What is sexual dysfunction?

It is important to check with your doctor for any physical causes for difficulties in sexual functioning. Sometimes your sexual functioning can be caused by psychological factors. Either way, there will be benefit from engaging with a psychologist to investigate, mitigate or adjust to the impact of sexual functioning.

Delayed ejaculation?

Delayed ejaculation is when you have difficulties reaching orgasm and ejaculating. Ejaculation either takes much longer than desired or does not happen at all. Delayed ejaculation can be a temporary or a lifelong problem. It's normal to experience it from time to time, and is only a problem if it is worrying you or your partner.

Mental health conditions and psychological factors can also be related to delayed ejaculation. These can include:

• anxiety
• depression
• relationship issues
• performance anxiety
• fears of pregnancy or intimacy
• stress

Loss of male libido?

Low libido or low sex drive refers to a lack of interest in sex and sexual desire. Sexual desire often rises and falls over time for no apparent reason. It is very common for people to lose interest in sex (low sex drive or, low libido), from time to time.

What causes low libido?

Low sex drive can be caused by physical and psychological factors. Your libido can rise due to things like relationship pleasures, good health, fitness, holidays and relaxation.

Your libido can fall due to things in your life like relationship problems, the birth of a child, stress, overwork, too much or not enough exercise, or personal issues.

Other things that can impact your sex drive include:

• low levels of the hormone testosterone
• anxiety, depression or fatigue
• being in pain
• some medicines, such as antidepressants, high blood pressure medication and epilepsy medication
• alcohol, smoking or drugs
• some medical conditions like obstructive sleep apnoea or diabetes
• negative sexual experiences and low self esteem
• history of unwanted sexual contact
• trauma or post traumatic stress disorder (PTSD)

What strategies can help improve my sex drive?

If you have low libido (low sex drive) because of stress, personal or relationship issues, it may be helpful to talk to your partner about how you are feeling. Not talking about it can sometimes make sexual issues more difficult.

You may feel uncomfortable talking about sex. Try asking your partner how they feel about your sex life first.

If you lose interest in sex for no apparent reason, and you or your partner are worried about it, talk to your doctor.

Remember there’s more to sex than having intercourse. If your interest in having sex has decreased, you may want to try some more sensual methods of becoming aroused. These include:

• exploring and caressing each other’s bodies
• taking a bath or shower together
• having a massage
• kissing each other slowly and in sensual places (such as the thigh)
• undressing each other
• experimenting with different sexual techniques alone or with other

Erectile dysfunction

Erectile dysfunction means not being able to obtain or keep an erection sufficient for sexual intercourse. Many people have erectile dysfunction at some time in their lives. It can come and go.

Erection problems affect around 2 in every 3 males over the age of 45 years. More than 1 in every 10 males cannot have erections. The problem is more common if you are older.

Erectile dysfunction is also known as ED or impotence.

Psychological factors that can cause erectile dysfunction include:

• unresolved problems, conflicts or issues within a sexual and emotional relationship
• anxiety about sexual performance (this is most common at the start of a new relationship, especially if you have had previous problems with sexual performance)
• stress
• mental health conditions such as depression or anxiety

Premature ejaculation

Premature ejaculation is when you have trouble controlling when you orgasm, and it happens too fast.

Premature ejaculation is the most common sexual problem to affect males. Many people ejaculate prematurely, or 'come too early', at some point in their lives.

There is no fixed time that you take to ejaculate. Premature ejaculation is normally considered when you ejaculate within one minute of your penis entering your partner. Premature ejaculation can also happen during foreplay, or when you are trying to insert your penis during sex.

If premature ejaculation happens occasionally, that's usually not a worry. But if you regularly come earlier than you would like, then it is an issue to think about.

Some people have premature ejaculation all their life, and some develop it. Premature ejaculation can happen at any age, but it's more common in younger males. This is because ejaculation tends to take longer as you get older.

Sometimes premature ejaculation is a lifelong problem that starts the first time you have sex. This may be due to:

• abnormal hormone levels
• genetic causes that affect the signalling between nerves

Premature ejaculation can also develop after a period of normal ejaculation. It's usually due to another problem like:

• performance anxiety
• generalised anxiety
• stress
• erectile dysfunction — about 1 in 3 people with premature ejaculation also have erectile dysfunction
• psychological or relationship problems

Alcohol and drug abuse can make premature ejaculation worse.

Counselling can help you identify any underlying psychological, sexual or relationship issues. It can also help improve other problems related to premature ejaculation, such as anxiety.

What is stress?

Stress is a common and normal physical response to challenging or new situations. Stress has both mental and physical aspects. When you are stressed, your body releases stress hormones such as adrenaline. This brings on physical changes in your body, which help you respond to the stressful situation.

While everyone will feel stress at times, each person’s experience will be different. Knowing what makes you stressed and how you respond to different challenges in life will help you manage stressful periods.

The body’s stress response, also called the ‘fight or flight’ response, is a helpful way your body has adapted to respond to danger. When you experience episodes of stress you need the stress hormones your body releases to keep you alert and able to face challenges.

Stress becomes a problem when it lasts a long time, or if you feel overwhelmed and unable to cope with your situation. When this happens, it is time to take steps to manage your stress to ensure that you are able to function well at work and at home.

The point where stress is no longer productive is different for everyone, but you might look out for the following clues:

• feeling overwhelmed or unable to cope
• feeling ‘on edge’ or unable to stop worrying
• changes in sleep patterns, feeling exhausted
• changes in appetite
• physical reactions such as headaches, muscle tension, upset stomach
• difficulty concentrating
• changes in mood, irritability, or anger
• withdrawal from friends and family
• reliance on alcohol or other substances to cope
• thoughts of self-harm or suicide

• Use your strengths and skills to make a positive plan to address the stressful events in your life and how you’re reacting to stress.

How can I manage my stress?

It’s not always possible to prevent stress altogether — life can be stressful. If you remember that some stress can be positive and motivating, you can aim to find the right balance between productive stress and an unhelpful level of stress.

Whether your stress is internal or external, relaxation techniques can help you manage stress and boost your ability to cope. There are many different techniques, and it’s important you find the ones that work for you. Examples include slow breathing, progressive muscle relaxation, mindfulness, meditation, yoga, and exercise.

A friend or family member can also be a great source of support, but at times you may feel you need help from a professional. Psychologists use a range of approaches to help manage stress and anxiety. One evidence-based approach is a technique known as cognitive behavior therapy (CBT) which is based on the idea that how you think and act affects how you feel.

What is anger?

• Anger is a normal human emotion that can range from mild annoyance to intense rage. But it's how you show your anger that matters.
• Anger is not a mental health condition itself.
• Problem anger can be addressed by psychological therapy.

• If you don't control your anger, it can lead to aggressive behaviour and violence. It's not okay to express anger in ways that can hurt you, other people or objects.

If you think you have problems managing your anger, it may help to ask yourself these questions:

• Has anger caused any problems in your relationships or work life?
• Do you sometimes have trouble controlling your behaviour when you're angry?
• Have you ever been angry and later regretted what you did?
• Have you ever become so angry that you damaged things or became abusive or violent?
• Have other people mentioned that anger might be a problem for you?

• Frequent unmanaged anger can damage your health and relationships.

Relationship Difficulties ?

Arguments and disagreements occur within all close relationships, and are a normal part of dealing with differences in ideas, beliefs, and perspectives.
However, chronic relationship conflict and stress is a serious issue. It has been linked to poorer mental and physical health1 and can affect other areas of life such as relationships with family and friends, and work colleagues2. Children also suffer when exposed to high levels of conflict at home, and are at greater risk for anxiety, depression, behavioural problems, and poorer health.1

There is no one, single cause for relationship problems, but a number of factors can play a part. Any relationship problems may be impacted by your past experiences, life transitions and stressors, thinking patterns, and your patterns of behaviour.

Learning effective and respectful ways to communicate differences is an important step in building a healthy, fulfilling relationship, and which can benefit our overall wellbeing and those around us. Learning to identify, process and express your emotions in a healthy way may be highly beneficial in your daily life and relationship. Learning how to tolerate and demonstrate intimacy and affection may sound challenging, but is likely to positively influence the quality of your relationship. And at times we can develop a negative view of our partners or relationship that significantly reduce the connection we feel. Exploring if we have developed any negative or unhelpful thinking styles, and learning how to shift this can also lead to opportunities to improve our relationship quality.

Cognitive Clarity is not a relationship or couples counselling service, as it focuses on individual therapy for men. If you require ‘couples counselling’ you may want to contact Relationships Australia or a similar specialist organisation.

The focus in working with Cognitive Clarity will be for helping men explore and address their individual contributors to any relationship difficulties. This can often enhance the effectiveness of couples counselling. As you develop insight and clarity into your own background and behaviours, and learn how to manage these effectively, you are likely to see an improvement in overall quality of life and relationship. While not a couples counselling service, your partner is welcome to attend sessions with you, with your consent.

Substance abuse

• Cognitive Clarity is not an alcohol and other drugs counselling service. If this is your primary concerns, you would benefit from accessing a specialist service. If substances like drugs and alcohol form a part of your overall concerns, such as a coping strategy for depression, then we can support you.

• Substance abuse involves using too much alcohol or other drugs, often leading to problems with health and everyday functioning.
• Around 1 in 20 Australians has an addiction or substance abuse problem. It can result in changes and long-term damage to your brain and other organs.
• Many treatment options are available for substance abuse, ranging from counselling through to hospital treatment.

What to look for if you suspect substance abuse

Signs that you or someone you know might be abusing a substance include the following.

• Regularly using more of a substance than intended.
• Regularly trying to cut down or stop using, but never succeeding.
• Spending too much time getting, using or recovering from the substance.
• Cravings, or a strong desire to use the substance.
• Using substances again and again, even when you're aware of the potential damage or danger.

You should also look out for signs of the impact on your life.

• Often failing to meet responsibilities at work, home or school because of substance use.
• Continuing to use a substance when it has caused relationship problems.
• Giving up social, work or leisure activities because of substance use.
• Dangerous or risky behaviour, such as criminal behaviour, drink driving or having unprotected sex.
• Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.

How does substance abuse affect mental health?

People with a mental illness experience drug problems at a higher rate than the general community.

Having a mental illness can make you more likely to abuse drugs to lessen your symptoms and make you feel better in the short term.

In other people, drug problems may trigger the first symptoms of mental illness. Drug use is also a risk factor for suicidal behaviour.

How is substance abuse treated?

Many treatment options are available for addictions and substance abuse. These range from counselling through to hospital treatment.

Treatment depends on which substance is involved and how dependent you are on the substance. It may also depend on your level of risk and how much support you have at home.

Treatment options include:

• lifestyle changes
• individual or group counselling
• peer support
• rehabilitation (rehab) programs
• residential or hospital treatment
• social support