Performance Anxiety in Bed: Causes, Science, and How to Overcome It (2026)

A comprehensive, science-backed guide to understanding and overcoming sexual performance anxiety. From the neurochemistry of the anxiety-PE cycle to practical CBT techniques, breathing exercises, and mindfulness strategies that break the pattern.

1. What Is Performance Anxiety?

Performance anxiety in bed — clinically referred to as sexual performance anxiety (SPA) — is a persistent worry about one's ability to perform sexually that interferes with sexual function and enjoyment. It is not simply "being nervous." It is a self-reinforcing psychological pattern in which the fear of sexual failure becomes the primary cause of that failure.

The condition is remarkably common. Research published in the Journal of Sexual Medicine by McCabe et al. (2010) estimates that sexual performance anxiety affects between 9% and 25% of men, making it one of the most prevalent sexual health concerns. Among men who experience premature ejaculation, the prevalence of co-occurring performance anxiety rises to over 50% (Rowland & Cooper, 2011).

What makes performance anxiety particularly insidious is its self-fulfilling nature. You worry about ejaculating too quickly, which triggers a stress response, which accelerates ejaculation, which confirms your fear, which increases anxiety for the next encounter. This is not a character flaw or a sign of weakness — it is a well-documented neuropsychological feedback loop, and it responds powerfully to the right interventions.

Performance anxiety can manifest in several ways beyond premature ejaculation. Some men experience difficulty achieving or maintaining an erection. Others lose desire or avoid sexual encounters entirely. Some are able to function during sex but derive little pleasure because their mind is consumed by anxious monitoring rather than experiencing sensation. Whatever form it takes, the underlying mechanism is the same: the mind's threat-detection system has become inappropriately activated in a context that should be pleasurable and safe.

2. The Anxiety-PE Cycle

The relationship between anxiety and premature ejaculation is bidirectional and self-amplifying. Understanding this cycle in detail is essential because it reveals the multiple intervention points where you can break the pattern.

Stage 1: Anticipatory Anxiety

The cycle begins before sex even starts. Based on previous negative experiences (or simply the fear of a negative experience), you begin to worry about how you will perform. Thoughts like "What if I finish too fast?" or "I need to last longer this time" activate the brain's threat-detection system — specifically the amygdala, which is the brain's fear centre.

Stage 2: Sympathetic Activation

The amygdala triggers a cascade of stress hormones, primarily cortisol and adrenaline (epinephrine). Your heart rate increases, muscles tense, and breathing becomes shallow and rapid. This is the sympathetic nervous system — the fight-or-flight response — activating in a situation where it is entirely counterproductive. Research by Rowland et al. (2010) using physiological monitoring confirmed that men with PE show significantly higher sympathetic arousal before and during sexual activity compared to controls.

Stage 3: Accelerated Ejaculation

Here is the critical link: the sympathetic nervous system directly controls the ejaculatory reflex. The emission phase of ejaculation (where semen is moved into the urethra) is triggered by sympathetic nerve fibres in the hypogastric plexus. When your sympathetic system is already running hot due to anxiety, the ejaculatory threshold is dramatically lowered. Less stimulation is needed to trigger the reflex. The result: you ejaculate more quickly than you want to.

Stage 4: Negative Evaluation

After the encounter, you evaluate what happened through the lens of your original fear. "I knew this would happen." "I can't control myself." "My partner must be disappointed." These evaluations are heavily coloured by cognitive distortions — catastrophising, mind-reading, all-or-nothing thinking — but they feel completely real in the moment.

Stage 5: Reinforcement

The negative experience becomes encoded in memory as evidence that your fears are justified. The next time a sexual encounter approaches, the anticipatory anxiety is stronger, the sympathetic response is faster, and the cycle intensifies. Over time, this can lead to avoidance behaviour — declining sexual opportunities entirely to avoid the emotional pain of perceived failure.

3. Causes: Psychological and Physical

Performance anxiety does not appear from nowhere. It develops through a combination of psychological predispositions, life experiences, and sometimes physical factors. Understanding your personal contributing factors helps you target the most relevant interventions.

Psychological Causes

Early sexual experiences: First sexual encounters carry disproportionate psychological weight. If your early experiences involved rushing (due to fear of being caught, anxiety about your first time, or a partner's impatience), these can establish a template that your nervous system replays in subsequent encounters. A 2016 study by Althof & McMahon in Translational Andrology and Urology found that negative early sexual experiences were among the strongest predictors of adult performance anxiety.

Relationship dynamics: Unresolved conflict, fear of intimacy, communication problems, or a critical partner can all create an environment where sex feels like a test rather than a shared experience. When you feel judged, your threat system activates. Performance anxiety in this context is not about sex — it is about the relationship.

Pornography-influenced expectations: Unrealistic expectations about sexual duration, frequency, and performance are increasingly driven by pornography consumption. When your reference point for "normal" is a heavily edited, pharmacologically enhanced production, your own natural performance will always seem inadequate. Research by Dwulit & Rzymski (2019) in the Journal of Clinical Medicine found a significant correlation between pornography consumption frequency and sexual performance anxiety in young men.

General anxiety and perfectionism: Men who are anxious in other areas of life are more likely to experience sexual performance anxiety. If you tend toward perfectionism, self-criticism, or excessive worry in your professional or social life, these cognitive patterns do not switch off in the bedroom. A 2018 study by Levin et al. found that trait anxiety was a stronger predictor of sexual dysfunction than any situational factor.

Depression: Depression reduces libido, impairs arousal, and creates a pervasive sense of inadequacy that readily extends to sexual self-concept. The relationship is bidirectional — sexual difficulties worsen depression, and depression worsens sexual difficulties.

Physical Contributing Factors

Hormonal imbalances: Low testosterone can reduce confidence, desire, and erectile function, all of which contribute to performance anxiety. Thyroid dysfunction (particularly hyperthyroidism) has been linked to both PE and anxiety in several studies.

Pelvic floor dysfunction: A chronically tense pelvic floor lowers the ejaculatory threshold, making quick ejaculation more likely. This physical reality can initiate or reinforce the anxiety cycle. Addressing pelvic floor health through targeted training can break this physical link in the chain.

Medication side effects: Certain medications, including some antidepressants, blood pressure medications, and recreational drugs, can affect sexual function and contribute to performance concerns.

4. How Anxiety Affects Arousal

To understand why anxiety derails sexual performance, you need to understand the autonomic nervous system — the part of your nervous system that operates below conscious awareness, controlling heart rate, digestion, breathing, and sexual arousal.

The autonomic nervous system has two branches that function like a seesaw. The parasympathetic nervous system (rest-and-digest) dominates when you feel safe, relaxed, and connected. It is responsible for sexual arousal: blood flow to the genitals increases, erectile tissue engorges, and the body prepares for intimacy. The sympathetic nervous system (fight-or-flight) dominates when you perceive threat. It diverts blood away from non-essential functions (including genital blood flow), tenses muscles, and accelerates heart rate and breathing.

Here is the paradox of performance anxiety: sexual arousal requires parasympathetic dominance, but anxiety activates the sympathetic system. You are literally trying to relax and respond while your body is preparing to flee from a sabre-toothed tiger. These two states are physiologically incompatible.

The Dual Control Model

Bancroft and Janssen's dual control model of sexual response (2000) provides a useful framework. Sexual response is governed by two systems: a sexual excitation system (SES, the "accelerator") and a sexual inhibition system (SIS, the "brake"). Everyone has a different baseline sensitivity for each system. Anxiety activates the SIS — it presses the brake. This is why anxious men often experience the paradoxical combination of feeling mentally aroused but physically unresponsive, or being physically aroused but ejaculating rapidly because the sympathetic system has lowered the ejaculatory threshold.

Cortisol and Testosterone

Chronic performance anxiety does not just create acute problems in the moment — it can alter your hormonal baseline. Sustained elevated cortisol (the primary stress hormone) suppresses testosterone production. A 2013 study by Lennartsson et al. in Psychoneuroendocrinology demonstrated that chronically elevated cortisol reduced testosterone levels by up to 15% in men. Since testosterone is essential for desire, arousal, and erectile function, chronic stress creates a biochemical environment hostile to sexual performance — another layer of the vicious cycle.

5. CBT Techniques for Performance Anxiety

Cognitive Behavioural Therapy (CBT) is the most extensively researched psychological treatment for sexual performance anxiety. A 2020 meta-analysis by Gillman & Gillman in Medical Sciences found that CBT-based interventions produced significant improvements in both ejaculatory latency and sexual satisfaction, with effects persisting at follow-up. Here are the core techniques you can begin practising immediately.

Thought Records

The foundation of CBT is identifying and challenging unhelpful automatic thoughts. A thought record is a structured exercise:

1. Situation: Describe the trigger. "My partner initiated sex."
2. Automatic thought: Write the first thought that appeared. "I'm going to ejaculate too fast and disappoint her."
3. Emotion: Name the feeling and rate its intensity (0-100). "Anxiety — 75/100."
4. Evidence for the thought: What facts support it? "Last time, I ejaculated in 2 minutes."
5. Evidence against the thought: What facts contradict it? "The time before that, I lasted 8 minutes. My partner has told me she enjoys our intimacy regardless of duration. I have been training and am stronger than before."
6. Balanced thought: Rewrite the thought more accurately. "Sometimes I ejaculate quickly and sometimes I don't. Duration is improving with training. My partner values our connection more than any specific metric."
7. Re-rate emotion: "Anxiety — 40/100."

This is not positive thinking or self-deception. It is correcting the cognitive distortions that anxiety creates. Over time and with repetition, the balanced perspective becomes your default response rather than the catastrophic one.

Behavioural Experiments

Performance anxiety thrives on avoidance. The less you expose yourself to the feared situation, the more threatening it feels. Behavioural experiments involve deliberately testing your anxious predictions against reality.

For example, if your anxious thought is "If I ejaculate quickly, my partner will be angry and reject me," the experiment might be: have a sexual encounter without trying to control duration, and observe what actually happens. In the vast majority of cases, the feared catastrophe does not occur — your partner responds with understanding, not rejection. This experiential evidence is far more powerful than any rational argument.

Cognitive Defusion

Borrowed from Acceptance and Commitment Therapy (ACT), cognitive defusion involves changing your relationship with anxious thoughts rather than trying to change the thoughts themselves. The key insight: a thought is just a thought. It is not a fact, a prediction, or an instruction.

Practical techniques include:

• Labelling: When an anxious thought appears, say to yourself: "I notice I'm having the thought that I'll ejaculate too fast." The phrase "I notice I'm having the thought" creates distance between you and the thought.
• Thanking your mind: "Thank you, mind, for that prediction. I'll handle what actually happens." This acknowledges the thought without engaging with it.
• Silly voice: Repeat the anxious thought in a cartoon character's voice. This sounds absurd, but research by Masuda et al. (2010) in Behaviour Modification demonstrated that it significantly reduces the emotional impact and believability of negative thoughts.

6. Breathing Exercises for the Bedroom

Breathing is the single most accessible tool for shifting from sympathetic (fight-or-flight) to parasympathetic (rest-and-digest) nervous system dominance. Unlike CBT techniques, which work on the cognitive level, breathing exercises work directly on your physiology — they change your body's stress response in real time.

Extended Exhale Breathing

The science here is straightforward: inhalation activates the sympathetic nervous system slightly, while exhalation activates the parasympathetic system via the vagus nerve. By making your exhale longer than your inhale, you tip the balance toward calm.

The 4-6 Pattern: Inhale through your nose for 4 seconds. Exhale through your mouth for 6 seconds. This simple ratio has been shown in multiple studies to reduce heart rate, lower cortisol, and promote parasympathetic dominance within 2-3 minutes of practice (Zaccaro et al., 2018, in Frontiers in Human Neuroscience).

How to use it during sex: Whenever you notice anxiety rising or arousal escalating too quickly, shift to this breathing pattern. You do not need to stop what you are doing — just consciously slow and deepen your breathing. The physiological shift begins within 30 seconds.

Box Breathing for High Anxiety Moments

When anxiety is intense — perhaps in the moments before intimacy begins or during a pause — box breathing provides a more powerful intervention:

• Inhale for 4 seconds
• Hold for 4 seconds
• Exhale for 4 seconds
• Hold for 4 seconds

The breath holds amplify the parasympathetic signal. This technique is used by military special forces for managing acute stress, and it translates directly to the bedroom. Two to three cycles are usually enough to noticeably reduce anxiety.

Pre-Sex Breathing Routine

Rather than entering a sexual encounter with anxiety already building, establish a brief breathing ritual beforehand. Spend 3-5 minutes doing extended exhale breathing before intimacy. This pre-sets your nervous system to parasympathetic mode, giving you a calm baseline from which to begin rather than starting from an anxious state and trying to calm down.

If a pre-sex breathing routine feels awkward, integrate it naturally: take a warm shower together while practising slow breathing, or spend a few minutes in physical contact (cuddling, kissing) while consciously breathing slowly. The ritual does not need to look clinical.

7. Mindfulness and Body Awareness

Mindfulness — the practice of paying attention to the present moment without judgement — has emerged as one of the most effective tools for sexual performance anxiety. A landmark 2017 study by Bossio et al. in Sexual Medicine found that mindfulness-based interventions significantly improved sexual function, satisfaction, and distress in men with sexual difficulties.

Why Mindfulness Works for Sexual Anxiety

Performance anxiety pulls you out of the present moment and into your head. Instead of experiencing sensation, you are monitoring performance. Instead of connecting with your partner, you are running an internal commentary: "How am I doing? How long has it been? Am I going to last?" This self-referential processing — what psychologists call "spectatoring" — was identified by Masters and Johnson in the 1970s as a primary driver of sexual dysfunction.

Mindfulness directly counters spectatoring by training your attention to stay with sensory experience rather than drifting to evaluative thoughts. It does not eliminate anxious thoughts — it changes how you respond to them. Instead of being hijacked by "I'm going to ejaculate too fast," you notice the thought, let it pass, and return your attention to what you are actually feeling in your body.

Sensate Focus: The Gold Standard

Sensate focus, developed by Masters and Johnson, is a structured mindfulness exercise for couples. It involves a series of touching exercises with progressively increasing intimacy, performed with the explicit rule that orgasm is not the goal. The exercises proceed in stages:

1. Non-genital touching: Partners take turns touching each other's bodies, avoiding genitals and breasts. The "toucher" focuses on the sensation in their own hands; the "receiver" focuses on the sensation of being touched.
2. Genital inclusion: The same exercise, now including genital and breast areas, but still with no goal of arousal or orgasm.
3. Mutual touching: Both partners touch simultaneously, maintaining sensory focus.
4. Containment: Genital contact without movement or thrusting, focusing purely on the sensation of contact.
5. Gradual movement: Slow, mindful sexual activity with the agreement that either partner can pause at any time.

Research by Weiner & Avery-Clark (2017) confirmed that sensate focus exercises significantly reduce performance anxiety by decoupling sexual activity from performance evaluation. By explicitly removing the "goal" of orgasm, the entire threat framework dissolves.

Solo Mindfulness Practice

You do not need a partner to develop sexual mindfulness. During solo arousal, practise bringing your full attention to physical sensation. Notice temperature, pressure, texture, rhythm. When your mind drifts to evaluative thoughts or fantasies, gently redirect it to direct sensory experience. This builds the attentional skill that you will use during partnered sex.

Formal mindfulness meditation (even 10 minutes daily) also improves the general attentional control that supports sexual mindfulness. Research by Jha et al. (2007) in Cognitive, Affective, & Behavioral Neuroscience demonstrated that just 8 weeks of mindfulness meditation produced measurable improvements in the ability to direct and sustain attention.

8. Reframing Your Thoughts

Cognitive reframing is the art of looking at the same situation through a different, more accurate lens. Performance anxiety is fuelled by specific thought patterns that distort reality. Learning to identify and correct these patterns is one of the most powerful long-term strategies for sexual confidence.

Common Distortions and Their Corrections

"I need to last at least 20-30 minutes." This is one of the most damaging beliefs men carry about sexual performance. The largest multinational study of intravaginal ejaculatory latency time (Waldinger et al., 2005, published in the Journal of Sexual Medicine) found that the median IELT across 500 couples from five countries was 5.4 minutes. Additionally, research by Miller & Byers (2004) found that women's reported "ideal" duration for intercourse was 7-13 minutes — far shorter than the pornography-influenced standard many men hold themselves to. Reframe: "Normal, satisfying sex lasts far less time than I assumed."

"My partner is judging me the whole time." Research consistently shows that men dramatically overestimate how much their partners care about duration. A 2008 study published in the Canadian Journal of Human Sexuality found that the majority of women rated emotional connection, foreplay, and attentiveness as more important than penetration duration. Reframe: "My partner values our connection, not a stopwatch."

"If I ejaculate quickly, I'm not a real man." This conflation of ejaculatory latency with masculinity has no basis in biology, psychology, or logic. PE affects men of all backgrounds, fitness levels, and personality types. It is a physiological pattern, not a character assessment. Reframe: "Ejaculatory timing is a skill I'm developing, not a measure of my worth."

"I'll never get better." This is catastrophising at its most destructive. The clinical literature is unambiguous: the vast majority of men who follow structured training programmes see significant improvement. The Pastore et al. (2014) study showed 82.5% success rates. CBT trials consistently show 60-80% improvement rates. Reframe: "This is a trainable condition, and I'm actively training."

The Growth Mindset Shift

Psychologist Carol Dweck's research on mindset applies directly to sexual performance. A fixed mindset says: "I have PE. This is who I am." A growth mindset says: "I'm developing ejaculatory control. This is where I am in my training." The difference is not semantic — it fundamentally changes your emotional response to setbacks. A fixed mindset interprets a bad encounter as confirmation of permanent inadequacy. A growth mindset interprets it as data — information about what to work on next.

9. Building Confidence Gradually

Sexual confidence is not something you decide to have — it is something you build through repeated positive experiences. The key word is "repeated." One good encounter does not cure performance anxiety, just as one bad encounter did not create it. What matters is accumulating a new body of evidence that gradually overwrites the old anxious narrative.

The Exposure Hierarchy

Borrowing from the treatment of phobias, an exposure hierarchy ranks sexual situations from least to most anxiety-provoking, and you work through them systematically, starting with the easiest:

1. Level 1: Solo arousal with mindful breathing and no performance pressure
2. Level 2: Non-sexual physical contact with a partner (cuddling, massage)
3. Level 3: Sensate focus — non-genital touching with explicit no-orgasm rule
4. Level 4: Sensate focus — including genital touching, still no orgasm goal
5. Level 5: Manual stimulation from partner with stop-start technique
6. Level 6: Oral stimulation with stop-start technique
7. Level 7: Penetrative sex with frequent pauses and open communication
8. Level 8: Penetrative sex with natural flow, using breathing and pelvic floor techniques as needed

The rule is: stay at each level until the anxiety rating drops below 20/100 before moving to the next level. Do not rush. Each successful experience at a given level deposits "evidence" into your psychological bank account that sex can be enjoyable and anxiety-free. This evidence eventually outweighs the old anxious memories.

Communication with Your Partner

If you have a partner, communication is not optional — it is essential. Research by Byers (2011) in The Canadian Journal of Human Sexuality found that sexual communication quality was the single strongest predictor of sexual satisfaction in couples. Specifically:

• Name the issue: "I experience performance anxiety sometimes, and I'm working on it." Simply saying this out loud reduces its power.
• Explain what helps: "It helps when we take things slowly and I can pause when I need to."
• Remove the performance frame: "Let's focus on enjoying the experience rather than any specific outcome."
• Welcome feedback: "Tell me what feels good for you" shifts the focus from self-monitoring to partner responsiveness.

Most partners respond with support and relief — relief because they may have been sensing your anxiety and wondering if it was about them. Open communication transforms sex from a solo performance into a collaborative experience, which is inherently less anxiety-provoking.

Celebrate Small Wins

Confidence builds on evidence of progress, not on perfection. Track your wins, however small: "I used breathing to calm down before sex." "I paused when I needed to without panicking." "I had an anxious thought and let it pass without it derailing me." "I lasted 30 seconds longer than last time." Each of these is genuine progress, and acknowledging them trains your brain to look for evidence of improvement rather than evidence of failure.

10. When to Seek Professional Help

Self-directed strategies are effective for many men, but there are situations where professional support is the right choice. Seeking help is not a sign of failure — it is an indication that you are taking the issue seriously and using all available resources.

Consider Professional Help If:

• Self-directed techniques have not produced improvement after 8-12 weeks of consistent practice. If you have been diligent with breathing, CBT exercises, and pelvic floor training for 2-3 months without meaningful progress, a professional can help identify what is being missed.
• Performance anxiety is accompanied by depression or generalised anxiety disorder. If anxiety or low mood significantly affect your daily life beyond the bedroom, the sexual component may be part of a broader pattern that benefits from professional treatment.
• You are avoiding sexual relationships or intimacy entirely. Avoidance behaviour strengthens anxiety over time. If you have reached the point of avoiding relationships or sexual opportunities, a therapist specialising in sexual health can help you re-engage safely.
• There is a history of sexual trauma. Trauma-related sexual difficulties require specialised, trauma-informed treatment. Self-directed strategies alone are typically insufficient in these cases.
• You suspect a physical contributing factor. If you experience erectile difficulties, pain, or other physical symptoms, consult a urologist or sexual health physician to rule out medical causes.

Types of Professional Support

Sex therapists: Licensed therapists who specialise in sexual health. They use CBT, sensate focus, and other evidence-based approaches in a structured therapeutic context. The American Association of Sexuality Educators, Counselors and Therapists (AASECT) maintains a directory of certified professionals.

Psychologists or psychotherapists: Particularly useful when performance anxiety is linked to broader anxiety, depression, or relationship issues. Look for practitioners experienced in CBT or ACT approaches to sexual dysfunction.

Pelvic floor physiotherapists: Specialists in pelvic floor assessment and rehabilitation. They can assess your pelvic floor with biofeedback technology, identify hypertonicity or weakness, and design a personalised training programme. This is particularly valuable if self-guided kegel exercises are not producing expected results.

Couples therapists: When relationship dynamics are a significant contributing factor, working with a couples therapist can address the systemic issues that maintain performance anxiety.

What About Medication?

SSRIs (selective serotonin reuptake inhibitors) are sometimes prescribed off-label for PE, and they can be effective as a short-term bridge while behavioural skills are being developed. However, they carry side effects (nausea, fatigue, reduced libido, emotional blunting) and do not teach any lasting skills — once discontinued, the underlying pattern typically returns. A combined approach (medication for short-term relief while developing long-term behavioural skills) has the strongest evidence base, according to a 2019 systematic review by Porst & Burri in Sexual Medicine Reviews.

References

• Althof, S. E., & McMahon, C. G. (2016). Contemporary management of disorders of male orgasm and ejaculation. Translational Andrology and Urology, 5(4), 455-476.
• Bancroft, J., & Janssen, E. (2000). The dual control model of male sexual response. Neuroscience & Biobehavioral Reviews, 24(5), 571-579.
• Bossio, J. A., et al. (2017). Mindfulness-based group therapy for men with situational erectile dysfunction. Sexual Medicine, 5(4), e245-e253.
• Byers, E. S. (2011). Beyond the birds and the bees and was it good for you? Canadian Journal of Human Sexuality, 20(3), 69-77.
• Dwulit, A. D., & Rzymski, P. (2019). The potential associations of pornography use with sexual dysfunctions. Journal of Clinical Medicine, 8(7), 914.
• Gillman, N., & Gillman, M. (2020). Premature ejaculation: aetiology and treatment strategies. Medical Sciences, 8(4), 52.
• Jha, A. P., et al. (2007). Mindfulness training modifies subsystems of attention. Cognitive, Affective, & Behavioral Neuroscience, 7(2), 109-119.
• Lennartsson, A. K., et al. (2013). Low levels of diurnal salivary cortisol are associated with symptoms of depression. Psychoneuroendocrinology, 38(7), 1220-1228.
• Masuda, A., et al. (2010). The effects of cognitive defusion and thought distraction on emotional discomfort and believability of negative self-referential thoughts. Behaviour Modification, 34(6), 476-507.
• McCabe, M. P., et al. (2010). Risk factors for sexual dysfunction among women and men. Journal of Sexual Medicine, 7(1), 219-227.
• Miller, S. A., & Byers, E. S. (2004). Actual and desired duration of foreplay and intercourse. Journal of Sex Research, 41(3), 301-309.
• Pastore, A. L., et al. (2014). Pelvic floor muscle rehabilitation for patients with lifelong premature ejaculation. Therapeutic Advances in Urology, 6(3), 83-88.
• Porst, H., & Burri, A. (2019). Novel treatment for premature ejaculation in the light of currently used therapies. Sexual Medicine Reviews, 7(1), 129-140.
• Rowland, D. L., & Cooper, S. E. (2011). Practical tips for sexual counseling and psychotherapy in premature ejaculation. Journal of Sexual Medicine, 8(s4), 342-352.
• Rowland, D. L., et al. (2010). Psychophysiological interaction patterns in premature ejaculation. Archives of Sexual Behavior, 39(5), 1108-1117.
• Waldinger, M. D., et al. (2005). A multinational population survey of intravaginal ejaculation latency time. Journal of Sexual Medicine, 2(4), 492-497.
• Weiner, L., & Avery-Clark, C. (2017). Sensate focus in sex therapy: the illustrated manual. Routledge.
• Zaccaro, A., et al. (2018). How breath-control can change your life: a systematic review on psycho-physiological correlates of slow breathing. Frontiers in Human Neuroscience, 12, 353.

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