“If I don’t, it means I’m not a man.”

Elizabeth Larson, director of the Seattle Institute for Sex Therapy, Education and Research, said these kinds of thoughts can lead to performance anxiety sexually.

Larson, who has been a sex therapist for over 40 years, said in the vast majority of cases of erectile dysfunction, it is because of anxiety or stress. For these types of cases, Larson will usually try not to reduce the anxiety but to teach people how to manage it, she said.

It usually stems from an erectile dysfunction, which is more common than one thinks, she said. First, the man has a stress such as his football team losing and then he doesn’t cope with that anxiety during sex and is unable to perform. For anyone whose belief system follows the “I’m not a man” perspective if they are unable to perform, having this occur can lead to increased anxiety in the bedroom, Larson said. This becomes sort of a self-fulfilling prophecy.

“Erections are a physiological response that does not have seniority over threat,” Larson said.

When someone becomes anxious, they might run away, get angry or just freeze, she said. The way to determine whether it is a physical problem or psychological is if the man can masturbate without issue. If the problem only happens when they are with another person in bed, it is sexual performance anxiety, Larson said.

Often, people wish to treat themselves alone, she said. Larson recommends against this unless the person being treated is single. In an ongoing committed relationship, it’s always best to work with the couple, rather than the individual, because otherwise they run the risk of curing dysfunction but not saving the relationship, she said.

“You’re really looking at what it means to him and what it means to her,” she said.

During therapy, there is a series of relaxation techniques that she teaches patients, including Mindfulness Training, which derives from Buddhist meditation practices, Larson said.

“People want a solution that will fix it overnight, but that is not possible,” she said.

It takes time to be able to learn how to manage that anxiety, and for people to teach themselves to calm down, Larson said.

It is fine to have some anxiety, she said, but it’s when a person can’t cope with the amount of anxiety they have that it becomes a problem.

“Anxiety motivates us to do all kinds of things better,” Larson said.

Performance anxiety itself is a broad term that doesn’t just refer to one’s actions in the bedroom, she said. Public speaking and sporting events among others can cause people performance anxiety as well.

While sexual performance anxiety isn’t diagnosed in women as often as in men, it can still happen to women, she said.

In choosing a therapist to treat this issue, Larson recommends a sex therapist rather than a general therapist.

“I’m a fan of specialists,” she said.

Therapists in particular are good because they have specific specializations usually, Larson said. A therapist who deals specifically with anxiety might also work, she said.