Stress, war and male sexual health

When a country is at war, attention naturally turns to what matters most: safety, physical health, psychological resilience, the ability to work, and supporting loved ones.

Yet there is one area of health that is discussed far less often: men’s sexual health.

Common concerns include reduced libido, erectile difficulties, premature ejaculation, and other changes in sexual function. However, these symptoms are not always psychological in origin. They may also be associated with hormonal imbalances, cardiovascular disease, diabetes, injuries, or medication side effects.

Why it is important to talk about male sexual health during wartime

When the body remains under prolonged stress, this can affect energy levels, emotional regulation, and sexual desire. Some men find it harder to relax and become sexually aroused. Others notice that their erections are less firm, the duration of sexual intercourse has changed, or their usual desire for intimacy has diminished.

This issue can be particularly sensitive for military personnel and veterans. A man may be focused on physical recovery, adjusting to life after combat, or returning to family life and may not feel ready to discuss intimate difficulties straight away.

However, sexual health is an integral part of a man’s overall health. It should not be put on hold until every other problem has supposedly been resolved.

How stress affects erections and sexual desire

Erections depend on the interaction of the nervous system, blood circulation, hormonal balance, and psychological state. Anxiety, insufficient sleep, and emotional exhaustion can interfere with sexual responses.

Men may notice the following changes:

• Reduced libido – sexual thoughts occur less frequently, the desire for intimacy weakens, or it almost disappears. A man may interpret this as losing interest in his partner, although the underlying causes may include exhaustion, sleep disturbances, depressive symptoms, hormonal changes, or a combination of several factors.
• Erectile difficulties – achieving or maintaining an erection during sexual intercourse becomes more difficult. Sometimes an erection occurs but subsides when a man starts worrying about the possibility of not being able to perform.
• Premature ejaculation or other changes in ejaculation – a man may notice that ejaculation occurs sooner than before or, conversely, that reaching orgasm has become more difficult.
• Changes in sexual desire – libido may fluctuate depending on emotional state, relationship dynamics, sleep, and other circumstances.

It is important to distinguish between sexual desire and erectile function. Libido refers to sexual desire, whereas an erection is a physiological response.

Are sexual performance problems always caused by stress?

No. Erectile dysfunction can have psychological, organic, or mixed causes. According to the European Association of Urology guidelines, an assessment should take into account a man’s overall health and associated risk factors.

Possible causes include:

• Vascular conditions: hypertension, lipid disorders, and impaired blood flow.
• Metabolic disorders: diabetes and the associated damage to blood vessels and nerves.
• Hormonal changes: including testosterone deficiency, which may be accompanied by reduced libido.
• Medications: certain antidepressants and medicines used to treat other conditions.
• Injuries and neurological disorders: including injuries to the pelvic organs or nervous system.
• Psychological and emotional factors: chronic stress, anxiety, depressive symptoms, and psychological trauma.

Persistent erectile difficulties may also be a reason to assess cardiovascular and metabolic health. For this reason, self-medicating with drugs intended to improve erectile function is not advisable.

Combat experience, PTSD, and sexual health

Combat experience, psychological trauma, and post-traumatic stress disorder (PTSD) can affect sexual desire, intimate relationships, and overall sexual functioning.

A systematic review of research involving military personnel and veterans identified an association between PTSD and sexual difficulties. However, findings regarding a direct relationship between PTSD and erectile dysfunction were inconsistent. Therefore, not every case of erectile dysfunction should be attributed to psychological trauma.

Sexual health may also be affected by physical injuries, coexisting medical conditions, medication use, and sleep disturbances.

Why psychological support alone may not be enough

Seeking help from a psychologist or psychotherapist can be an important step, particularly if a man is experiencing anxiety, emotional exhaustion, the effects of traumatic experiences, or relationship difficulties.

However, psychological support and a urological assessment are not alternatives to one another. On the contrary, they can complement each other.

A urologist-andrologist assesses the health of the male genitourinary system, identifies possible causes of symptoms, and recommends additional investigations when indicated.

Some cases require input from several specialists. At Doctor Sam, consultations are available in urology, psychiatry, psychology, and endocrinology. The need to involve other specialists is determined on an individual basis.

When should a man consult a urologist-andrologist?

Consider booking a consultation with a urologist-andrologist if you notice any of the following:

• Difficulty achieving or maintaining an erection occurs repeatedly.
• Sexual desire has remained consistently low or has changed noticeably.
• Changes in ejaculation are causing concern.
• Usual morning erections have disappeared, particularly if this is accompanied by other symptoms.
• Hormonal imbalances or underlying medical conditions are suspected.
• Changes in sexual function have occurred following an injury, wound, surgery, or the start of a new medication.
• Previous treatment has not produced the expected results, or symptoms have returned.

An isolated episode of erectile difficulty does not necessarily indicate a medical condition. However, if the problem recurs, affects your intimate life, or is accompanied by other symptoms, it is worth identifying the underlying cause.

What to expect during a urologist-andrologist consultation

An initial consultation provides an opportunity to discuss issues that can sometimes be difficult to talk about even with those closest to you.

The doctor will ask about the nature and duration of your symptoms, any existing medical conditions, previous injuries, and medications you are taking. A physical examination may be performed if necessary, and the doctor will determine which investigations are appropriate.

Depending on the clinical situation, the following tests may be recommended:

• Blood tests to assess glucose levels or glycated haemoglobin (HbA1c).
• A lipid profile.
• Measurement of morning total testosterone levels when clinically indicated.
• Additional hormonal or other investigations, if needed.

The aim of the assessment is to identify the cause of the problem, evaluate associated health risks, and determine the appropriate next steps. Do not start taking erectile dysfunction medication, begin hormone therapy, or use questionable supplements without medical advice. These products may have contraindications, interact with other medications, and fail to address the underlying cause of the problem.

Consultation with a professor of urology at Doctor Sam

The first step is to establish what is happening and determine what kind of help is needed. In some cases, adjusting certain lifestyle factors may be sufficient. In others, treatment for an underlying physical condition or a combination of medical and psychological support may be necessary.At Doctor Sam Medical Center in Kyiv, consultations are provided by Mykola Ivanovych Boiko, a urologist, andrologist, and sexologist. A consultation with a professor of urology may be appropriate for erectile dysfunction, reduced libido, ejaculation disorders, diseases of the male reproductive system, or an inadequate response to previous treatment.

During the consultation, you can discuss your symptoms, possible causes of sexual difficulties, and the next steps in diagnosis and treatment.

A urology consultation is an important step towards maintaining sexual health and quality of life.

To book an appointment, call +380 97 312 92 91 or submit a request through our website. Our address: 1 Kil’tseva Road, Respublika Park Shopping Mall, Kyiv, Ukraine