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.”