How do negative thoughts effect your erections? Just as we are not always conscious of the way we walk or how we drive a car, we are often not aware of our thinking. Some of our thinking is so habitual that it is automatic, and just like driving, when things are automatic, we might not be conscious of them. Negative thoughts perpetuate performance anxiety and therefore sexual dysfunction. It has been researched that men with Erectile Dysfunction present negative automatic thoughts during sexual activities. These thoughts tend to be; “I am not achieving an erection”, “I am not able to keep an erection”. Alongside the fixation of the possibility of disappointing their partner and thoughts around shame. Finally; fear and anxiety about penis size and body image can also play a role in performance anxiety. Capturing and documenting negative thoughts is a great way to start looking at what is happening to you sexually.