Men’s sexual health & mental health

Work, money and family pressure can leave little room for desire. In a 2023 survey, 83% of U.S. men said they had felt stress in the past six months.

If sex has dropped off during a hard season, that’s often your body asking for rest, not a sign something is broken.

Losing interest in things you used to enjoy is a common part of depression, and sex is often one of them. The NHS lists stress, anxiety and depression among the main causes of low sex drive.

One difficult night can lead to worry about the next. That worry triggers the stress response, which makes erections or timing harder, which adds to the worry. Cleveland Clinic names performance anxiety as a common cause of finishing too soon.

Low self-esteem, low confidence and negative body image are listed as emotional factors that can cause or worsen erection problems.

Past sexual abuse and relationship problems are among the psychological causes of sexual difficulties that Cleveland Clinic lists.

Mental health and emotional issues can either cause ED or make it worse. These include anxiety, depression, stress, feeling isolated or lonely, and low confidence.

Depending on the cause, you may still get erections at other times, such as when you wake up. The NHS says counselling can help when erection problems are linked to emotional or mental health problems.

ED is linked to heart and blood vessel diseases, including hardened arteries, high blood pressure and stroke. Diabetes and carrying extra weight also raise the risk.

Heavy drinking, smoking, illegal drug use and not getting enough physical activity can all contribute to ED.

In a 2023 survey, 56% of men said they knew their drinking could affect their sexual health.

Some treatments for blood pressure, mood and other health conditions can affect erections or desire. Please don’t stop or change anything on your own.

Psychological causes Cleveland Clinic lists

• Depressive thoughts, like guilt or feeling overwhelmed
• Low self-esteem or body image worries
• Performance anxiety, like nerves with a new partner or after a long break
• Relationship problems
• Stress from work, relationships or life changes

Most causes are first treated with behavioral techniques and counselling. These include the start-and-stop method, where you pause stimulation before you get too close, and shifting your attention to something neutral for a moment.

Cleveland Clinic says behavioral therapy and methods to delay finishing tend to be the most helpful, and that combining approaches may work better than one alone.

For psychological or relationship causes, Cleveland Clinic suggests seeing a psychologist, psychiatrist or sex therapist. A urologist can also refer you.

Unspoken conflict, feeling unappreciated or drifting apart can all lower desire. The NHS suggests relationship counselling when this is part of the picture.

Treating the cause should help desire return, the NHS says. For depression, that can include talking therapies like CBT.

Hormone levels drop slowly with age, and conditions like heart disease, diabetes, an underactive thyroid or cancer can lower desire.

Testosterone plays a part in sex drive and erections. It falls slowly with age, about 1% a year from your late 30s. Low levels can bring low desire, fewer morning erections, low mood and less energy.

Carrying extra weight, diabetes, sleep apnea, heavy drinking and illness can all lower testosterone. Poor sleep matters too: in one small study, young men who slept 5 hours a night for a week had 10% to 15% lower testosterone.

Ads and online clinics often blame tiredness and low drive on “low T”. But stress, depression and relationship strain cause many of the same changes. Checking properly takes symptoms plus repeated morning blood tests.

Neither person is “wrong”. Talking about what closeness means to each of you, beyond sex, can take pressure off and make room for both.

Bodies respond to tiredness, stress, alcohol, mood and how safe and close you feel. A night when your body doesn’t respond is not a verdict on your manhood.

Porn is edited and staged. Comparing your body, stamina or partner to it can leave you feeling inadequate. Real sex includes awkward moments, laughter and talking.

If porn use feels hard to control, is affecting your relationship, or you feel shame afterwards, a therapist can help without judgement.

Touch, kissing, closeness and pleasure don’t depend on an erection. When couples focus on connection rather than a “goal”, anxiety often eases, and that can help the body respond.

In a 2023 survey, about 2 in 5 men with sexual problems had sought professional help, and 65% of men who had trouble with sex said it left them frustrated.

Pick a relaxed time, like a walk or a drive, when neither of you feels rushed. Talking side by side can feel easier than face to face.

• “It’s not you. I’ve been stressed and it’s showing up in bed.”
• “I’ve been embarrassed to talk about this, but I want us to figure it out together.”
• “Can we take sex off the table for a bit and just be close?”
• “I’m going to see my doctor about it. Would you come with me?”

Things that help

• Avoid jokes or blame, even light ones
• Encourage a checkup gently, without making it an ultimatum
• Keep showing affection outside of sex
• Let him know it doesn’t change how you see him

A doctor or nurse may ask about your lifestyle and relationships, check your blood pressure, and do a short physical exam to rule out obvious physical causes. This helps work out whether the cause is mainly physical, mainly emotional, or both.

A urologist focuses on the physical side, while a psychologist or sex therapist can help with anxiety, relationship strain and the worry loop. Many men benefit from both.

Almost half of U.S. men (44%) in a 2023 survey said they don’t get a yearly physical.

The CDC advises that sexually active gay, bisexual and other men who have sex with men test for HIV, syphilis, chlamydia and gonorrhea at least once a year, and more often (every 3 to 6 months) with multiple or anonymous partners.

The CDC also advises everyone aged 13 to 64 to test for HIV at least once.

Hiding parts of yourself, or carrying shame from family, faith or culture, can make it harder to relax and feel close. This is not a personal failing. It’s a response to a hard environment.

Trans men may have specific sexual health needs and feelings about their body during sex. It’s okay to tell a provider the words you use for your body, and to look for clinics with experience in trans health.

About 1 in 8 U.S. men will be diagnosed with prostate cancer in their lifetime.

The National Cancer Institute explains that surgery or radiation near the pelvis can affect erections, and some cancer treatments can lower desire. Speaking up about these changes can lead to treatment and support.

Heart disease, diabetes and other long-term conditions can affect erections and desire.

Living with a long-term condition can also bring grief, frustration and worry, which affect sex too. Both sides are worth raising with your care team.

The National Cancer Institute suggests sharing your feelings with people you’re close to, asking your nurse or social worker about counsellors, and joining a professionally led support group.

Men going through fertility problems may feel grief, shame or pressure, and sex can start to feel like a task. Talking about it, as a couple and with a counsellor, can help.