(681) The Fear of Failure: A Case of Performance Anxiety in a Healthy Adult Male

Abstract Introduction Erectile dysfunction (ED) is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Although its prevalence increases with age and comorbidities, psychogenic ED remains a frequent cause among younger and otherwise healthy men. Performance anxiety is one of the most common psychogenic mechanisms, typically triggered by a single episode of failure and maintained by fear of recurrence. In primary care, early identification and a holistic, nonpharmacological approach are key to preventing chronicity and psychological distress. Objective To describe a clinical case of psychogenic erectile dysfunction related to performance anxiety in a middle-aged man, emphasizing the diagnostic reasoning and the effectiveness of a primary care–based intervention. Methods A 40-year-old man, divorced and bisexual, presented with a six-month history of difficulty maintaining an erection during sexual intercourse. He reported the ability to initiate erection with multiple partners but an inability to maintain rigidity throughout intercourse. Morning and masturbatory erections were preserved. No relevant medical history, medication use, or psychological disorders were reported. Physical examination and complementary laboratory tests, including metabolic, hormonal, and cardiovascular parameters, revealed no abnormalities. The patient’s only relevant finding was overweight. After exclusion of organic causes, the case was managed in a stepwise approach: general measures: lifestyle counseling focused on weight reduction and physical activity; sexual education: explanation of the sexual response cycle and the role of anxiety in erectile function, provision of reliable educational materials; pharmacological support: sildenafil 25 mg prescribed on an as-needed basis, mainly for psychological reassurance. Results At one-month follow-up, the patient reported significant improvement in sexual confidence and satisfaction. He had resumed sexual activity, achieving and maintaining erections adequate for intercourse. Interestingly, he did not use the prescribed medication, keeping it only as a “backup” option, which contributed to his sense of security. These findings support a diagnosis of psychogenic erectile dysfunction due to performance anxiety, with positive response to a brief, nonpharmacological intervention led in primary care. The case demonstrates that reassurance, education, and restoration of self-efficacy may be sufficient to resolve symptoms, even without formal psychotherapy or pharmacologic treatment. Conclusions This case highlights the importance of recognizing performance anxiety as a frequent and reversible cause of erectile dysfunction. The presence of spontaneous erections and situational variability are key diagnostic clues to a psychogenic origin. Early, empathetic, and educational intervention by primary care physicians can successfully restore sexual function and confidence without invasive investigations or long-term medication. A biopsychosocial, patient-centered approach remains the cornerstone of management in psychogenic sexual dysfunction. Disclosure No