The extent of your sexual education at school (that’s if you were given one) likely involved a banana and a condom, focusing on puberty and avoiding pregnancy. While these are undoubtedly important topics for adolescents, it might be time adults got a refresher course.
Unfortunately, there’s still a significant amount of stigma associated with sex and sexual health in Australia. One of the issues sexual health nurse Luke Mitchell says he sees in his work is that men don’t know what is considered ‘normal’ to know when something might be wrong.
So, we’re taking it back to basics and raising the red flags that deserve a visit to the doc.
There’s a lot more going on below the belt than you might realise, or remember from school, and you aren’t alone in not knowing much about it. For example, a survey by Prostate Cancer UK found that more than half of the 2,000 men they queried didn’t know where their prostate was and 17% didn’t know they had one. Only 8% knew what it did1.
The male reproductive system is an intricate area with many different organs working together and is responsible for producing semen and sex hormones. Some of the genitals are visible, such as the penis and the scrotum, and some are hidden, such as the testes, epididymis and vas deferens.
Genitals come in all colours, shapes and sizes so there’s no one set that’s ‘normal’ however, what’s not normal is anything that causes you pain or distress.
It’s normal for your penis to curve slightly to the left or right when erect but a significant bend, paired with swelling or pain, could be a sign of Peyronie’s disease. It occurs when the tissue in the penis hardens permanently and a lump of scar tissue forms on the lining of the penis. This area stops the penis from stretching normally during an erection. In severe cases it can make sex impossible because of the shape of the penis or problems getting an erection. If you’re experiencing this, take a photo to show your doctor and make an appointment to discuss it.
Balanitis is a common and treatable infection that can happen when you don’t keep the inside of your foreskin clean, causing pain or tenderness at the head of the penis, redness or swelling or the foreskin, itchiness or a rash, the inability to pull back your foreskin, or discharge. It can also be caused by irritation from chemicals, allergies, viruses and diabetes. If you do have a foreskin, it’s important to look after it. This means gently pulling your foreskin back and washing inside and outside with water, daily. Don’t overdo it on the soap.
As everyone’s anatomy is slightly different it can sometimes be hard to discern what’s part of the scenery and what needs to be seen to. This can often be the case with lumps and bumps down below. There are several different types of penis lumps, most of which are harmless. Common ones include cysts, ulcers, genital warts and penis papules. Very rarely will a penis lump be cancer. Nevertheless, it’s best to speak to your GP about any lumps you’ve noticed.
Healthy sexual function can be influenced by your biology, mental state and society at large. It can also change naturally as you age. But the bottom line is that it should be pleasurable and pain-free, both physically and emotionally. Unfortunately, there are a number of factors that impact this important part of life for men.
When it comes to sexual health there’s plenty to compare. From the tape measure to time spent between the sheets, it’s unsurprising that men get stressed about what’s seen as normal and what’s not. If you find your response to sexual stimulation or lack of interest in sexual activity causes you distress, that’s a problem.
Ejaculation is the release of semen from the penis at orgasm or sexual climax. Ejaculate, or ‘cum’, is a mix of sperm and a small amount of fluid, it’s normally a whitish-gray colour and the amount can range anywhere from 1.5ml to 5ml. The ’normal’ amount of time it takes to ejaculate is subjective and there’s no set time that’s ’too soon’.
Premature ejaculation is the most common male sexual problem, impacting men of all ages but predominantly younger men. Premature ejaculation is when you have trouble controlling when you orgasm and you ejaculate at a time that you or your partner feel is too fast or early, causing a significant amount of anxiety and distress.
Premature ejaculation can be ‘lifelong’ — continuing consistently from your first sexual experience — or ‘acquired’ — when you’ve had a normal period of control over your orgasm before experiencing premature ejaculation. It’s important to speak to your doctor about it as there are treatments available.
Erectile dysfunction (ED) — the inability to get or maintain an erection — is very common, more so as you get older. At least one in five men over the age of 40 has erectile problems, but there’s no age when you’re ‘too old’ to get help with your erection and enjoy healthy sexual function. There might be several contributing issues that cause your ED, usually it’s a combination of physical and psychological factors. Given the statistics, you won’t be alone in raising erection problems with your doctor and it’s important to do so whether you want to have sex or not as ED may be a symptom of underlying conditions such as heart disease or diabetes.
Sex drive is another subjective area — a level of desire that’s natural for one person isn’t necessarily the same for another. Your sex drive can also change over time depending on what’s happening in a person’s life. However, if you lose interest in sex for no apparent reason, and it worries you, talking to a doctor can help. Low sex drive can be caused by short-term or long-term conditions such as depression or low testosterone.
Sexually transmitted infections (STIs) are a group of bacteria and viruses that can be transmitted through vaginal, anal or oral sex. They’re more common than you probably think, about 16% of Australians report having an STI in their lifetime2. While there’s no need for shame and stigma around STIs, it’s also important to be switched on about prevention and understand the long-term consequences if STIs go untreated. STI symptoms will vary between infections, but they can include unusual discharge from the penis or anus, pain during urination, pain in the scrotum or testicles, and sores, rashes, blisters, warts, lumps or bumps on the genitals. Sometimes there are no signs that you, or your sexual partner, has an STI.
The most effective way to protect yourself is by using condoms and having regular tests. These tests are incredibly simple and nothing to stress about (your doctor has seen and done it all before). Get tested at your GP or a sexual health clinic, every six to 12 months and when you change partners.
While there are some major wins in Australia’s management of STIs (including significant increases in vaccinations against Human Papillomavirus and the near elimination of previously endemic donovanosis in remote Indigenous communities) some conditions have bucked the downward trend — particularly in high priority populations such as gay men, Aboriginal and Torres Strait Islander people, men who have sex with men (MSM), and young people. Compared to 2008, rates of infections for males in 2017 were four times higher for gonorrhoea, three times higher for syphilis and almost twice as high for chlamydia3.
So, what gives? There are a range of factors behind each STI’s growing prevalence in different populations, some of which researchers and healthcare professionals are across and others aren’t as clear. What can be agreed on is timely testing and treatment, which are essential for stopping the spread of STIs. While there has been an increase in screening for many priority populations, further education and encouragement is needed for others. There’s also been an increase in testing among gay and bisexual men4, in part thanks to the uptake of HIV prevention tool, Pre Exposure HIV Prophylaxis (PrEP), which requires a routine STI screening every three months. More advanced and widespread testing has contributed to the statistical jump in Australia’s most commonly diagnosed STI, chlamydia3, however, there’s still a concerning gap in screening for younger people. Stats show that while 15 to 29-year-olds accounted for 75% of chlamydia cases in 2016, they only accounted for 15% of Medicare-rebated testing3. The lack of access to testing and treatment is an issue particularly facing Aboriginal and Torres Strait Islander people, who are disproportionately impacted by STIs compared to the non-indigenous population5.
Despite the prevalence of STIs and the relative ease of testing and treatment, there’s still a significant amount of shame attached to the conditions6. The expression, experience and anticipation of stigma can influence whether someone will get tested, take treatment and notify their sexual partners to prevent further spreading7. Overall, there’s a critical need to improve the knowledge and awareness or STI among priority populations, health professionals and the wider community.
4Jenness SM, Weiss KM, Goodreau SM, Gift T, Chesson H, Hoover KW, Smith DK, Liu AY, Sullivan PS, Rosenberg ES. Incidence of Gonorrhea and Chlamydia Following Human Immunodeficiency Virus Preexposure Prophylaxis Among Men Who Have Sex With Men: A Modeling Study. Clin Infect Dis. 2017 Sep 1;65(5):712-718. doi: 10.1093/cid/cix439. PMID: 28505240; PMCID: PMC5848234.
7The Kirby Institute. (2017). Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: Annual Surveillance Report 2017. University of New South Wales: Sydney.