Ask most men how their knee feels after a run, and you’ll get an honest answer. Ask about a change in sexual function, something that’s been building quietly for months, and the answer is usually silence. Not because it doesn’t matter to him. Because almost nothing in how men are raised prepares them to say it out loud.

One study of primary care encounters found that sexual health came up in only about four percent of documented consultations, and the researchers couldn’t say for certain whether that low number reflected patient reluctance, physician reluctance, or some combination of both (Gahm et al., 2024). That uncertainty is worth sitting with. This isn’t only a story about men staying quiet. It’s also a story about a healthcare system that hasn’t made it easy to speak up.

A Problem Hiding in Plain Sight

Primary care visits are short, and sexual health is rarely the stated reason for the appointment. A long-standing body of research on physician-patient communication has found that men are often hesitant to bring up sexual problems because of embarrassment, misinformation about what counts as normal, or uncertainty about whether a doctor can even help (Sadovsky, 2003). Addressing these concerns well requires a comfortable, unhurried setting, and because so many men wait to be asked rather than raising the issue themselves, that responsibility often falls to the clinician.

It doesn’t always land that way. In a scoping review of men navigating sexual dysfunction after cancer treatment, researchers found that patients frequently described their doctors as uninterested or unsupportive when sexual concerns came up, which left them apprehensive about asking for help at all (Charlick et al., 2024). Some men in the underlying studies described feeling that their physician was focused entirely on keeping them alive, with little room left for questions about their quality of life afterward. When that’s the message a man receives even once, the door tends to stay closed the next time.

It’s Not Just Discomfort. It’s Wiring.

Men aren’t avoiding these conversations because they don’t care about their health. Decades of research on masculine socialization point to something more specific: many men are raised inside a framework that prizes self-reliance, stoicism, and emotional control, and asking for help runs directly against that training (Addis & Mahalik, 2003). Reviews of this research consistently find that stronger conformity to traditional masculine norms is linked to lower rates of help-seeking and more negative attitudes toward treatment in general (Seidler et al., 2016).

Interestingly, this reluctance isn’t uniform across every kind of health concern. Addis and Mahalik (2003) noted that a man shaped by norms of stoicism and self-reliance might resist seeing a mental health professional for depression while feeling far less resistance about seeing a doctor for something like back pain. Sexual health concerns tend to sit closer to the resistant end of that spectrum, because unlike a sore back, they touch on identity and a man’s sense of himself as capable.

The Cost of Staying Quiet

Here’s what makes this silence dangerous rather than simply uncomfortable: sexual symptoms are often early warning signs of conditions that have nothing to do with sex.

Erectile dysfunction is the clearest example. A growing body of research now treats ED not as an isolated inconvenience but as one of the earliest visible signs of vascular disease, sometimes appearing years before a heart attack or stroke. Because the blood vessels involved in an erection are smaller and more sensitive to circulation problems than the coronary arteries, trouble tends to show up there first, making ED a kind of early warning system for the heart (Cortese et al., 2023). Clinical guidance built around this connection now encourages primary care providers to treat erectile changes as a potential signal worth investigating, not something to brush past.

Put plainly, a man who avoids mentioning erectile changes to his doctor isn’t just delaying a conversation about sex. He may be delaying the discovery of a heart condition while it’s still treatable.

Even Doctors Struggle With This

If you assume physicians are immune to this same discomfort, the data suggests otherwise. In a survey of male physicians about their own sexual health, only about one in nine of those who reported a sexual health concern had actually seen a doctor about it, and a similar share who’d considered establishing care never followed through, mostly citing being too busy (Lin et al., 2024). If the people trained to have these conversations still struggle to have them about their own bodies, this points to something beyond a lack of information. It’s a gap in culture, one that shows up on both sides of the exam table.

What Actually Helps

The research offers a genuinely hopeful thread here. A warm, patient, and nonjudgmental communication style from a physician has been linked to significantly higher satisfaction among patients navigating sexual health concerns (Sadovsky, 2003). Men aren’t looking for a clinical lecture. They’re looking for a signal that the conversation is expected and safe, and won’t be met with discomfort or dismissal.

That means the burden shouldn’t sit entirely on men to somehow become more comfortable disclosing. It also falls on physicians to ask directly, normalize the topic as part of routine care, and create a setting where a man doesn’t have to be the one to bring it up first. Something as simple as a sexual health question on a standard intake form can lower that barrier considerably.

Where This Leaves You

If you’ve been sitting on a symptom, a change, a worry you haven’t said out loud to anyone, you’re not weak, and you’re not alone. You’re responding the way you were trained to respond. But that training was built for a different set of stakes than a heart condition that hasn’t announced itself yet, or a struggle that’s quietly affecting your relationships and your sense of self.

The conversation might be uncomfortable for ninety seconds. Staying silent can cost you far more than that.

About the Author

Gregory Harmeling, Psy.D., LMFT, is a licensed marriage and family therapist specializing in men’s sexual health, narcissistic abuse recovery, and travel therapy. He works with men who are done being confused about why they feel the way they do — and are ready to do something about it. Learn more at fenixtherapeuticservices.com.

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References

Addis, M. E., & Mahalik, J. R. (2003). Men, masculinity, and the contexts of help seeking. American Psychologist, 58(1), 5–14. https://doi.org/10.1037/0003-066X.58.1.5

Charlick, M., Tiruye, T., Ettridge, K., O’Callaghan, M., Sara, S., Jay, A., & Beckmann, K. (2024). Prostate cancer related sexual dysfunction and barriers to help seeking: A scoping review. Psycho-Oncology, 33(8), e9303. https://doi.org/10.1002/pon.9303

Cortese, F., Costantino, M., & Luzi, G. (2023). Can we consider erectile dysfunction as an early marker of cardiovascular disease? JACC: Advances, 2(4), 100384. https://doi.org/10.1016/j.jacadv.2023.100384

Gahm, E., Peterson, M., & Larsson, K. (2024). Men’s views on causes and consequences of erectile dysfunction or premature ejaculation in a primary care population: A qualitative study. Scandinavian Journal of Primary Health Care, 42(2), 355–364. https://doi.org/10.1080/02813432.2024.2327501

Lin, J. S., Dubin, J. M., Aguiar, J., Greenberg, D. R., Bennett, N. E., Brannigan, R. E., & Halpern, J. A. (2024). Prevalence of sexual dysfunction and pursuit of sexual medicine evaluation among male physicians—a survey. International Journal of Impotence Research, 36, 854–857. https://doi.org/10.1038/s41443-024-00827-4

Sadovsky, R. (2003). Asking the questions and offering solutions: The ongoing dialogue between the primary care physician and the patient with erectile dysfunction. Reviews in Urology, 5(Suppl 7), S35–S48. https://pmc.ncbi.nlm.nih.gov/articles/PMC1502379

Seidler, Z. E., Dawes, A. J., Rice, S. M., Oliffe, J. L., & Dhillon, H. M. (2016). The role of masculinity in men’s help-seeking for depression: A systematic review. Clinical Psychology Review, 49, 106–118. https://doi.org/10.1016/j.cpr.2016.09.002

Text © Gregory Harmeling