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Roxana Whelan on
dilemmas of men’s
sexual health
Ten years of
Aman has a quick consultation. You deal (62 out of every 1,000 single men married each year).
This had dropped to 28 per 1,000 by 2000. By contrast prescription but he hovers. ‘Actually the divorce rate in 1960 was 1.7 per 1,000 married there’s something else, doctor… err, I’m men, rising to 12.7 per 1,000 by 2000. 6 The age at first seeing this lady and, well, I’m having problems. I was marriage has also risen. People are more likely to wondering, err, you know those tablets…?’ have sexual relationships before marriage and to This scenario has become more familiar over the start new relationships at various stages of life.
last ten years because of new therapies for erectiledysfunction, greater media attention, and hence greater public awareness of the problem.
Viagra (sildenafil) celebrates the tenth anniversary The issue of men’s sexual health is not often covered of its British licence this year. Previous therapies were in Christian medical publications. Triple Helix ran an unappealing, ineffective, or little known. Some article 1 on Viagra when it was first licensed in 1998, unlicensed therapies were helpful, while recreational but since then the issue has hardly been considered.
drugs were often used to enhance performance.
We frequently read about abortion, contraception and Viagra’s arrival made a big splash; seductive advertising teenage sex, but rarely about male sexual dysfunction. in the medical press was paralleled by provocative A US study showed that 52% of men aged 40-70 headlines nationally. People became aware not only experienced some degree of erectile dysfunction that erectile dysfunction was common, but something (ED), while 10% experienced complete erectile could be done about it. That something could be as dysfunction. 2 Premature ejaculation is also simple as taking a tablet obtained on prescription.
common, affecting up to 40% of men 3 while On the one hand was a sense that ‘everybody’s doing it’, yet on the other the taboo remained. To We know men consult doctors less frequently than obtain Viagra a man had to admit to his doctor there women do. 5 Reasons include busyness and lifestyle was a problem. Fuelled by demand, many private stress, but also embarrassment, reluctance to admit to clinics and providers sprang up, and the internet problems, and fear. Sexual problems carry a particular became a common source of supply. The blue taboo. Visiting a doctor about a sexual problem not only introduces an embarrassing topic but acknow- across the globe, a symbol of sexual freedom and ledges that all is not well in the bedroom. This can rejuvenation for men, as the contraceptive pill had feel like an admission of guilt, failure or weakness, been for women. A problem which had been hidden or even a threat to one’s masculinity. There is also under the bed-clothes for years suddenly came into a common belief that nothing can be done anyway.
the limelight and competitors brought other oraltreatments onto the market. Changing timesThe advent of the contraceptive pill and the legal- isation of abortion in the 1960s have led to a radical Christian doctors will meet a range of men change in attitudes towards sex and relationships. requesting Viagra or similar treatments, or asking for In 1960 the marriage rate for men was 62 per 1,000 help with sexual problems. Each man will have his own situation. Some will be married, some The dilemma is this: is a prescription in certain cohabiting, some in a new relationship, some having circumstances tantamount to condoning sin? Or does an affair. Some will be in homosexual partnerships.
failure to prescribe constitute passing judgment? Some will be engaging in casual sex. Some mayeven be perpetrators of abuse.
So what is the dilemma? Is there a dilemma at There are no easy answers, and the decision will all? Is erectile dysfunction purely a medical problem ultimately be a matter for each doctor’s conscience.17 which needs to be managed with the best available It will also depend on the individual situation. treatment, whatever the context? Or is there an For a man in a consenting adult heterosexual relationship, it could be argued we should respecthis lifestyle choice and provide treatment for his medical problem. We could argue that those in By its very nature, a sexual problem has several dimen- long-term relationships are living ‘as if married’ and sions. Erectile dysfunction is not merely the inability should be treated as such. While most Christians to achieve an erection. Emotionally, it often causes would view homosexual partnerships as wrong, 18 anxiety and loss of self-esteem, and socially, it affects we must be careful not to judge the couple. And we the man’s relationship, often leading to awkwardness must be aware of GMC guidelines and recent legal and insecurity. The partner’s response may be loving changes on discrimination. Where we feel unable to and accepting, or there may be tension and prescribe, patients are entitled to a second opinion arguments. The security of the relationship may if they are unhappy with our decision.
become conditional on the man’s performance.
We also have a duty to protect both our patients Erectile dysfunction may not only be the cause but the and others. Somebody requesting Viagra for a series manifestation of emotional problems, relationship of casual relationships is putting his physical and difficulties, or spiritual issues such as guilt.
emotional health at risk, and may spread sexually As doctors we need to explore not only what transmitted infections to others. Somebody having an is happening physically but what is happening extramarital affair is harming his wife. One would have emotionally, socially and spiritually. Is the strong grounds for saying ‘No’ in these situations. A relationship compatible with the patient’s value man having intercourse with a minor of either sex is system, or is it a source of guilt? Is it a healthy acting illegally, and we should take appropriate action.
relationship? Is there pressure to have sexual inter- Whether or not we eventually prescribe in these course? We may be able to tease out other issues situations, we may be able to introduce some of which need addressing. There may be a mental God’s values within the consultation. One useful health problem which requires treatment. There may question is ‘How important is sex within your be issues which would be helped by counselling.
relationship?’ This gently challenges the assumption There may be problems within the relationship which that it is all-important. Encouraging couples to shift need to be tackled, possibly with the help of a third the focus away from sex and to spend more time party such as Relate. 7 The man may need to think talking or enjoying each other’s company in other from the Massachusetts MaleAging Study. Journal of Urology carefully about whether he is in the right relationship.
ways can be helpful. It may be necessary to challenge the attitude of a partner whose love has become conditional on sexual performance.
Having explored these issues, the problem may persist and we have to decide: are we going to prescribe or not? What would God have us do in these situations? Finally we turn to the case of married men with In the Bible we read that sexual intercourse is given erectile dysfunction. Often they are more reluctant to by God to unite a man and a woman within marriage: come forward and discuss their problems. Yet here ‘For this reason a man will leave his father and we need to affirm God’s gift of sex within marriage, 8 and women: a cohort study. BJGP2005; 55(511):108–113 mother and be united to his wife, and they will encourage them to talk, and at least to consider become one flesh’. 8 The Ten Commandments forbid therapeutic options. We need to communicate that adultery, 9 and both Jesus 10 and Paul 11 endorse this.
this is an important issue worth exploring.
Does this mean we should decline to prescribe Viagra and the like to men who are not married? We know many of our patients have different Men’s sexual problems are common, and present in beliefs, and hence different lifestyles, from our various scenarios. While we should uphold the Bible’s own. Jesus taught we should not judge others. 12 He teaching about sex within marriage, we need to demonstrated this with the woman caught in adultery, respect our patients and not to judge. Individual but then told her to ‘go now and leave your life of sin’.13 doctors will draw the line in different places about Paul specifically taught that we should not judge prescribing medication for erectile dysfunction. In those outside the church. 14 The GMC guidelines on all situations, we should bear in mind our patients’ Personal Beliefs and Medical Practice 15 state that we emotional and spiritual needs as well as their medical should not impose our personal beliefs on patients, ones, and also the wellbeing of other parties.
nor should we allow our beliefs to prejudice their care.
But we are required to obey God rather than men. 16 Roxana Whelan is a GP in Nottingham

Source: http://admin.cmf.org.uk/pdf/helix/win08/THwin08p10-11.pdf

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