perform

verb

per·​form | \ pər-ˈfȯrm  , pə- \

performed; performing; performs

Definition of perform

3a: to do in a formal manner or according to prescribed ritual

b: to give a rendition of : PRESENT

intransitive verb

1: to carry out an action or pattern of behavior : ACT, FUNCTION

2: to give a performance : PLAY

 

I’ve been thinking about the word “performance” a lot lately. My patients, mostly the men, talk about it like this:

• “I can’t perform sexually anymore.”
• “My performance isn’t what it used to be.”
• “What if I meet someone and I can’t perform?”

Why is sexual activity described this way? A performance suggests an audience; perhaps one’s partner is the audience, but is that person actually watching? Or are they part of the action, a fellow actor, involved in their own “performance”? Is there a critic in the theater, someone sitting silently, perhaps in the loges, taking notes surreptitiously illuminated by a small flashlight, quietly apologizing to those seated nearby? Are the actors aware that someone is judging their every utterance and the quality of their movements across the stage? Will they wait to read the reviews the next morning over coffee and toast?

Does this “performance” apply a certain pressure that results in anxiety, the aptly named “performance anxiety”? The occurrence of this is cited in the medical and psychological literature and discussed over and over in therapists’ offices. Sexual dysfunctions including erectile problems and the inability to experience orgasm often are related to performance anxiety, and not only in men. Masters and Johnson described the phenomenon of “spectatoring” in which individuals, often but not exclusively women, focus on aspects of themselves during sexual activity, and this interferes with their own pleasure. Performance anxiety is said to occur in up to 25% of men and 16% of women.¹ Treatments range from cognitive behavioral therapy and mindfulness training to serotonergic anxiolytics, nitric acid boosters, and a range of herbal products. But is performance anxiety something that needs to be treated—or should we rather reframe the notion that sex is a performance?

Perhaps we should start by changing our ideas about what sex is.  Some prefer the term “making love”—but what if there’s no love involved? Is a one-night stand with a stranger making love or is it novel and exciting sex? Is coerced sex making love? Is the term “having sex” too plain, lacking in romance and mystery? And do these terms apply strictly to penetrative sex?

There are many other terms used to describe sexual activity, many of them euphemisms I hear all too frequently from patients and strangers alike. “Intimacy” is a common one, and so often a patient tells me that they are “having problems with their intimacy”—and yet their emotional connection to their partner, the true meaning of the word, is strong, perhaps even stronger after their treatment for cancer. I explain that if they are having a sexual problem and they are able to tell me exactly what is happening, then I can help them.

Is our understanding of what sex is limited by our vocabulary or by the “coital imperative” described so well by Jane Ussher?² If we see sex as only that which involves penetration, then we are so much poorer because of our limited understanding of the rich sensual world that exists outside of intercourse. This is a challenge for the couples that I see in my practice, many of whom cannot “perform” after pelvic surgery or radiation, or because of the side effects of cancer therapies. From a bio-medical perspective, penetrative intercourse is seen as “normal” and anything else as merely “foreplay,” activities that prepare one for the “ultimate” goal of intercourse. This happens in my office every day; women who cannot tolerate penetration describe themselves as “broken” and are looking for a way to repair the damage from treatment so that they can engage in “real” sex. Men who are unable to achieve or maintain an erection want to do whatever they can, including invasive methods, to once again be able to function “normally.”

Normal sexual function is a vast range of experiences. My role as a sexuality counselor is to encourage the people I see in my practice to look beyond what used to be and to move forward to a new way of being sexual, alone or with their partner. No matter what you call it, sex, however it happens, is not a performance.

References

1. Pyke RE. Sexual Performance Anxiety. Sex Med Rev. 2020;8:183-90.
2. Ussher JM, Perz J, Gilbert E, et al. Renegotiating sex and intimacy after cancer: resisting the coital imperative. Cancer Nurs. 2013;36:454-62.