November is Men’s Health Month, an important time for men to think about their physical, mental, and sexual well being. The Movember organization works to bring awareness and create programs to battle against the stigma of men’s physical and mental health. On average, cis-gender men in the United States die 5 years earlier than their cis-gender female counterparts. According to Harvard Health, there are multiple reasons for this:
- Men generally work more dangerous jobs
- die by suicide at higher rates than women,
- are less socially connected and
- generally avoiding doctors more often.
Hannah Farrimond, a sociology researcher based in the UK, describes this avoidance of medical help as a way for men to feel more masculine and in control. In her study, she describes that her subjects felt as though not seeking out help from anyone else was their way of acting responsibly and maintaining their masculinity. By taking matters into their own hands instead of relying on a medical professional, they feel stronger and more capable.
It is often very difficult for men to put down the facade of feeling strong and masculine when thinking about their physical health, but things really compound when we talk about men’s mental and sexual health. In an extensive 2018 literature review of 49 published studies in The Journal of Sexual Medicine the nexus between erectile dysfunction (ED) and Depression in men was discussed. The findings suggested that men with ED are significantly more likely to experience depressive symptoms than those without ED. While the review found this link, it remains unclear which is the cause and which is the effect. From a behavioral model perspective the authors state that “patients with depression tend to engage in negative thought and are less confident, which results in performance anxiety that further reduces erectile function”. On the other hand, the “biological model postulates that depression affects the hypothalamic pituitary adrenocortical (HPA) axis, leading to excess catecholamine production, which in turn, leads to poor cavernosal muscle relaxation and ED”. In clinical practice, therapists find that when men’s sexual prowess and mental strength are being questioned, many report feeling emasculated due to societal pressures instilled in them from early ages. They commonly begin to avoid all intimate touch or even verbal expression that might be interpreted as a sexual initiation by a partner.
Societal expectations for men to be tough, competitive, emotionally stoic, and the primary breadwinners can result in men neglecting preventative health measures, especially when it comes to mental and sexual health. While the tie between depression and ED is apparent, our society still makes working through these issues even more difficult. Therapists should understand how to have clear, honest, and compassionate discussions with their male clients surrounding sexual wellness. Since studies and sexual therapy clinical observations support the biopsychosocial-sexual connection between ED and Depression, therapists need to get more training and sense of comfort in asking their male clients about their sexual health and functioning in addition to screening for their mental health. General therapists might need to learn more about how each client’s or couple’s challenges are frequently complex and varies from case to case It’s important that clinicians treat ED as a multifactorial condition frequently requiring a multidisciplinary team approach which might include:
- urologists
- sex therapists
- pelvic floor physical therapists
- oncologists.
While there are PDE5 inhibitors (like Cialis and Viagra) and other medical interventions that treat symptoms of ED, medical providers often forget the importance of the psychosocial-sexual-spiritual component of sexual wellness. Researchers at the European Society of Sexual Medicine published a 2021 report stating that there is “increasing evidence that psychological treatments of ED can improve medical treatments, the patient’s adherence to treatment, and the quality of the sexual relationship”. Since many general therapists aren’t trained in sexual health issues and specifically male sexual disorders, it might be more intimidating to ask detailed questions regarding ED symptoms including; timing, frequency, how full an erection is, and the history of the disorder. If general therapists gain more sexual health information while also becoming more comfort in asking these questions, they can support their male clients through the stigmatized barriers that society has put up around sexual expression, while inviting them to seek out medical care and treatment for the biological aspects of their symptoms leading to an emotionally healthier and a more fulfilling sex life. They may also provide the support they need in going to a urologist or a cardiologist since many research studies has shown that early signs of ED can be red flag warnings to future cardiovascular disease.
In order for therapists’ male clients to feel empowered emotionally, physically, and sexually, clinicians must be ready to get more educated on how to assess for sexuality related issues and disorders that may feel taboo to bring up or had previously not been part of their own training and education. Encouraging male clients in psychotherapy to express more of their sexual health and psychological challenges is key to men gaining the medical and emotional treatment needed. By expanding their training and becoming biopsychosocial-sexual and spiritually clinicians, psychotherapists can model for their male clients to overcome the stigmas society has engrained in them. Therapists can offer them guidance and support to seek out appropriate medical professionals which will not only help them to improve their mental health but will get targeted treatment for sexuality and sexual-health related disorders which can also prevent potentially serious medical problems down the line.
