Beyond Performance: A Holistic Approach to Men's Sexual Health

Interviewer: Often when we talk about men's sexual health, it really focuses on performance and avoiding STIs, or sexually transmitted infections. But today, we're going to maybe explore some of the other elements of sexual health for men with an expert in the field. We're speaking with Dr. John Smith, a non-surgical urologist with University of Utah Health.

Now, Dr. Smith, when it comes to sexual health, I mean, it's got to be more than just performance and whether or not we have a disease, right?

Dr. Smith: Yeah, absolutely. Sexual health, especially when we talk about men's sexual health, includes a lot of different things.

And when we get right down to it, a lot of it comes about the time we hit puberty, where we start to have our libido, our sex drive starts to come, we develop our secondary sexual characteristics, and we start to kind of explore that a little bit more.

And then within that, there's also a fertility side of that, because sexual health can also be a fertility side as well.

So there is more to it than just performance and erectile function and those types of things. There are other things that need to be thought of as well.

Physical Health and Its Impact on Sexual Wellness

Interviewer: So why don't we dive into a couple of these? There seems to be a real relationship between a person's physical health and their sexual health. What are some of the elements of a man's physical health that can really impact the amount of sexual wellness they're experiencing?

Dr. Smith: Oftentimes men tend to not go to the doctor as often as they should, and so they ignore some of those things, and that's a great thing to think about.

Early on in life, we tend to be a little bit more athletically outgoing as far as our activity level. Maybe not necessarily athletic, but our activity level is higher when we're younger. And then that kind of slows down as we get older or may fall into a job or start to have kids or whatever. And so overall health and just cardiovascular health is a huge one, because the more healthy we are cardiovascularly, the less likely we are to have vascular disease.

Now, some of it is genetic, but we'll talk about the things we can control, not the things that we can't. And so maintaining good cardiovascular health will help maintain healthy vessels.

One of the main drivers of erectile dysfunction is a vascular compromise. And so the more healthy we stay on that front, the better off we are, the less likely we are to have those issues.

With that also comes the more sedentary we become, the more we have weight gain. The more we gain weight, oftentimes, will lead us towards a higher predisposition to low testosterone which can really affect libido and sexual function as a whole.

And so maintaining a proper weight, maintaining a healthy diet, maintaining healthy habits, and maintaining those good health habits will impact sexual health. Maybe not in your 20s or 30s, but definitely long-term, it will start to affect those things.

Lifestyle Factors Beyond Diet and Exercise

Interviewer: Are there any other lifestyle factors beyond just diet and exercise? What about smoking or alcohol use?

Dr. Smith: Oh, of course. Substance use and/or abuse can definitely play a role. Smoking in general, like cigarette smoking, can really affect the cardiovascular system, which is something that we mentioned, and it can really kind of hasten some of those changes. So those are never healthy things to do.

A lot of studies that are out there on alcohol consumption show that one or two drinks . . . or oftentimes now they put them in a "how many drinks you have in a week." One drink a day for a man is considered kind of the average. And that may or may not affect things as much as we would think, but heavy use of alcohol can also affect cardiovascular health and affect a lot of other things as well.

There are studies that show people who tend to binge drink may have a higher incidence of putting themselves at risk for STIs, which I know we're not talking about, but sometimes there are those things that kind of go along with substance use.

Mental Health and Its Role in Sexual Function

Interviewer: And I guess moving on beyond just the physical elements of it, mental health plays a big part in sexual health as well, doesn't it?

Dr. Smith: Absolutely. Oftentimes when I have younger men who come into the office with erectile problems, a large portion of them have what's considered psychogenic erectile dysfunction. Sometimes I'll kind of term it something a little bit different to them where I'll say it's more of a life erectile dysfunction, where there are stressors and different things that can really impact sexual function.

I bring up big stressors, like if your grandmother is sick and in the hospital and is about to die. You may not have as high of a priority on your sexual function at that moment. Or if you have a pet that's sick or a parent that's ill and ailing, or you've just gotten into a really large argument with your partner, you're less likely to be interested in sexual satisfaction in those moments.

And so those are things that we need to factor in because the erectile function in and of itself isn't just a binary thing of erection/no erection. There's a lot of nuance to that where a lot of our emotional stability and things like that do play a role.

Partner Communication: Navigating Sexual Health Discussions

Interviewer: The other element that comes into play with sexual health is that you have a partner involved as well. Now, Dr. Smith, what are some of the ways that we could maybe communicate or kind of bring up some of these issues with our sexual health or concerns, etc.? How can we communicate with our partners about these things?

Dr. Smith: That's perfect, because that's a huge thing that I see. People come in and they want to talk about these things, and some of them are very difficult to talk about with their partner or they're affecting their relationship. I have patients who come in with premature ejaculation, where sexual encounters are shorter than their partner may like or that they may like.

And so one of the biggest things I start with is, "You've got to have a conversation with your partner about the things that you may have insecurities about, that you may be struggling with that may affect the sexual experience for both you and your partner."

That's one of the areas where I really just get them to talk to each other, because a lot of times it's not necessarily even that it's taboo or anything else, but it's maybe embarrassing or anxiety provoking or something like that.

But really, it's nice because I can start that in the office oftentimes with them and their partner, if their partner comes to the appointment, and say, "Hey, guys, let's talk about this together." I can kind of be the intermediary.

Now, I'm not saying go find someone to be an intermediary in your relationship, but if you can, have the opportunity to really be open and honest with each other.

I think that some of that comes down to your choice in sexual partners and feeling safe in the relationship to be able to have those conversations. And if you don't feel like you can have those conversations, try to get yourself in a position where you can.

Those are going to help sexual health and sexual function between you and your partner and allow for just a better overall sexual experience for both of you by having the ability to be open and honest about your feelings, things that you may have insecurities about, and those things.

Having those intimate moments, I mean, you are making yourself vulnerable to the other person, and so it is nice to be able to have those open and honest conversations.

And you should look to find partners who will allow for that open honest communication, which is going to allow you to have less angst and be more open in the sexual encounter, which is going to overall benefit both partners.

Seeking Specialist Advice for Sexual Health and Wellbeing

Interviewer: If a patient has any questions about any element of their sexual health, or maybe they do need to get that conversation started about how to have healthy communication about their sexual health, when should a man consider going to a specialist?

Dr. Smith: Well, if they have those questions, they're probably already there where they should think about talking with someone. You can go see your primary doctor. They oftentimes deal with some of this. Men's health specialists, urologists, deal with a lot of sexual dysfunction or sexual health with men as well. I'm not saying there needs to be dysfunction there.

There are also sex therapists out there. I have a list of folks in the area that do kind of sexual health as far as having opportunities to talk and bring your partner together with these specialists as well. So you can look for those folks in your area.

And if there's ever a thought or question where you have it, don't hesitate to seek out help. I think that's one thing that men tend to do, is they just kind of suppress it and figure, "I'll figure it out at some point." It's okay to get help. It's okay to go talk to someone and hear their perspective and get the opportunity to receive some information or counsel or whatever you want to call it from someone who does it all the time.