The cost of being a man: social and health consequences of Igbo masculinity

In the bid to explain reproductive health outcomes in most developing countries, men have often been seen as the cause of the problem. However, no systematic attempt has been made to examine men's perception of their own social and health needs, including how ideologies of masculinity impact men's social and physical health. This study examines the Igbo context and shows how men understand and interpret masculinity and the consequences of this for social and health behaviours. Data from adolescent and adult Igbo men aged 15–75 were collected using both quantitative survey interviews (n = 1372) and qualitative techniques such as focus-group discussion (n = 20), in-depth interviews (n = 10) and key informant interviews (n = 10) in selected areas of south-eastern Nigeria. We collected data on gender role ideologies and sexuality issues and practices. Our analysis shows that there are social and health costs associated with adherence to masculine ideologies and a strong association between masculine ideologies and men's health, risk-taking and health-seeking behaviours in the study population. We conclude that all sexual and reproductive health programmes should include services that address the specific needs of men and those negative aspects of masculinity that tend to expose men to adverse health outcomes.     

The relational dynamics of hegemonic masculinity among South African men and women in the context of HIV

In South Africa, the frequent positioning of men's sexual behaviours as a prime driver of the HIV epidemic has generated much interest in men's sexuality. However, the relational nature of dominant male norms that exacerbate the risk of HIV transmission is inadequately understood. This study used sexual biographies to explore how men and women negotiate gendered norms and how this affects their sexual and reproductive health (SRH). A total of 50 sexual-history interviews and 10 focus group discussions were conducted with men, and 25 sexual-history interviews with women, with participants sampled from three age categories (ages 18–24, 25–55 and 55+years), a range of cultural and racial backgrounds and urban and rural sites across five provinces in South Africa. The narratives illustrate that men and women's SRH is largely dependent on the type and quality of their relationships. Men's sexuality was regularly depicted as being detached from intimacy and uncontrollable, which was premised as being opposite from and/or superior to women's sexuality and could justify men's high-risk sexual behaviours. Yet many participants also supported gender equitable relationships and endorsed accountable and healthy SRH behaviours. The narratives reveal that HIV-risky dominant male norms should be addressed relationally for the sake of better SRH outcomes.     

(Not) talking about sex: couple reports of sexual discussion and expression in Bangalore,India

Adolescent marriage is common in India, placing young women at risk of HIV, early pregnancy and poor birth outcomes. Young women's capacity to express their sexual desires is central to negotiating safe and mutually consensual sexuality. Men, too, play an important role in shaping women's sexual and reproductive health outcomes, but little research has examined how men influence women's sexual expression. Using paired husband and wife data, this paper reports on a preliminary investigation into the patterns of and concurrence between women's sexual expression and their husbands' attitudes about it, as well as the influence of men's approval of their wives' sexual expression on women's actual expression of sexual desire. The results suggest that, among this sample, men are more open to sexual expression than their wives and that, for women, expressing desire not to have sex is far more common than expressing desire to have sex. Further, men's approval of sexual expression from wives appears to positively influence women's actual expression. These findings suggest that men may be resources for women to draw upon as they negotiate sexuality in adolescence and early adulthood.     

‘But I'm not like that’: young men's navigation of normative masculinities in a marginalised urban community in Paraguay

Young men often define themselves and their masculine identity through romantic and sexual relationships, and their resulting sexual decisions can affect their successful transition into adulthood, as well as STI, HIV and pregnancy rates. This paper looks at how young Paraguayan men's peer groups, family and masculine identity formation influence their behaviours in sexual and romantic relationships. In Asunción, Paraguay, we conducted five focus-group discussions (FGDs) examining neighbourhood norms in 2010, with male peer groups ranging in age from 14 to 19 years. We then interviewed half the members from each peer group to examine their relationships with friends, family and young women and their beliefs about existing gender norms. Young men described two types of masculine norms, ‘partner/provider’ and macho, and two types of romantic relationships, ‘casual’ and ‘formal’. The language used to describe each spectrum of behaviours was often concordant and highlights the connection between masculine norms and romantic relationships. The perceived norms for the neighbourhood were more macho than the young men's reported behaviours. Norms cannot change unless young men speak out about their non-normative behaviours. This provides evidence for more research on the formation, meaning and transformation of male gender norms.     

Sexuality,ethnicity and language: Exploring Chinese Filipino male homosexual identity

This paper explores the intersection of sexuality and ethnicity in the lives of a group of South-East Asian gay men. Data derive from an exploratory study conducted in Manila involving semi-structured face-to-face in-depth interviews with self-identified homosexual Chinese Filipino men. Findings suggest that the men shared a strong sense of being Chinese while also being conscious of their double marginalization as homosexual and as part of an ethnic minority. Ethnicity was found to play a key role with respect to sexual partnership, influencing choice of partners and age and class status of their ideal mates. Chinese gay men's use of Fukkien was identified as a key marker of their identity both as gays and as Chinese Filipinos. Further research is needed to explore further the relationship between sexuality and ethnicity, as well as how class and age influence present and prospective sexual relationships.     

You'll “Get Viagraed:” Mexican men's preference for alternative erectile dysfunction treatment

The pharmaceutically focused clinical and epidemiological literature on erectile dysfunction (ED) treatment has paid little attention to men's non-medical responses to changing erectile function. This study explores the relationship of erectile function change, resulting use of medical or alternative treatments, and Mexican men's understandings of masculinity and aging, through a mixed method approach utilizing both quantitative survey and ethnographic interview data. A survey of 750 men undertaken at the Instituto Méxicano del Seguro Social hospital in Cuernavaca, Mexico in April to June 2008 showed that only about half of those who experienced erectile function changes sought treatment for these changes; treatment users were far more likely to seek alternative treatment than medical treatment, especially preferring lifestyle change and vitamins. Ethnographic data from interviews with 250 male urology patients undertaken from October 2007 to August 2008 at the same site reveal that treatment users' preferences were linked to fears about the safety and situational inappropriateness of medical ED treatment. These findings suggest that by focusing on patients' use of pharmaceuticals, biomedically oriented research has overlooked the most common responses to changing erectile function. Broadening the focus of ED treatment research to include analysis of men's rejection of pharmaceutical treatment – either in favor of alternative treatment, or because they do not see their erectile function changes as requiring medical intervention – would correct this imbalance in the literature. Further, the knowledge that even men who seek treatment may prefer alternatives to pharmaceutical interventions will help physicians to offer treatments, such as lifestyle change, that their patients might find more acceptable. Such measures would simultaneously help to mitigate the chronic illnesses, like diabetes and hypertension, which frequently co-occur with diminished erectile function.     

Gender,masculinity and migration: Mexican men and reproductive health in the Californian context

An appreciation of the social, cultural and economic dimensions of gender and sexuality is important in increasing reproductive health service utilisation. This analysis of recent Mexican male immigrants in Southern California focuses on changing views of gender roles, masculinity and relationship dynamics in the context of migration in order to explain low levels of reproductive healthcare utilisation. Semi-structured, in-depth interviews were conducted with 23 men who had migrated from Mexico. Some men saw their migratory experience as empowering, both individually and within the couple context. Migration reinforced positive male qualities, such as being a good provider. However, for others, the levelling of economic power between immigrant couples challenged traditional male gender roles and threatened men's identities. Maintaining control and decision-making power, especially in reproduction, remained tenacious, especially among older men. In response to immigration, however, men's views of ideal family size and contraceptive method preferences had evolved. The migration process caused some divisions in family networks and aspirations of fatherhood as an expression of masculinity contributed to varying levels of contraceptive use. Recommendations are made on factors that may empower male clients more actively to seek reproductive healthcare in the context of more equitable couple decision-making.     

New Sexual Repertoires: Enhancing Sexual Satisfaction for Men Following Non-traumatic Spinal Cord Injury

Sexuality is an important priority for people following spinal cord damage (SCD), due to the impact on sensory and motor function, including paralysis and associated mobility restrictions. Men living with SCD report difficulty in achieving and maintaining erection, impaired capacity for orgasm (with or without ejaculation), and increased likelihood of retrograde ejaculation as significant challenges for sexuality. The implications of these issues for men following non-traumatic SCD (spinal cord dysfunction or SCDys) has not been examined. Drawing on interviews with eight heterosexual men following SCDys, this paper seeks to examine the factors that impact sexual satisfaction. Due to a focus on coitus and the significance of erectile function in this, most participants reported dissatisfaction with their sexuality post-SCD. However, this could be overcome through expanding their sexual repertoires. Through providing information and education about non-coitus focused expressions of sexuality, there is scope for sexual rehabilitation services to significantly increase the quality of life of men after SCDys.     

"Viagra stories": challenging 'erectile dysfunction'

Medical approaches to sexual difficulties prioritise the physical aspects of sexuality over other aspects, locating 'disorders' primarily in the anatomy, chemistry or physiology of the body. In accordance with this perspective on sexual matters, physicians look to physical interventions (for example, hormones, drugs, and surgery) to treat any 'abnormalities'. Following the discovery of popular--and profitabl-e-sexuopharmaceuticals such as sildenafil citrate (Viagra) for the treatment of erectile difficulties affecting men, the medical model has gained increasing influence in the domain of sexual health and well-being. However, while medical definitions of--and interventions related to--sexual difficulties are underpinned by an understanding of a 'universal' body (that is, an essential biological body that transcends culture and history), and by the categorisation of the normal and the pathological, the accounts of users of Viagra, and their sexual partners, do not necessarily support such understandings. In some cases, the experiences and perspectives of those affected by erectile difficulties directly challenge the reductionist model of sexuality and sexual experience espoused by medicine. In this paper, we report on a New Zealand study investigating the socio-cultural implications of Viagra, involving 33 men and 27 women discussing the impact of erectile difficulties and Viagra use within relationships. The diverse experiences of participants are discussed in relation to two key issues: the notion of 'sexual dysfunction' itself; and the idea of drugs such as Viagra acting as a 'quick fix' for sexual difficulties affecting men. We argue that the existence of a range of Viagra 'stories' disrupts a simplistic mechanistic portrayal of the male body, male sexuality and 'erectile disorder'.     

The Start of the Sexual Transition in Mali: Risks and Opportunities

Analysis of data from a questionnaire survey of 2,000 young Malians undertaken by the authors in 2002 demonstrates that, even in underprivileged urban and rural populations, changes in sexual behavior are emerging. Among women, first sex and motherhood are taking place slightly later, and a minority is now dissociating sexuality and procreation. Our data confirm the considerable impact of female education on this transition. Girls’ sexual activity before procreation is also influenced by lower religiosity. Among men, in contrast, in a traditional context of late sexual debut and fatherhood, the trend is toward earlier sexual activity and procreation. Fatherhood is delayed, however, among better‐educated, wealthier, and less religious urban men, who therefore experience a longer period of sexual activity before they begin to build their own families. The study concludes with an analysis of the possible association of the sexual transition with young people's increased vulnerability resulting from their adoption of risky sexual behaviors and from unfavorable conditions surrounding the arrival of their first child.     

Prostate cancer: embodied experience and perceptions of masculinity

Abstract While some argue that gender differences, which refer to the social classification into ‘masculine’ and ‘feminine’, have their source in ‘culture’, others argue there is no need to have an absolute dichotomy between culture and nature, or between constructionist and anti‐constructionist epistemologies. Although there has been much theorising about the body, until recently little attention has been paid to empirical evidence. This paper looks at the way in which prostate cancer and its treatment affects men's bodies, their roles and sense of masculinity. Interviews were conducted with 52 men, exploring their experiences of prostate cancer. Findings suggest that many men are reluctant to consult their doctors, because ‘men don’t cry’, thus reinforcing the notion that ‘masculinity’ is a social construction. However, while the illness and the side effects of surgical and radiotherapy treatments sometimes led to impotence and incontinence, the treatments that involved hormones were reported to have an additional, sometimes profound effect on libido, energy, ability to work, body shape and competitiveness. These side effects reduced some men's sense of masculinity. We conclude that the physical body as well as culture should be considered when trying to explain what it means to be masculine, and how illness may affect men's sense of masculinity.     

Men managing cancer: a gender analysis

As researchers consider gendered patterns in men's prostate cancer experiences, little attention has been devoted to how men manage ‘cancer’, more generally. Drawing on the experiences of 30 Canadian men with a variety of cancer types, this article details how men engaged illness self‐management and help‐seeking activities with lay and professional support persons. Results indicate three broad responsive strategies: fortifying resources, maintaining the familiar, and getting through. In these pursuits, the participants drew on a variety of performances to respond to social contexts demanding that men embody masculine ideals including strength, control, and stoicism. Considering gendered dynamics in how men manage the challenges of cancer, this article broadens understandings about men's cancer experiences by highlighting the drivers orienting participants' responsive efforts and challenging assumptions of help‐seeking as essentially problematic for men in Western society.     

Book Review

Many treatments for breast cancer are traumatic, invasive and harshly visible. In addition to physical trauma, breast cancer is often associated with a variety of psychosocial issues surrounding romantic relationships, sexuality and feminine identity. Pink Ribbon Pin-Ups was a pin-up girl calendar wherein all the models were women who were living with, or had survived, breast cancer. The project's purpose was to raise funds and awareness for breast cancer research and to create a space where survivors could explore and express their post-cancer sexuality. This study uses an observational approach, paired with semi-structured interviews, to explore the ways that breast cancer survivors perceive their post-cancer body and the subsequent impact on relationships and feminine identity. By examining contemporary discussions regarding breast cancer, body image and the objectification of women, it is concluded that although this photographic approach may be at odds with some modern breast cancer activism, it does appear to meet the expressed needs of a particular group of women living with the disease.     

Sexual ideology and experience in a Papua New Guinea society.

Recent anthropological interest in sexuality has been closely related to symbolic constructions of gender in different societies. Most studies explore the cultural constitution of sexual meanings without addressing how sex is experienced by actors. Material from the Bumbita Arapesh of the East Sepik Province of Papua New Guinea reveals that the local cultural ideology of male sexual domination does not adequately describe actual sexual experiences of Bumbita men and women. Cultural ideology states that men control sexual encounters as a part of their masculine essence, yet in actual marriages women often take the initiative in limiting sexual practice following postpartum prohibitions. Contrary to cultural expectations, men exhibit anxiety concerning sexual relations in a marriage. The public assertion of sexual dominance and suppression of sexual intimacy compensate for a sense of vulnerability accompanying sexual experience. An analytical distinction between "cultural ideology" and "individual experience" helps clarify the climate of sexual relationships in a cultural context.     

Switching on After Nine: Black gay-identified men's perceptions of sexual identities and partnerships in South African towns

ABSTRACT

There is considerable diversity, fluidity and complexity in the expressions of sexuality and gender among men who have sex with men (MSM). Some non-gay identified MSM are known colloquially by gay-identified men in Mpumalanga, Province, South Africa, as ‘After-Nines’ because they do not identify as gay and present as straight during the day but also have sex with other men at night. Based on, key informant interviews and focus group discussions in two districts in Mpumalanga, we explored Black gay-identified men's perceptions of and relationships with After-Nine men, focusing on sexual and gender identities and their social consequences. Gay-identified men expressed ambivalence about their After-Nine partners, desiring them for their masculinity, yet often feeling dissatisfied and exploited in their relationships with them. The exchange of sex for commodities, especially alcohol, was common. Gay men's characterisation of After-Nines as men who ignore them during the day but have sex with them at night highlights the diversity of how same-sex practicing men perceive themselves and their sexual partners. Sexual health promotion programmes targeting ‘MSM’ must understand this diversity to effectively support the community in developing strategies for reaching and engaging different groups of gay and non-gay identified men.     

‘It's like taking a bit of masculinity away from you’: towards a theoretical understanding of men's experiences of infertility

In the UK, nearly half of all cases of infertility involve a ‘male‐factor’. Yet, little empirical work has explored how men as men negotiate this terrain. Three interrelated concepts; ‘hegemonic masculinity’, ‘embodied masculinity’ and the linkages between ‘masculinities’ and male help‐seeking, provide the theoretical framework that guided a qualitative study conducted with 22 men experiencing infertility. The paper explores men's propensity to delay their help‐seeking in relation to infertility despite their desire for children. It also demonstrates how, in the context of infertility, the male body can be defined as both a failed entity in itself (unable to father a child) and a subordinated social entity (unable to measure up to hegemonic ideals) that characterises men's masculine identities. The paper also illustrates how men appear willing to accept responsibility for their infertility and adopt aspects of hitherto subordinate masculine practice. This does not, however, constitute the total unravelling of well understood and accepted expressions of masculinity. Finally, the paper demonstrates how infertility is perceived as having the potential to fracture current and even future relationships. Moreover, regardless of how well men measured up to other hegemonic ideals, ultimately they can do little to counteract the threat of other (fertile) men.     

Erectile dysfunction in early, middle, and late adulthood: symptom patterns and psychosocial correlates

The prevalence of erectile dysfunction (ED) increases with age. However, it may emerge at any time during the adult years, and may bear a close relationship to ongoing psychosocial issues affecting the patient and his partner. The present study examined ED symptomatology and its associated psychosocial context in 560 men aged 19-87 attending a urology clinic for erectile difficulties. We divided participants into three age groups: early adulthood (age 19-39); middle adulthood (40-59); and late adulthood (60+). They completed a self-report assessment battery evaluating medical, psychological, and lifestyle factors empirically or theoretically related to ED. Results showed that although younger men reported more positive overall ratings of their sex life and better overall erectile functioning relative to older men, they also reported comparatively less relationship satisfaction, greater depressive symptomatology, more negative reactions from partners, and less job satisfaction. Results suggest that older men experience less difficulty than younger men adjusting to life with ED.     

Heteronormativity and ‘troubled’ masculinities among men who have sex with men in Addis Ababa

In most societies, heterosexuality is the dominant way of expressing sexuality and masculinity and those men outside of it are stigmatised and discriminated against. This paper explores the sexual lives of men who have sex with men and the personal and social conflicts that arise as they attempt to both live up to societal expectations and manage their sexual desires. It critically explores how an overriding heteronormativity structures and influences men's perception and understanding of sexuality and masculinity/femininity. The paper draws on data from 24 in-depth/life history interviews, one focus group discussion and ethnographic observation conducted between July 2006 and June 2007. The study reveals that powerful and dominating beliefs about heteronormativity and masculinity result in men who have sex with men dealing with a number of issues of personal conflict and contradiction resulting in uncertainty, resentment, ambivalence, worry and discomfort. Heteronormativity or the expectations of parents, community and society at large is far more influential on the sexuality of men who have sex with men than their own individual desires and needs. The paper concludes that there is little room for individuality for Ethiopian men who have sex with men with their sexual bodies ‘belonging’ to parents, families and to society at large.