohol consumption, recreational drugs, etc.

Men are human beings and not robots that can always function on command. It is not always easy to “stand and deliver” and, unquestionably, the lion’s share of the sexual “burden” is on the male.  In the circumstance of failure to achieve a good quality erection in a new sexual situation, it is not a matter of insufficient male rocket fuel (testosterone), poor sexual desire,  malfunctioning plumbing or sexual orientation.  It’s all about chemistry and by this I do not mean the attraction and spark kind of chemistry between two individuals.

The brain is the most important sex organ and the mind-body connection is profound. One’s emotional state drives the release of a “cocktail” of chemicals that can make or break their ability to perform any pursuit, whether it is giving a speech, sports or in the bedroom. When it comes to the bedroom, one’s internal “biochemical environment” at any given moment in time can chemically promote a bone-hard erection or, at times, no erection at all.  The problem is not with the hardware, but with the software!

Performance anxiety is nothing other than stage fright—the stage the bedroom—due to emotional stress (whether conscious or subconscious) that causes the release of adrenaline, the “flight or fright” chemical that causes tightening of blood vessels and restriction of blood flow to the penis.

Adrenaline is an amazing chemical to have onboard when you are in precarious situation, such as being chased by a lion in the jungle. It causes your pupils to dilate, blood pressure to rise and pulse and breath to quicken.  This stress hormone that is churned out by the adrenal glands prepares you to confront the danger in a turbo-charged state so that you can react optimally.  However, adrenaline causes a restriction of blood flow to non-vital organs including the penis, so that blood flow can be directed to where it best serves one to deal with the precarious situation. The point is that stress does not belong in the same sentence as sex, and when it does, it is a formula for a losing situation. For some men, the stress of having to wear a condom can doom the erection to failure.

Fact: On the occasion that a man has a prolonged erection (a.k.a. priapism) that lasts for more than four hours, an adrenaline-like drug is injected directly into the erectile chambers of the penis to cause the erection to subside. 

The chemistry of erections and performance anxiety

The chemistry of erections: With erotic stimulation or touch, the erectile nerves release nitric oxide, which in turn causes the release of cGMP. This causes the erectile chamber arteries to expand and blood to gush into the penis and also causes the smooth muscle of the erectile chambers to relax, allowing space for blood to fill the erectile chambers.  The chemistry of defeat: If enough adrenaline is present, the erectile arteries will narrow and the smooth muscle of the erectile chambers will contract. The presence of enough adrenaline trumps the presence of nitric oxide and cGMP.

The psychology of performance anxiety

What goes on in the man’s mind: Performance anxiety often “gets in the head” of the man plagued with it.   Excessively focusing and dwelling on the issue further decreases the likelihood of obtaining a rigid erection by creating a self-fulfilling prophecy of failure. When entering a sexual situation preoccupied with anxiety and doubts, one often ends up being a spectator of his own performance (Masters and Johnson referred to this as “spectatorating”), instead of being in the moment and present as one needs to be to be able to function properly, often dooming one’s erectile potential.

What goes on in the female’s mind: As they say, “It takes two to tango.”  Another big problem is the partner’s interpretation of the man’s inability to obtain and/or maintain an erection. The partner, confronted with the poorly functioning male, commonly thinks—erroneously– that the root of the problem is that the man does not sufficiently care for her,  find her attractive or that her sexual allure and proficiency is lacking.

So, the male not only has performance anxiety, but often experiences secondary anxiety from being consumed by the problem, creating a “vicious cycle.”  And the female now has anxiety and concerns about her looks, her skills in the bedroom, his feelings, the future of the relationship, etc.  This is clearly not a good combination for the start of a healthy relationship!  The truth of the matter is that the root of the problem is neither the man’s plumbing, his sexual orientation, nor his feelings about his partner and it is not a question of the female’s attractiveness, allure or sexual prowess.

Bottom Line: Performance anxiety is a common form of emotional stress that can be experienced with a new sexual partner.  Enter adrenaline in high enough levels and an erection will never occur, or if it does so, will rapidly be lost. Adrenaline may be your friend in life and death situations, but not in the bedroom!  Although oral ED medications (Viagra, Cialis, etc.) can chemically kick-start and often help counter performance anxiety and break the vicious cycle that has been established, adrenaline is such a powerhouse chemical that it can sometimes even doom an erection in a man who has taken performance-enhancing drugs.

The female in the relationship should understand that she is not the cause of the problem and she should not hold herself nor her partner accountable, which serves to further exacerbate the stress and anxiety.  Rather, she should stay calm, be understanding and supportive and realize that once her partner becomes more comfortable with the relationship, the anxiety and the problem will most often magically disappear.

Finally, it is important to understand that other common sexual issues, including premature ejaculation and delayed ejaculation, elicit virtually the identical psychological and emotional responses from both male and female partners as does performance anxiety.

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food


These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx




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One Response to ““Butterflies” In Your Penis: What You Need To Know About Performance Anxiety/E.D.”

  1. Phallic Fallacies: 10 Misconceptions Women Have About Male Sexuality | Our Greatest Wealth Is Health Says:

    […] cannot always rise to the occasion and performance anxiety is a not uncommon occurrence, particularly with a new partner. It is a form of stage fright […]

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