Men are still taking chances with their sexual health, according to a number of recent studies, writes Ciarán Brennan
SEXUAL PROMISCUITY in men has always been accepted with a bit of a wink and a nudge - all that stuff about sowing wild oats and getting all of the wild, crazy, youthful sex out of the way before they get married.
But for many it meant putting their health at risk. And even today men are still putting their health at risk.
A number of studies published in the past year indicate that men's use of sexual health services remains low. Last August, a report, Men's Use of Sexual Health Services, published by the HSE in Cork and funded by the Crisis Pregnancy Agency, gave an insight into men's sexual health practices, knowledge and use of services as well as the barriers which prevent men from accessing or engaging with services.
Fewer than one in four men attended a GP for sexual health reasons and less than 10 per cent of men attended other sexual health services.
The primary barriers to availing of services included lack of awareness, with about half of men saying they did not know where to access sexual health services; embarrassment or fear of being seen (one-third of men reported a high level of embarrassment at the thought of attending services and this was higher in older men); cost; and the gender of staff working in services.
When it came to sexual practices, the findings of the survey of more than 500 men also revealed an ambivalence towards sexual health among men. Nine out of 10 men never used a condom when receiving oral sex with a casual partner; while 42 per cent of men never used a condom when engaging in anal sex with a casual partner and almost one in five men never used a condom when engaging in vaginal sex with a casual partner.
While cost was one of the barriers mentioned in the lack of use of condoms, 40 per cent of men acknowledged that drink and drugs had a negative impact on their use of condoms.
"The research highlights the need for targeted information for men around sexual health and making services more accessible," said Linda Hogan, health promotion manager, HSE South, when the report was launched.
"The report indicates that men have a low awareness of sexual health services and engage in risk-taking behaviour around sexual activity."
A separate report entitled Men, Sexuality and Crisis Pregnancy: A study of Men's Experience by the Crisis Pregnancy Agency last year found that there was a general lack of exposure to sex education among men as a whole, which led to a lack of knowledge of fertility and contraception.
This finding was in line with nationally representative data, which shows that men are not receiving adequate sex education in school or in the home, although younger men (under-25s) report receiving more sex education than older men.
However, the clinical director of the Everyman clinic in Dublin, Dr Tom Kelly, says attitudes to sexual health are changing among men. "People are much more aware of sexual health issues," he says. "It seems that more men are using contraception and protection for sexual encounters. Still a lot aren't, but it is definitely improving. Something is getting through.
"Another encouraging thing I have seen over the years in the Everyman Centre is I'm getting a lot of men coming to get tested for sexually transmitted infections, having been referred by friends. That's a change. I wouldn't have seen that five or six years ago."
Media reports in the past number of years have highlighted a sharp rise in the number of sexually transmitted diseases in Ireland, which would seem to indicate that messages on sexual health are not getting through to people.
But Kelly says it is difficult to judge whether this is because more people are presenting or that STIs are more prevalent today.
"That's always the unknown - are we picking up more cases because more people are coming forward and there are better diagnostic techniques, or is there is a genuine increase?" he asks.
"That is always the big question in situations like this. My impression from meeting men at the clinic is that people are coming forward in a way they wouldn't have had before and their attitude is different.
"The girlfriends or female partners of heterosexual men are not ringing for the appointments near as much as they used to 10 or 15 years ago.
"There was a lot of that 10 or 15 years ago - more often than not it would have been the partner who rang to make inquiries or an appointment. It is still the case but not nearly as much so."
Men, particularly younger men, are better educated, more knowledgeable and have more confidence when it comes to dealing with sexual matters, he says.
"Sex is more a matter-of-fact thing now than it was in the past. The cultural and religious taboos and prohibitions are not near as strong as they used to be."
To build on this, the Cork HSE report made a number of recommendations, including: the need to implement appropriate and targeted sex education for boys and girls (in and out of school) and provide relevant and accessible sexual health information and appropriate and targeted sexual health services for men.
"It also said there was a need to provide training to sexual health service providers on how to effectively engage with men and that it was necessary to tackle cultural biases that sexual health services are for women only."