What kinds of sexual difficulty do men bring to counselling?
The presentations vary enormously and almost all of them arrive late, after months or years of the man dealing with it alone. Common examples include losing erections with a partner but not alone, desire that has disappeared inside a long relationship, desire that feels compulsive and unmanageable, anxiety that starts hours before anything happens, pain, avoidance of sex altogether, or a persistent sense of being bad at something everyone else appears to find straightforward.
There is often a second layer underneath: not the mechanics, but the meaning. What it says about you, about the relationship, about whether you are still wanted, about whether you were ever any good at this.
Men frequently arrive apologetic, having rehearsed a version of the problem that keeps it at arm's length. That is normal, and there is no requirement to be blunt before you are ready.
Is this a medical problem or a psychological one?
Frequently it is both, and this is worth being clear about. Erectile difficulty, low libido and pain can have physical causes including cardiovascular health, diabetes, hormone levels, prostate treatment and the side effects of prescribed medication, particularly antidepressants.
Counselling is a talking therapy. It does not diagnose or treat physical conditions, and any new or persistent sexual difficulty is worth raising with a doctor. What counselling addresses is the part that medicine does not reach: the anxiety, the anticipation, the shame, the avoidance, and the effect on the relationship — all of which commonly persist after a physical cause has been ruled out or treated.
Why is sexual shame so common among gay and bi men?
Because most gay and bi men learned about sex in an environment that was, at best, silent about them. Sex education did not describe their lives. Early experiences were often secret, rushed, or arranged in ways that had to be hidden. Religion, family or school frequently supplied an explicit message that the desire itself was wrong.
Add to that the HIV context that shaped the generation above and still shapes attitudes, plus a dating culture in which bodies and performance are ranked openly, and shame is not a personal quirk. It is an entirely predictable outcome of the conditions.
Shame's practical effect is silence. It stops men raising it with partners, with doctors, and with friends — which is precisely why so many men are dealing with something extremely common as though they are the only one.
What does the counselling involve?
It is person-centred counselling: conversation, at your pace, with no exercises assigned and no requirement to disclose more than you choose. The counsellor is not there to assess your sex life or to tell you what a normal one looks like.
- Talking about it plainly, often for the first time, without managing anyone's reaction
- Separating performance anxiety from physical cause, and being supported to seek medical input where relevant
- Understanding desire that has changed inside a long relationship
- Shame carried since adolescence that has never been examined
- Sex that feels compulsive, or that is being used to manage other feelings
- Deciding what you actually want your sex life to be, rather than what you assume it should be
Why choose private counselling for this?
Discretion and continuity both matter more than usual here. Free LGBTQ+ services do good work, and they typically involve capped sessions, a waiting list, allocation by availability and a case file held by a third-sector organisation. Few men want to explain this subject twice to two different people.
The Great Thriving offers the same counsellor every session, no session cap, no waiting list, no triage, complete discretion and appointment times including early mornings and evenings. If you are in a position to pay, the free places stay available for men who aren't.