Even the best patient-physician relationship can be challenged by complex subjects such as sexual health. From the physician’s perspective, we may make unwitting and harmful assumptions about patients’ sex lives, assuming they have one partner, have a heterosexual relationship, or don’t hope for pregnancy. We may incorrectly assume older patients are no longer sexually active and stop asking about sexual health. We may think patients don’t want to talk about their sexual health or don’t have sexual problems to discuss. Clinicians who assume patients don’t want to talk about sexual health are probably wrong. Research suggests that patients not only want to have these discussions, they want their physicians to initiate them.1
For patients, particularly men, the conversation may be even more difficult if there is a gender mismatch, a significant age gap, or the patient is worried he will be judged. Men report embarrassment about having sexual health issues and fear they are unable to be helped.2
This edition of FP Essentials addresses important topics in men’s sexual health. (This issue uses “men” and “male” to refer to people assigned male sex at birth who identify as men.) The authors of this edition show us that family physicians should be familiar with the management of these conditions and comfortable with these conversations about sexual health problems in men.
It is clear from the information in this edition that sexual health problems are common among men. Just how common depends on the exact problem. Section One covers infertility and low libido. It informs us that infertility affects up to 15% of heterosexual couples, and 5% to 8% of men experience hypoactive sexual desire disorder.3–5 Section Two discusses evaluation and management of disorders of the penis. Up to 50% of men between ages 40 and 70 years experience erectile dysfunction.6 This section describes evaluation and management of this common condition and others such as phimosis.
Section Three covers disorders of ejaculation. In this section, readers will learn that about 5% of men experience premature ejaculation, and up to 4% experience delayed ejaculation.7,8 Section Three also discusses conditions such as hematospermia and retrograde ejaculation. Section Four addresses sexually transmitted infections, the most common of which, human papillomavirus, affects 42.5 million people in the United States.9 Section Four additionally discusses diagnosis and management of long-standing and emerging sexually transmitted infections.
The need for knowledge and skills in the field of men’s sexual health is evident from the high prevalence of these many conditions. I hope this edition of FP Essentials helps you initiate conversations and provide better care for the patients in your practice.
Kate Rowland, MD, MS, FAAFP, Associate Medical Editor
Vice Chair of Education and Associate Professor,
Department of Family and Preventive Medicine
Rush University, Chicago, Illinois
