Self-criticism and the recurrence of sexual problems in men

I see a lot of men who are extremely hard on themselves. Most of them would not describe themselves that way. They would describe themselves as driven, ambitious, motivated, high-performing. They would point to what they have built. The career, the relationships, the things they have wanted and gone after and got. They would not call this self-criticism, because to them it does not look like criticism. It looks like the engine that has made everything in their life work.

The men who arrive in my clinic carrying this pattern are often the last to recognise it. By the time they reach me, the engine has started to take them somewhere they did not want to go, often into compulsive behaviours, exhaustion that does not lift, or sexual difficulties that keep coming back. And they cannot quite see why.

In over ten years working in sexual health services, across NHS and private practice, and across the outcomes we have now published in peer-reviewed work, this is one of the most common patterns I see. The harsh inner voice, what clinicians often call self-criticism, doesn't always feel harsh. Often it feels like motivation. That is part of what makes it so hard to spot, and part of why it can shape a whole life before someone realises what it is doing.

Two men I have been thinking about

A.L. A man in his early thirties, white, who identifies as gay. He came to clinic struggling with compulsive pornography use. The pattern had slowly taken over his life: his work, his social relationships, his ability to live in line with the things he actually valued. He did not look like someone in psychological difficulty. He was in a high-profile, well-paid job. He dressed well. He had a strong social life and was well connected. By every external measure, he was succeeding. And yet the behaviour was widening into every part of his life.

R.B. A man in his mid-forties, heterosexual, of British Pakistani origin, married for twelve years and with four small children. He is from a liberal Muslim community. Practising, but not strictly. He owns a small business that has done well. Good social network, well respected in his local community, well resourced. He came to clinic struggling with erection difficulties and with taking longer than he wanted to reach climax during sex with his wife. The pressure he was under to perform sexually in particular ways was producing real distress, and it was bleeding into other parts of his life.

These two men look almost nothing alike. Different ages, different ethnicities, different sexual orientations, different presenting problems. And yet what brought them both into the room turned out to be the same underlying pattern.

What looks like motivation, and what is actually underneath

Most men I see are running on two systems and only noticing one of them.

The first is the part of us that moves toward things. Goals, ambition, drive. We all have it, and we need it. Both men I have just described had been drawing on it heavily for years. It had built them careers, families, the lives they had wanted.

The second is the part of us that responds to threat. Something feels dangerous, or risky, or like it might go wrong, and this part switches on. It alerts us. It keeps us safe.

In a settled life, the two work alongside each other. The drive moves us forward; the threat response steps in when something is actually wrong. But over time, in some people, they tangle. The threat response starts to power the drive. We stop moving toward things because we want them, and start moving toward them because not moving feels dangerous. From the outside, the behaviour looks the same. From the inside, the experience is completely different. And the cost adds up.

What men call self-criticism is often that tangle. The inner voice is not telling you that you are bad. It is telling you that you have to keep achieving, keep performing, keep proving, because if you don't, something will collapse. It feels motivational. It produces results. That is why most men live with it for years before recognising it for what it is.

It feels motivational. It produces results. That is why most men live with it for years before recognising it for what it is.

What this can look like

The cases described in this essay are anonymised. Initials and identifying details have been changed throughout. Some are composites.

For the first man, the messages had started young. He had been told from early in his life that he might not be successful. There had been shaming messages about his sexuality, and beyond it. To be gay and to not achieve, he had absorbed, would be the ultimate failure. He had spent years trying to prove his value in an array of ways. He worked harder at school. He won his family's love back, partly, through his grades. He went to university. He got the first. He landed the internship. He earned. He showed people he could be successful, that he had made it. The inner voice that drove this was relentless, and it worked. From the outside, he had everything he had set out to get.

What he could not see, until our work, was what it had cost him. He had become reliant on porn as the only way to step off the treadmill. It was an escape. It was a way of regulating the constant pressure. And it was also, quietly, a way of avoiding the parts of life he had not been able to achieve: intimacy, real connection, relationships with men, a sense of himself that was not contingent on the next achievement. The pornography did two jobs at once. It relieved the stress, and it shielded him from looking at the things the inner critic had not yet managed to fix.

He came to therapy after a difficult period at work, which had included receiving negative feedback and conflict within the team. To him, it felt catastrophic, because the inner voice was telling him that if he failed at work, everything would collapse. He did not arrive saying "I have an inner critic problem." He arrived saying he was struggling with porn and that work was difficult. The inner critic is rarely visible to itself.

For the second man, the architecture was different but the mechanism was the same. He carried a deep sense of expectation around what it meant to be a husband, a father, a provider, a respected man in his community. The pressure was not invented by him; it was real, and reinforced from many directions. He had to provide. He had to succeed. He had to perform sexually, in particular ways, at this stage of his marriage. The drive system had been turned all the way up for years. The threat underneath was the fear of failing in the role he had been given.

What this had done to him physically was significant. He was exhausted. His sexual response had started to shut down. His body, under sustained pressure to perform, was no longer able to respond the way he wanted it to. He could not produce reliable erections, could not climax in the time he wanted. The harder he pushed himself, the less his body cooperated. The inner critic told him this was further evidence of failure. The cycle tightened.

What happened in his body matters beyond his particular case. Chronic motivation by threat does not stay in the mind. It exhausts the body. It produces fatigue that does not lift with rest, sleep that does not restore, and in the territory I work in most, it can shut down the sexual response itself. The body, under sustained pressure to perform, often stops performing. Men rarely connect their physical or sexual symptoms back to the inner critic. It is one of the most common missed links in the work.

Chronic motivation by threat does not stay in the mind. It exhausts the body.

Neither of these men would have walked into my consulting room and said "I am self-critical." Both of them, after weeks of work, recognised that everything they had been calling motivation had been running on a quieter, harder voice underneath, the one that had been telling them they were not yet enough. The work, with men like these, did not start where most therapists would expect it to.

Why I don't try to remove it

Most clinicians, when they meet a self-critical voice in a man, treat it as the problem. Something to be challenged, weakened, replaced with something kinder. The textbook position is that the voice is harmful and the work is to dial it down. I don't think that is quite right, especially for men, and I have learned to be careful about moving toward it too quickly.

The reason is that for most of the men I see, the harsh voice is not an add-on. It is woven into how they have been taught success works. Push yourself harder. Discomfort is the price. Material achievement is the signal you are doing it right. These messages are still everywhere, particularly in how men are socialised. The inner critic is not just a voice in someone's head. It is part of a much wider belief system about how the world works and how a man earns his place in it.

That is why a man can sit in front of me and resist any attempt to soften the voice, even when he can see what it has cost him. Letting it loosen is not just letting go of a habit. It is questioning the whole architecture of how he has been told to be in the world. Challenge that too quickly, or too directly, and a man hears it as you trying to take away the thing that has kept him afloat. He disengages, or he stops coming.

So the work, when it works, does not start with the voice. It starts with the consequences. The behaviours the voice has produced. The compulsive porn use. The performance pressure on the body. The exhaustion that no longer lifts. The escape, the avoidance, the things he reaches for to step off the treadmill the voice keeps demanding. Clinicians sometimes call this self-soothing. In ordinary terms it is just trying to look after yourself when life feels hard, in the only ways you have available. These behaviours are what bring a man in. Building the link between the internal voice and the external behaviour is the first piece of real work. The voice he has been calling motivation has driven him into something he did not want.

Once a man can see that, the question changes. It is not "do I keep this voice or get rid of it." It is "where is this voice useful, and where is it costing me, and can I have a different relationship with it." Recalibration, not removal. The voice does not become the enemy. It becomes something he can hear, understand, and choose how much to take seriously in any given moment.

Recalibration, not removal.

How this shows up in the room

You can often hear self-criticism before someone names it. It is in the way they describe themselves. The slightly tight, slightly self-mocking way they talk about their own achievements. The reluctance to take credit. The instinct to point immediately to what they have not yet done, or what they should be doing better. The faintly apologetic note when they describe stepping off the treadmill, even briefly. They tend not to call it harsh. They call it "being driven", "having high standards", "wanting to do well." Those things can be true and the inner critic can still be running underneath.

In their bodies it often shows up as exhaustion that they have stopped noticing. They have been tired for so long that the tiredness has become baseline. They have lost track of what rest feels like. They speak about needing to keep going as a fact of life, not a choice.

What sometimes shifts the recognition is slowing the whole thing down. Asking how long they have been running at this pace. Asking what they think would happen if they stopped. The answers, when they come, are rarely about the present. They are usually about something much older.

What the work looks like

The first move is rarely to name self-criticism. Most of the men I see would push back on it, because they do not yet see themselves that way. So I start somewhere quieter. I ask whose voice it is, doing the measuring. Whose standards they are working against. Almost without exception, the voice belongs to someone else. A parent who set the rules early. A teacher. A community. A culture. The voice has just been there long enough that it has begun to sound like their own.

The voice has just been there long enough that it has begun to sound like their own.

What changes when a man hears that question is sometimes visible in the room. There is a pause. Something he had taken for granted as just who I am opens up slightly. From there, the work can begin. We look at where the drive is still serving him, and where it has tipped. We look at what kind of motivation he is running on. Being moved by something we value is sustainable. Being moved by what we are afraid will happen if we fail is not. The two often feel identical from the inside, but only one of them can be lived with over time.

Being moved by something we value is sustainable. Being moved by what we are afraid will happen if we fail is not.

Many of the men who arrive in my clinic feel, when they first walk in, that there is no choice. This is who I have to be. This is what is expected. This is not up for debate. Part of the work is asking, very gently, whether that is fully true. Often it is not. There are real obligations, of course. But the inner critic tends to treat every standard as non-negotiable, when in fact some of them are.

In practice, that means noticing when the voice is speaking, recognising what it is asking us to do, and making a choice about whether we want to do that today, in this situation, in this part of life. Sometimes we go along with it. There are real obligations to ourselves, our families, our work. Other times we will not. We pause. We rest. We give something up for a bit and see what happens. We let the voice say what it wants to say, and choose differently.

Alongside this, we work on the part that can respond with some warmth, what clinicians call self-compassion, and what in ordinary terms is learning to look after yourself when life feels hard. Most men find this harder than the noticing. They can be direct, sometimes brutal, with themselves. Warmth toward themselves feels unfamiliar, almost embarrassing at first. We practise it in small ways: eating properly when work is hard, resting when tired, talking to someone instead of pushing through alone, allowing a difficult day to count as a difficult day. Over time the harsher voice loses some of its weight.

What gets in the way

This work is hard, and it is worth being honest about why. Letting the inner critic loosen its grip can feel dangerous. It has worked. Most of what someone has built may have been built on it. Giving it any space at all can feel like throwing the engine of your life.

The cultural messages that fed the inner voice in the first place rarely stop arriving in adulthood. The community that expects success. The family that defines achievement. The wider culture that rewards endless drive. They keep pressing. So the work is not only internal. It involves choosing, sometimes, to step off when the world is still telling you to push harder, and trusting that you will not lose everything by doing so. That is uncomfortable. It takes time. Most men do it in small, deliberate steps.

What change actually looks like

The change is rarely dramatic. It is usually subtle, and it builds.

People begin to notice the voice. They stop taking it at face value. They start to ask whose voice it actually is.

One man I worked with described this moment to me near the end of our sessions. He had been so used to the inner voice driving him that it had never occurred to him it might have come from somewhere else. We had spent weeks together exploring where these voices originate. He said:

> "One day, I woke up and I heard the voice telling me that I need to work harder, that I need to earn more money. And I suddenly realised this voice wasn't mine. It was an amalgamation of men in my family who had told me that the only way to be successful was to earn more. It made me stop in my tracks. It made me think hard about what I actually want, and whether continuing in this way was good for me, or even where I wanted to be in the longer run."

That kind of recognition does not always announce itself. It tends to arrive quietly, often when something else has cracked open first.

Another man, a week later, came back and said:

> "I found myself wanting to go to work on Sunday. I even opened the laptop. But then I heard the voice really clearly, and it just didn't make sense. I don't know how I did it, but I closed the laptop and spent the day with my kids. I could still hear it sometimes, but it just didn't seem to matter as much. It just didn't have so much power."

That second moment, the closing of the laptop, is what change usually looks like in practice. The voice is still there. It still asks. It just no longer gets the final word.

The voice is still there. It still asks. It just no longer gets the final word.

Over time, men in this position begin to discover that they can stop the treadmill briefly without everything collapsing. They find that when they prioritise themselves, or rest, or take time with their family instead of putting in another hour, the world does not punish them the way the inner critic warned it would. They notice their relationship with their partner deepens. They have more time with their kids. They have headspace for the things they actually value.

The voice does not go away. It comes back, especially at moments of pressure or perceived failure. That is normal. The aim is not to silence it, but to be able to recognise it when it shows up, hear what it is saying, and choose what to do with it. Anchored in what matters to them now, rather than driven by what they were afraid of years ago.

For many of the men I work with, this is the most significant change of the work. It is not just about sexual difficulty, or porn use, or performance pressure. It is the ability to live alongside themselves with some warmth. To stop running from a part of themselves that has been telling them they are not yet enough.

This work touches other territory too: shame, the messages a particular community sends, the experience of being marginalised. We may move into those as the work develops. But noticing when the inner voice is telling you that you have to do more, and learning to respond to it differently, is the foundation skill that opens everything else.

Dr Michael Yates is a Clinical Psychologist, EFS-ESSM Certified Psychosexologist and COSRT-registered Sex and Relationship Therapist. He is Lead Clinician and Psychology Service Lead at 56 Dean Street, part of Chelsea and Westminster Hospital NHS Foundation Trust.