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Often when a penis-having person experiences a sexual dysfunction like the inability to get an erection, the inability to maintain an erection, or problems with orgasm, one euphemism we as a society use to sidestep discussing the embarrassing specifics is to say “he/I/they have performance issues" or "performance anxiety.”
Now, if this person is in a sex therapist’s office (or on a Zoom call with a sex therapist during a global pandemic), that is the cue for the sex therapist to conduct a thorough assessment. Questions like “What do you mean by that?” “Do you have problems with getting an erection? Keeping an erection? Both?” “Do you come when you want to?” “Have you always had this problem during your whole sexual life or is this a recent development?” “Do you have this problem with every partner?” “What have you tried to treat this?” are some of the questions the client should be ready to be asked and answer.
I have always found it to be interesting that in sex, folks use the terms "performance issues" and "performance anxiety" to explain what they are experiencing. The term originates from the world of entertainment. Entertainers of all sorts (actors, musicians, singers, dancers) can also have "performance anxiety"—they understand they are being watched, that there is some expectation placed upon them by their audience, that they have an expectation of themselves, and that they are being evaluated by others. Hmm. Not that different in sex.
When it comes to sex, the phrase “performance anxiety” is immediately understood to mean that the individual felt a sense of "pressure to perform”—like those entertainers, the pressure is to work, to function as expected by either him or his partner or both, to accomplish something, to deliver the goods —basically, whatever the goods are understood to be.
And in the case of penis-havers, delivering the goods generally means having a strong, reliable erection, control over his orgasm, and drop a big load. This somehow reflects his sexual virility, his sexual skills as a lover, his masculinity, and is what he thinks (or projects) his partner wants or is supposed to want. Or at least, this is often what the person believes to be true. Egads. So much is put on a bodily process.
But now, I am noticing that vulva-having clients are reporting the equivalent of performance anxiety. Some of this is, unfortunately, porn-informed. She/they think they need to be enthusiastic, not have any sexual boundaries, and especially have big, demonstrative, earth-shattering — and multiple — orgasms.
And if she/they struggle with orgasm in some way (which a lot of women do) then she/they are worried about their partner’s reaction and behavior. For example, will their partner feel responsible, as if they are not a skilled lover if she does not come? Or another common reaction that I’ve seen: Will her partner then try harder and harder to get her to orgasm, becoming overly preoccupied with trying all sorts of maneuvers and gymnastics to the point of losing the interpersonal connection and mutual erotic pleasure of the sexual moment?
A woman's performance anxiety has a different layer to it. Her orgasm becomes a reflection of her partner's sexuality and sexual skills. No surprise, vulva-having people are socialized to take care of others and her orgasm can become how she takes care of her partner's sexual psychology.
In sexual encounters, I often hear my female clients talk about not being a disappointment to their partners. “I don’t orgasm from P-V sex" (with the implied belief by either her and/or her partner that either she and/or her partner thinks she should); “I don't really like receiving oral sex" (implied: I/she is less than or abnormal because of it); “I have never had an orgasm" (implied: something is wrong with my/her body); “I’ve tried but I don’t think I’m capable of having multiple orgasms" (implied: something is wrong with my/her body).
The female client often feels a need to live up to some unconscious sex kitten image they may be picking up from their partner…or they themselves feel they need to be. Therefore, the assessment question that uncovers a lot for female clients is, “Who do you think you are disappointing and why?”
These days, everyone can have performance issues during sex. It is my clinical experience that it is no longer reserved just for people with penises. The general processes between these examples I have just described are not that different from one another. Sure they involve different anatomy, different physiology, different perceived roles, and different desired outcomes in sexual encounters. But the psychology itself is not that different.
The trick is to figure out what exactly the anxiety is about and work to treat/change that. So with female clients: You don't orgasm during intercourse? No biggie. Let's help you figure out other ways to orgasm and help you communicate these to your partner. For male clients: You struggle to stay embodied and maintain your erection? That's OK. Let's help you learn ways to stay in the moment and stop spectatoring.
I am a big advocate for helping my clients find and express their authentic sexual voices. The key is for my clients to have the courage to own it, whatever it is. Because then the client can relax into the here and now sexual encounter and truly enjoy themselves.
© 2021 Diane Gleim
