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Sexual difficulties are common among Australian men, affecting over half the population regardless of age or sexual identity. It can have significant impacts on physical health, mental well-being, and quality of life if left untreated. The present study aimed to examine sexual difficulty trends, sources of seeking help, and factors associated with sexual help-seeking behavior among a cohort of Australian men. Four waves of data from the Australian Longitudinal Study on Male Health (Ten to Men) were used in the analysis. We included men aged 18 years and above who had engaged in vaginal, oral, or anal sex, leading to a total sample size of 12,737 (wave 1), 8,933 (wave 2), 6,991 (wave 3), and 5,804 (wave 4) men. Logistic regression was undertaken to identify factors associated with sexual help-seeking behavior. Across the four waves, there was a significant rise in the prevalence of men experiencing at least one form of sexual difficulty, increasing from 54.1% (95% CI 52.7, 62.5) in 2013/14 to 64.7% (95% CI 62.8, 66.7) in 2022. The increase in prevalence of sexual difficulties was more pronounced among men from culturally and linguistically diverse backgrounds which increased from 42.8% (95% CI 38.1, 47.5) in 2013/14 to 61.5% (95% CI 55.6, 67.1) in 2022. Around 17.6% of men sought assistance for their sexual health concerns in 2022, with no significant change over the study period. Number of sexual difficulties, age, sexual identity, relationship status, conformity to masculine norms, depression, and number of financial hardships were factors significantly associated with sexual health-seeking behavior. Despite the burden of sexual difficulties increasing among Australian men, few have sought assistance, suggesting a significant level of unmet sexual health need. This underscores the necessity of evaluating current services and considering co-designed sexual health initiatives, informed by an intersectional approach, to enhance accessibility, engagement, and responsiveness to the distinct sexual health needs and preferences of men from a range of communities.