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Performance anxiety · Confidential · Specialist Urologist-led clinic

Sexual Performance Anxiety Treatment London

Assessment and treatment for sexual performance anxiety — including checking whether a physical problem started the cycle in the first place.

Delivered byDr Kishore Bahl, Specialist Urologist
ConsultationAssessment before any treatment
Session timeTypically 15–30 min
DowntimeNone
Back to Men’s HealthAll Services

Educational information — not a substitute for clinical assessment

This page describes sexual performance anxiety in general terms to help you decide whether an assessment may be useful. It is not a diagnosis and does not promise a particular result. Suitability, the number of sessions and whether treatment is appropriate at all are decided at consultation. Outcomes vary between individuals and treatment is not suitable for everyone.

Why people come to us about this.

Performance anxiety usually starts with a single difficult experience. Worry about it happening again makes it more likely, and a cycle establishes itself. Breaking that cycle usually means addressing both the anxiety and whatever started it.

What this condition actually is.

Sexual performance anxiety is anxiety about sexual performance that itself interferes with performance. It is self-reinforcing.

It is frequently triggered by an initial physical problem — a one-off difficulty caused by alcohol, tiredness or stress — which then becomes a pattern maintained by worry.

Assessing it properly means asking whether a physical contributor is still present, not assuming the problem is now purely psychological.

What you might be noticing.

  • Difficulty that is worse with a new partner or in new situations
  • Normal erections when alone but difficulty with a partner
  • Preoccupation with performance during sex
  • Anticipatory anxiety before sexual activity
  • Avoidance of situations that might lead to sex
  • Rapid ejaculation driven by anxiety
  • Physical anxiety symptoms — racing heart, sweating, tension

What tends to cause it.

  • An initial episode of difficulty, often with an ordinary explanation
  • Fear of repetition, which raises arousal in the wrong system
  • Unrealistic expectations, often shaped by pornography
  • Relationship anxiety or fear of a partner's reaction
  • Generalised anxiety or depression
  • An underlying physical cause that has not been identified
  • Alcohol or recreational drug use

How treatment helps.

Assessment first establishes whether a physical contributor is present. Retained night-time and solo erections point away from a physical cause; their absence points towards one.

Where a physical contributor exists, treating it — which may include focal shockwave for vascular ED — often breaks the cycle.

Where the problem is primarily anxiety, psychological approaches are more effective than physical treatment.

In many men both are present, and both need attention.

Why we use focal shockwave.

We use focal shockwave because it delivers energy to a defined depth — up to approximately 12 cm — allowing accurate treatment of deeper structures. Radial devices spread energy outwards from the applicator and lose intensity quickly, which limits them to more superficial targets.

Why focal reaches what radial cannot.

Pulses travel from the probe and converge on a target at depth. The dashed line marks where radial devices stop.

036912 cm Radial device range ► stops here Focal probe Target SkinFat layerMuscleDeepmuscle
Focal shockwave · depth of penetration

What treatment can offer.

Assessment that distinguishes physical from ps

Assessment that distinguishes physical from psychological rather than assuming

Access to both physical investigation and cons

Access to both physical investigation and consultation in one clinic

Treatment aimed at the cycle rather than only

Treatment aimed at the cycle rather than only the symptom

Confidential and unhurried

Confidential and unhurried

Referral to specialist psychosexual therapy wh

Referral to specialist psychosexual therapy where that is the right route

What to expect during treatment.

  1. Step 1

    A confidential consultation covering when the difficulty started and how it varies by situation.

  2. Step 2

    Specific questions about night-time and solo erections, which help distinguish physical from psychological.

  3. Step 3

    Examination and blood tests where a physical cause is suspected.

  4. Step 4

    A shared explanation of what is maintaining the cycle.

  5. Step 5

    A plan addressing both components where both are present.

Questions people usually ask.

How do I know if it is physical or psychological?

Situational variation and retained night-time erections suggest a psychological component. Their absence suggests physical. Assessment establishes this properly.

Will tablets fix it?

They can break the cycle by restoring confidence, but they do not address the anxiety itself. That is discussed at assessment.

Is shockwave the answer?

Only where there is a vascular contributor. For purely psychological performance anxiety, it is not the right treatment.

Does it get better on its own?

Sometimes, particularly in a supportive relationship. It commonly does not, because worry maintains it.

Should I tell my partner?

Most men find it helps considerably. We can discuss how.

Related treatments.

Psychosexual Consultation

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Shockwave Therapy for Erectile Dysfunction

Non-invasive, drug-free focal shockwave therapy for erectile dysfunction of vascular origin — offered after as…

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Premature Ejaculation

Confidential assessment and treatment for premature ejaculation, covering physical, psychological and relation…

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Low Libido & Sexual Wellness

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Before you book.

Referral

No GP referral needed. You can book directly.

First appointment

An assessment with Dr Kishore Bahl, Specialist Urologist. Treatment follows only if the assessment supports it.

Where

Whitechapel, East London. Whitechapel station is on the Elizabeth line, District, Hammersmith & City and Overground.

Fees

Published in full on our price list.

Privacy

Consultations are private and confidential. You are entitled to a chaperone at any appointment, at no cost.

Speak to a specialist.

Speak to Dr Kishore Bahl, Specialist Urologist, about whether this treatment is appropriate for you.

Book a consultation Call 020 7916 0029 See full pricing on our price list
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