Men are often reluctant to discuss health concerns, particularly those relating to sexual function, a silence experts say can have serious consequences. This hesitancy, stemming from shame or a desire to avoid appearing weak, can lead to delayed diagnosis and treatment of preventable or curable conditions. As Raevti Bole, a urologist at the Cleveland Clinic in Ohio, explains, a significant part of an andrologist’s role involves reassuring patients they are not alone in experiencing these issues.
The internet, while offering readily available information, is often a source of misinformation. Tony Chen, a urologist at Stanford Medicine in California, urges younger men to consult with their doctors rather than relying on artificial intelligence or social media for guidance on their sexual health.
Understanding men’s sexual health requires addressing several key areas, from erectile dysfunction to pelvic floor health and sperm quality. Ignoring these aspects can have far-reaching implications for overall well-being.
Erectile Dysfunction: A Cardiovascular Warning Sign
Approximately 50 percent of men experience episodes of erectile dysfunction (ED) after the age of 40. Often, this is linked to underlying circulatory issues. Maintaining a healthy blood flow is crucial for achieving and sustaining an erection, and this is directly tied to cardiovascular health. A Dutch study conducted in 2008, following 1,248 men aged 50 to 75, found that those reporting ED had a 60 percent higher likelihood of experiencing a heart attack or stroke within six years.
“We need to think of the penis as a barometer of an individual’s cardiovascular health,” says Matthew Ziegelmann, a urologist at the Mayo Clinic in Minnesota. Difficulties with physical arousal can be an early symptom of type 2 diabetes or high cholesterol, both of which damage artery linings and increase the risk of stroke or heart attack.
Vaibhav Modgil, an andrologist at Old St. Mary’s Hospital in London, emphasizes that ignoring ED represents a missed opportunity for cardiovascular disease prevention.
The Importance of Pelvic Floor Health
The pelvic floor muscles, located between the anus and the genitals, provide support for the bladder, intestines, and sexual organs in both men and women. Strengthening these muscles can improve bladder control, which is why Kegel exercises are often recommended for pregnant women and those recovering from childbirth. However, these exercises can also benefit men experiencing incontinence after prostate surgery and can help address premature ejaculation.
Conversely, overly tense pelvic floor muscles can cause pain during intercourse, contribute to erectile dysfunction, or create difficulties with bladder and bowel emptying. During sexual activity, these muscles contract rhythmically. If already tense, contracting them can be painful. Gentle stretching of the hips, glutes, and hamstrings, along with diaphragmatic breathing, can help relax these muscles. For persistent or severe symptoms, Ziegelmann recommends consulting a pelvic floor physiotherapist.
Sperm Quality and the Impact of Age
Age significantly impacts semen quality. Contrary to a common misconception, simply achieving an erection and ejaculating does not guarantee fertility, according to Michael Carroll, a reproductive medicine researcher at Manchester Metropolitan University in the UK. Semen quality tends to decline with age, affecting sperm motility, damaging DNA, and increasing the risk of complications during pregnancy. Chen notes that this is an area where men are becoming increasingly relevant in family planning.
While there is no precise age threshold, a progressive decline occurs throughout a man’s life. A study found that the risk of miscarriage increases by 43 percent when the father is over 45 compared to those under 30. Urologists advise men to consider their age when planning parenthood, just as women do. “Fertility is a team sport,” Chen explains.
Lifestyle Factors: Diet, Exercise, and Testosterone
Diet, alcohol consumption, and exercise all play a role in sexual function. A diet high in fats and sugars increases the production of reactive oxygen species, which can damage cells, including those in the testicles. Carroll suggests that the Mediterranean diet, rich in antioxidants, is associated with healthier sperm. Obesity is another significant risk factor. Fat cells produce aromatase, an enzyme that converts testosterone into estrogen. Low testosterone levels can make it difficult to maintain an erection and reduce sperm production. A Harvard study found that a 2.5-centimeter increase in waist circumference is associated with a 3 percent decrease in sperm concentration. Weight loss can improve sperm counts in obese individuals.
However, experts caution against testosterone therapy unless a medical examination confirms a deficiency. Modgil notes that testosterone is frequently promoted to younger men seeking muscle gain and improved sexual performance, but few are aware of its potential to disrupt sperm production and reduce fertility.
Regular exercise can benefit fertility, but intense training during conception attempts should be avoided. High-intensity workouts can trigger a stress response that disrupts testosterone production and reduces sperm count. Carroll warns that pushing the body to its limits can increase the production of DNA-damaging chemicals. Cycling also requires caution, Bole adds, as prolonged compression of the scrotum and tight clothing can increase testicular temperature. A leisurely bike ride is unlikely to cause harm, but intense training can pose problems.
It takes approximately two months for sperm to mature, meaning lifestyle changes will not produce immediate results.
Breaking the Silence: Addressing Embarrassment and Seeking Help
Reluctance to discuss genital health can prevent men from seeking medical attention for conditions like testicular cancer. Juan Andino, a urologist at UCLA Health, emphasizes that early detection of testicular cancer has a 98 percent cure rate and urges men to undergo regular check-ups. Concerns about penis size and shape are also common reasons for avoiding medical consultation. These anxieties can fuel anxiety, depression, and sexual dysfunction, and in severe cases, develop into body dysmorphic disorder. Carroll notes that many patients are reassured to learn that the average erect penis length is 13 centimeters. He discourages treatments promising penis enlargement, suggesting that simply trimming pubic hair can boost some men’s confidence. Ziegelmann stresses that urologists are accustomed to discussing sensitive topics and that open communication with a healthcare professional can be invaluable.
