ACRM | IVF & Fertility Clinic in Singapore / Fertility  / Are you dealing with performance anxiety or male infertility?
Couple looking upset on bed

Are you dealing with performance anxiety or male infertility?

For many couples who are trying to conceive, sex, once a natural activity that’s meant to be enjoyed, becomes a to-do with rules, expectations, and time frames. This can really zap 

the passion out of getting hot and heavy.

Along with the added tension comes the issue of performance anxiety. Sexual performance anxiety is very common for couples who are trying to conceive and tends to increase the longer a couple tries for a baby.

Additionally, studies have shown that the pressure on men to perform sexually on cue can result in impotence1, and in some unfortunate cases, adultery. Performance anxiety and the stress of trying to conceive can greatly affect both men’s and women’s quality of life.

This is all common and understandable. We’ve seen many patients struggle their way to conception. If you’re trying to conceive, one of the ways you can help yourselves is to first decipher if you are struggling with performance anxiety or infertility. 

What is sexual performance anxiety?

Sexual performance anxiety (SPA) refers to the fear that an individual will not measure up to a preconceived sexual expectation2. SPA is one of the most prevalent sexual complaints amongst couples. Yet, research into available treatment has been minimal.

SPA affects up to 25%3 of men and can lead to premature ejaculation and erectile dysfunction. Similarly, SPA affects up to 16% of women and can severely inhibit sexual desire for both sexes.

The causes of male infertility

Making mature, healthy sperm depends on a myriad of factors. Fertility problems can stop cells from growing into sperm, reaching the egg, and more. Even the temperature4 of one’s scrotum may affect fertility. 

Here are the top causes of male infertility:

Infertility issue

What it is

Sperm disorders and obstruction

About 4 out of every 10 men with total lack of sperm (azoospermia) have an obstruction within the tubes that their sperm travels through. Blockages can be caused by birth defects or problems like an infection.

The most common problems with making and growing sperm are:

  • Oddly shaped sperm
  • Sperm not growing fully
  • Sperm not moving the right way
  • Sperm in low numbers (oligospermia)
  • Total lack of sperm (azoospermia)

Sperm problems can be a result of innate traits or lifestyle choices. Tobacco, alcohol, and certain medications can lower sperm numbers.

Other causes of low sperm numbers include chronic conditions like kidney failure, childhood infections, and hormonal imbalances.


Sometimes the male reproductive tract through which sperm travel can become blocked. With a blockage, sperm can’t leave the body during ejaculation.

This can be caused by:

  • Repeated infections
  • Swelling or developmental defects

Erectile dysfunction

Hormonal changes, psychological factors, and physical issues are some of the factors that can make it difficult to get or keep an erection.

Regular erectile dysfunction can interfere with sexual intercourse and/or signify an underlying condition.


Varicoceles are swollen veins in the scrotum. The condition is present in approximately 40 out of 100 infertile men.

They harm sperm growth by causing blood to flow back into your scrotum from your belly, blocking blood drainage. This causes testicles to be too warm for making sperm.

Retrograde ejaculation

Retrograde ejaculation occurs when semen goes into the bladder instead of out through the penis. This happens when nerves and muscles in one’s bladder don’t close during orgasm.

Symptoms to watch out for are:

  • Cloudy urine after ejaculation
  • Less fluid during ejaculation
  • Dry ejaculation

Retrograde ejaculation can be caused by surgery, medications, or nervous system issues.

Immunologic Infertility

This occurs when a man’s body produces antibodies that attack his own sperm; antibodies usually keep sperm moving and working normally.

But in this case, antibodies make it hard for sperm to swim to the fallopian tube and successfully enter an egg.

Hormonal imbalances

Hormonal imbalances can affect a man’s fertility.

Testosterone, for example, is a key hormone for male fertility, so problems with the testes, which produce this hormone, can cause infertility.

Testicular changes

Small, firm, and tight-feeling testicles may be a sign of hormonal issues.

On the other hand, swollen, painful, or tender testicles may be a sign of an underlying issue that can also impact male fertility.


Changes to the number and structure of chromosomes can also affect fertility. The male Y chromosome, for example, may have missing parts.


Certain medications can alter sperm production, quality, and delivery. These medications are typically used to treat health conditions such as:

  • Arthritis
  • Depression
  • Digestive problems
  • Anxiety or depression
  • High blood pressure
  • Cancer, and more

Lady holding on to a pregnancy kit

Other risk factors for male and female infertility

Other risk factors may also contribute to infertility in both men and women. These include:

  • Age
  • Stress
  • An unhealthy diet
  • Drinking alcohol
  • Smoking tobacco or marijuana
  • A history of sexually transmitted infections
  • Obesity

How to tell if it’s infertility or performance anxiety?

The top telltale sign of infertility is not getting pregnant after trying for a year or more. If a couple is over the age of 35, this period can be shortened to six months.

When to seek help for infertility

Firstly, try to take the pressure off sex. Keep in mind that it is normal to take up to one year to become pregnant. Secondly, consider seeking the help of a trusted professional to confirm if you’re struggling with performance anxiety or infertility – especially since the two can be easily confused for the other.

Your doctor may be able to suggest simple techniques or lifestyle adjustments that will help improve your chances of conceiving, and if any underlying conditions are detected, you and your partner will be able to undergo the treatment you need.

Even after an infertility diagnosis, there is still hope; modern technology such as IVF can help create the family you want. 


  2. Rowland, D. L., & van Lankveld, J. J. D. M. (2019). Anxiety and Performance in Sex, Sport, and Stage: Identifying Common Ground. Frontiers in Psychology, 10.
  3. ‌Pyke, R. E. (2019). Sexual Performance Anxiety. Sexual Medicine Reviews.
  4. ‌Thonneau, P., Bujan, L., Multigner, L., & Mieusset, R. (1998). Occupational heat exposure and male fertility: a review. Human Reproduction, 13(8), 2122–2125.