Men's sexual health

Gender has an impact on health and behaviour, which is why work with boys and men to promote sexual health awareness is crucial to improve health outcomes for them and their partners. Some features about men's sexual health are described below:

• Men are less likely to seek health care advice or treatment.
• Mens' sexual behaviours are more risky than women - more likely to have multiple sexual partners, take alcohol and drugs.
• Men may not admit to sexual ignorance.
• False sexual claims and myths about sex are sometimes used in order to appear as 'real men' in the eyes of their peers - e.g. "I managed it three times last night".
• Discussions about sexual experiences might be about their prowess, perhaps rarely mentioning the sexual needs of their partners.
• Mens' behaviour puts women at risk - for instance, HIV and some sexually transmitted diseases are more easily transmitted from men to women than women to men.
• Globally men are under pressure to conform to destructive ideas and behaviours of  'manhood', e.g. being 'Jack the Lad' - instilling the ideas of sexual prowess and multiple sexual partners which facilitates risk-taking behaviours. For some, having a STI is considered a badge of honour that confirms one's manhood.
• Class, culture, ethnicity, religion and sexuality and sexual orientation are all factors that affect men's sexual behaviour.
• Myths exist - for instance, the male sex drive is boundless and irrepressible. The myth of male superiority that is deeply ingrained in many societies inadvertently assists the transmission of HIV.

There are resources such as the Men's Health Forum which help to overcome some of these problems and pressures - see the 'Useful resources' section for links.

View the video of 'Blake's story' and think about how you might respond if you were the nursing staff member in this situation. To read a transcript of the audio in this video, select the link Blake's story (Word 15KB).

How you can help

You  do not have to be a sexual health practitioner or work in this speciality to enable men to access information and advice - many men visit their doctor or nurse and come away without revealing their health concerns.  Men still find it very difficult to talk about a number of issues that affect their health, especially sexual health symptoms, mental difficulties, and drug and alcohol problems.

Fortunately there are several effective ways you can introduce the topic of sexuality during visits. You might open with a statement such as, “It is part of my routine to ask about sexual health", for instance during new patient checks and chronic disease clinics in general practice, or visits for other medical problems in walk-in centres. With teenage boys it could be at their 'school leaver' immunisations appointment if you are a school nurse. This sort of question makes it clear that it's usual for you to ask everyone - it's a 'normalising' statement. Similarly, "Do you have any concerns about sexual health?” is another useful question once the consultation is well underway and trust and rapport have been established.

You also need to provide an atmosphere in which a gay or bisexual man feels safe to disclose his sexual orientation. Many men will not, for fear of being judged, and consequently they do not access the health care they need. Although heterosexual and homosexual men share the same health needs, there are some particular considerations for men who have sex with men. For instance, STIs such as HIV, gonorrhoea and syphilis may be more common, vaccination against hepatitis A and B is indicated, and higher use of alcohol and drugs are sometimes an issue. Coping with prejudice or trying to hide their sexuality can trigger emotional disorders and mental health problems.

We all have a duty of care to enable patients and clients to access accurate information, and to promote good sexual health. It is helpful to have an awareness of the STIs addressed in the previous section, but also of testicular and prostate cancers, and erectile dysfunction. You can find out more about these in Further learning. In summary, our role is to:

• Initiate a conversation so that the man has the opportunity to talk about any concerns.
• Don't assume their sexual orientation, it's alienating to gay men and will exclude health needs related to bisexual activity.
• Be aware of the environment and protect confidentiality.
• Listen and react appropriately with leading prompts for further information.
• Signpost or refer to someone who can help him, as is appropriate to your role.
• Provide leaflets, point out their relevance for his needs.
• Document and date the consultation so his sexual health needs can be acted upon by other relevant professionals.

Blake's case study makes it clear about how important these communication skills are for your male patients and clients.