Dear men, your bodies are your most precious possessions

November has been renamed Movember! It is the Men’s health awareness month, with emphasis on creating awareness around prostate cancer, testicular cancer and mental health issues.

According to Awarenessdays.com, Movember originated in Australia in 2003 when a group of friends decided to grow mustaches to raise awareness about prostate cancer and depression in men. It has since evolved into a global movement that is even being celebrated here at home this year!

In line of my work, I very rarely have to treat men, and they keep asking, who is the equivalent specialist for men’s reproductive health issues. Well, the urologists took up the role, even though, strictly speaking, they do deal with a lot more than just male reproductive issues. The andrologists also do come in to handle matters pertaining reproduction.

However, men’s health, just like women, is handled by all other specialists across board, as per their needs. These needs also vary with age, resulting in varying specialist care through the life course.

In childhood, all children will see paediatricians for wellness care and treatment of childhood ailments. Those who have chronic diseases such as hemophilia, sickle cell disease, epilepsy, muscular diseases and cardiac problems will remain in long-term specialist care, eventually transitioning to the adult version specialists for continued care.

All other young boys tend to drop off the care system as they enter adolescence, tending to see healthcare providers only as a result of acute illness of trauma. Injuries due to contact sports, falls and motor vehicle accidents are common reason for visiting the emergency department and possibly ending up in surgery. Seasonal infections such as malaria, pneumonia and rarely meningitis would put the youngsters in the wards.

As a result, many grow into men who have very limited contact with the health system. It becomes an uphill task to re-introduce the culture of health and wellness that was promptly lost after childhood. Most men struggle with how to respond to illness. They tend to view illness as a weakness and prefer to distance themselves from the health system, including wellness checks and follow-up.

This becomes a lifestyle until it is too late. Studies by Harris et al., (2016); and Crimmins et al., 2019 note that in comparison to women, men have poor health-seeking behaviours. They are less likely to seek medical attention for even severe conditions, hence are more likely to have poorer treatment outcomes as they present late, have a higher mortality rate for life-threatening conditions, and are more likely to have a poorer quality of life when they are dealing with a chronic illness.

Men are more likely to request over-the-counter prescriptions; have less patience waiting in the hospital or clinic queues to be seen; are less likely to adhere to the instructions given with regard to medications; and are less likely to return for follow-up clinic visits.

It is important to note that the health seeking behaviour of men is not just a response to illness, but it is also dependent on a host of socio-economic factors as demonstrated by Shehu, 2005 - gender norms, age, cultural norms, level of education, marital status, income level, occupation, religion and rural/urban background.

As a result, most of the time men will seek care when the illness is much more severe, or when the pain associated with the illness is unbearable. Men are more likely to walk around with a huge lump without seeking a diagnosis as long as it is not interfering with function or it is not causing pain. They are more likely to cough for months before seeing a doctor, hence will be more likely to have advanced tuberculosis at diagnosis compared to their female counterparts.

This was true of an acquaintance of mine, Calvin*, who kept asking me to prescribe antacids for him after a night out with the boys, to calm his irritated stomach. On the third ask, I insisted that he sees a doctor for a thorough review. He was adamant that this was just a result of his alcohol overindulgence. Fortunately, his wife was listening; and she dragged him off to see a family doctor she knew. Two weeks later, Calvin was diagnosed with stage four cancer of the stomach (gastric cancer). In less than a year, Calvin had left us. It was traumatising to say the least.

Men are also more likely to succumb to cancers as they are likely to be diagnosed at advanced stages compared to women; they have a shorter diagnosis-to-death lifespan and have a poorer quality of life in the advanced disease stage. The mental strain of a terminal illness appears to be far worse for men than women as many struggle to come to terms with it, and are unable to communicate their feelings and fears with regard to the same. This is a little easier for those who are single, but a lot tougher for those with younger children.

Away from life-threatening conditions, men struggle to handle a diagnosis of infertility far much worse than their female partners. For Cindy* and Kenneth*, it was the beginning of the end of their marriage. Kenneth struggled to accept that he had a challenge making Cindy pregnant. He only remained in care for four months, a timeline that was insufficient for us to determine whether our interventions were working or not. He refused to scale it up to more invasive interventions and instead opted to walk out of the marriage. Cindy’s heart was shattered.

For Janice* and Robert*, they toughed it out for four years before their twins were born. However, for Janice, every single time we were alone, she confided that she felt it would have been much easier for them if she was the one who had a problem, and not Robert. Despite Robert fully investing in their care, she felt that he went overboard to ensure they conceived, from a place of guilt and pressure to make it right. This is despite the fact that he had no control over his low sperm count. The pressure nearly made Janice break down. She was saved by psychotherapy.

Karyn* had to abandon ship altogether with regard to an offspring. She had battled with multiple medical conditions and was only ready to conceive at 42. She automatically assumed that she would be the one with a fertility challenge; only for the fertility specialist to tell the couple that her husband’s sperm quality was poor and he had to change his lifestyle, exercise, cut down on alcohol and stop smoking. A year later, Karyn gave up on conception after multiple attempts to get her husband to observe the doctor’s directive failed. She opted to save her marriage by giving up on her dream.

This Movember, my plea to men is - your body is your most precious possession, it deserves better service than your car!

 Dr Bosire is a gynaecologist/ obstetrician