Sexual Difficulties of Indian Men Archives

The Silent Bedroom · Article 4 of 18 (This article was originally published on Substack)

A heavy chest

Prakash is thirty-eight, a civil engineer in Bengaluru, the elder son, the one who paid for his sister’s wedding and his father’s knee surgery. For six months he has woken at four every morning with a weight on his chest and a racing heart. Twice he has been to a cardiologist. Twice the ECG has been normal. “Gas,” his mother says. “Too much tension,” says his colleague.

He is not sleeping. He snaps at his son. He has stopped visiting his friends. The project he was promised has gone to a younger engineer, and there are rumours of layoffs. He and his wife have not had sex in four months; when they last tried, he could not keep an erection and turned to the wall without a word. She thinks he is having an affair. He thinks he is becoming useless.

If you asked Prakash whether he was depressed, he would be puzzled, perhaps offended. Depression is for people with nothing to do, or for the weak. He would tell you instead that his heart is heavy, that his body has no energy, that his dil baith raha hai, his heart is sinking. He would also tell you, if you were a stranger who would never meet his family, that some nights he wonders whether everyone would be better off without him.

Prakash is a composite, drawn from patterns described in clinical research.

A paradox in the numbers

The first three essays of this series kept arriving at the same place: anxiety, shame and depression sitting underneath sexual difficulty. This essay steps back to ask a wider question. What do we actually know about the mental health of Indian men?

The answer begins with a paradox. On most surveys, Indian men report less depression and anxiety than Indian women. Yet in 2024, men made up 73.5% of the 170,746 suicides recorded in India, and nearly 69% of the men who died were married (NCRB report, via ThePrint). If men really were less distressed, those two facts would be hard to reconcile.

This essay argues that they reconcile easily once we stop looking for men’s distress in the places it is supposed to appear. Indian men’s suffering is real, but it is often expressed through the body rather than in words, measured through alcohol and anger rather than tears, and bound up with a sense of worth that lives in other people’s eyes: the family’s, the community’s, the wife’s. The same features that make it hard to count also make it dangerous. And, as the rest of this series will show, they lead straight into the bedroom.

A note on evidence. Some of what follows rests on large national surveys. Some rests on anthropology and on ideas from the psychodynamic tradition about how a self is formed. Those ideas are offered as a way of reading the numbers, and set beside cross-cultural research that has tested similar claims by other means.

What the surveys show

India’s best evidence comes from the National Mental Health Survey (NMHS), conducted by NIMHANS in 2015-16 across 12 states. On its headline figure, men look worse off: current mental morbidity was 13.9% among men against 7.5% among women (NMHS summary). But that gap is driven largely by alcohol. Alcohol use disorder was found in 9.1% of men against 0.5% of women (alcohol research update). For most specific conditions, including depression, generalised anxiety, phobias and obsessive-compulsive disorder, women had higher rates (NMHS summary). Women were 1.67 times as likely as men to have an anxiety disorder (NMHS anxiety analysis).

Read quickly, that seems to settle it: Indian men drink, Indian women worry. Three details complicate the picture.

First, one form of anxiety runs the other way. For social anxiety disorder, the persistent fear of being judged, embarrassed or humiliated by others, the NMHS found that men had significantly higher odds than women (an odds ratio of 1.6). Risk was highest among young adults aged 18 to 29, and nearly three times higher in big cities; worldwide, the usual pattern is the reverse, with women more affected (NMHS social anxiety study; same study, full text). For a series about performance and evaluation, this is a telling finding. The fear Indian men carry most distinctively is the fear of being watched and found wanting.

Second, men get even less help. The treatment gap for anxiety disorders was 84.2% among men against 80.5% among women (NMHS anxiety analysis), and 82% for social anxiety. For depression overall, 85.2% of affected people received no adequate treatment (gender and common mental disorders).

Third, diagnosis is a narrow net. Diagnostic interviews count people who meet strict criteria. Screening questionnaires capture the much larger group in significant distress. In one study of young men in Ranchi, 87% of those with depression also had anxiety (as cited in Global Mental Health). Among adolescents in a Maharashtra urban slum, the stressors reported significantly more often by boys than girls included sexual desire, conflicts in love affairs, jobs, exam failure and family relationships (Maharashtra adolescent study). That list reads like a table of contents for this series.

What the numbers suggest, then, is not that Indian men suffer less, but that their suffering takes particular forms: drinking, social fear, and distress that rarely reaches a doctor.

The suicide paradox

India recorded 170,746 suicides in 2024. Men accounted for 73.5%; nearly 69% of the men who died were married; and the leading recorded causes were “family problems” (33.5%) and illness (17.9%). People aged 18 to 30 accounted for the largest share (NCRB 2024, via ThePrint). Among men who died in 2023, daily wage earners formed the largest group, followed by the self-employed and salaried professionals (NCRB 2023, via The News Minute).

Rates, rather than raw numbers, show where the pressure falls hardest.

Across the three groups, men’s rates run between about 1.7 and 2.9 times women’s; the widest gap is among the married, and the highest rate of all is among unemployed men (Yadav et al.). Researchers who have studied the pattern point to the provider role: in a society where a man’s standing rests on supporting his family, failure to provide, through job loss, debt or business collapse, can become unbearable (summary of research).

This is the heart of the paradox. The men in these numbers rarely appear in clinics for depression or anxiety. They appear, if at all, as debtors, as husbands in conflict, as labourers without work, and finally as police records. Their distress was real long before it was counted; it simply never took a form the surveys were designed to catch. Two caveats belong here, and the essay returns to both: official data under-count suicides, especially among women; and Indian women’s suicide rates are, by world standards, more exceptional than men’s.

Speaking through the body

Prakash’s “sinking heart” is not a figure of speech. In 1989 the anthropologist Inga-Britt Krause described dil ghirda hai, the sinking heart, among Punjabi families in Britain: an illness felt as physical sensations in the heart or chest, attributed to heat, exhaustion, worry and social failure. She noted that it carries a bodily and a psychological meaning at the same time, and that it most resembles the Western idea of stress (Krause, Social Science & Medicine; idioms of distress review). Across South Asia, young men speak in similar terms of “tension”, a word that can stretch from mild worry to severe depression and thoughts of suicide (study of young men in Dhaka).

Why speak through the body? It is tempting to say that Indian men lack a psychological vocabulary. The evidence does not support that. Krause’s work found Punjabi patients as able as British ones to describe their inner states when asked (citation summary). The better explanation is social. In a landmark NIMHANS study in Bangalore, patients who presented depression through bodily symptoms carried less stigma than those who described psychological ones; depressive symptoms were seen as socially damaging, threatening marriage prospects and family status (Raguram & Weiss, British Journal of Psychiatry; Indian Journal of Psychiatry).

In other words, the body is a respectable messenger. A heavy chest can be shown to a cardiologist, discussed with a mother, and treated with rest and home remedies without anyone concluding that the man is weak or that his family carries “madness”. A sad mind cannot. This is also why so many Indian men, like Prakash, cycle through ECGs, gastroenterologists and tonics before anyone asks about their mood.

Alcohol is the other messenger. Alcohol use disorder affected 9.1% of Indian men in the national survey, and its treatment gap was 86.3% (alcohol research update; NAMS task force report). For many men, drinking is the one socially permitted way to dull worry, shame or grief. It worsens all three, and, as the earlier essays showed, it also erodes erections. In one Indian record-based study of suicide attempts, 21% involved alcohol intoxication (same update).

Irritability, withdrawal and overwork complete the picture. Clinicians who work with men often describe depression that looks less like sadness than like anger, numbness or relentless busyness. Those signs are easily mistaken for character, and rarely for illness.

The self that lives in others

Consider how an Indian man’s life is narrated by those around him. His exam results are the family’s results. His job is announced at weddings. His marriage is negotiated by elders and judged by relatives. His son is everyone’s “good news”. When he succeeds, hamara beta (our son) has done well. When he fails, the whole household lowers its eyes. Anyone who grew up in such a family knows both the warmth and the weight of this.

The American psychoanalyst Alan Roland spent years working with patients and therapists in India and Japan. He concluded that the self most of his Indian patients lived in was different from the one Western therapy assumed. He called it the familial self: a sense of identity rooted in close, emotionally intense, hierarchical relationships with family and group, contrasted with the Western “individualized self” built around personal autonomy (Roland, In Search of Self in India and Japan; summary).

Readers wary of psychoanalysis need not take Roland’s word alone. Cultural psychologists arrived at a similar picture by a different route. Hazel Markus and Shinobu Kitayama distinguished an independent self, defined by personal attributes, from an interdependent self, defined by relationships and group memberships, and showed how each shapes emotion and motivation; people with interdependent selves tend to manage both the expression and even the experience of emotion so as to preserve their relationships (Markus & Kitayama, 1991). The framework has its critics, who note that the evidence is uneven and that individuals vary widely within any culture (Matsumoto’s critique). But the convergence of a clinician’s couch and a psychologist’s laboratory on the same idea is worth taking seriously.

Shame, not guilt

A self that lives partly in others has great strengths: belonging, support, a sense of place. Its vulnerability shows when a man fails at a role. Two feelings help explain the difference. Guilt is the private sense of having done something wrong; it can be repaired by making amends. Shame is the feeling of being exposed as deficient before others; it attacks not what a man did but who he is, and it is hard to repair because it lives in other people’s eyes.

For a man whose worth rests on being a good son, provider, husband and father, the loss of a job, a failed business, infertility, a broken marriage or a failing erection is not just a setback. It is a public verdict, and it seems to fall on the whole family. That is why log kya kahenge (what will people say?) carries such force, and why men so often hide trouble until it has become a crisis. It is also the bridge to the previous essay: the “inner audience” a man carries into his bedroom is simply the familial self at its most intimate.

There is a further consequence. A man taught that his worth is conditional, earned through marks, salary and status rather than given, has little to fall back on when performance falters. The self-respect that might carry him through a bad year was never his own to begin with.

Are Indian men unusually fragile?

It would be easy to read the last few sections as a portrait of uniquely brittle men. The comparative evidence says otherwise.

Manhood is precarious everywhere. Psychologists use the term “precarious manhood” for the widespread belief that manhood, unlike womanhood, must be earned and can be lost. A study across 62 countries found such beliefs stronger where human development and gender equality are lower. India’s score was almost exactly the international average, far below the highest scorers and far above the lowest (Bosson et al., 62-nation study). Indian men are not outliers in how much they feel manhood must be proven. What differs is where, and before whom, the proof is demanded.

Men die by suicide more often almost everywhere. Worldwide in 2019, men died by suicide at 12.6 per 100,000 against 5.4 for women, more than twice the rate (WHO, via PAHO). The male excess in India’s police records is therefore part of a global pattern, not an Indian peculiarity.

And Indian women’s suffering is, if anything, more exceptional. WHO’s modelled estimates for 2021 put India’s suicide rate at 13.8 per 100,000 for men and 11.2 for women, a ratio of only about 1.2 to 1, far narrower than the global ratio (WHO estimates, compiled). South Asian women have had the highest female suicide rates of any region (global trends study). One analysis estimates that official Indian data under-count male suicides by about 27% and female suicides by as much as 50% (Centre for Mental Health Law & Policy). Any honest account of men’s distress must sit beside this fact: the same patriarchal system that burdens men harms women more severely still, a theme Part IV of this series takes up.

The conclusion this essay draws is narrower and more useful than “Indian men are fragile”. Their vulnerability is situational. It concentrates around particular roles and transitions (unemployment, debt, marital conflict, infertility, sexual failure) and around particular channels of expression (the body, alcohol, silence) that keep distress out of sight until it becomes dangerous.

Where the roots lie

Later essays in this series trace the deeper roots in detail. Four deserve a first mention here, because they shape which men are most at risk.

Childhood. Adversity in childhood is common in India and leaves long shadows. In a 2026 study of young adults in Chennai, nine in ten reported some form of childhood adversity, and emotional abuse showed the strongest and most consistent link with adult depression and anxiety (Chennai study). Among young adults in Delhi-NCR, the more adverse experiences people had, the higher their odds of depression and anxiety, with bullying and emotional abuse the most damaging (Delhi-NCR study). In a Gujarat sample of 909 adults, emotional abuse roughly doubled the odds of screening positive for depression and for anxiety (Gujarat study). For boys raised on scolding, comparison and “be a man”, these are not abstractions. Part IV of the series returns to how Indian sons are raised.

Caste. Analyses of the Longitudinal Ageing Study in India find that people from marginalised castes report more everyday discrimination and more depressive symptoms than upper-caste peers, and that everyday discrimination is strongly associated with depression (LASI caste study). For a Dalit or Adivasi man, the humiliations of the wider world add to the pressures of the family.

Sexuality. Men who have sex with men face pressure to marry women, to hide, and to perform. Estimates of depression among them range from 11% in a large 12-city study to between 29% and 59% in smaller ones; disclosing their sexuality to family more than doubled the odds of depression (12-city study; online sample). Some of the most anguished sexual dysfunction in Indian marriages belongs to men who never wanted that marriage at all.

Work and money. The provider role is the load-bearing wall of Indian masculinity. When it cracks, the risk is stark. Unemployed men have the highest suicide rate of any group in the chart above, and “family problems” cited in men’s suicides rose by 107.5% between 2014 and 2021 (changing pattern of suicide deaths). Two-thirds of suicides in 2023 were in the lowest income group (Centre for Mental Health Law & Policy). As automation and artificial intelligence reshape white-collar work, a theme for the final part of this series, men like Prakash are discovering that the wall can crack in an office as well as on a farm.

How it shows up in the bedroom

Mental health and sexual health are not neighbours; they share a house. A review of Indian studies concluded that men’s erectile dysfunction and premature ejaculation are closely linked to psychiatric comorbidity, alongside stigma and age (Bhat et al., 2025). The connections run along several lines.

Depression drains desire and erections. As the previous essay showed, depression raises the risk of erectile dysfunction, and erectile dysfunction nearly triples the risk of later depression (Liu et al., 2018). Prakash’s four months without sex were not a separate problem from his heavy chest. They were the same problem, seen from the bedroom.

Social anxiety and performance anxiety are cousins. The fear that Indian men carry distinctively, of being watched and found wanting, is exactly the fear that turns sex into an exam. A man already braced for judgement at work and among relatives does not leave that vigilance at the bedroom door.

Alcohol promises and then betrays. Many men drink to quieten anxiety before sex. Shakespeare’s porter in Macbeth put it best: drink “provokes the desire, but it takes away the performance”. Heavy drinking is a well-documented risk factor for erectile dysfunction, and the hangover of shame afterwards feeds the next round.

Treatment can collide with intimacy. Some antidepressants dampen desire and erections even as they help mood. Men who are not warned, or who are too embarrassed to report it, often stop treatment quietly. A frank conversation about sexual side effects, and about alternatives, keeps many men in care.

Silence is read as rejection. Prakash’s wife concluded he was having an affair. Withdrawal, irritability and avoidance of sex are often the most visible signs of a man’s depression, and the ones most easily misread by the person closest to him.

At the extreme, sexual and reproductive failure can be lethal. Police records attribute only about 0.2% of Indian suicides to “impotency or infertility” (374 deaths in 2021), almost certainly an undercount. Researchers note that while young women are especially vulnerable, men in their thirties and forties show delayed distress tied to masculine identity and reproductive failure (infertility-linked suicides analysis; summary).

There is a hopeful side to this tight connection. For many Indian men, a sexual complaint is the one problem they will bring to a doctor. Handled well, a consultation about “weakness” or a failing erection can be the doorway to recognising and treating the depression or anxiety beneath it.

What this account cannot claim

The data are thin and ageing. India’s only completed national mental health survey dates from 2015-16. Police suicide records under-count, especially for women, and assign each death a single tidy cause, which researchers have criticised as misleading (Centre for Mental Health Law & Policy). The figures in this essay describe patterns, not precise magnitudes.

Men’s pain is not a counterweight to women’s. Statistics on married men’s suicides are sometimes used to argue that men, not women, are the true victims of Indian family life. That reading is wrong on the evidence: Indian women’s suicide rates are among the highest in the world, and the same system of honour, obedience and provider roles that crushes some men constrains most women far more. Recognising men’s distress is a complement to recognising women’s, not a rebuttal.

“Speaking through the body” is not uniquely Indian. Bodily symptoms are a core part of depression in every culture studied, and some researchers dispute that South Asians somatise more than others. What the Indian evidence shows is that bodily language carries less stigma, not that Indians cannot speak psychologically.

The “familial self” is a lens, not a law. Roland’s concept comes from clinical experience, and cultural psychology’s support for it is real but contested. Individual Indian men range from deeply interdependent to fiercely individualistic, and urban, migrant and diaspora life is reshaping the balance.

Families protect as well as pressure. The same closeness that makes failure feel public also supplies care, money, housing and company in hard times. Many Indian men survive crises precisely because their families do not let them face them alone. The task is not to weaken families but to make room in them for a man to say that he is struggling.

What this means

For men. Learn the disguises distress wears: waking at four in the morning, a heavy or racing chest with normal test results, irritability, drinking more, losing interest in friends, food or sex. These are signs worth taking to a doctor, not tests of character. Saying “I am not coping” to one trusted person is not weakness; it is the first step out of the loop.

For partners. When a husband withdraws, stops initiating sex or turns irritable, the cause is often depression or anxiety rather than another woman or lost love. A gentle, direct question (“You seem very low; is something worrying you?”) can open a door that he cannot open himself.

For families. Comparison, public scolding and the constant measuring of sons against others build worth that collapses at the first failure. Families can protect men by letting them fail without disgrace, by asking about their feelings as well as their salaries, and by treating a son’s or husband’s mental illness as an illness, not a family secret.

For workplaces. Layoffs, demotions and performance surveillance land on men whose identity is built on providing. How a job loss is handled, with notice, dignity and access to counselling, can matter as much as the decision itself.

For clinicians. When a man presents with chest pain and a normal ECG, with “weakness” and semen worries, or with a failing erection, ask about mood and sleep. Ask about thoughts of suicide directly; a review of thirteen studies found no evidence that asking increases suicidal thinking, and some found it reduces it (Dazzi et al., Psychological Medicine; review summary). Use the man’s own language (“tension”, a sinking heart) as a bridge, not an obstacle.

If you are struggling: persistent low mood, loss of interest, poor sleep, heavy drinking, or thoughts that others would be better off without you are reasons to seek help now. In India, the government’s Tele-MANAS helpline (14416) offers free mental health support. If you are in immediate danger, contact emergency services or go to the nearest hospital. Readers abroad can contact their local crisis line or emergency number.

Key takeaways

The paradox: Indian men report less depression and anxiety than women, yet made up 73.5% of recorded suicides in 2024, and nearly 69% of the men who died were married.
Men’s distress takes particular forms: alcohol use disorder (9.1% of men against 0.5% of women), social anxiety (where, unusually, men are at higher risk than women), and very low rates of treatment.
The body is a respectable messenger. Sinking hearts, “tension” and semen worries carry less stigma than sadness, so depression often reaches doctors disguised as a physical complaint.
Many Indian men live in a “familial self”, with worth that rests on roles and other people’s regard. Failure then becomes shame, which is public and hard to repair.
Indian men are not uniquely fragile. Their vulnerability is situational, concentrated in job loss, debt, marital conflict, infertility and sexual failure. Indian women’s suicide rates are, by global standards, more exceptional still.
Mental and sexual health share a house. Depression, social fear and alcohol all erode sexual function, and a sexual complaint is often the doorway through which a man can be helped.
Asking helps. Families, partners and clinicians can ask directly about mood and suicidal thoughts; the evidence shows asking does not increase risk.

Sources and further reading

National surveys and suicide data

Symptoms, idioms and stigma

Self, culture and manhood

Roots and risks

Sexual health and help

Disclaimer: This content is for general information only and does not replace professional medical advice. Asmidev is not responsible for any diagnosis made based on this content, nor does it endorse or take responsibility for external websites or products mentioned. Always consult a qualified healthcare professional for health-related concerns. This article was created through a human–AI collaboration. The ideas and direction come from the author’s research, with AI used only to assist in organizing information and refining expression, while cross-checking against established scientific literature.