Improving men's health: Sexual health and fertility are key barometers


Men die an average of five years younger than women do. In addition, men generally suffer from more diseases and have higher suicide rates. Treating preventable diseases may be key to improving men’s overall health. An American Urological Association (AUA) men’s health checklist offers guidelines for both general and urologic health maintenance and screening.

Sexual health concerns bring men to the clinic


“The AUA came out with the checklist because we men don’t usually start regular screenings with physicians until we’re 50 because that’s when we’re due for a colonoscopy,” says urologist Jesse Mills, MD who directs the Men’s Clinic at UCLA. “At 18, men graduate from their pediatrician’s care. Often the next visit they have is 20 to 30 years later.”

Dr. Mills suggests that by age 50 many men have developed poor lifestyle habits and often conditions such as high blood pressure, which they may not be aware of. The goal of the checklist is for providers to diagnose health concerns in men when they are younger and have time on their sides to improve their general health.

While the checklist is a valuable tool, it is ineffective if men avoid in-person preventive clinic visits. Dr. Mills says more providers need to capitalize on the two reasons men do see a physician before age 50: sexual health and fertility.

Underlying health conditions may cause erectile dysfunction

“I see a lot of men under 40 coming in with complaints of erectile dysfunction (ED),” says Dr. Mills. “What many men don’t realize is that erectile dysfunction can be an indicator of a bigger health condition.”

The inability to have an erection could indicate:

  • Heart disease: ED increases the risk of cardiovascular disease threefold. Plaque buildup in the arteries that supply blood to the heart might also affect arteries that supply blood to the penis. When blood flow to the penis is restricted it can be difficult, if not impossible, to get an erection.
  • Diabetes: Nerves and vessels that supply the penis may become damaged when blood sugar isn’t controlled.
  • Neurological diseases: Some neurological conditions can affect the nerve signals that the brain sends to the penis.
  • Kidney disease: Changes in sexual function and sex drive could be related to kidney function because the kidneys play a crucial role in hormone levels and circulation.

Infertility linked to cancer

It isn’t uncommon for Dr. Mills to identify varicoceles (large, swollen veins) on the scrotum, which may be a cause of infertility. He also points to several studies that link male infertility with an increased risk for different types of cancer, including:

  • Prostate
  • Testicular
  • Brain
  • Melanoma and lymphoma
  • Small intestine

“As with ED, we’re finding evidence that infertility could be a barometer for cancer development in men,” says Dr. Mills. “This cancer link is specific to men who have infertility related to the absence of sperm in their ejaculate (azoospermia).”

Dr. Mills says that by establishing contact through infertility evaluation, he can use “watchful waiting,” to help avoid future cancers in these men.

Diagnosing underlying men’s health problems: History and physical is key

According to Dr. Mills, around 30 percent of men under 40 have medical issues that can’t be found without an in-person visit. Men often prefer to use a telemedicine visit through an online provider to have ED medicines dispensed, but Dr. Mills cautions against this.

“Men need a history and physical and usually some bloodwork to diagnose any underlying causes for ED or infertility,” says Dr. Mills. “With a quick office visit, we can not only improve a man’s sexual health, we might also prevent premature death. Talking with a doctor over the computer is not the same as having someone provide a thorough exam.”

While treating erections and infertility, Dr. Mills pulls in the checklist to ensure he addresses other health topics. He often refers men to a primary care provider who can help manage underlying health concerns like high blood pressure, high cholesterol and excess weight.

Patients who are experiencing sexual health or fertility concerns can request an appointment with the Men’s Clinic at UCLA. Dr. Mills and the team of men’s health specialists offer comprehensive care that puts men on a path to better overall health.