Men's Sexual Health: What It Covers and Where to Start

Many men come to see me with the same opening line: "Doctor, I don't know where to start." That is completely understandable. Most of us were never taught to talk about sex openly. This article gives you a rough map of what men's sexual health covers, which problems are common, and where to begin looking after it.

What is men's sexual health?

The World Health Organization describes sexual health as physical, mental, emotional and social well-being in relation to sexuality, not simply the absence of disease. For men, in plain terms, that means:

• How the genitals work: erections, ejaculation and sensation
• Hormones, especially the male hormone testosterone, which affects sex drive, energy, muscle and bone. You can read the basics in Testosterone basics every man should know
• Fertility: the ability to have children and the quality of your semen
• Prevention of sexually transmitted infections (STIs) and regular screening
• Mind and relationships: confidence, stress and communication with your partner

All of these are connected. For example, stress makes erections harder to get; once erections become difficult you start to worry; once you worry you may ejaculate faster. It can easily become a cycle.

Men's sexual health

Genitals

• Erections
• Ejaculation
• Sensation

Hormones

Testosterone

• Sexual desire
• Energy
• Muscle and bone

Fertility

• Having children
• Semen quality

STI prevention

• Protection against STIs
• Regular screening

Mind and relationships

• Confidence
• Stress
• Talking with a partner

Based on the WHO view of sexual health: physical, emotional, mental and social well-being, not just the absence of disease.

Common problems in men

These problems are more common than most men think, and most of them can be improved once the cause is found.

Why sexual health is a "warning light" for your whole body

The blood vessels that supply the penis are small. When blood vessels throughout the body start to be damaged by diabetes, high blood pressure, high cholesterol or smoking, erection problems often appear years before any heart symptoms. For this reason the Princeton IV consensus (2024) recommends that men with erection problems also have their cardiovascular risk assessed.

The reverse is also true: chronic illnesses and some medicines, such as antidepressants, can affect your sex life. Looking after your sexual health is therefore a doorway to looking after your overall health at the same time.

Where to start looking after yourself

1. Observe yourself honestly. When did the problem start? Did it come on gradually or suddenly? Does it happen every time or only in certain situations?
2. Try a self-assessment tool such as the IIEF-5 questionnaire or the Erection Hardness Score to get a clearer picture.
3. Look at the basics of your life. Are you sleeping enough? Do you exercise? Do you drink heavily or smoke? How is your weight?
4. Review the medicines you take, including supplements and herbal products.
5. Talk with your partner. A sexual problem is nobody's fault, and talking about it takes away a lot of the pressure.

1. 1Observe yourselfWhen it began, gradual or sudden, every time or not
2. 2Use a questionnaireSuch as the IIEF-5 or Erection Hardness Score
3. 3Check the basicsSleep, exercise, alcohol, smoking, weight
4. 4Review medicinesIncluding supplements and herbs
5. 5Talk with your partnerNobody is to blame; talking reduces pressure

If a problem lasts more than 2-3 months or affects your wellbeing, see a doctor.

Basic checks a doctor may recommend

• A medical history and physical examination, including blood pressure and waist size
• Blood tests, such as blood sugar and cholesterol, and in some men a morning testosterone level
• STI screening based on your risk
• An assessment of stress, low mood and your relationship

You do not need every test at once. Your doctor will choose based on your symptoms and your individual risks.

When to see a doctor, and how the clinic can help

See a doctor if a problem has lasted more than 2–3 months, affects your happiness or your relationship, or if you also have a chronic illness. Go to hospital immediately if an erection lasts more than 4 hours, or if you get chest pain during sex (in Thailand, call 1669 for a medical emergency).

At Dr. Kris Clinic, I am a family physician who looks after sexual health. We take a whole-person approach covering erections, ejaculation, hormones, STI prevention, and sexology and relationship counselling, without judgement. You can see us at the clinic in Surat Thani or book an online consultation; consultations in English are available.