The symptoms of erectile dysfunction (ED) pose a threat to physiological and psychological well-being, making it important that men feel comfortable seeking ED medication. Unfortunately, some men feel a sense of emasculation and shame in seeking medical help for their symptoms.
We sat down with Dr. Stephen Foster to talk about his new coauthored research investigating how men in cultures of honor, who place a strong emphasis on their masculine reputation and their virility, might be particularly hesitant to seek medication for ED symptoms due to the masculinity threat posed by such help-seeking. The paper was published in our flagship academic journal, Psychology of Men & Masculinities, and the full citation is below.
Foster, S., Pomerantz, A., Bell, K., Carvallo, M., Lee, J., & Lee, J. (2022). Victims of virility: Honor endorsement, stigma, and men’s use of erectile dysfunction medication. Psychology of Men & Masculinities, 23(1), 47–58. https://doi.org/10.1037/men0000369
What were the key questions you were addressing in this article?
This article was seeking to address if men from cultures of honor may be reticent to seek out treatment for erectile dysfunction (ED), given that men from these cultures tend to place a strong emphasis on their masculine reputations. Prior research has shown that individuals from honor cultures struggle with help-seeking for fear of being viewed poorly by their peers/family.
What were the main conclusions of your article?
We found that honor-endorsing men (those who endorse the values and norms found in cultures of honor) are less likely to support help-seeking for ED, and that links between honor endorsement and negative attitudes toward ED help-seeking are explained by beliefs that ED help-seeking would be a threat to their masculine identities. These relationships are consistent not only for young men (who may have difficulty imagining having ED) but older men as well, who experience ED at significantly higher rates. We also found, using a state-level analysis of ED prescription rates, that men living in cultures of honor (in this case, the southern United States) appear to be actually seeking out ED prescriptions less frequently than their northern U.S. counterparts.
What are the key implications of your article for research, policy, or practice?
First, we feel this is an intriguing set of findings for future work. it appears contradictory, because if men in cultures of honor feel their sexual prowess is so important, wouldn't they be more likely to seek help if they were having issues? In this case, the fear of social ramifications for help-seeking appears to outweigh that. In terms of practice, it seems that a large swath of the population in honor cultures way may be hesitant to help-seek for ED, which can have substantial impacts on wellbeing and relationship satisfaction. It is important in these regions to emphasize the confidentiality of seeking help, the normalcy of experiencing ED as a man ages, and reassuring men that they are not in some way weaker for seeking treatment.
Where do you see this line of research heading in the future (i.e., what's next)?
I feel this has the strongest implications in the area of patient-doctor relations- the question is why are men not going to their doctors for these issues? Are they embarrassed and, if so, does that embarrassment stem from the interactions they have with doctors? It is difficult to get access to clinicians, but we are interested in examining how doctors in honor regions may approach this topic with their male patients. It is entirely possible that the discussion is either less likely to happen for honor-endorsing clinicians or not happening at all. We also feel this has implications for survivors of prostate cancer. In another article of ours, we found that honor-endorsing men are less likely to seek prostate cancer screenings, heightening their risk for prostate cancer mortality. One of the well-known outcomes of prostate cancer treatment is sexual dysfunction, and many men need to reconstruct their views of sexuality and intimacy after receiving treatment. We feel that honor-endorsing men may be particularly impacted by these changes, given what we found here regarding the fears surrounding ED, and it may also play a role in why they aren't getting screened in the first place (fear of a positive test, fear of what the potential treatment may do to impact their sexual function).
How did you become interested in this line of inquiry?
At the time, our lab was searching for new avenues of research into the health world. This topic is so close to traditional discussions of masculinity that it was a straightforward window into the psyche of honor-endorsing men that allowed for the study of the impacts of honor endorsement outside of aggression (where much of the research focused for many years). Men joke about this topic amongst their peers but are very quick to change their tune if they begin to experience issues with sexual function, making it pretty clear that this is a topic that contributes to men's self-concepts in an important way. We were fortunate to find the state-level data to incorporate into this, and I think this began a wider discussion of the types of behaviors honor endorsers avoid as a means of maintaining their honor. I hope other honor researchers continue to think within his framework, seeing where stigma and avoidance of identity threats may play a role in honor-endorsing men and women.
Dr. Stephen Foster
Department of Psychology, Penn State York