Introduction
When sexual difficulties occur, many men experience deep self-doubt, shame, or embarrassment. Yet male sexual dysfunction is not unusual—it affects men of every age and background. From erectile difficulties and premature ejaculation to reduced libido, these concerns can impact wellbeing, relationships, and self-esteem.
The truth: You are not alone. A wealth of academic research, as well as countless therapy clients’ stories, confirms that male sexual issues are neither inevitable nor untreatable. In fact, most men who seek support see dramatic improvement. This article unpacks the causes, reviews evidence-based solutions, and—most importantly—invites you to replace self-judgment with self-compassion.
What is Male Sexual Dysfunction?
The term male sexual dysfunction covers a range of persistent challenges with sexual activity or satisfaction, including:
- Erectile Dysfunction (ED): Difficulty attaining or maintaining an erection firm enough for penetration.
- Premature Ejaculation (PE): Ejaculation happening sooner than the person or their partner would like, often within 1-2 minutes of penetration.
- Delayed Ejaculation: Difficulty or inability to ejaculate despite stimulation.
- Low Libido: Little or no interest in sexual activity.
These issues are only labelled as “dysfunction” when they occur frequently, persist over three months, and cause significant distress or relationship difficulty (DSM-5, APA, 2013).
UK Prevalence
According to the NHS (2023) and data from Natsal-3, up to 20% of UK men report issues with sexual functioning each year, with ED and PE the most common (Mitchell et al, 2013). Yet most never seek help, fearing judgement or dismissal.
Biological Causes: Separating Fact from Fiction
Sexual function is influenced by a delicate mix of physical and psychological factors—it is rarely “just in the mind,” but also not strictly a matter of physical health.
Physical Contributors:
- Cardiovascular disease (reduced blood flow)
- Diabetes (nerve/vessel damage)
- Hormonal changes (testosterone, thyroid)
- Side effects of medications (antidepressants, blood pressure drugs)
- Chronic illness or surgery
- Lifestyle: smoking, excessive alcohol, obesity, lack of exercise
Key Study:
A meta-analysis in the British Journal of Urology International (Yafi et al., 2016) found that ED often signals early heart disease, and early medical intervention can improve both sexual and overall health outcomes.
Psychological and Relational Causes
It’s normal for emotional factors to impact sexual function:
- Performance Anxiety: The most common trigger in men under 40. Worrying about sexual performance can lead to a “self-fulfilling prophecy” of arousal or orgasmic difficulties (see previous article for more).
- Relationship Stress: Poor communication or unresolved conflict can decrease desire and increase anxiety.
- Low Self-Esteem: Body image, past trauma, or cultural messages about masculinity may all have an influence.
- Depression or Anxiety: Mental health struggles are closely related to reduced libido and arousal issues (NICE, 2021).
Therapists consistently find that addressing psychological contributors can be just as effective as medical treatments for many men.
Busting Stigma: You Are Not Alone
A pervasive myth is that “real men” never struggle sexually, yet the reality is just the opposite. A study by Corona et al. (2013) found:
- 1 in 3 men over 40 experience ED at least once
- PE is reported by nearly 1 in 5 men at some stage
- Most men who experience these problems report a significant impact on their self-image and happiness
Open, honest conversations are the antidote to shame—and therapy is a proven and safe starting point.
Actionable Tips: Lifestyle, Mind, and Relationships
1. Prioritise Physical Health
As simple as it sounds, general health strongly impacts sexual function:
- Exercise regularly: Even brisk walking improves blood flow and testosterone.
- Eat a balanced diet: Mediterranean-style diets support vascular health.
- Moderate alcohol: High intake negatively affects performance.
- Stop smoking: Quitting greatly benefits sexual and cardiovascular health.
- Manage chronic health conditions: Follow up with your GP for diabetes, high blood pressure, or medications that may affect sexual function.
Reference: English Longitudinal Study of Ageing, 2017.
2. Practice Self-Compassion
Self-criticism only reinforces anxiety and avoidance. Shift your inner dialogue:
- Remind yourself, “Sexual problems are part of being human. This does not define my worth.”
- Treat yourself as you would a dear friend.
- Engage in activities that reaffirm your sense of pleasure, connection, and success outside the bedroom.
Compassion-based approaches have shown to boost sexual satisfaction and reduce performance anxiety (Laurent et al., 2017).
3. Open Up to Your Partner
Research suggests that open, non-blaming conversation improves outcomes for men with sexual dysfunction (NHS, 2023):
“I’m feeling a bit anxious about sex at the moment—not because of you, but because I really want to feel close. Can we take things slow and focus on connection?”
Let go of silent suffering—mutual understanding lays the groundwork for change.
4. Explore Sensate Focus
Sensate Focus, developed by Masters and Johnson and widely used in sex therapy, is a stepwise, non-penetrative touch exercise for couples:
- Agree to avoid intercourse, focusing instead on gentle touching, cuddling, or massage.
- Attend to sensations, not performance.
- Gradually reintroduce arousal as comfort builds.
Many therapists teach and guide this process—see BACP or COSRT-accredited practitioners.
5. Try Mindfulness
Mindfulness helps quiet the inner critic, reduces “spectatoring”, and increases presence. The evidence (Brotto et al., 2012) supports regular, brief practices as beneficial for sexual wellbeing.
Example:
- Take 5 deep breaths before intimacy.
- Notice sensations in your body without judgement.
- If anxiety builds, gently refocus to touch or breath.
When to Seek Therapy
You should consider professional support if:
- Problems persist for more than three months
- It is causing emotional distress or relationship tension
- You notice avoidance or “shutting down”
- Self-help strategies have not led to improvement
UK therapists with special training in psychosexual therapy (BACP, COSRT) are well-versed in both the psychological and relational elements of male sexual dysfunction.
What Happens in Therapy?
- History-taking: Your therapist may ask about your life, relationships, health, beliefs, and sexual experiences—but only at your pace.
- Education: Learning about the sexual response cycle, normal ageing, and debunking myths.
- Cognitive-behavioural techniques: Changing negative thought habits and anxiety patterns.
- Couple support: Therapy can include your partner if you wish.
- Liaison with Medical Providers: Therapists may refer you (with your permission) to your GP if physical causes need reviewing.
Therapy is never about blame, but about rediscovering what’s possible.
Real Stories: Hope and Healing
James, 47:
After heart surgery, James feared he could no longer enjoy intimacy. Therapy helped him adjust expectations and activities, leading to intimacy that felt as meaningful and connected as ever.
Aaron, 31:
Aaron struggled with PE linked to work stress. Through a combination of mindfulness, communication, and brief couple’s therapy, he gained confidence and satisfaction returned—for both him and his partner.
Further Resources
Books:
- Overcoming Sexual Problems by Vicki Ford and Michael Balint
- Mindful Sex by Dr. Lori Brotto
Conclusion
Every man faces sexual difficulties at some point. Some pass quickly; others linger. But with self-kindness, practical changes, and perhaps therapy, healing is always possible. You are not your diagnosis. Your value is not measured by performance. Seek support—you deserve pleasure, connection, and dignity.
References
- APA. (2013). Diagnostic and Statistical Manual, 5th Edition.
- Mitchell, K. et al. (2013). Sexual function in Britain: Natsal-3. The Lancet.
- NHS. (2023). Sexual problems in men.
- NICE. (2021). Sexual dysfunction: Summary.
- Yafi, F. et al. (2016). Erectile dysfunction. BJU International.
- Laurent, S. et al. (2017). Compassion focus and sexual well-being. BMJ Open.
- Brotto, L. et al. (2012). Mindfulness interventions for sexual dysfunction. Archives of Sexual Behavior.
- Corona, G. et al. (2013). Male sexual dysfunction association with age and comorbidities. The Journal of Sexual Medicine.
