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The Sleep-Sex Disconnect

Posted on by Akash Kapadia, MD in

Close-up of man in bed, stretching hand behind head

You can fake your way through a workday on little sleep, but not through passion – it’s hard to feel like a powerhouse on four hours of shut-eye. Over time, irregular sleep or ongoing disruptions chip away at multiple body systems and inevitably impact your sex life.

Sleep is foundational, and sleeping less than 7 hours per night can interfere with cognition and the hormonal rhythms that keep your body balanced and your mood stable. Chronic sleep deprivation has been linked to weight gain, insulin resistance, hypertension, depression, and cardiovascular disease, but it also takes a toll on sexual desire and other markers of male sexual function.¹‾²
Whether it’s sleep apnea, late nights, or stress keeping you up, reclaiming rest may be one of the most overlooked ways to reignite your libido.

A Dip in Desire

Grogginess. Patience that runs thin. A body that feels like it’s running on fumes. Several nights of inadequate sleep can make anyone cranky, but it can also dim sexual desire.

Your libido is the mental and physiological drive for sexual activity, and research increasingly shows that sleep has an impact on maintaining sexual impulses. Unlike erectile dysfunction, which describes a specific physical challenge, libido encompasses desire, motivation, and interest in romantic engagement.

Men with obstructive sleep apnea (OSA), non-standard work shifts, or chronic sleep deprivation often report decreased sexual drive, even when testosterone levels are within the normal range, suggesting a fatigue-induced deficit in neuroendocrine pathways, rather than through hormone deficiency alone.² Disruptions in circadian rhythm and fluctuations in testosterone bioavailability can produce hypogonadal symptoms (fatigue, low energy, and diminished sexual interest) in otherwise healthy men with biomarkers that appear normal.²

Running on Empty

Sleep recharges us mentally, but it also recalibrates hormones. Short-term sleep restriction in young men has been shown to lower daytime testosterone by 10–15%, particularly in the afternoon and evening, which may reduce energy, vigor, and libido.³ Luteinizing hormone (LH), which signals the testes to produce testosterone, follows a circadian rhythm. When that rhythm is disturbed by sleep loss or irregular schedules, testosterone secretion drops, and with it, the motivation and vitality that support a healthy libido. ⁴

Preliminary evidence also suggests that short-term sleep restriction may reduce sex hormone-binding globulin (SHBG), a protein that regulates the availability of testosterone in the body. ⁵ Lower SHBG levels can alter free testosterone levels, possibly contributing to fatigue and diminished sexual interest. Researchers also noted that afternoon cortisol levels increased in response to restricted sleep, reflecting a stress-hormone response that may further influence energy, mood, and sexual drive.

Prolactin, a modulating hormone that is naturally already low in men and related to sexual function, metabolism, neurogenesis, and immune function, may decline further when sleep is curtailed or interrupted in the second half of the night. ⁶ That same predawn sleep interruption also reduces morning testosterone, and sleep deprivation-related shifts in metabolic hormones (like leptin and insulin) can compound fatigue and reduce overall sexual motivation. ⁷ Though the studies include a small number of participants and more research is needed to fully understand the endocrine consequences of poor sleep on libido, the trends are consistent.

The downstream effects of disrupted sleep can throw off hormone balance and alter how men experience desire, stamina, and performance, and obstructive sleep apnea (OSA) is one of the most common culprits. The combination of intermittent oxygen deprivation and fragmented sleep undermines testosterone production and dampens arousal pathways in the brain. In one study, men with sleep apnea were 9.4 times more likely to develop erectile dysfunction than those without, even after adjusting for other factors like age, BMI, and comorbidities. ⁸

Men who work irregular hours, especially overnight or rotating shifts, as well as men at a higher risk of insomnia, frequently report lower libido and symptoms consistent with hypogonadism. In two separate observational studies involving nearly 1,000 men, those who were ‘very dissatisfied’ with their quality of sleep scored significantly lower on measures of sexual function and satisfaction than their well-rested counterparts. ⁹

Reconnect Rhythm, Rest, and Romance

Men who maintain consistent sleep schedules, reduce late-night screen exposure, and create a calm sleep environment often find that their energy and desire improve naturally. Managing stress, light exercise, and structured downtime can further stabilize hormonal rhythms, supporting both mental clarity and sexual motivation.

Interestingly, the relationship between sleep and sex also spins the other way: research shows that sexual activity, particularly orgasm with a partner, can improve sleep through oxytocin, prolactin, and cortisol modulation, helping the body relax and fall into deeper, more restorative sleep.¹⁰ Better sleep can improve libido, and a stronger libido can equate to more satisfying sexual activity; renewed sexual activity, though its own reward, is reinforced by even better sleep.

Small changes – shifting bedtime earlier, carving out moments for intimacy, and tending to stress – can nudge your rhythm in the right direction. But it helps to understand exactly what your body is telling you in the first place: is it hormonal, metabolic, sleep-related, or a combination?

A urologist who specializes in men’s health can help identify where the imbalance begins – whether it’s hormonal dysregulation, metabolic stress, or lifestyle factors. Through targeted evaluation of testosterone, LH, and SHBG levels, alongside a review of sleep patterns and daily routines, it becomes possible to pinpoint whether fatigue stems from the endocrine system, the nervous system, or both.

If you’ve noticed a slump in libido or diminished sexual function, Dr. Kapadia can help pinpoint the source. Contact us for a personalized consultation and bring balance back between the sheets.

Resources:

  1. Consensus Conference Panel, Watson, N. F., Badr, M. S., Belenky, G., Bliwise, D. L., Buxton, O. M., Buysse, D., Dinges, D. F., Gangwisch, J., Grandner, M. A., Kushida, C., Malhotra, R. K., Martin, J. L., Patel, S. R., Quan, S. F., Tasali, E., Non-Participating Observers, Twery, M., Croft, J. B., Maher, E., … Heald, J. L. (2015). Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 11(6), 591–592. https://doi.org/10.5664/jcsm.4758.
  2. Kohn, T. P., Kohn, J. R., Haney, N. M., Pastuszak, A. W., & Lipshultz, L. I. (2020). The effect of sleep on men’s health. Translational andrology and urology, 9(Suppl 2), S178–S185. https://doi.org/10.21037/tau.2019.11.07.
  3. Leproult, R., & Van Cauter, E. (2011). Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA, 305(21), 2173–2174. https://doi.org/10.1001/jama.2011.710.
  4. Chen, K. F., Liang, S. J., Lin, C. L., Liao, W. C., & Kao, C. H. (2016). Sleep disorders increase risk of subsequent erectile dysfunction in individuals without sleep apnea: a nationwide population-base cohort study. Sleep medicine, 17, 64–68. https://doi.org/10.1016/j.sleep.2015.05.018.
  5. Reynolds, A. C., Dorrian, J., Liu, P. Y., Van Dongen, H. P., Wittert, G. A., Harmer, L. J., & Banks, S. (2012). Impact of five nights of sleep restriction on glucose metabolism, leptin and testosterone in young adult men. PloS one, 7(7), e41218. https://doi.org/10.1371/journal.pone.0041218.
  6. Schmid, S. M., Hallschmid, M., Jauch-Chara, K., Lehnert, H., & Schultes, B. (2012). Sleep timing may modulate the effect of sleep loss on testosterone. Clinical endocrinology, 77(5), 749–754. https://doi.org/10.1111/j.1365-2265.2012.04419.x.
  7. Reynolds, A. C., Dorrian, J., Liu, P. Y., Van Dongen, H. P., Wittert, G. A., Harmer, L. J., & Banks, S. (2012). Impact of five nights of sleep restriction on glucose metabolism, leptin and testosterone in young adult men. PloS one, 7(7), e41218. https://doi.org/10.1371/journal.pone.0041218.
  8. Chen, K. F., Liang, S. J., Lin, C. L., Liao, W. C., & Kao, C. H. (2016). Sleep disorders increase risk of subsequent erectile dysfunction in individuals without sleep apnea: a nationwide population-base cohort study. Sleep medicine, 17, 64–68. https://doi.org/10.1016/j.sleep.2015.05.018.
  9. Kohn, T. P., Kohn, J. R., Haney, N. M., Pastuszak, A. W., & Lipshultz, L. I. (2020). The effect of sleep on men’s health. Translational andrology and urology, 9(Suppl 2), S178–S185. https://doi.org/10.21037/tau.2019.11.07.
  10. Lastella, M., O’Mullan, C., Paterson, J. L., & Reynolds, A. C. (2019). Sex and Sleep: Perceptions of Sex as a Sleep Promoting Behavior in the General Adult Population. Frontiers in public health, 7, 33. https://doi.org/10.3389/fpubh.2019.00033.

Dyspareunia in Men: When Sex Hurts

Posted on by Akash Kapadia, MD in ,

Man lying in white sheets experiencing discomfort, both hands over eyes

Many people, for a multitude of reasons, don’t talk about experiencing pain during sex. When the infrequent conversation does come up, it’s usually in the context of women’s health. In men’s health, it comes up even less often.

Do a quick search online, and you’ll find that most articles and studies about dyspareunia focus on women. Very few address men. That knowledge gap reflects just how little attention it gets, even though men can also experience pain during or after intercourse. Pain during sex in men remains under-recognized, under-reported, and under-studied.

That doesn’t mean it’s uncommon. Studies estimate that about 5% of men worldwide experience painful intercourse at some point in their lives – that’s roughly 190 million men across the globe.¹

Intimacy is natural, and a healthy sex life is part of overall well-being. When things in the bedroom become uncomfortable, it’s not something to ignore. In this article, we’ll spotlight common causes, what you can do about them, and when it’s time to speak with a healthcare provider.

What’s Triggering the Pain?

Sex isn’t supposed to hurt. When it does, it’s likely a signal that something deeper could be going on, so don’t just power through it. Do some medical detective work with your urologist and men’s health provider to figure out what’s going on. Although not exhaustive, here are some of the most common causes.

Infections and Inflammation

Pain during sex can be the body’s way of sounding the alarm for an underlying infection. Urinary tract infections (UTIs), sexually transmitted infections (STIs), and prostatitis (inflammation of the prostate) can all cause discomfort or burning during ejaculation, urination, or penetration. Balanitis (inflammation of the head of the penis or foreskin) is another common source of pain. Any inflammation in the genital region can make even mild friction feel unbearable.

We can’t avoid every germ we encounter or the disruption microbes can cause. Still, safer sex practices and good hygiene can create a physiological environment that is inhospitable to them. When the culprit isn’t bacterial, proactive health strategies (like regular checkups, stress management, and an anti-inflammatory lifestyle) can support immune function and lower the risk of chronic inflammation.

Treatment depends on the source: antibiotics for bacterial infections, antivirals for STIs, and pelvic floor therapy or medication for chronic prostatitis. All of the above respond well to additional dietary or lifestyle adjustments in conjunction with medical attention.

Pelvic Floor Dysfunction

When the pelvic floor muscles are overly tense, imbalanced, or irritated, they can compress or entrap nearby nerves like the pudendal nerve, which runs through the pelvis and into the genitals. This can lead to pain that radiates into the groin area, thighs, lower back, and toward the penis or scrotum that’s sharp, burning, tingling, or aching. Some people also describe a pressure or “foreign body” sensation in the rectum or urethra.

The pelvic muscles also support the bladder, bowel, and reproductive organs. Because of the neighboring structures, issues with pelvic floor dysfunction (PFD) can create a cascade of symptoms that feel worse with sitting, sex, bowel movements, or stress.

Referred or radiating pain is one reason PFD can be misdiagnosed or overlooked. It often mimics other issues like prostatitis, sciatica, or hernias, but doesn’t respond to antibiotics or typical treatments for those conditions.

Pelvic floor dysfunction can stem from physical strain, injury, prolonged sitting, poor posture, or stress-related muscle clenching. It’s especially common among cyclists, weightlifters, and people with chronic tension patterns. Unlike infections or injuries, this type of pain often doesn’t show up on imaging or lab work, making it frustrating to diagnose.

Once it can be identified, it’s highly treatable. Pelvic floor physical therapy, biofeedback, breathing exercises, and bodywork can all help retrain muscles to relax and coordinate properly. In some cases, muscle relaxants or targeted injections may be helpful, and many men find lasting relief through conservative, movement-based approaches or a combination of therapies.

Skin Conditions

The skin on the penis is delicate, and like skin anywhere else, it can be affected by dermatological conditions. Eczema, psoriasis, lichen sclerosus, and contact dermatitis can all show up in the genital area, sometimes without warning. These conditions may cause redness, dryness, flaking, or cracking of the skin. Add the friction of sexual activity to already irritated skin, and discomfort is almost inevitable.

Flare-ups can be mitigated by identifying triggers – harsh soaps, fragranced body products, latex, certain fabrics, or even excessive moisture can all contribute to skin irritation. When it comes to our more sensitive parts, switching to gentle, non-irritating products can go a long way.

Treatment often includes topical steroids or barrier creams, but a dermatologist’s insight is warranted, especially if the condition is chronic. Avoiding allergens, keeping the area clean and dry (but not overly so), and using lubricants during sex can help prevent skin irritation.

Phimosis

Phimosis is a condition in which the foreskin is too tight to be pulled back over the head of the penis. In some cases, it’s present from birth and resolves naturally. But when it persists or develops later in life, often due to repeated infections or inflammation, it can make erections and intercourse painful. Even minor retraction can cause tearing or micro-injuries, making future encounters more stressful and uncomfortable.

Maintaining good hygiene and avoiding irritants can help prevent inflammation that exacerbates tightness. In recurrent or more severe cases, topical steroid creams can reduce tightness and inflammation, sometimes eliminating the need for surgery. Gentle stretching exercises may also help at times when inflammation isn’t present. When conservative options don’t work, surgical approaches like circumcision or preputioplasty might be considered.

Peyronie’s Disease

Peyronie’s disease occurs when scar tissue develops under the skin of the penis, causing it to bend or curve, sometimes too sharply, making erections quite painful. The curvature can make sex painful or even impossible. The condition can develop gradually or occur after an injury, and some men may not recall a specific event that triggered it.

There’s no surefire way to prevent Peyronie’s disease, but reducing the risk of injury during sex by using adequate lubrication and avoiding rough thrusting can help. Early diagnosis and treatment in the initial inflammatory stage can help prevent progression.

Treatment depends on the severity of the symptoms. For mild cases, watchful waiting may be enough. In more bothersome cases, options include injections into the scar tissue, traction therapy, or surgery for unresponsive cases.

Past Trauma or Surgery

Past injuries to the penis, pelvis, or perineum, usually from accidents, sports, or surgical procedures, can leave behind more than just scar tissue. Nerve damage, altered anatomy, or chronic pelvic floor tension may develop long after the original injury has healed. Even surgeries like hernia repair, prostate procedures, or circumcision can lead to lingering pain or changes in sensation that show up most clearly during sex.

Prevention isn’t always possible, but seeking early treatment for injuries and being proactive with post-surgical care can reduce incidences of long-term pain.
Treatment depends on the nature of the trauma. Pelvic floor therapy, nerve pain medications, scar tissue mobilization, or even reconstructive surgery might be needed. It’s also helpful to work with a provider familiar with post-surgical complications, particularly if pain develops months or even years after the event.

Pain Echoes

Sexual pain is often made worse by the stress it causes – our perception of pain, and the anticipation of it, can intensify how we experience it. Anxiety, fear of pain returning, and a sense of embarrassment can create a feedback loop, where worry tightens muscles, dulls arousal, and heightens the body’s pain response.

Even when the root cause is physical, the nervous system’s pain signals can become amplified, and the body may stay on high alert. Addressing pain with awareness of both the source and the surrounding stress is part of a holistic approach to care and leads to better outcomes.
Therapists who specialize in sexual health can be a real asset in this department. They’re trained to help people reconnect with their bodies through guided support that calms the stress response, reduces discomfort, and rebuilds confidence in intimacy.

Get In Touch

Painful sex doesn’t need to be your norm, and it’s not something to tough out alone. If you’ve been experiencing discomfort that doesn’t go away, seems to be getting worse, or is interfering with your ability to enjoy intercourse, it’s time to talk to someone.

Start with a provider who listens, takes your symptoms seriously, and is willing to explore beyond surface-level explanations. You deserve honest answers and relief.

Dr. Kapadia is a board-certified urologist with fellowship training in male sexual and reproductive health. Schedule a visit to dissolve pain, restore intimacy, and start enjoying your sex life again.

Reference:
  1. DelCea, C. (2019). Dyspareunia in Men. International Journal of Advanced Studies in Sexology, 1(1), 48–52. https://doi.org/10.46388/ijass.2019.12.11.120.