Its Time To Discuss Performance Anxiety In Women

by Rachel Sanoff

Sexual performance anxiety in cisgender men is, of course, a very real, upsetting, legitimate health issue. But let's take a second to think about how commonly male performance anxiety is discussed in our society, in comparison to female performance anxiety. Frankly, the difference between the two is that we don't really talk about what happens to women. I can remember being a grade schooler watching TV, and my parents uncomfortably changing the channel when commercials for male performance enhancement drugs popped up on the screen. So at that young of an age, the culture had already exposed me to the fact that men can have issues during sex, and that there is at least one option for treatment.

This point is not at all meant to minimize the frustration, depression, or shame that these men can experience, nor am I trying to question the validity of the struggle. I am trying to point out how unfair it is that women often have to go through their sex lives not understanding that their anxiety is legitimate, that they are not alone, and that there are ways to treat it, while men can get an introduction to it on TV.

To learn about this quiet issue affecting the sex lives of an unknown percentage of women, I spoke to Dr. Jennifer Caudle, Family Physician and Assistant Professor at Rowan University, and Dr. Emily Morse, sex and relationships expert and host of the popular podcast Sex With Emily.

Why Don't We Talk About It More?

As Dr. Caudle and Morse both explain, performance anxiety is an issue faced by men and women, but it is hardly presented that way. Dr. Caudle tells Bustle, "This is something that happens to women of all ages. It is not the most common complaint [from my patients], but when they are comfortable, these things come out." One can't help but wonder how many more female patients would seek treatment if the issue wasn't as invisible. Dr. Caudle stresses that it can be a difficult, uncomfortable topic to breach for her patients of all genders, but certainly more so for women.

It is no secret that our patriarchal culture at large does not understand women's sexuality. We don't have to look that far back in medical research to find documentation from doctors and psychologists questioning a woman's ability to even enjoy sex at all. When you realize that this is our foundation for women's sexual health, it's a bit easier to understand how we got to this sad state of current affairs — though it's no less infuriating.

Because of all of the unnecessary and damaging "mystery" surrounding female sexual desire, performance anxiety for women is not often discussed because we don't really know how to discuss it.

"For men, performance is a question of their ability to maintain an erection for a socially acceptable amount of time (be that five minutes or 60 minutes).If a man can get hard and stay hard for the duration of sex, he is pretty much guaranteed a climax," Morse tells Bustle. She references the SKYN Condoms' 2015 Millennial Sex Survey, which found "that men report being more confident in their sexual performance than their female counterparts," and this likely stems from confidence in the fact that they will achieve orgasm. However, women — as many of us know — do not orgasm as easily, and this contributes to the performance anxiety that many feel. More on that later.

What Happens?

First, let's look at what physically happens in a woman's body when she is experiencing performance anxiety. WebMD explains that anxiety "causes your body to launch a response called 'fight or flight.'" When sexual acts result in you feeling stressed or anxious, your body releases stress hormones — epinephrine and norepinephrine — that are actually meant to ready your body to hide from or face a threat. In this case, the threat to your body's well being is the fear of displeasing your partner (of if there is trauma involved, the fear of physical intimacy). A few different things can happen once these stress hormones take hold: 1) It is difficult to get wet enough for intercourse. 2) Vaginal muscles tense up, making penetration difficult or impossible. 3) You won't have any desire to engage in sex.

Now, let's take a look at some of the mental and emotional things that happen to a woman when she is experiencing performance anxiety. Morse says, "It can be seen in a woman feeling disinterested in sex altogether — why would anyone want to regularly partake in an activity in which they feel consistently inadequate? Many women withdraw and make excuses to avoid having sex to avoid these anxious feelings and perhaps convince herself that she just 'isn’t that sexual of a person.' Maybe she would be if the priority was on her pleasure versus her performance." And typically, a woman is considered "good in bed" if she moans and achieves the kind of orgasm we see in the media — a performance that many women feel pressured to fake. Morse continues, "Instead of being in the moment with her partner, connecting sexually and being in tune with her body (all things that can enhance sexual satisfaction and actually help her reach climax), she is worrying about whether or not she will ever finish."

What Causes Performance Anxiety In Women?

While there are plenty of factors contributing to this problem, let's first explore the orgasm anxiety further. Dr. Caudle says, "Society has put pressure on women and men and everyone to orgasm all the time. And we already know that women often orgasm a lot less than men." The SKYN Condoms' 2015 Millennial Sex Survey states that 97 percent of men reported having an orgasm during sex, versus 89 percent of women reporting an orgasm. 75 percent of women are unable to achieve orgasm from penetration alone, according to research from Emory University. Some women can only orgasm from masturbation, Dr. Caudle explains. When explosive, loud, dramatic orgasm by women is what media and pornography teaches us to be the sign of "good sex," there is immense pressure on women to achieve that kind of orgasm — despite the fact, as Dr. Caudle emphatically reminds us, "Porn isn't real."

Morse elaborates on the disconnection that a woman can feel after the act. "She barely remembers what positions they did or how it felt because all she can think about it that bright shiny orgasm that she once again failed to achieve... A lot of women fall into this trap of believing that it is the man’s responsibility to bring home the orgasm. So when their partner is doing his various moves and nothing is happening for a woman down below, she immediately becomes anxious and starts to assign the blame to herself and her sexual response."

In addition to concerns over orgasms, as explained by the Huffington Post, "Body image issues, orgasm obstacles and STD woes are just a few of the concerns that can keep women from letting go and enjoying their time between the sheets." Anxiety over accidental pregnancies can also disrupt a woman's ability to perform. Women dealing with performance anxiety "are often worried about something," says Dr. Caudle. Women are already taught to be ashamed of any "flaw" on their body even when it's covered up by clothing. So, as Dr. Caudle explains, "Being naked feels extremely vulnerable." Women are socialized to fear and/or hate the appearance of their vulva and labia, and many grown women admit to being too anxious to have ever looked at it in the mirror. So imagine the anxiety that would accompany another person viewing their genitals. Dr. Caudle continues, "I definitely think the societal hype about sex makes it hard for so many people. Society tells us how to look, what is sexy and what is not, what is good sex, what is considered attractive or not. All these rules make it harder for people to be intimate in a way that makes sense for them."

Besides body image issues, says Dr. Caudle, "Difficulties in the relationship can cause anxiety. When you're not in tune with your partner from an emotional or psychological standpoint, intimacy and confidence can suffer."

What Can Help You Overcome It?

Dr. Caudle explains, "In order to get a hold of anxiety, it's important to understand where it's coming from. That could mean a heart to heart with yourself, with your partner, with your doctor, or with anyone you trust. Then you can reveal the underlying issue. Often, just feeling like you can communicate is the most important thing sometimes." For this reason, Dr. Caudle says that therapy can be very important as it allows you to confide in a third party. And once you have an understanding of the underlying issue — maybe it's body image issues or trauma — you can learn how to cope with the root of the anxiety. When you don't have clarity over the cause, it can create a cycle of panic attacks whenever sexual intimacy is present, and that only makes the situation worse.

Sometimes simply altering your environment eases anxiety — whether that means creating a specific playlist of soothing, romantic music to stream in the background or cuddling and watching a movie as foreplay. These activities can distract you from any anxiety-triggering aspects of what is about to happen.And as Morse stresses, it is especially important to let yourself learn about your body, understand your sexuality, and discover what pleases you in order to rid yourself of that unfair orgasm anxiety. For one, Morse explains that just because you didn't achieve an orgasm doesn't mean the sex was bad or that you performed improperly — not even close. "Instead of putting all that pressure on yourself to perform, take a kinder approach, cut yourself some slack, and accept that it might not happen every single time. Learn to enjoy all aspects of sex. If you orgasm, great! If you don’t, you’re still enjoying the physical intimacy that comes with being with your partner." And the best way to learn what makes you orgasm is to find out for yourself. The confidence that you'll gain through taking ownership of your body and your pleasure will transfer into sex with your partner.

Morse also recommends speaking up and taking control! If throughout your self-exploration, for example, you realize that you enjoy vibrators or toys, suggest incorporating them into your sex life as a couple. If your partner makes you feel bad about wanting pleasure, they are in the wrong — not you.

So just remember, you have the right to pleasure (which can be achieved with or without a pornified orgasm), your anxiety is understandable and valid, and, with time and self-care, you can overcome it.

Want more women's sexual health coverage? Check out Bustle's new podcast, Honestly Though, which tackles all the questions you're afraid to ask.

Images: Andrew Zaeh/Bustle; Giphy (4)