Why Do Men Experience Sexual Problems, and What Can Be Done About It?

When we talk about basic human needs—such as safety and food—we often forget about one more need: the need for sex. And satisfying this need in a meaningful way is, among other things, an indicator of good psychological and mental health. We’ll talk later about why it’s often difficult to fulfill this need in a fulfilling way.

I would like to start with the fact that sexual problems in men are complex issues. Sometimes a urologist works on them, sometimes a sexologist works on them, sometimes a psychologist works on them. Therefore, to say in this text that sexual problems in men are solved only by a psychologist, I would not turn my tongue. On the other hand, a fairly large layer of problems related to sexuality and sexual behavior in men is still the work of a psychologist. If we are talking about whether a man makes such requests, then here I will destroy the myth that says that "men do not turn to a psychologist" – they do, they treat well. 

Why Is It Hard for Men to Admit to Sexual Problems?

I will even say more, sexual problems in men are quite a large layer of work, especially with men. But this does not happen immediately, because it is very often difficult for a man to accept that he has some problems. This is due to the fact that in our society there is a stereotype that a man is such a male, he should always want, he should not have such problems, he should always be the best. And what happens? Very often, all sexual problems that could be solved with one click, most likely, have to be solved for a long time in therapy. And what I would like to say is the only thing that can be remembered from this article, if everything else falls on deaf ears:

We need to tackle these problems and find solutions to them.

What kinds of sexual problems might there be?

Well, first of all, for men, it's Erectile dysfunction, premature ejaculation, and a loss of interest in sex and other sexual dysfunctions.

Let’s figure out why this is sometimes a job for a psychologist. Well, first of all, if you have any objective problems related to erectile dysfunction, then most likely the process goes like this. First, we go to a doctor to find out if we have any physical urological issues, and if not, then we go to a psychologist. Sometimes the process might be that we receive treatment from a doctor and then still end up seeing a psychologist. Why is that? Because sometimes these sexual problems can be traumatic for us.

Look, if I have erectile dysfunction and have had a few setbacks, I’ll most likely avoid sex because I’ll assume I’ll run into these problems again. If we go back to the idea that there’s this myth that a man must always want sex no matter what, then we’re reinforcing the behavior of avoiding sex. And if I do manage to have sex, what will I most likely strive for? To avoid traumatizing myself, I’ll worry, I’ll be nervous, and I’ll want to do it well or as quickly as possible.

Premature Ejaculation, Coping Strategies, and the Pitfalls of Anxiety

This brings us to the second, most common problem among men: premature ejaculation. But don't rush to see a doctor just yet; I'd like to outline a few criteria:

• Premature ejaculation is when the penis stays in the vagina or anus for less than 1 minute. That is, if you have sexual intercourse lasting less than 1 minute, then you have a problem.
• The inability to control things. This is important. If you know how to keep your composure in the moment, then maybe you don't even need to fight.
• Negative consequences. You’re bound to experience distress, suffering, and so on. There are some couples for whom this isn’t a problem because, for example, one partner didn’t enjoy long sex. Although, more likely than not, that’s a problem too. It’s something you can work through.

It’s important to understand that what matters with premature evacuation is that it’s a systemic issue. If you’ve experienced this symptom just once, what’s the point? This is where the main mechanism behind any physiological problem comes into play: "Don't get in the way, or it'll kill you."

Very often, our elimination is a physiological process. If we interfere with it unnecessarily, we risk disrupting this delicate system.

For example, if a man reads a lot of supplementary material—sometimes of poor quality—about how to hold back or, conversely, how to be more potent in bed, he’ll end up focusing too much on that. As a result, he gets nervous in bed and runs into problems.

I’m not a doctor, but I have to say, you also need to be careful with erectile dysfunction medications because they can make you dependent and reinforce the idea that you can’t function without the pills. In other words, just when you wanted to surprise your partner and show her how great you are, you end up reinforcing the behavior in the long run—that you can’t do without the pills. That’s why you need to be extra careful with these medications as well.

Loss of interest in sex, stress, and traumatic experiences

Another issue people often bring up is loss of interest in sex. And here I’d like to share a case I had recently: a couple came in—everything was perfect, everything was fine—but the only issue was that the man simply wasn’t interested. That is, his sexual function was normal, but he wasn’t interested in sex itself. In that case, the therapy involved diagnosing depression through his sexual behavior, which was fairly well masked by the fact that he went to work, he went to work and stayed active in some way, but this manifested itself as a loss of sexual interest.

Therefore, if you notice a change—a sudden change—in your sexual interest, it could be a symptom of, for example, depression. It’s worth paying attention to this as well.

And I would also describe other sexual functions here. These include, for example, problems with sexual dysfunction—that is, when a person cannot reach orgasm, or when a person lacks sexual desire even though their sexual functions are working properly.

And I’d say that if you’re looking for some kind of one-size-fits-all solution, there isn’t one. Each specific situation calls for specific behavior. And that’s why, in this case, you probably shouldn’t be taking courses or attending training sessions—you should instead try to figure things out for yourself. Why? Because in every specific situation, our sexual behavior was influenced by something.

Let me give you an example. A man was treated for prostatitis in the army. With all due respect to our doctors, she was not the best in the army. And he got a cold in his prostate, he had a rather painful service and a rather painful treatment in the army. And he had such a behavior from there that everything related to the genitals was associated with pain and discomfort. Naturally, when he came from the army, he had problems with sex. Namely, that it was unpleasant for him when someone touched them.  It was fear therapy – we didn't work with fear.

Why do men sometimes have problems with sex? First and foremost, it’s stress and depression. This actually makes sense: evolution has determined that, during times of stress and anxiety, humans should not be focused on procreation. Sexual function is most likely not essential for humans, so the more we live under stress, the less our bodies are generally attuned to a sexual life. If your life is filled with stress, anxiety, and depression, and this manifests as sexual dysfunction, then you need to address issues unrelated to sexual desire; instead, you need to tackle the underlying stress, anxiety, or depression.

Another classic example is psychological trauma and negative experiences. As I was saying, society has some pretty unrealistic expectations of men. I mean, men are portrayed as alpha males there, and if you were to ask a psychologist what the scariest movies imaginable are, I’d say it’s porn. First of all, they create unrealistic expectations in boys about themselves. Naturally, the guys who appear in these videos are physically well-endowed and can last a long time. On the other hand, this creates unrealistic expectations for men regarding their partners. Most likely, an average girl or an average guy, or man or Woman, and it doesn't look like it does in those pornographic movies. So why do I say they're scary?

They can traumatize us and create an experience of high expectations for sex—even though, in real life, sex isn't like it is in the movies. And that reminds me of an old joke where a girl says, “I want sex today, just like in the movies.” So the guy ends up having a BDSM session with her, and at the end, she says, “We must watch different movies.”

And that’s where this joke comes in, by the way, because watching all these kinds of movies creates—and I’m talking about us, like many people—unrealistically high expectations and demands of ourselves and our partners. So what will the therapy involve? The therapy will involve establishing normal, human standards for one’s sex life. Sometimes it even involves sex education, where a man comes to understand that sexual intercourse lasting 5–7 minutes—and I’m referring specifically to the time the penis is inside the vagina—is normal sexual intercourse, and he isn’t experiencing premature ejaculation.

Another problem with psychological trauma is that our—I’d say—boys and men are very susceptible to the stereotypes that exist in society. And you know, it’s the “fisherman’s effect”—when people go fishing, they always claim to have caught more fish than they actually did. And here, most likely, the idea is that when it comes to sex, we sometimes exaggerate, too.

And how does this affect the fact that everyone keeps saying that things are really bad for me, but really good for them? And here, first and foremost—even before seeing a psychologist—I would turn to some good, educational literature on sex.

Sex, Relationships, and Working with a Psychologist

Another issue that can be addressed during a consultation is the relationship between two people. In other words, sex is always about two people. And very often, a lack of sexual interest or problems with sex can point to issues in the relationship itself, not with sex. Maybe I don’t trust this person, or I’m holding a grudge against them. So if you feel that there are sexual issues in your relationship, first take a look at what underlying problems exist between you and try to resolve them.

Sometimes when a man with erectile dysfunction seeks treatment, it ends up leading to couples therapy, because we discover, for example, that his sexual function is perfectly normal and the real issues lie in his relationship with his partner.

What It's Like to Work with a Psychologist—and Why You Shouldn't Be Afraid of It

If you’re choosing a psychologist, first and foremost, make sure to choose one—I won’t be promoting specific approaches right now—but make sure they follow at least scientifically-based approaches, have relevant experience, and prioritize confidentiality. If you don’t trust the person, it will most likely be difficult for you to talk to them. I can say this based on what my colleagues tell me—clients always find it hard to talk about sex and money.

There’s no need to be afraid of working with a psychologist. Sometimes it involves just one or two sessions, which are simply about psychological education. Sometimes it’s a long-term process. If we’re talking about trauma related to past experiences—or even cases I’ve had involving rape—it’s not customary to speak openly about this, but sexual violence against men does exist, and we have to address it as well.

I’d say my perspective is a little clouded here—I only see the worst aspects—but it seems to me that men have a harder time coping with rape than women do, because they can’t open up about it and the subject is taboo.

What should you do with a psychologist? First, once you’ve established a connection and realized that you trust this person, describe what’s happening to you without sugarcoating it. And I’d even advise many people who come in with these kinds of problems to learn how to talk about them. This is usually how it goes during a session. “I’d like to talk to you about ‘this.’” “What exactly do you mean by ‘this’?” And if you call a penis a penis and a vagina a vagina, that’s the very first step toward getting your sex life back on track.

A psychologist can also help you overcome anxiety and depression, guide you toward building healthy sexual relationships, and help you develop skills for emotional regulation and stress management. And if you find a good specialist, sexual problems are, in principle, solvable.

И я бы даже больше сказал, сошлюсь на исследования немцев, где они приводят, что порядка 90% проблемы мужчин в постели связаны все-таки не с функцией или физиологией, они связаны все-таки с психологией. 

In the end, I would like to say that it is very important to turn to a psychologist to solve sexual problems, because sex is your needs at the level, of course, as you think for yourself, but without covering the basic needs, it is hardly possible to build a happy life in which you will want to develop in other areas, for example, work and so on.