Mental health problems in men resulting in under-performance in the bedroom are on the rise in South Africa and health care professionals are concerned.
"There is already a lot of shame for men with mental health issues. Couple that with sexual difficulties caused by mental health issues such as depression and it's a double shame," said clinical psychologist Zamo Mbele.
This is because depression is often seen as unmanly, "unseen, unspoken and untreated."
Author Terrence Real in his book "I don't want to talk about it: overcoming the secret legacy of male depression," says the stigma is real.
"Depression carries...a double stain--the stigma of mental illness and also the stigma of feminine emotionality."
Sexual health problems only perpetuate the stigma, said Mbele, which makes the conversation on depression and sexual health in men even more difficult to have. Yet, depression in men is said to be at an all-time high in South Africa.
What is a lesser known fact, argues Mbele, is the effect of mental health on a man's sexual activity. "It can manifest in erectile dysfunction, delayed ejaculation and premature ejaculation," he said.
Sexologist and psychotherapist Elmarie Craig told HuffPost SA: "Sexual dysfunction has actually been proven to be a symptom of psychological traumas and a range of other mental health problems."
She explained that the desire to have sex starts in the brain. Sexual organs rely on chemicals in the brain to promote sexual desire. The challenge, then, with a mental health condition like depression is that it "disrupts brain chemicals and can make sexual activity more difficult or not pleasurable."
This is something sexologist and clinical psychologist, Eugene Viljoen also attested to. "I have seen many men from all walks of life expressing concern with sexual satisfaction, thinking there is something wrong with them, or their sexual organs when it's actually a mental health-related condition."
So where to get help?
Mbele, Craig and Viljoen said it starts by identifying that one has depression or a mental health condition.
The South African Depression and Anxiety Group (SADAG) said although depression symptoms differ, the most common are mood changes, where someone may be persistently irritable, sad or anxious. This may be accompanied by feelings of hopelessness, guilt and helplessness. One may have trouble sleeping and appetites may change. Thoughts of death or suicide may be common.
A sexologist may also be able to assist and advise on appropriate treatment.
More importantly, however, "we need to normalise the conversation around men and mental health, and men and sexual disorders," said Mbele. This will encourage more men to seek help if they suspect they have depression or if they are not sure what may be causing their sexual health problems.
"There is no shame in seeking help and there is no shame in having a sexual disorder from a mental health illness."
The South African Depression and Anxiety Group offers free and confidential counselling. Their toll-free number is 0800 212 223. You can also call the Suicide Crisis Line on 0800 567 567 or SMS 31393.