Performance anxiety was identified in the early work of Kaplan (1974) as well as by Masters and Johnson (1970) and has continued as an important factor in most cases of erectile dysfunction. Males are more likely to experience performance anxiety. A man’s sexual response is observable in a man; his partner will be aware of the status of his penile erection performance anxiety could be considered the sole contributing factor to erectile dysfunction or it may accompany cases of erectile dysfunction even when the etiology is primarily medical.

The term “performance anxiety” is somewhat misleading since anxiety in a physiological sense may actually facilitate sexual arousal (1996). A more descriptive term might be “performance warranty.” However it is term, it is common for most men to experience erectile failure at some point in our lives. A more useful question could be considered, “why are some men unaffected by the experience of erectile failure and continue to worry with sexual success while other men are devastated by the episode of erectile dysfunction and worried to the point that all subsequent experiences sexually are compromised?” It appears that some men have not yet had any sexual experiences yet tend to be preoccupied about the possibility of erectile dysfunction and as a result avoid sexual intimacy altogether.

Havelock Ellis in his studies of the psychology of sex stated that men experiencing erectile dysfunction were “men of abnormally sensitive temperament” more contemporary research seems to identify a similar factor accounting for the risk of both performance anxiety and erectile dysfunction. More recently, Nobre and colleagues (2009) have observed that men susceptible to erectile dysfunction are: 1. much more likely to endorse myths about male sexuality (for example “a man is always ready for sex and always wants to be sexual”, 2. View themselves as incompetent and powerless and 3. view this sexual problem is internal and stable. Collectively, all of these myths tend to be factors that contribute to worry about sexual performance and lead to and maintain erectile dysfunction.

In addition to performance anxiety, there are a number of other factors that tend to contribute to erectile dysfunction. There is the co-morbidity of mental health conditions often associated with erectile dysfunction that could include generalized anxiety disorder, obsessive-compulsive disorder, depression and paraphilic disorders and general stresses could include financial problems, conflicts at work or family concerns that could preoccupy, overwhelm or contribute to sexual problems more specifically to erectile dysfunction. Similarly, marital conflict and anger with one’s partner would also contribute to erectile dysfunction where relationship problems could account for being at the root of erectile dysfunction. One final area of concern that might contribute to erectile dysfunction is the sexual environment. For example lack of privacy that could relate to children with poor boundaries or pets in the bedroom, work schedule, and sleeping in one’s deceased parents bedroom.