Why Young Men Avoid Sexual Health Care
Rates of sexually transmitted diseases (STDs) such as syphilis, chlamydia, and gonorrhea are at a record high, according to the Centers for Disease Control and Prevention (CDC). One contributing factor could be that men, especially young men, don’t receive regular sexual health care.
Overall, men are much less likely to visit a doctor than women and very few discuss sexual concerns. A survey by the Kaiser Family Foundation found that 91 percent of women indicated they had seen a doctor within the past two years, as opposed to only 75 percent of men. Of the men who did go to the doctor, only 25 percent actually discussed their sexual history and even fewer were counseled on HIV or STD’s.
Avoiding the doctor
A study completed in 2016 looked at why young men didn’t seek out sexual health care. This study focused on minority men in urban settings, but many of the reasons cited are likely to be relevant for all adolescents and young adults:
Our current health care culture focuses primarily on women
The cost of health care was prohibitive
Long waiting times meant taking time off from work
Concerns about confidentiality
There was a stigma attached to seeking health care, especially if STD screening was involved
The fear that the doctor would find something wrong
Why don’t doctors discuss sexuality and sexual health with adolescents and young adults more often?
During adolescence, many males still go to the doctor for an annual exam — perhaps because it is mandated by their school, required before participating in sports or because of parental guidance. These visits, especially for those in the late teen years, would seem like the perfect time to introduce young men to sexual health care and emphasize the need for continued check-ups and STD screenings. But most doctors don’t spend much time talking about sexual health. A study completed in 2013 looked at the audio records of doctor visits for 253 teens with 49 different doctors. They found there were rarely discussions about sexual health and when there was, the teens never initiated the conversation. As a matter of fact, the physicians who did try to talk about sexual health made an average of 17.2 references to sexuality before a teen would reciprocate in the discussion. The authors attributed the teens' hesitancy to not wanting to be judged, a lack of confidence in talking about sex, and general discomfort in discussing sex.
According to the study, many of the doctors never brought up the topic of sexual health, even though teens have a high rate of STDs. The authors speculate that some of the reasons that doctors don’t initiate discussions about sex and sexual health include:
The teen came in for a specific health concern that was unrelated to sexual health
There wasn’t enough time, as primary office visits usually are short visits
The doctor was uncomfortable talking about sexual health
The physician was concerned that parents do not want the discussion initiated
The doctor made judgments based on the appearance of the patient (Researchers did not specify what specific judgements these might be, but noted that the doctor may stereotype the patient preventing the topic of sexual health from being addressed.)
The lack of role models in seeking health care
Adolescent boys whose fathers resist going to the doctor might do so themselves. Once the annual physicals are no longer required, they don’t see any reason to continue. They feel good, they aren’t having any specific health problems, so going to the doctor and waiting an hour before being seen might seem like a waste of time.
Girls have a different perspective. Once they have completed their childhood and teen annual exams, they move on to annual OB/GYN visits. For them, this is a natural progression. Their mothers, aunts, grandmothers, and older sisters probably continue to visit the gynecologist each year. They have grown up believing that is the right thing to do. During these visits, girls and women receive annual screenings for cancer and many are asked if they want additional screenings for STDs. Even when these aren’t included in regular testing, the annual exam gives women the opportunity to discuss problems and request screening tests.
Sexual health screenings for men
Besides discussing any specific sexual health issues, there are self-examinations and screening tests men should be aware of.
Testicular self exams: According to Cornell University, men over the age of 18 years old should complete testicular self checks once a month. Any changes, especially hardness, lumps, sores, bumps, or swelling should be checked by a doctor. In addition if you have discharge, redness, or pain, you should see your physician. The American Cancer Society provides information on how to complete a testicular self-exam.
STD screenings: Everyone between the ages of 13 and 64 should be tested for HIV at least once in their lifetime according to the CDC. If you have had unsafe sex or share injection drug equipment, you should be tested at least once per year.
Heterosexual men are not currently listed on the CDC’s recommendations for regular screening, giving men the false assumption that they are not at risk for developing an STD. With the high rate of STDs today, it makes sense for men to get regular testing as well. Some men do have screenings completed because of their past sexual history, being previously diagnosed with an STD, or because a partner requested it. Many simply are not aware that they are at risk or should have regular screenings.
The CDC does recommend that gay and bisexual men who are sexually active should be tested at least once a year for syphilis, chlamydia, and gonorrhea, and more often if one has multiple or anonymous partners.