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Fear of Sexual Failure

Today we bring you an interview conducted with two individuals concerning sex performance anxiety.

The first, is Dr. Robert J. Filewich. He's a clinical psychologist specializing in anxiety disorders. He's also the Executive Director for the Center for Behavior Therapy. That's in White Plains, New York.

The second is Dr. Ken Rosenberg. He is a psychiatrist affiliated with New York Presbyterian Hospital and Cornell University Medical Center in New York City. He's also in private practice in New York, specializing in substance abuse and sexual disorders.

What is sex performance anxiety?

• Filewich "Performance anxiety, in sexual terms and with sexual problems, is where a person has an anticipation of some sort of problem occurring in the sexual act. As a consequence of that, they develop a sense of anxiety which translates into an inability to become erect or an inability to go ahead and have sex for a certain duration before they actually achieve orgasm, or premature ejaculation."
• Rosenberg "Performance anxiety refers to just what Dr. Filewich said. It's more of a popular term than a medical term. You can't really find "performance anxiety" in a medical book. It's the common term for erectile dysfunction or impotence. It also can lead to premature ejaculation in some. We were not made to be anxious and have sex at the same time. When we're anxious, we're running away from dinosaurs, we're not ready to have intercourse. So our plumbing does not work when we become anxious, and therefore when we're extremely anxious we just can't perform very well sexually."
• Filewich "In addition, the anxiety is usually fear-based. It's the sense of fear of being rejected, fear of performing in a certain way where you're partner's going to be disappointed."

Does that happen with couples? Does it happen when you're just meeting somebody for the first time, or does it matter?

• Rosenberg "There are so many reasons. There are immediate causes, there are deeper causes. Erectile dysfunction is so multi-determined it ultimately is a biological phenomenon. It's ultimately a fact of the blood staying in the penis. Why or how the blood stays in the penis could be any number of reasons from psychological to biological to cultural reasons, as well."

Does this always manifest -- I guess the stereotype seems to be you're ready for sex, maybe you've even been turned on prior to getting down to the wire, and then right when you're ready to go the wind goes out of the sails, so to speak?

• Filewich "It can happen whereby you do get erect, and as you're about to have sex, you lose your erection, or it can be when you're actually in the course of having intercourse, you lose the erection, or you don't get erect at all. So it can happen in any of those kind of ways. Usually what happens is that the person is focusing more or less on the final goal, which is orgasm or pleasing the partner with an orgasm, and not really focusing on all the rest of what goes on in the sexual encounter, which is really one of the things that we try to do as therapists, to try to get the person to focus more on the relationship and the sensory experiences that they're having as opposed to the final goal -- more focusing on the process rather than the product."

If you're a man and this is a problem that you're having and you go to seek treatment, what is the normal routine treatment?

• Filewich "There is actually a multitude of different treatments. One of the treatments that was developed some time ago by Masters and Johnson is what is known as a sensate focus technique. Through a series of four stages, what a person begins to learn to do is to stop focusing on the end result, which is orgasm, and worrying about whether or not you can go ahead and achieve that or provide your partner with the opportunity to achieve that, and start focusing more on what the sensory stimulation is like, what it feels like to actually enjoy being stimulated, what are the ways in which you can go ahead and pleasure each other, and it takes the focus off of what's happening at the end. So you'll start off with a stage where you'll keep your clothes on, and you'll actually just go ahead and touch each other and communicate with each other. Once you're doing that for a while and you're comfortable with that, you'll move to the second stage."

You move to the second stage during that session, or the next ...

• Filewich "No, this is after several sessions of you getting comfortable."

Interview continued on sexual performance anxiety

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