Dr. Daniela Mazor, certified sexologist and sex therapist, head of the Israeli Society for Sex Therapy (ISST), and founder of a sex therapy center in Haifa, explains how performance anxiety can affect women and what they can do to face these issues.
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One of the topics you deal with as a sex therapist is performance anxiety in women. What does that mean?
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Dr. Daniela Mazor is a certified sexologist and sex therapist
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"It refers to the worry or anxiety that a woman experiences before engaging in sexual activity. She imagines a negative scenario of what might happen to her and acts on these emotions despite the fact that, in reality, things could turn out much differently.”
How does performance anxiety manifest in sexual relationships?
"The first expression is the issue of pain. Leading up to the sexual encounter, a woman has a memory of pain from previous experiences and instead of saying to herself, 'Maybe it’ll hurt,' she says, 'It hurts!'”
“Therefore, anxiety increases significantly, the body tenses up, and then, naturally, a sexual act will become painful. There are women who, due to fear, are unable to be partially naked in bed or be embraced by their partner at night,” she explains.
"The second issue is anxiety about not having an orgasm. Women feel a lot of pressure to climax, and focusing on getting there actually takes them away from the physical experience and replaces it with a sense of fear. The more a woman wants and tells herself, 'I'm completely focused on reaching orgasm,' the less she’s present in the act itself.”
“She plans out the steps to reach an orgasm and, if she fails, she approaches her next sexual encounter even more fearful and anxious,” Mazor says.
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The woman is under such psychological stress due to performance anxiety that her body doesn’t relax
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“This cycle continues and becomes performance anxiety. The woman is under such psychological stress that her body doesn’t relax. It can’t be under such stressful emotions."
What causes performance anxiety in women?
"I think it often stems from unrealistic perceptions about sexual functioning, and stereotypes of what sexuality, orgasm and penetration should be like,” Mazor says.
“Social constructs also influence thoughts about what makes a woman attractive and sexual: on one hand, being a 'pure' and 'modest' woman, and on the other hand, being a woman with experience and sexual acceptance. It can be very confusing to know what's expected from you as a woman."
Do women ever think that their partner’s ex was better than them?
"Yes, those are intrusive thoughts that often connect with a feeling of worthlessness when a woman believes she isn’t good enough – and then she tries to prove that she meets unrealistic expectations, or she gives up in advance,” Mazor explains.
“It may even be that she tries to meet the standard of her partner's ex, which in turn creates a comparison between her and another person. What’s difficult is that when I’m constantly focused on what’s expected of me, I don’t know myself or what I want of out the experience. I’m busy fulfilling a role instead of being in the moment."
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Performance anxiety often stems from unrealistic perceptions about sexual functioning
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How do you treat sexual performance anxiety?
"In my opinion, Cognitive-Behavioral Therapy (CBT) is very helpful. One of the tools is to engage in gradual exposure to triggers: looking at the threatening factor and breaking it down into stages,” she explains.
“For example, if someone says they’re insecure about their body, I won't ask them to look at themselves naked in the mirror. We build a gradual and mindful plan that allows the woman to take small and safe steps forward with slight elements of discomfort.”
"Many times, women try to solve sexual issues by thinking: ‘If I think positively, it’ll be okay,' 'I’ll make it work if I’ll focus on my orgasm.’ And when the focus becomes too cognitive, the body remains out of the sexual experience,” Mazor says.
“During therapy, we primarily address the physiological focus on the experience: what the body feels, and what it needs."
To whom would you recommend talking to for treating the issue?
"To a certified sex therapist. In cases of issues with pain, it’s recommended to combine a physiotherapist who treats the body with a sex therapist who treats the mind," she concludes.