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‘Keep quiet and carry on’ — time to change the narrative around men’s fertility
Prioritising prostate health in the black community
Young men rarely discuss fertility, yet there’s a cultural assumption that ‘everything will be fine’ when it’s time to conceive. However, 7% of men across the world experience infertility according to the World Health Organization. 1
Prostate cancer is the most common cancer for men in the UK, responsible for the death of one man every 45 minutes. Black men face an even higher risk.
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n the UK, one in seven couples have trouble conceiving, and in half of these couples, the problem may exist with the male partner. 2 Because the focus is often on women, men rarely discuss their fertility struggles, leading many to face isolation, pressure and shame. Given the serious mental health challenges men face in the UK, it’s essential to address such issues and highlight available preventative and supportive measures. Common men’s fertility risks Young men across the UK benefit from extensive sex education but often remain unaware of how lifestyle choices can affect their future fertility. Risk factors include being overweight, excessive drinking, STDs, genetics, pollution, smoking, drug use and even tight underwear. While men can reproduce into an older age, those under 40 are more likely to have healthy, successful pregnancies, making age an important factor in male fertility. Many of the above risk factors can be managed. The more we engage young men in conversations about fertility, the better equipped they will be to make informed choices about their future. Fertility help is available If there are challenges for men conceiving, there are many ways medical professionals can help. Tests range from blood and urine tests to semen tests or scans, for example. Meanwhile, treatments include many hormonal and surgical options. There is also emotional support available for men, such as from Fertility Network UK’s HIMFertility group. Merck is a global leader in fertility and is proud to have helped over 5 million babies to be born. We strongly believe that by shifting the narrative for young people to include the full spectrum of choices from career to lifestyle and parenthood, we can offer them true empowerment to have more choices for their future — whatever they aspire to.
References 1. World Health Organization, ‘Infertility prevalence estimates 1990–2021’. Available at: https://iris.who.int/bitstream/hand le/10665/366700/9789240068315-eng.pdf?sequence=1 [Accessed Oct 2024]. 2. British Association of Urological Surgeons, ‘Fertility Problems’. Available at: https://www.baus.org.uk/patients/conditions/4/fertility_ problems/ [Accessed Oct 2024].
WRITTEN BY Dr Stuart Hill Medical Director, Merck Healthcare UK and Ireland
Paid for by Merck
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he reasons for prostate cancer more widely impacting black men than any other race are complex, intertwined and varied.
Some reasons black men are more at risk • Genetics: Black men have higher Gleason scores and higher prostate-specific antigen (PSA) levels than white men, indicating they are at greater risk for more aggressive forms of prostate cancer. • Racism: Lack of representation in clinical trials and studies combined with a history of ethical malpractice and mistreatment of people of colour have led to a lack of trust. Many black men fear that their PSA screenings may not be thorough enough or their test results may be misused.1 • Fear and cultural stigma: There can be hesitation among black men to undergo routine screenings, such as a digital rectal exam (DRE) or PSA testing. Concerns about the invasiveness of these procedures and the fear of potential diagnoses contribute to this reluctance.
Increasing awareness and trust in prostate cancer health
Although the above factors pose challenges, steps can be taken to dismantle the barriers around prostate cancer care for black men. Medical representation: Currently, there is a lack of data in clinical trials for black patients. A large proportion of treatment and diagnostics for prostate cancer has been based on data for white patients, which negatively impacts the healthcare of black patients.2 Increasing representation from people of all minority backgrounds in trials will lead to more inclusive and trusted healthcare. Early detection: Given the heightened risk and aggressiveness of prostate cancer in black men, early detection and diagnosis are crucial. The European Association of Urology has been taking steps to combat this stigma. One of the steps involves the development of a patient-reported outcome measures (PROMs) study focused on prostate cancer care for black men of African and Caribbean descent. The other will be the roundtable ‘Championing Black Health Equity in Prostate Cancer,’ which will take place on Patient Day at the Annual EAU Congress in Madrid, 21–24 March 2025. References 1. American Cancer Society, (2022), Racial disparities in Black men with prostate cancer: A literature review, Journal of the American Cancer Society 2. Prostate Cancer Research, supra
How prosthetic surgery is revolutionising erectile dysfunction treatment Penile prosthetics offer a transformative solution for erectile dysfunction. These devices can restore confidence and intimacy, marking a significant advancement in medical technology and patient care.
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rectile dysfunction (ED), the persistent inability to achieve or maintain an erection for sexual performance, is self-reported in 50% of men aged 40–70.1 It can have a profound impact on men’s health and wellbeing, causing strain on relationships. It is associated with cardiovascular disease, diabetes, obesity and smoking in addition to other psychological disorders such as depression and anxiety.2
Multifaceted approach to ED treatment ED management requires a holistic approach tailored to the underlying cause. Lifestyle modifications include a healthy diet, regular exercise, improved sleep, stopping smoking and reducing alcohol intake. Various medical options are available, including tablets, topical creams, intraurethral pellets and penile injections, as well as vacuum erection devices. Psychosexual counselling is pivotal when potential psychological factors such as performance anxiety and relationship issues are present. Impact of prosthetics on erectile dysfunction Penile prosthetics are a surgical option, typically considered when other treatment options are unsuitable or have failed. Two types of devices can be inserted inside the penis: malleable (semirigid) or inflatable implants. A malleable implant is bent upwards to facilitate sexual intercourse and bent down when not required. The inflatable prosthesis offers a more natural option dependent on a hydraulic mechanism. It is activated when a pump, located in the scrotum, is engaged. This pump moves fluid from a reservoir in the abdomen to the penile prosthesis, which inflates to provide a rigid penis. The procedure has potentially serious risks and complications. However, in a suitable, wellcounselled patient, studies have demonstrated one of the highest satisfaction rates of 80–90%.3 It offers men with ED restored erectile function, eliminates dependence on variable effectiveness of medical therapy and offers a degree of spontaneity. Accessing ED medical interventions Men should seek medical attention and treatment information, as it may also be the first presentation of underlying disease. As research and technology advance, the future holds promise for even more effective and accessible solutions for ED. References 1. Henry, A. et al. (1994). Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. Journal of Urology, 151(1), 54-61. https://doi.org/10.1016/S0022-5347(17)34871-1. 2. Yafi, F. A. et al. (2016). Erectile dysfunction. Nature Reviews Disease Primers, 2, 16003. https://doi.org/10.1038/nrdp.2016.3 3. Hellstrom, W. J. G. et al. (2010). Implants, mechanical devices, and vascular surgery for erectile dysfunction. Journal of Sexual Medicine, 7(1 Pt 2), 501-523. https://doi.org/10.1111/j.1743-6109.2009.01626.x
WRITTEN BY
WRITTEN BY
Mr Eamonn Rogers Chair, EAU Patient Office
Ms Maria Satchi Consultant Urologist and Andrologist, Kings College Hospital NHS Foundation Trust
Find out more at merckgroup.com
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