Sexual health shapes more of our lives than most people realize.

Tatyannah King is a New York-based writer with specialties in all things intimacy and dating.

While the majority of Americans say they’ve had sex in the past month, many are still unsatisfied with the frequency (or lack thereof). In fact, respondents said their ideal sex life would include about 13 times a month, which is roughly double how often they’re actually having sex.  

The link is even stronger for men (63%), but nearly half of women (49%) feel it too, making it clear that this isn’t limited to gender. When a person’s sex life shifts, the ripple effect goes beyond physical discomfort or lower libido. Conditions like erectile dysfunction, low testosterone, perimenopause, and menopause can begin to chip away at people’s identity.   

Dr. Peter Stahl, Head of Men’s Health at Hims, says, "ED, at its core, is a failure of a predictable physiologic response. When a man can’t reliably achieve or maintain an erection, he begins to treat his own body as unreliable."

Those changes rarely stay confined to the bedroom. Dr. Stahl also explains why there's shame associated with sexual unpredictability. "Once a man has experienced failure in a vulnerable moment, he often starts anticipating it in other high-stakes settings: a work presentation, a difficult conversation, a round of golf," he says. "The erosion of confidence becomes the clinical issue as much as the erection itself."

For example, people might think of erectile dysfunction as only a sexual issue, but ED causes withdrawal from other types of physical intimacy, like hand-holding and casual affection.   

“Any physical closeness carries the risk of escalating into a situation where they might fail, so they eliminate the category,” Dr. Stahl says. “Partners typically interpret this as lost attraction, when clinically it’s protective avoidance driven by performance anxiety.”

Through Dr. Stahl’s work at Hims, he also explains that when men experience ED, they also become fatigued, short-tempered, less engaged with their children, and less interested in the activities that used to define them. “Testosterone directly influences mood regulation, minor stressors generate disproportionate reactions, and the cumulative effect on a relationship is significant,” he says.

During menopause, estrogen and testosterone levels naturally decline, which can lead to changes like thinner vaginal tissue, less elasticity, and reduced blood flow—factors that all play a role in arousal and overall comfort. On top of that, Dr. Jessica Shepherd, Chief Medical Officer at Hers, explains there’s a layer of emotional variability that comes with menopause that many women aren’t prepared for. “Increased anxiety, irritability, low mood, or even a sense of disconnection from oneself can emerge during this time. And while these shifts are common, they can feel deeply unsettling, especially for women who have always felt steady, confident, and in control,” she says. “When intimacy becomes a source of pain or frustration rather than pleasure, a woman’s brain instinctively begins to guard against it.”

In other words, from a biological and psychological standpoint, sexual confidence is about a lot more than just “feeling sexy.” Hormones, stress, and energy levels all play a role, and so do other factors, like body image, self-esteem, and how connected someone feels to themselves and their partner. 

When no one really talks about menopause, it’s easy for women to internalize changes in their sex lives and wonder if something is “wrong” with them. This stigma can extend beyond the physical symptoms in a way that contributes to diminished confidence, reinforcing how closely sexual well-being is tied to self-perception and identity.