Sexual health Issues in Dads

Fatherhood can be one of the most meaningful transitions a man ever makes—and it can also be a perfect storm for sexual health problems. Sleep disruption, stress, identity shifts, relationship changes, body image concerns, and pressure to “perform” can all hit at once. For many dads, the result is not just a physical issue, but a confidence, nervous-system, and connection issue.

Research on fathers’ sexuality after having a child highlights that sex often changes less because desire “disappears” and more because the context changes—fatigue, logistics, emotional load, relationship dynamics, and a different sense of closeness or belonging.

There are also real biological shifts that can accompany new fatherhood. Studies have found that men often experience lower testosterone after becoming fathers, which may relate to caregiving and relationship factors. And dads can experience postpartum depression symptoms too, which can strongly affect libido, erection quality, and intimacy.

Below are some of the most common sexual health concerns I see dads struggle with—and how psychotherapy can help.

Common sexual health issues dads experience

1) Erectile dysfunction (ED)

ED is often multi-factorial: cardiovascular/metabolic health, sleep, medications, hormones, alcohol/substances, stress, and relationship factors can all contribute. Psychologically, ED is closely tied to anxiety, attention, self-monitoring, shame, and fear of failure—often creating a vicious cycle (one tough night → pressure → avoidance → more anxiety → more difficulty).

2) Performance anxiety and anticipatory anxiety

Many dads describe a “countdown” feeling: “What if it happens again?” Anticipatory anxiety pushes the nervous system into threat mode, making arousal harder and attention more self-critical. The more you try to “force” confidence, the more your body may resist. Reviews of ED highlight the importance of psychosocial factors and recommend addressing them—not just the mechanics.

3) Loss of libido

Low desire is incredibly common in fatherhood, especially in seasons of:

  • chronic sleep deprivation

  • high stress / burnout

  • resentment or emotional distance in the relationship

  • untreated depression or anxiety

  • sexual scripts that no longer fit your life (e.g., needing spontaneity when life requires planning)

Hormonal changes in fathers may also play a role for some men.

4) Fertility stress and infertility-related distress

Fertility challenges can hit a man’s identity hard—often triggering shame, isolation, grief, anger, and “I have to be the strong one” coping. Research shows male infertility can be associated with significant psychological distress and impacts on quality of life and sexual functioning over time.
There’s also evidence that psychosocial interventions (especially CBT-based approaches) can be helpful for couples navigating infertility-related distress.

Why psychotherapy can help (even when the issue feels “physical”)

Sexual functioning is a mind–body process. Erection, arousal, and desire rely on safety, presence, and connection—not just anatomy. When the nervous system is stuck in threat mode (stress, shame, fear of failure, trauma reminders), sexual response often downshifts.

Modern clinical work and reviews describe ED and sexual difficulties as shaped by psychological factors like anxiety, depression, self-esteem, attention, relationship stress, and expectations—meaning psychotherapy can be a direct part of effective care.

Therapy benefits for dads commonly include:

  • Breaking the performance-anxiety loop (fear → monitoring → avoidance → more fear)

  • Reducing shame and rebuilding sexual confidence through targeted cognitive and behavioral work (CBT/CBST approaches are commonly discussed in the literature)

  • Reconnecting sex to values and connection, not “passing a test”

  • Improving communication with a partner (especially when sex has become tense, pressured, or avoided)

  • Processing grief and identity impacts related to infertility, pregnancy loss, birth trauma experiences, or postpartum mental health challenges

  • Creating a realistic intimacy plan for the season you’re in (fatigue, kids, schedules, privacy)

What therapy for sexual health issues can look like (practical, structured, confidential)

A good therapy plan is usually straightforward and skills-based:

  1. Assessment + coordination
    We clarify what’s happening (when it started, patterns, anxiety triggers, relationship context, stress/sleep, meds, porn use if relevant, medical factors). Therapy often works best alongside a medical evaluation to rule out/identify contributors (e.g., cardiovascular risk, diabetes, low testosterone, medication side effects).

  2. Nervous-system and anxiety work
    Skills to shift from “performance mode” to “presence mode”: reducing monitoring, working with catastrophic predictions, and practicing arousal-friendly attention.

  3. Confidence repair
    A plan to rebuild trust in your body—often using gradual, low-pressure exercises and measurable steps rather than “try harder.”

  4. Couples/communication support when needed
    If a partner is involved, aligning expectations and reducing pressure can be a major accelerator.

  5. Identity + meaning work for dads
    Addressing the deeper layers: provider pressure, masculinity scripts, resentment, loneliness, role overload, grief, or trauma history that may be getting activated.

Work With The Dad Therapist, Maxim Arbuzov

I work with fathers who want:

  • A confidential, judgment-free space

  • Practical strategies—not clichés

  • Therapy that respects masculinity without reinforcing harmful pressure

  • Help restoring confidence, intimacy, and connection

If sexual health issues are affecting your relationship, self-esteem, or quality of life, therapy can help.

***When to also involve a physician (important)***

If ED, low libido, or other sexual symptoms are new, persistent, or worsening—especially with risk factors like diabetes, high blood pressure, sleep apnea, depression, or medication changes—medical evaluation matters. ED can sometimes be an early signal of broader health concerns. Psychotherapy can still help a lot, but it works best as part of a whole-person plan.