Sexual Anxiety Disorder is a common problem in which anxiety about engaging in sexual activity becomes an overriding block to the spontaneous flow of sexual feelings and thoughts. The fear of sexual performance, or more accurately the fear of not performing sexually, can affect sexuality in a variety of ways.

Sexual anxiety disorder can result in avoidance of sexual encounters, lowered self-esteem, relationship discord and sexual dysfunction. Typically, an awareness of sexual anxiety disorder produces so much preoccupation with the anxiety itself that the person becomes less fully involved in the sexual interaction, bringing about the very failure that is feared. In one common scenario, as the anxious partner worries about how to be sexually responsive and spontaneous; he or she focuses on each detail of the lovemaking. One partner may focus on how rapidly the other partner is breathing, whether a shift in position is required, or how much lubrication or erection is present. The sexual interaction is dissected so deliberately that enjoyment is virtually impossible. Sexual encounters that proceed in this fashion have a high probability of being unfulfilling for one or both partners.

Anticipation of the next sexual encounter arouses the same anxiety coupled with the memory of the previous failure and often leads to avoidance of sexual activity altogether, or at least to minimizing the amount of sexual interaction that occurs. This may result in one member of a couple mistakenly interpreting the situation as a form of rejection. The underlying avoidance, however, is usually not to reject one's partner, but to save face in a way that helps the person feel more in control and less guilty about being inadequate.

Erectile dysfunction, is a disorder that can develop as an outgrowth of performance anxiety. Isolated episodes of not getting an erection or of losing an erection at an inopportune time are so common that they are almost a universal occurrence among men. Such isolated episodes do not mean that a man has a sexual dysfunction. They may occur as a result of a temporary physical stress (having a cold, being tired, having consumed a large meal or too much alcohol), or may relate to other problems like tension, lack of privacy, or nervousness about a new partner. If the man does not take such incidents in stride and becomes upset by his failure to respond physically, he may set the stage for difficulties in future sexual experiences by worrying about his ability to perform.

Fears of sexual performance are likely to put a damper on sexual arousal and cause loss of erection. Eventually the fears may become so pervasive that they will become a self-fulfilling prophecy and the man will experience an actual inability to get or keep an erection. Over the long run, performance fears may lead to an avoidance of sex, loss of self-esteem.

Fears of sexual performance are not limited to men or to worries about physical responsiveness such as the speed with which vaginal lubrication or an erection is attained, or the length of time that it is maintained. Fears can also reflect anxiety about one's sexual response on a broader level, such as how much passion, tenderness, intimacy and sensitivity a person feels toward his or her partner. In these cases, a person having no apparent problems in the physical side of sexual responsiveness may be distressed by an internal perception of inadequate or inappropriate sexual performance.