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Reproductive and sexual health problems

opinion

Men have been neglected as a target population for sexual and reproductive health services. Data from the National Survey of Family Growth were used to examine utilization of sexual and reproductive health services among 3, men aged 20—44 who had ever had sex with a woman.

Associations between demographic and behavioral variables and measures of service utilization were assessed in univariate and logistic regression analyses. The odds of having received nontesticular services were elevated among men who were nonwhite and older, engaged in sexual risk behaviors, had had a physical exam and had public health insurance. The odds of having received only a testicular exam were elevated among men who were white, had lower levels of sexual risk, had had a physical exam and had private or no insurance.

Men who have sex with women Reproductive and sexual health problems not receiving adequate levels Reproductive and sexual health problems sexual and reproductive health care, and the care they receive is neither comprehensive nor integrated.

Standards of clinical care need to be defined and communicated to men and providers. Heterosexual men remain largely invisible, although there have been calls for change.

The need for more accessible sexual and reproductive health services for men is demonstrated by the fact that although condom use has increased during the past two decades, levels of unprotected sex and other sexual risk behaviors among men remain high.

For example, data from the National Survey of Family Growth NSFG indicate that more than one-third of sexually active men who were neither married nor cohabiting had not used a condom during sex at any time in the past four weeks. Given these high levels of risky behavior, it is unfortunate that the U.

Although one document offers guidelines for men during and beyond adolescence, 10 most suggested standards of care focus on adolescents. The inadequate response to the sexual and reproductive health needs of heterosexual men in the United States is related to other factors as well. First, men who have sex with women are not perceived as the primary population at risk for the two highest-priority sexual and reproductive health issues: Second, Reproductive and sexual health problems to condoms, the major method by which men prevent pregnancy and STDs, does not require a health care visit.

Men also face economic barriers to sexual and reproductive health care. Moreover, demand factors may impede the use of sexual and reproductive health care among men who have access to services. Men make substantially fewer health care visits than women, 18—20 a finding that persists even among people with health problems.

Finally, because a large proportion of STDs are asymptomatic, men often are unaware that they need care even when infected. Office of Reproductive and sexual health problems Affairs and its Office of Family Planning issued an initiative in that funded community-based health and social service organizations to deliver clinical and educational sexual and reproductive health services to men.

Research is needed to examine access to and patterns of sexual and reproductive health care utilization among men 20 and older. For example, women are more likely to receive clinical gynecologic services Pap and pelvic exams than any other sexual or reproductive health service—a pattern that is particularly evident among women who are white, are well educated and have high incomes.

Does the pattern of care that men receive vary by race, education, income or other individual characteristics? The NSFG provides Reproductive and sexual health problems that address these limitations. In the analyses presented here, we used NSFG data to provide a timely and in-depth portrait of the rates and patterns of sexual and reproductive health care use among men aged 20— We also examined the factors that may be associated with whether men receive various types of sexual and reproductive health care.

We analyzed data from the in-person and audio computerassisted self-interview questionnaires for the 4, men aged 15—44 interviewed for the NSFG.

The NSFG uses Reproductive and sexual health problems nationally representative multistage area probability sample; the sampling design and procedures have been described in detail elsewhere. We focused our analysis on the 3, men aged 20—44 who had had oral, anal or vaginal sex with a woman at least once.

We omitted men who had had sex only with men because information about sexual and reproductive health is more limited for men who have sex with women than for men who have sex exclusively with men.

Key among the issues and...

The time frame for all behavioral measures and nonfixed individual characteristics e. Our most comprehensive sexual and reproductive health services variable was receipt of any of the following during that interval: Because a sizable minority of men who had received services had had only a testicular exam, we constructed two other summary measures: A range of additional individual attributes—social and demographic factors, sexual risk factors and access to health care—were included as variables.

Finally, access to health care was measured by health insurance status private, public or no insurance and whether a man had had a physical exam in the past year. Respondents who had had both public insurance Medicaid, Medicare, state-sponsored health plan, Medigap, military health care, Indian Health Service or other government health care and private insurance in the previous year were coded as having had public insurance. Data were analyzed using SPSS version All univariate analyses were conducted on weighted data to yield nationally representative estimates.

This program employs the Taylor series linearization method to generate the variance estimates. We derived odds ratios from bivariate and multivariate logistic regressions from within the complex samples program. However, we used a two-step process Reproductive and sexual health problems indirectly estimate unmet Reproductive and sexual health problems. First, we estimated the proportion "Reproductive and sexual health problems" men who engaged in various sexual risk behaviors and who did not Reproductive and sexual health problems a condom at their last sexual encounter.

We then estimated unmet need as the proportion of these men who had not received any nontesticular sexual and reproductive health services in the year before the interview. The logistic regression models of service utilization included three sets of variables previously found to be associated with health care utilization—namely, the social and demographic variables, sexual risk factors and health care access variables noted above.

The 3, men included in our analysis were relatively evenly distributed among five-year age-groups Table 1. Five percent had had sex with an injection-drug user or with an HIV-infected individual, or had given or received money or drugs for sex.

Among men who had engaged in sexual risk behaviors, the unmet need for sexual and reproductive health care was substantial Table 2. Forty-nine percent representing Relatively small proportions of men reported having received services for or advice about birth control including condoms or sterilization. The predominance of testicular exams over nontesticular sexual and reproductive health services is more evident if the sample is restricted to eligible men who had received at least one service in the past year.

Finally, a testicular exam, but no other sexual or reproductive health service, appears to be a routine part of a physical examination for men.

Good sexual and reproductive health...

Data on the three most common types of nontesticular services STD care, HIV care and birth control services indicate that men do not generally receive comprehensive sexual and reproductive health care. Seventy percent of men reported having received none of these services in the year before the survey.

Among men who had received at Reproductive and sexual health problems one service, the data on comprehensiveness of care yielded a mixed picture. Fifty-seven percent of men who had received nontesticular care had had a testicular exam as well. The NSFG data challenge the notion that HIV testing is conducted for sexual and reproductive health reasons and that such testing functions as a Reproductive and sexual health problems to related services.

Nineteen percent reported that they had been tested for a practical reason that had no direct relationship to sexual and reproductive health e. Fifty-seven percent of men who had had an HIV test for sexual health reasons reported that they had talked to a doctor about HIV in the year before the survey or had received HIV information or counseling from a health care provider in that interval.

Sexual and reproductive health issues may have played a role in HIV testing among some men who cited practical or other reasons for their tests. To cast the widest net for identifying HIV testing within a sexual and reproductive health context, we counted both men tested for sexual and reproductive reasons and those tested for practical or nonspecific reasons who had received HIV information, counseling or advice from a medical professional in the year before the survey.

In other words, among U. From a sexual and reproductive health perspective, a sensible approach to care would combine HIV testing with STD testing. Multivariate models reveal notable differences in the predictors of nontesticular and testicular sexual and reproductive health care Table 5.

Among social and demographic variables, age was positively associated with receipt of nontesticular care odds ratio, 1. Black and Hispanic men were significantly more likely than white men to have received nontesticular care Reproductive and sexual health problems. Black men also were more likely than Hispanic men to have received nontesticular care 1.

All three sexual risk behavior measures were associated with receipt of care. Men who had a partner but were neither married nor cohabiting were more likely than other men to have received nontesticular care odds ratio, 1. Reproductive and sexual health problems same pattern of care was true for men with multiple or concurrent partners versus those without 1. Finally, men who had engaged in any of the other sexual risk behaviors were more likely than other men to have received nontesticular care 2.

We also examined the relationship between health care access and receipt of sexual and reproductive health care. Compared with men who had private or no insurance, respondents with public insurance were significantly more likely to have received nontesticular care odds ratios, 3. However, men with private insurance were no more likely than those without insurance to have received Reproductive and sexual health problems form of care.

Having had a physical exam in the past year was positively associated with receipt of both types of care, but the magnitude of the relationship was substantially greater for receipt of a testicular exam only. Men who had had a physical exam had 3. Safe and responsible sexual decision-making requires action from men as well as from women. To act safely and responsibly, men need screening and clinical care.

They also need counseling and education about sexual health, safer-sex behaviors, shared responsibility for contraception and parenting, and the rights of both men and women to have volitional and pleasurable sexual experiences. It is encouraging that men who engaged in sexual risk behaviors were more Reproductive and sexual health problems than other men to have received nontesticular services.

Good sexual and reproductive health...

At the same time, sizable numbers of men at heightened risk for STDs or unplanned pregnancy had received no nontesticular sexual and reproductive health Reproductive and sexual health problems in the year prior to their interview. Neither men themselves nor their providers receive clear messages about the types of services that men should receive, or how often they should receive them.

Addressing the unmet need for services requires a consensus document that establishes guidelines of care for adolescent and nonadolescent men, insurance coverage for the recommended services and plans for communicating these standards of care to providers and the public.

1. Introduction

When men do Reproductive and sexual health problems sexual and reproductive health services, the care is fragmented. Far more men receive testicular than nontesticular care. Moreover, although testicular exams are a routine aspect of physical exams for men, nontesticular sexual and reproductive health care apparently is not.

This finding is interesting, given the current debate about the clinical value of testicular exams: Evidence does not support their effectiveness in reducing mortality and morbidity from testicular cancer. None of the proposed standards for routine sexual and reproductive health care for men endorses a Reproductive and sexual health problems that prioritizes a testicular exam over other sexual and reproductive health services for men aged 20— A comprehensive service delivery model would include, at minimum, HIV, STD and birth control services including female methods, sterilization and emergency contraceptionas well as a testicular exam for all sexually active men.

APHA believes access to the...

These services would consist of counseling or advice about these topics and, for some men, testing and treatment. Although this analysis indicated that men are not receiving comprehensive care, further research is needed to examine the determinants of comprehensiveness of the nontesticular sexual and reproductive health services men receive.

The initiative from the Centers for Disease Control and Prevention CDC endorsing routine HIV screening in health care settings for all patients aged 13—64 36 raises concerns about the Reproductive and sexual health problems of comprehensive sexual and reproductive health services for men.

Integrating HIV testing into routine Reproductive and sexual health problems exams may help to destigmatize and increase testing, as well as to link it to other sexual and reproductive health services; to this end, the initiative explicitly endorses routine HIV testing for any patient receiving STD tests. We are concerned, however, about the delinking of HIV testing and counseling.

Although HIV tests conducted in the year prior to the NSFG were supposed to be linked to pretest counseling, a substantial proportion of men reported having been tested without receiving any counseling. The CDC guidelines will only increase this practice. Although the acceptance of testing without pretest counseling may increase the likelihood that medical providers will conduct HIV tests, it represents a Reproductive and sexual health problems acceptance of nonintegrated services and misses a significant window of opportunity for education and counseling.

Our multivariate analysis indicated that men of color are more likely than white men to receive nontesticular sexual and reproductive health care, even after racial and ethnic differences in income, relationship status, sexual risk behavior and connectedness to the health care system have been controlled for.

What might explain this finding? Adolescent girls face a number of sexual and reproductive health challenges. and providing them with safe environments in which to discuss their problems. Sexual and reproductive health care providers in the United States have a finding that persists even among people with health problems.

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Key among the issues and concerns are human rights related to sexual health, regarding reproductive behaviour regardless of age, sex and marital status.

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