Given guys have more than a passing interest in their bits, why are we so bad when it comes to our understanding of sexual health? Men’s Fitness sat down with Dr Jeff Foster, an NHS GP and private practitioner with a long-held speciality in matters below the belt to find out what a sex MOT could mean
WORDS David Leck
“We think about our MOT and psychological health but rarely do we address our sexual health. When you factor in most GPs have had little or no training in this area, it’s unsurprising we have a perfect storm of ignorance, fear and anxiety.”
That’s how Dr Jeff Foster sums up the current state of play when it comes to mens’ sexual health.
“Erectile dysfunction [ED] is one of the first indications a man could go on to have a stroke or heart attack, while low testosterone is consistently linked to a higher risk of mortality,” says Foster, who is also director of men’s health at Manual, a fully regulated online platform covering conditions like ED and testosterone replacement therapy.
“We need to be more open about our sexual health but we must also address the building blocks of healthy living,” adds Foster, hence the idea of a sex MOT.
Speaking earlier this year on the Man Alive podcast [which Foster hosts], Dr Mohit Khera – one of the world’s leading urologists and sexual medicine doctors – said the best mind shift to improve a man’s sexual health immediately is to focus on diet, exercise, sleep and stress reduction.
Khera adds we should think about our “sexspan” – the portion of our life in which we’ll have the desire and or ability to engage in sexual activity – because as many of us live longer there’s a good chance we’ll want to be active in the sack well into older age.
Size does matter [no, not that size!]
According to the charity Prostate Cancer UK, almost half (44%) of men don’t know where their prostate is and 74% aren’t sure what it does. In addition, just a third (35%)are aware early-stage prostate cancer [now the most diagnosed in the UK] often has no symptoms.
The prostate is a small, walnut sized gland that enlarges with age and this change in its size is where problems can first present. It sits below your bladder and its job is to release the fluid component of your semen. Okay, now we have your attention…
Prostate cancer affects one in eight men [one in four if you’re black] and claims around 12,000 lives annually. Diagnosis is usually via the PSA [prostate-specific antigen] blood test but, okay, let’s address the dreaded finger up the butt. Firstly, this is often done only if you have symptoms. Secondly, it takes a few seconds and could be part of a process that saves your life.
Dr Jeff says: “The biggest challenge with prostate cancer is that it’s often symptom free. Screening isn’t routine, but guys over 50 can request a PSA test, while black men and those with family history are advised to ask from age 45 due to increased risk. Early signs of a problem are likely to be in urinary changes such as a need to pee more often [especially at night], a weak stream or difficulty getting going or stopping.”
If you go for a PSA test, you’re advised to avoid vigorous exercise [cycling, running and heavy lifting] – and nor should you ejaculate – 48 hours prior as it may result in a false-positive reading.
While you’re down there…
Testicular cancer is the most common cancer in men aged 15 to 49 and often presents as a painless lump, swelling or a feeling of heaviness in one of your balls, sometimes with a dull ache in the groin. It’s highly treatable if caught early.
Dr Jeff says: “You should perform a self-examination once a month and it can be easier in or immediately after a bath or shower when your balls and scrotum are ‘relaxed’. If you do this regularly, you’ll be more able to detect anything unusual. However, as Joey Tribiana said, ‘it’s complicated down there’, and many things that might feel out of the norm will be completely harmless and you can be reassured with a simple ultra-sound.”
Too soon…or not at all
Studies suggest the average guy lasts between five and seven minutes from penetration to finishing. On the flip side, symptoms of ‘retarded’ ejaculation include a significant delay or inability to cum despite stimulation over prolonged time.
Dr Jeff says: “The basic issue here is down to unreal expectations. Guys see a male porn star banging away for 45 minutes and think it’s the norm. It’s not. Premature ejaculation can be down to psychological factors [anxiety, stress, depression] but there can also be physical causes, so talk to your GP.”
Am I getting enough?
The age-old question. Dr Khera suggests the medically ‘ideal’ frequency to engage in sex is invariably down to age. For younger couples it might be twice a week, under 50 it could be once a week and, as we get older, frequency may decline.
Dr Jeff says: “Again, we have unrealistic expectations and, of course, social media has a knack of making us feel inadequate in just about every area of modern life. People tend to feel they should be having sex way more often than the norm.”
Hard times
This is the one that causes guys the most distress because it’s accompanied by all sorts of issues from a serious kick to your masculinity to an impact on relationships. Erectile dysfunction [ED] is common, affecting anywhere up to a half of men aged between 40 and 70. Young dudes aren’t immune either with some studies showing a fifth of guys under 40 have experienced ED.
Worryingly, this is one of the first markers of cardiovascular disease. Research suggests men with ED today are at a significantly higher risk of having a heart attack or stroke within as little as seven years.
ED stems from a mix of MOT (blood flow, diabetes, heart disease, hormones, lifestyle] and psychological (stress, anxiety, depression, relationships) factors, often working in tandem. An occasional flop is completely normal but persistent issues may signal underlying health problems and require investigation.
Dr Jeff says: “There are many drugs on the market designed to help you get and stay hard. Personally, I don’t think any guy should be buying over the counter without first consulting a doctor. What’s important is lifestyle. Exercise is one factor as certain muscles play a part in helping achieve and maintain erections, while being overweight may only compound the problem.
“A healthy diet may improve things because difficulty in getting hard is related to poor vascular function. And there is some suggestion protein rich foods may help as they provide an amino acid [L-arginine] that improves blood flow to your favourite appendage. Then there’s stress but there’s rarely a magic cure for that. If it’s a big issue, consult a professional.”
Down to a T
This is rarely about body building and being a God in the bedroom. Low testosterone is consistently linked to a higher risk of overall mortality, particularly from cardiovascular and respiratory diseases.
“Testosterone is the ultimate marker of a man’s overall health,” says Mohit Khera. “Men with low testosterone are more likely to have a heart attack, more likely to have diabetes, more likely to break a bone and much more likely to suffer from depression. You show me a blood test that’s a better marker”.
Understanding around low testosterone and testosterone replacement therapy can be shockingly low. At best, many go undiagnosed. At worst, it’s not unknown for anti-depressants to be prescribed before tests are performed.
Dr Jeff says: “Testosterone declines in men from around the age of 30 and that decline continues. Symptoms include poor mental wellbeing, low quality sleep, lack of concentration and decreased sex drive as well as an inability to lose weight even when on point with diet, exercise and lifestyle.”
Playing safe
The statistics around sexually transmitted infections [STIs] vary but the overall picture is one of concern according to Dr Hamish Mohammed of Public Health England.
“Levels of STIs in this country remain a big threat to sexual wellbeing,” he says. “These infections can have a major impact on your health and that of sexual partners, particularly if you or they are antibiotic resistant.”
Dr Jeff says: “If you’ve had or are having condomless casual sex, firstly, why? Given you are, you should get tested at least yearly, even if you’ve no symptoms. Untreated STIs can lead to severe side effects, from infertility and chronic pain to organ damage and various cancers. Just wrap-up guys!”
Cancer of the penis is a thing
This is rare and tends to affect men over 50. Common symptoms are a growth, lump or sore that doesn’t heal within four weeks, a rash or change in skin colour and a smelly discharge. If you’re uncircumcised, it may present as a discharge from under the foreskin or a difficulty pulling your foreskin back [known medically as phimosis].
Dr Jeff says: “It’s important we don’t start fixating on every aspect of our health because health anxiety can be a real and debilitating condition. My advice is know your body, listen to it if you sense something isn’t right, and never let embarrassment be a barrier to your health.”
Ahead of a curve
Peyronie’s Disease is the growth of fibrous scar tissue in the penis causing painful erections and penile curvature that can hinder sexual intercourse and lead to significant distress.
Dr Jeff says: “The cause of Peyronie’s Disease is not always known but it can be due to an injury or poor lifestyle. More common than once thought, it often causes few problems, is treatable and may improve naturally. It can though have a profound psychological impact so, again, speak to your doctor.”
‘No nut’ nonsense
Forget everything you’ve read about the ‘magic powers’ of semen retention and that social media construct ‘No Nut November’. There is zero evidence [aside from one ‘study’ in China in 2002 involving, wait for it, 28 men] to support claims of it increasing energy, intelligence [really?] or your sexual magnetism.
Masturbation isn’t harmful unless you let it get out of hand [pun intended]. In fact, there’s science to back-up one serious medical benefit of what Woody Allen referred to as “sex with someone you love!”
Dr Jeff says: “Masturbation promotes relaxation and stress reduction and can play a role in helping you understand your sexual responses better for when you’re with a partner. And if you need the science to support your “me time”, studies – including a major Harvard research project – suggest frequent ejaculation is linked to a significantly lower risk [31%] of prostate cancer. Mind you, that was based on cumming 21 or more times a month!”
• Man Alive is available wherever you get your podcasts.
