My friends have had all kinds of romantic and sexual experiences. Some have spent years in devoted relationships, followed after a breakup by a frenzy of new partners. Others focus on serious dating with an eye toward the aisle. Then there is the rake who leapt from his window (first floor) to escape a jealous lover, but later found love, monogamy, and a shared apartment. And, oh, the open relationships I’ve seen.
I estimate that about half of my close circle (men and women, whatever their preferences) have had more sexual partners than can be counted on two hands. It’s almost inevitable: If you begin dating in your teens or college years and don’t get married until, say, your 30s (if ever), the numbers start to add up. In my experience, no particular romantic tendency maps strictly to either gender, but I have noticed which friends tend to be better at protecting themselves from the possible dangers of a rich and varied sex life: women.
Many women have annual gynecological visits starting when they are teenagers, which ideally involve sexual health counseling, a pelvic exam, a pap test to screen for cervical cell irregularities, STD testing, and vaccinations. My housemate, for example, has been tested for chlamydia and gonorrhea every year since she was 16, in addition to receiving birth control counseling, and the pelvic and pap regimen. Such visits make engagement with the health care system routine and provide a basis for regular care. (A recent study reports that 63 percent of gynecologists discuss sex with patients, and 40 percent ask about sexual problems. But those numbers should improve: Young female gynecologists are better on both scores, and the majority of residents entering the profession are female.)
There is no equivalent process for men. And it shows. I’ve known many men, most of whom identify as straight, who have a decidedly laissez-faire relationship with condoms. Regular STD screenings are not the norm, either. A friend of mine who had slept with close to 20 people didn’t get an STD test until his new, and justly horrified, girlfriend frog-marched him to the clinic.
Women end up bearing a lot of the sexual health burden, says Scott Williams of the Men’s Health Network, because men and teenage boys don’t know much about their own health. And that disparity “reinforces the idea that men don’t have to worry, that it’s a woman’s issue,” says Adina Nack, a sociologist at California Lutheran University.
Tests for STDs “are not generally a part of a man’s physical checkup unless the doctor picks up signs or symptoms,” says Jean Bonhomme, president of National Black Men’s Health Network. He noted that getting men, particularly the young, to go to the doctor at all, for anything, is a feat roughly equivalent to wrestling an alligator. “I’m not sure men are being regularly tested for a doggone thing.”
The numbers bear Bonhomme out. A recent study from the Agency for Healthcare Research and Quality found that only 57 percent of men had seen a doctor in the previous year, while 74 percent of women had. A Commonwealth Fund study from 2000, “Out of Touch: American Men and the Health Care System,” found similar disparities. “Physicians are especially unlikely to discuss sexual health with their male patients,” the report notes. Only 14 percent of men reported that their doctors had counseled them on sexual health. A 2009 study showed no improvement in sexual health counseling for sexually active young men ages 15 and 19 between 1995 and 2009: Less than 25 percent were receiving any attention.
Many of the experts I interviewed attested to the fact that many men simply drop out of the health care system entirely after outgrowing their pediatrician, only to re-emerge in their 40s. But a host of problems are most likely to bedevil men during the exact time they are least likely to be receiving care. According to the CDC, “Young people represent 25 percent of the sexually experienced population in the United States, but account for nearly half of new STDs,” many of which may not have immediately apparent symptoms, including HPV, chlamydia, syphilis, and HIV. Aside from STDs, other diseases often strike during these years; testicular cancer is the most common cancer among men aged 15 to 34.
There are alternatives to this dysfunctional arrangement. Large cities with active LGBT communities often host health centers and doctors that cater specifically to these communities’ needs, often encouraging more open and sex-inclusive medical norms. (LGBT-oriented health care is virtually nonexistent outside of urban centers.)
“Not speaking as a clinician but speaking as a gay man, in my consciousness [getting sexual health checkups] was always something I was supposed to do,” says Dustin Latimer, a physician assistant at Philadelphia’s Mazzoni Center. Testing for and preventing HIV and other STDs “was something I was always coached [in] from the age of 17 when I came out.”
Many of Mazzoni’s male patients who have sex with men get regular sexual health screenings and, Latimer says, LGBT-oriented health care providers tend to be much better at being frank with their patients about sex than other practitioners are. “I talk to almost every patient I see about sex,” Latimer says. “If they come in with an ear infection, we’ll focus on that. But for most general follow-ups, we’re going to talk about sex.”
I can attest to that. My previous primary care physicians discussed sex only if I initiated the conversation. I had to specifically ask for an STD test, and once my request was met with a surprised, “Again?” One doctor seemed utterly clueless about HPV (“I don’t see any genital warts, so you don’t have it”), and the office did not even offer the HPV vaccine to men. When I switched to Mazzoni for my primary care, I was quizzed on my sexual history, got my HPV shots, and received an STD test, without a fuss.
The question is how to get such care for the vast majority of American men. Among the Affordable Care Act’s virtues is a wonderfully comprehensive list of free preventive services for women: contraceptives, mammograms, pap smears, and screenings for all the major STDs. “Well-woman visits” are also included: general annual preventive care checkups “for adult women to obtain the recommended preventative services that are age and developmentally appropriate.”
Similarly sweeping services are not provided for men. The ACA does offer screenings for HIV and syphilis and STD-prevention counseling, regardless of gender, if a patient is deemed a “higher risk.” Immunizations against HPV and hepatitis B should also be freely available. But these are not particularly thorough or comprehensive standards.
What would an annual “well-man visit,” as the Men’s Health Network terms it, look like? Williams’ organization recommends HPV vaccinations, annual screenings for gonorrhea and chlamydia, along with prostate exams for those at higher risk: black men, anyone exposed to Agent Orange, and those with a family history of prostate cancer.
But there is only one organization I know of that has a comprehensive list of men’s sexual health services akin to the ACA’s preventive package for women: Planned Parenthood.
On Planned Parenthood’s web page devoted to men’s sexual health, the list of services (which vary by location) includes everything from colon, testicular, and prostate cancer screenings, erectile dysfunction and premature ejaculation services, male infertility screenings, “jock itch exam and treatment,” vasectomies, and the whole battery of sexual and routine physical examinations and testing. Many Planned Parenthood locations also offer the HPV vaccine for men. An affiliate in Denver treats obesity in young men, and centers in Texas screen for diabetes and teach men how to perform a testicular exam.
How many men go to Planned Parenthood for these treatments? Leslie Kantor, vice president of education for Planned Parenthood Federation of America, says the number of male patients has doubled in the past 10 years. The organization is popularly associated with women’s sexual health, and I have never known a man, even in my progressive and relatively sexual-health-conscious circles, to utilize their services. Men should support Planned Parenthood not just for the sake of the women in their lives but because it’s an excellent place to get their own sexual and reproductive health needs met.
Planned Parenthood probably can’t be expected to go to bat politically for “well-man” visits, as the organization is still battling a frontal assault from the Republican Party. The Men’s Health Network has issued a position statement about the preventive care they would like to see included as the Affordable Care Act moves forward. Back in the early 2000s, there was a bipartisan bill pushed by Sen. Mike Crapo, R-Idaho, and Rep. Vito Fossella, R-N.Y., to establish a federal office of men’s health, under the auspices of HHS. It never went anywhere, and in our current hyper-polarized and austerity-obsessed political environment, it seems unlikely to be resurrected.
Policymakers and health care stakeholders should take a keener interest in men’s sexual and reproductive health. If close to half the population is going without regular, standardized checkups, often for years, public health will be, and is being, harmed. Without such norms, American men will continue to be woefully uninformed, unprotected, and unexamined. And that’s not good for anyone.