The Ins & Outs of Male Sexuality

Our sexuality lies at the core of what makes us human, contributing significantly to our sense of overall wellbeing and – in particular - what it means to be a man. A doctor explores the often-oversimplified field of men’s sexual wellbeing.

The term ‘sexuality’ carries multiple meanings and interpretations that differ from person to person and change throughout the various stages of life, relationships and states of health.

A man’s sexuality is often defined by his penis. There is no escaping the fact that, when something goes wrong or the penis doesn’t behave in the desired manner - the problem is evident. Because of this, traditional male sexuality has often been over-simplified, assuming that a penis is always ready for action, and that anything short of this constitutes failure.

The reality of male sexual wellbeing is very different and more complex, and understanding the foundations of a healthy, satisfying and enduring sex life requires a much broader approach.



Enjoying a good sex life means prioritising pleasure - both for yourself and your partner. Vital to the pursuit of pleasure is knowing what you and your partner enjoy, and developing the ability to communicate your needs, wishes and desires. This type of communication will ensure a consenting, respectful sexual partnership that cultivates trust - the true lubricant for deepening the sexual connection. Many societal norms remain opposed to certain types of pleasure and overcoming these is an integral part of freeing yourself to experience a wider range of possibilities. It’s also important to remember that pleasure is not about performance. Presence and connection are far more important than any acrobatic or intricate moves meant to impress.



Keeping a healthy and vital body is essential. Physical strength and fitness and following a healthy diet boost self-esteem, elevate your mental state and optimize sexual potential. However, even the healthiest body can be vulnerable to sexually transmitted diseases. Young men not in established relationships, those with multiple partners or those who are older and recently out of long-term relationships need to be particularly aware. Equip yourself with the knowledge of what you need to do to protect yourself and practice safe sex. It may even be necessary to think about PREP – or pre-exposure prophylaxis - if you are at risk of being exposed to the HIV virus.

Older men need to be aware of the close association between erectile dysfunction and the state of their blood vessels. A poor erection can be the canary in the mineshaft warning of atherosclerosis and problems with your coronary arteries. It’s also important to be mindful of prostate health and screen for prostate cancer. For many men, the ageing process is accompanied by a decline in libido. While this is generally par for the course, if it disappears altogether or is accompanied by fatigue, depression and reduced muscle strength, you may be suffering from hypogonadism, or low testosterone levels. This is something that can be assessed by a doctor and treated proactively.A variety of other medical conditions and medications can also affect sexual performance, so start the conversation with your doctor, as he or she may not address it directly.



Intimacy is the bedrock of a healthy sex life and requires time to flourish. Set aside time with your partner that’s uninterrupted by the intrusions of work, family and routine domestic chores. Problems in your relationship will eventually find their way into your sexual life, and while it’s normal to disagree, if there are major conflicts, reasons for anger or signs of contempt, you will need to attend to these as a priority. A relationship counsellor could help. Sex is an intimate form of communicating, and even before you step into the bedroom you can create a sexual language with your partner that expands your sexual vocabulary and increases your erotic potential as a couple.

In long-term relationships, your sex lives become a journey, and will no doubt face many obstacles and challenges - including the changes of ageing. Respecting and accepting these will allow for ongoing rewarding sexual activity.



As men age, there will invariably be times when libido, erectile function and intensity of orgasm wane. While this is natural, studies have shown that these factors need not necessarily decrease sexual satisfaction. As each man’s sex life is unique, comparing yourself to some imagined ideal or being inflexible can cause further challenges, whereas a relaxed and non-judgmental approach will serve you well. Should you run into a sexual challenge that you can’t seem to resolve, there’s no shame in seeking professional advice. A healthy male sexuality is something that’s cultivated over a lifetime and should be an ongoing priority that includes a combination of meaningful relationships, good physical health and mental equilibrium.


Dr Anthony Smith is a family physician and sexual health practitioner working in private practice. He is a Fellow of the European Society for Sexual Medicine and the President of the Southern African Sexual Health Association. 

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