A 34-year-old man sought help from doctor Tra Anh Duy, Center for Men's Health, for reduced libido and unstable erections, particularly "inability to focus" when with his wife. He reported constant anxiety during intercourse, fearing he would disappoint his wife, fail to achieve orgasm, and be judged.
Test results revealed low testosterone, high cortisol, pre-diabetic blood sugar levels, and an average of 4-5 hours of sleep per night. The doctor diagnosed erectile dysfunction caused by prolonged stress with secondary endocrine disorders, treating it by adjusting hormones, improving sleep, 30 minutes of daily exercise, and combining cognitive behavioral therapy (CBT).
After 6 weeks, his testosterone increased, and erectile function significantly improved. "My mind feels clearer, and emotions are more natural when intimate with my wife", he stated.
According to doctor Duy, sexuality is a subtle combination of psychological, neurological, and endocrine factors. When men overthink their ability, performance, or partner's satisfaction, the brain enters an alert state, blood vessels constrict, blood flow to the penis decreases, and the body releases adrenaline and cortisol – stress-fighting hormones that are also "enemies" of pleasure. Elevated cortisol inhibits testosterone, reducing libido and erectile function, while also increasing blood sugar, causing metabolic disorders, chronic fatigue, and sleep disturbances – two factors directly linked to sexual dysfunction.
Overthinking is a common cause of erectile dysfunction and premature ejaculation. Studies indicate that men who focus excessively on performance have more than 2 times higher risk of erectile dysfunction and 1.6 times higher risk of premature ejaculation compared to those who are relaxed and emotionally engaged. The vicious cycle of stress, failure, and anxiety prolongs the condition.
"Sex is a resonance between body and mind; if the mind is always in 'survival mode', the body cannot engage in intimacy, so the best way to maintain performance is to stop trying to prove it", the doctor explained.
Premature ejaculation in individuals who overthink is sometimes not due to physical weakness, but because the brain does not allow them to enjoy intimacy. For example, a 29-year-old IT engineer experienced ejaculation after only about one minute, even though his erectile function was normal during masturbation. His obsession with "performance" made him constantly tense, as if taking an exam during each sexual encounter. Tests showed high cortisol and severe stress levels, despite normal testosterone and semen analysis. The doctor diagnosed secondary premature ejaculation due to anxiety disorder and overthinking, treating it with medication combined with psychological counseling, the "stop-start" technique, and relaxation exercises. After 3 months, his ejaculation time extended to an average of 6 minutes, stress significantly decreased, and his marital life improved.
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Patient undergoing tests. Photo: Quynh Tran |
Patient undergoing tests. Photo: Quynh Tran
The danger is that many individuals resort to erectile dysfunction medication for a "quick fix", while the underlying psychological issues remain unaddressed. Treating men who overthink is not just about prescribing erection-enhancing drugs, but involves multi-dimensional therapy. This includes cognitive behavioral therapy (CBT) to help identify and change distorted thoughts, relaxation and mindfulness meditation to help the body reconnect with sensation, and couples therapy to foster open communication and reduce the pressure of "facing it alone".
"Intercourse is not a test but a connection; when the brain is preoccupied with control, the body loses its natural spontaneity. Treating individuals who overthink is not solely about medication, but about helping them learn to relax their minds", doctor Duy stated.
Furthermore, overall brain health requires attention. Lack of sleep, excessive alcohol, tobacco, and caffeine intake impair the hippocampus – the emotional regulation center – increasing stress. Additionally, insufficient physical activity reduces endorphins (happiness hormones), making it harder for the body to achieve natural pleasure. A rested brain, a well-cared-for body, and an understood relationship are three core elements of healthy sexuality. Overthinking not only diminishes pleasure but also erodes emotional connection, transforming sex into a burden rather than a joy.
Le Phuong
