Nguyen Tuan projects an image of success, with a stable income and a harmonious family life. To outsiders, he embodies the ideal successful man. However, beneath this calm exterior, he secretly battled erectile dysfunction for six months.
At the Men’s Health Center, Dr. Tra Anh Duy conducted an examination and found Nguyen Tuan’s physical indicators to be normal. His total testosterone level was 16,8 nmol/L, within a healthy range, and his blood sugar, blood fat, and penile vascular Doppler ultrasound results were all good.
Delving deeper into Nguyen Tuan’s lifestyle, Dr. Duy discovered he regularly worked 10-12 hours a day, rarely shared his emotions, and constantly strived to maintain an "I’m fine" facade for his wife and children. Dr. Duy noted, "The patient has no physical damage. This is functional erectile dysfunction caused by chronic stress, a typical outcome of 'duck syndrome'."
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Dr. Duy consults with a patient. *Photo: Lam Anh*
The term "duck syndrome" describes the image of a duck gracefully gliding on the water’s surface, while its feet paddle furiously and continuously beneath to stay afloat. This is not a formal medical diagnosis but a common psychological concept in modern society. It refers to individuals who strive to appear successful and in control, while internally grappling with anxiety, pressure, and a fear of failure. In men, this is often linked to the expectation of being a strong "pillar of the family" and not showing weakness.
According to Dr. Duy, male sexual function requires a harmonious coordination of psychological, neurological, endocrine, and vascular systems. For someone experiencing duck syndrome, their body remains in a state of heightened vigilance.
Biologically, chronic stress activates the hypothalamic-pituitary-adrenal axis, increasing cortisol levels. Research published in the Annals of the New York Academy of Sciences indicates that elevated cortisol inhibits the endocrine axis that controls sexual function, impairing testicular function even if overall testosterone levels appear normal.
Furthermore, sexual activity requires the dominance of the parasympathetic nervous system, which is associated with a relaxed state. When a man’s brain is constantly in "problem-solving" and "risk-management" mode, the sympathetic nervous system becomes overstimulated, leading to various consequences.
Erectile dysfunction is the most common manifestation. Men may experience morning erections but "fail" during actual intercourse due to performance anxiety. Men with this syndrome also frequently experience a decrease in libido. Their minds are too preoccupied with maintaining a perfect image, leaving no room for pleasure. A study in the Journal of Sexual Medicine shows that occupational stress is inversely proportional to sexual desire. Additionally, chronic stress can disrupt nervous-muscular reflexes, leading to premature ejaculation or difficulty reaching orgasm.
The most dangerous aspect of duck syndrome is silence. The more men try to appear fine, the more isolated they become. When sexual problems arise, they fear their "strong" image will shatter, leading to intimacy avoidance and exacerbating marital strain.
In Nguyen Tuan’s case, Dr. Duy did not prescribe long-term erection-supporting medication but focused on psychological therapy. Nguyen Tuan was guided on how to identify stress, adjust his work pace, and learn to express his true emotions to his partner. After three months, his physiological function notably recovered without pharmacological intervention.
Research published in the Archives of Sexual Behavior affirms that sharing stress within a relationship is a vital "remedy" for improving sexual satisfaction. From a sexological perspective, sexual dysfunction in "duck syndrome" is not a sign of weakness, but a warning signal from the body. "Allowing oneself to be 'not okay' and seeking professional support early is the first step for men to regain their identity and balance in life", Dr. Duy emphasized.
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