Victims of virility: Honor endorsement, stigma, and men’s use of erectile dysfunction medication.

Abstract

The symptoms of erectile dysfunction (ED) pose a threat to physiological and psychological well-being, making it important that men feel comfortable seeking ED medication. Unfortunately, some men feel a sense of emasculation and shame in seeking medical help for their symptoms. The current research investigated how men in cultures of honor, who place strong emphasis on their masculine reputation and their virility, might be particularly hesitant to seek medication for ED symptoms due to the masculinity threat posed by such help-seeking. Across three studies, we found that young, honor-endorsing men held higher levels of stigma in regard to seeking ED medication (Study 1), that older men showed a decreased likelihood to seek ED medication, and that the link between honor endorsement and intention to use ED medication was explained by the emasculating stigma of ED help-seeking (Study 2). Finally, we found that honor-endorsing regions had significantly lower levels of ED prescription fills than nonhonor regions (Study 3). Findings suggest that honor-endorsing men are not willing to seek medication for ED symptoms due to the threat to masculinity that help-seeking poses. This phenomenon thus increases the likelihood that older, honor-endorsing men experience the psychological detriments associated with ED.

Damaged Masculinity: How Honor Endorsement Can Influence Prostate Cancer Screening Decision-Making and Prostate Cancer Mortality Rates

“…Prior research has also shown that men may avoid screenings for fear of a positive test, as treatment for prostate cancer may lead to the loss or damage of their sexual function (James et al, 2017). Given that sexual virility is also an aspect of honor-endorsers’ masculine reputation (Brown, 2016; Foster et al, in press), these fears may need to be assuaged as well. It would likely be useful to use specific message-framing when practitioners present screening options to honor-endorsing patients.…”

“…Honor-state group classification divides the United States into honor and non-honor groups primarily by regional location. This division places most southern and western states in the honor-state category, with all other states (including Alaska and Hawaii) in the non-honor state category—this categorization established by Cohen (1998) has been used in a myriad of studies examining different outcomes as a function of regional differences in honor orientation (e.g., Barnes et al, 2012; Brown et al, 2009, 2014, 2018; Foster et al, in press; Osterman & Brown, 2011).…”

“…Work by both Brown et al (2014) and Bock et al (2019) found honor endorsers are significantly less likely to seek out psychological services for depression and are more likely to commit suicide when they feel a lack of “honor fulfillment.” These findings were expanded upon by Foster, Carvallo, Lee, and Bernier (2020) who found that the link between honor endorsement and decreased psychological help-seeking was due to reputation concerns and the fear of being stigmatized by others. Recent work has even shown that honor-endorsing men will avoid seeking help for erectile dysfunction for fear of being seen as less masculine (see Foster et al, in press). In sum, there is evidence to suggest that honor endorsers actively avoid certain health-seeking behaviors that are perceived as a threat to one’s reputation as “honorable.”…”

Precarious Manhood Beliefs are Positively Associated With Erectile Dysfunction in Cisgender Men

“…Another study analyzing reports of men being treated for prostate cancer, which often is accompanied by ED, revealed that the most important reasons why men feel a diminished sense of their masculinity are changes in bodily functions, such as the loss of the ability to achieve an erection, reduced libido, or impaired physical strength (Tsang et al, 2019). The fact that many men suffering from ED don't use ED medication has been shown to be associated with the emasculating stigma of ED help-seeking presenting a masculinity threat (Foster et al, 2022).…”

Openness to Using an External Penile Prosthesis for Maintaining Sexual Intimacy by Individuals with Erectile Dysfunction: A Cross-Sectional Study

“…3 ED patients have difficulty seeking medical support due to embarrassment and the condition is associated with psychological morbidities such as anxiety and depression. 4,5 ED may distress not just patients but their sexual partners, contributing to relational strain and reducing the quality of life for both. 6 First line treatment for ED includes phosphodiesterase-5 inhibitors (eg, Viagra, Cialis, Levitra), while second-line treatments include vacuum erection devices (VED) and intracavernous injections (ICI).…”