The Silent Crisis: Men’s Health
Men’s medical self-care has long been a topic avoided by men. However, it’s a critical issue that deserves to be amplified. On average, men live 5 years shorter than women, and often experience poorer health outcomes and die earlier from preventable causes. A study published in Psychology of Men & Masculinity names 11 distinct masculine norms in society that men view as “ideal” — winning, emotional control, risk-taking, violence, playboy, self-reliance, dominance, primacy of work, heterosexual self-presentation, power over women and pursuit of status. Partly due to these pressures on men to adhere to these “masculine” ideals, men’s health actually suffers. As therapists, it is crucial to open up conversations about medical symptoms and conditions with men who are in psychotherapy.
The Toxic Mask of Masculinity and Its Impact on Mental and Sexual Health
Since societal pressure on men to present as strong, independent, and emotionally stoic it discourages men from seeking the proper medical help, even when they’re struggling with physical or mental health issues. As a result, many men delay seeking medical attention, leading to more severe health problems. Men die earlier than women, despite having more socioeconomic resources. According to a study by the American Sociological Association, men with strong masculinity beliefs are half as likely as men with more moderate masculinity beliefs to receive preventative care.
Even when men with high masculinity beliefs are educated on the importance of preventative care, the likelihood of them seeking out care actually decreases as their occupational status, wealth, and income increases. In another study done at Indiana University among Black men in Chicago, researchers found that masculinity, but not socioeconomic status, was positively associated with excellent self-reported health, leading them to choose NOT to seek out preventative medical care.
How does this stoicism get seen in a sex therapist’s practice? Men tend to suffer in silence and avoid intimacy with their partners (if married or partnered) for months in order to prevent being viewed by their partners as broken or lacking in so-called masculinity. They also feel deep shame if they can’t “perform” sexually, which is indicative of how they understand what sex is supposed to be; that is a performance. Their erectile and/or ejaculatory challenges or disorders also impact their mental health, decreasing the ability they may have had before to express emotional intimacy and may have the domino effect of their partners feeling like they are no longer attractive to their male partners. It is usually when a man is given an ultimatum by their partner who threatens to break up or divorce them unless they go to sex therapy or if the man is unpartnered, he finally accepts that he needs help that he agrees to seek out sex therapy.
The Role of Therapists in Men’s Mental and Sexual Health
In 2021, nearly 80% of deaths by suicide are men. Additionally, the NIH reported that 60% of men who died by suicide had accessed mental health care in the past year. Although many men do not seek out preventative mental health services, when they do, many clinicians may not accurately assess their mental health and sexual health diagnoses. It is shown that depression in men often presents differently than in women, leading many clinicians to misdiagnose when men are actually struggling. And, since the majority of general clinicians and couples counselors aren’t trained and/or comfortable asking about their clients’ sexual health and function, erectile or ejaculatory disorders are missed as well. In a 2019 study(1) of 79 mental health professionals, only a third of the participating psychiatrists and psychotherapists stated they addressed sexual health in patients as part of their daily routine. 25% of the physicians suspected sexual health problems in 60–100% of their patients but did not ask their patients about whether they had sexuality concerns.
Based on the 11 masculine norms for men stated earlier in this blog, research by the NIH has shown that the masculine norms of Self-Reliance, Playboy (i.e., desire to have multiple sexual partners), and Violence, had heightened risk of Depression symptoms. These traits may differ greatly for women, leading certain therapists to not be able to note key warning signs for men. Aggressiveness, substance abuse, and risky sexual behavior can be telltale signs of Depression in men but may not be directly screened for by therapists.
More research is needed to understand the ties between negative health outcomes and masculinity. Organizations like Movember, the Canadian Men’s Mental Health Foundation, and HeadsUp Guys all have great toolkits for therapists to battle the biases we all carry to help men with their mental health. Non-profits like The Sexual Medicine Society of Sexual Medicine Foundation and the Urology Care Foundation are good sites to get accurate sexual medicine information.
While the month of November has ended and with it, men’s mental health awareness month, all medical and mental health professionals need to become more confident and better informed around mental health and sexuality related disorders to better serve their male clients all year round.
