Sexual performance anxiety can turn intimacy into a source of worry, pressure and fear of failure. When people become focused on whether they can “perform” — for example, achieve or maintain an erection, experience orgasm, manage penetration, or satisfy their partner — anxiety can interfere with sexual arousal, pleasure and emotional connection. Over time, this can create a cycle of anticipation, unsuccessful sexual experiences, avoidance and increasing relationship distress.
For some couples, these difficulties contribute to non-consummation, where penetrative intercourse has not taken place despite attempts or expectations that it should. Non-consummation may involve Erectile difficulties, Genito-pelvic pain or fear of penetration, sexual performance anxiety, limited sexual knowledge, relationship difficulties, previous negative experiences, or a combination of factors.
This three-hour online training will help therapists, particularly psychosexual and relationship therapists, understand how sexual anxiety, pressure to perform and non-consummation can develop and reinforce each other. It will explore psychological, physical and relationship factors alongside the influence of sexual expectations, gender roles, culture and religion.
Learners will develop practical skills in assessment and formulation and explore therapeutic approaches for reducing performance pressure, managing anxiety and avoidance, challenging unhelpful sexual beliefs, improving couple communication and rebuilding sexual confidence. The training will consider sensate focus, graded intimacy and appropriate approaches to penetration difficulties, helping clients move from performance-focused sex towards pleasure, safety, intimacy and connection.
Clinical examples and case discussions will connect theory with everyday psychosexual and relationship therapy practice.
Class schedule:
1:30–1:45 PM | Introduction and context
- Understanding sexual performance anxiety
- When normal sexual concerns become a source of distress
- The meaning of “performance” in sexual relationships
1:45–2:15 PM | Pressure to perform and the anxiety cycle
- Anticipatory anxiety and fear of failure
- Spectatoring and self-monitoring
- Expectations around erection, penetration, orgasm and satisfying a partner
- Sexual avoidance and the maintaining cycle
2:15–2:45 PM | Understanding non-consummation
- Different presentations and contributing factors
- Erectile difficulties and penetration difficulties
- Genito-pelvic pain and fear of penetration
- Limited sexual knowledge and sexual myths
- Individual and couple factors
2:45–2:55 PM
Break
2:55–3:25 PM | Assessment and formulation
- Taking a sensitive psychosexual history
- Biopsychosocial and couple assessment
- Identifying maintaining factors
- When medical assessment or onward referral may be required
3:25–3:50 PM | Culture, religion and relationship context
- Sexual scripts and gender expectations
- Virginity and expectations around consummation
- Wedding-night and family pressures
- Shame, guilt and limited sexual education
- Culturally sensitive therapeutic practice
3:50–4:20 PM | Therapeutic interventions
- Psychoeducation and reducing performance pressure
- Challenging unhelpful sexual beliefs
- Sensate focus and graded intimacy
- Managing anxiety and avoidance
- Couple communication
- Moving from performance and penetration goals towards pleasure and connection
4:20–4:30 PM | Case discussion, questions and key learning points
Learning Outcomes
By the end of the session, participants will be able to:
- Recognise the psychological, physiological and relational mechanisms involved in sexual performance anxiety.
- Explain how pressure to perform can contribute to sexual dysfunction, avoidance and non-consummation.
- Assess non-consummation using an integrated biopsychosocial and couple perspective.
- Formulate the cycle linking anticipatory anxiety, performance pressure, unsuccessful sexual experiences and avoidance.
- Identify relevant cultural, religious and relationship factors while avoiding assumptions about individual clients.
- Apply psychosexual and couple interventions to reduce performance pressure and sexual anxiety.
- Use approaches such as psychoeducation, sensate focus and graded intimacy appropriately within therapeutic work.
- Support individuals and couples to move from performance-focused sexuality towards greater safety, pleasure, intimacy and connection.
About the Trainer
Dr Wafaa Eltantawy
Associate Specialist in Sexual and Reproductive Health, Sex Therapist, Relationship Counsellor and Executive Coach. MBChB, DRCOG, FFSRH, MA Relationship Therapy, PGDip Psychosexual Medicine, Level 7 Certificate in Executive Coaching
Dr Wafaa is a licensed GMC Gynaecologist with over 25 years of medical practice and experience, and is a Fellow of the Faculty of Sexual and Reproductive Health (FFSRH). She is also a qualified Psychosexual Therapist (Sex Therapist) and Relationship Psychotherapist with ten years of practice experience.
Alongside her medical work, Dr Wafaa has led the Psychosexual Clinic at her NHS trust in London for the past 10 years, working with individuals and couples from diverse cultural, religious and ethnic backgrounds with a wide range of sexual and relationship difficulties. She also worked for the Relate Institute for 7 years.
She is an accredited member of the College of Sexual and Relationship Therapists (COSRT), the British Association for Counselling & Psychotherapy (BACP), the International Society for Sexual Medicine (ISSM) and the Middle East Society of Sexual Medicine (MESSM).
