While it’s often something of a running joke that men can be notoriously bad at asking for help with their health, the worrying downside is that there are several physical and mental health conditions that disproportionately impact men in the UK and, on average, men live almost four years less than women.
So what factors contribute to men using health services less often than women and what impact does this have on men’s health outcomes?
Robert Shelswell is a nurse practitioner specialising in men’s health at Torbay & South Devon NHS Foundation Trust. He says some of the issues men cite around not accessing primary care services are:
- Employers not being supportive of men needing to take time out in the day to speak to their GP surgery or go to an appointment
- Not wanting to show weakness through admitting feeling unwell
- Older generations becoming isolated, and lacking the ability to reach out for support, or who are too proud to ask.
The impact, says Robert, is that “men delay accessing health services, and therefore the problem worsens until they are physically unable to work, or the family dynamic is upset.”
Good sexual health is also an important factor in health and wellbeing, with sexual health recognised as a public health priority since the publication of the first national sexual health strategy in 2001. Pharmacies are key settings for the provision of a wide range of sexual health services since people have ready access to a pharmacist, so it is vital for the pharmacy team to feel confident initiating conversations, especially on ‘embarrassing’ topics such as men’s sexual health in the following areas…
Infertility support in pharmacy
A common cause of infertility in men is poor-quality semen, with reasons for this including:
- A very low sperm count or no sperm at all
- Sperm that are not moving properly
- Abnormally shaped sperm, making it harder for them to move and fertilise an egg
- Damage to the testicles, undescended testicle(s), or testicular cancer.
In addition, some men experience problems that can make it difficult for them to ejaculate, or they may have an abnormally low level of testosterone – known as hypogonadism – the male sex hormone involved in making sperm.
Certain types of medicines can sometimes cause infertility problems, including:
- Sulfasalazine – an anti-inflammatory medicine used to treat conditions such as Crohn’s disease and rheumatoid arthritis – can temporarily decrease the number of sperm
- Anabolic steroids – often used illegally to build muscle and improve athletic performance – can reduce sperm count and sperm mobility
- Chemotherapy can sometimes severely reduce sperm production
- Illegal drugs, such as marijuana and cocaine, can also affect semen quality.
“When it comes to fertility treatment and awareness, it is often one-sided and female-focused,” says Dr Catherine Hill, head of policy and public affairs at Fertility Network UK. “Yet when it comes to fertility issues, we know that male fertility is half of the problem. Research conducted by our charity, alongside Leeds Beckett University, found that a majority of respondents (93 per cent) stated that their wellbeing had been impacted by fertility issues, leading [men] to feelings of being emasculated and isolated, harming their self-identity, and causing stress, depression, anxiety, and low self-esteem.”
As a result, Catherine’s advice for pharmacy teams is to “approach male fertility with equal importance and sensitivity as they would with female-related fertility issues”, as well as being able to signpost to spaces for men to feel “comfortable and supported” in their experiences, such as Fertility Network UK’s HIMFertility support group.
“Good sexual health is also an important factor in health and wellbeing”
Help for erectile dysfuntion
Erectile dysfunction (ED) is the persistent inability to attain and/or maintain an erection sufficient for sexual performance. ED affects up to one in five men in the UK – roughly 4.3 million people – and there are a few products available in pharmacy that can help.
The Medicines and Healthcare products Regulatory Agency (MHRA) reclassified Pfizer’s Viagra Connect tablets (active ingredient sildenafil) from prescription-only medicine (POM) to a pharmacy medicine (P) in November 2017, and these became available to purchase following a consultation with the pharmacist in the spring of 2018. Sanofi’s Cialis Together (active ingredient tadalafil) was also reclassified from a POM to a P early in 2023 – and both these medicines are also available to patients on the NHS who obtain a prescription from their prescriber. For customers who prefer not to take a tablet, Eroxon’s Erectile Dysfunction Treatment Gel was launched in the UK in April 2023.
“Erectile dysfunction is both a common problem and an embarrassing one,” says Dr Janine David, a men’s health specialist from Eroxon. “According to new research from Eroxon, sufferers admitted ED can cause them to feel like a failure, with 40 per cent feeling awkward and embarrassed and 30 per cent feeling guilty letting their partner down. These feelings can make it difficult to discuss the condition with the pharmacy team. These discussions call for excellent communication skills, with pharmacy team members not showing awkwardness with the customer. Showing kindness and compassion are vital, so ask questions empathetically, and don’t offer advice too quickly before establishing what the customer understands about their erection problems. The aim should be to help the customer to take control of their condition – and be aware that partners often seek help for this condition as the ED sufferer may feel too awkward to visit the pharmacy.”
It’s also vital to advise customers that erection difficulties can be a symptom of an underlying medical condition. It is really important to either ask whether the person has any medical conditions they know about, or refer them to their GP to get checked out.
“Of key importance is that ED is linked with cardiovascular disease and diabetes,” says Janine. “The pharmacy team is well placed to provide information on these issues and to refer the customer to their GP.” Janine’s advice is to check if the customer has any symptoms such as chest pain, shortness of breath and pain or numbness in the arms and legs which could indicate heart disease. “Other symptoms that could point to diabetes include thirst, drinking more than usual and urinating more than usual, and losing weight without trying, feeling tired and weak, blurry vision and slow-healing sores are other possible signs,” she says. “So customers with these symptoms should be referred to the GP through the pharmacist.”
As essential members of primary care, pharmacy teams are in an ideal position to reach out to men specifically in an accessible environment using language and advice they can really engage with. Now, and in the longer term, this could have a significant impact on the health of men in the UK.
“When it comes to fertility treatment and awareness, it is often one-sided and female-focused”
Dealing with STIs
People can have a sexually transmitted infection (STI) – such as HIV, chlamydia, gonorrhoea, trichomoniasis, genital warts, genital herpes, syphilis and human papillomavirus (HPV) – without realising, putting them at risk of health and fertility complications and increasing the possibility that they could infect their partner/s during sex.
STI symptoms in men can include discharge from the penis, and pain in the testicles and when passing urine; itching, burning or tingling around the genitals; and blisters, sores, spots or lumps around the genitals or anus.
Some pharmacies may also provide testing for some STIs, with the National Chlamydia Screening Programme (NCSP) including pharmacies from the start in 2003. Chlamydia is the most common bacterial STI, with sexually active young people at highest risk. However, since NCSP chlamydia screening in community settings such as pharmacies and GP surgeries is only proactively offered to young women, this means men will not be proactively offered a test unless an indication has been identified, such as being a partner of someone with chlamydia or having symptoms.
Pharmacy teams can recommend adults looking for information on chlamydia and chlamydia testing to visit the NHS website or the Government’s Sexwise website (sexwise.org.uk) – part of The Department of Health and Social Care’s (DHSC) programme to promote sexual and reproductive health information across England. People may also be able to access online test kits by searching for local online sexual health services.
Since many STIs have no symptoms at all, the only way to know for sure is to get tested. Pharmacy teams should advise anyone who is worried about STIs to visit a sexual health clinic if they or a partner have symptoms of an STI, if they are worried after having sex without a condom, or if they are pregnant with symptoms of an STI.
Human papillomavirus (HPV) infection in men
HPV infection causes cancer and other serious diseases, but has predominately been focused as a ‘female-only’ disease when in fact it affects men too. Thankfully, that is changing now, in part from a Government pledge to eliminate cervical cancer by 2040 for the first time ever, which could save thousands of lives every year in England.
There are around 200 types of HPV and while many are harmless – and for most people HPV usually goes away on its own – some can cause warts on the penis and anus, and others can cause cancer of the penis, anus, head and neck.
Most people with HPV don’t know they’re infected because there are no symptoms, making the HPV vaccination the best way of protecting against HPV and the diseases it can cause – including up to 99 per cent of cervical cancers. Girls in the UK have been vaccinated against HPV since 2008 and HPV vaccination for boys started in September 2019.
Following the latest advice from the Joint Committee on Vaccination and Immunisation (JCVI), the NHS recently updated its HPV vaccination programme to a single dose instead of two doses for under 25s. One dose of the vaccine is now being offered to those in year eight (aged 12 or 13 years) via the school aged immunisation service. Children are also able to get their vaccine either in school or at a community clinic. Anyone eligible who hasn’t received their one dose HPV vaccine can catch up until their 25th birthday via their GP practice.
Update: men's health strategy
A Women’s Health Strategy was launched in 2022 for England, paving the way for campaigning and debate around a Men’s Health Strategy. Outside the UK there have been several national men’s health strategies including in Ireland (first published 2008) and Australia (published in 2010 and updated in 2019), but it wasn’t until July 2023 that the House of Commons Health & Social Care Committee launched an inquiry on men’s physical and mental health outcomes.
This inquiry explored a range of issues relating to male health outcomes, looking at:
- What factors drive lower, and falling, male life expectancy and what would have the biggest impact on addressing this?
- What is known about why men have a higher risk of dying from cancer and how can this risk be reduced?
- What is driving higher rates of suicide amongst men and how could this be addressed?
- What factors contribute to men using health services less often than women and what impact does this have on men’s health outcomes?
- What role do community and sport-based projects play in reaching men at high risk of isolation or poor mental health, and how can this support be spread equitably across the country?
- What are the challenges in delivering health equity across different population groups among men and how best can they be addressed?
Calling the inquiry “a hugely positive step forward”, Jim Pollard of the Men’s Health Forum, says: “The challenge now is to persuade Rishi Sunak and his team that a Men’s Health Strategy deserves a place in the Government’s agenda.”
Although the results of the inquiry are yet to be published, in November 2023 the Government announced that a Men’s Health Ambassador would be appointed along with the establishment of a men’s health task and finish group, focusing on increasing awareness of certain conditions and health needs faced by men and improving men’s engagement with health services.