tag:theconversation.com,2011:/ca/topics/male-health-2036/articlesMale health – The Conversation2020-09-02T13:51:10Ztag:theconversation.com,2011:article/1442492020-09-02T13:51:10Z2020-09-02T13:51:10ZMen are buying potentially risky steroid substitutes online to get the ‘ideal body’<figure><img src="https://images.theconversation.com/files/354966/original/file-20200826-7087-dhrj2z.jpg?ixlib=rb-1.1.0&rect=22%2C0%2C6809%2C4891&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Selective androgen receptor modulators (SARMs) may be perceived as a safer muscle-building alternative to steroids.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Unapproved muscle-building drugs are being <a href="https://doi.org/10.1210/jc.2018-01706">sold over the internet</a>. These chemicals, called SARMS or selective androgen receptor modulators, are popular in part due to their <a href="https://www.uspharmacist.com/article/recreational-use-of-selective-androgen-receptor-modulators">perceived safety compared to anabolic steroids</a>, but the health risks of these drugs are still widely unknown and potentially serious.</p>
<h2>Images in society influence our body image</h2>
<p>Images of bodies surround us in our daily life, in advertising, media, the Twitterverse and dating apps, informing <a href="http://hdl.handle.net/10523/7863">the way we feel and think about our bodies</a>. We come to understand ourselves through the images circulating in our culture and society that define what it means to belong to a particular gender. </p>
<p>For many men, social images create an understanding of what their bodies should look like to be <a href="https://doi.org/10.1177/1557988316669042">considered masculine</a>. Often the dominant ideal, both celebrated and desired, is fat-free, with bulging muscles and well-defined pecs: a celebration of <a href="https://doi.org/10.1080/14680777.2017.1367701">strength and power</a>.</p>
<figure class="align-center ">
<img alt="A young man in a hoodie looks pensive with his arms folded across his chest. Behind him, on a blackboard, a drawing of caricatured muscular arms lines up with his shoulders." src="https://images.theconversation.com/files/354704/original/file-20200825-15-5cxmst.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/354704/original/file-20200825-15-5cxmst.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=380&fit=crop&dpr=1 600w, https://images.theconversation.com/files/354704/original/file-20200825-15-5cxmst.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=380&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/354704/original/file-20200825-15-5cxmst.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=380&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/354704/original/file-20200825-15-5cxmst.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=478&fit=crop&dpr=1 754w, https://images.theconversation.com/files/354704/original/file-20200825-15-5cxmst.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=478&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/354704/original/file-20200825-15-5cxmst.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=478&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">For many men, social images create an understanding of what their bodies should look like to be considered masculine.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>Many men strive to embody this idealized image of masculinity, but it’s not one everyone can achieve. The difference between men’s actual bodies and the cultural ideas about masculinity that may <a href="https://doi.org/10.1176/appi.ajp.157.8.1297">explain the rise of muscle dysmorphia and anabolic steroid abuse</a>. </p>
<p>We suggest that more discussion is needed surrounding both masculine body image ideals and the potential dangers of SARMs in our society.</p>
<h2>Body image standards affect men differently</h2>
<p>For many <a href="https://www.apa.org/pi/lgbt/programs/safe-supportive/lgbt/key-terms.pdf">sexually diverse men</a> (gay, bi, pansexual, queer, men who have sex with men, etc.), the consequences of not living up to idealized standards for masculine bodies <a href="https://doi.org/10.1176/appi.ajp.157.8.1297">can be toxic</a>, including negative body image and <a href="https://doi.org/10.1016/j.bodyim.2019.08.007">body dissatisfaction</a>. </p>
<p>This can influence the way people live, such as eating and exercising. For example, one study noted a small association with social media use and <a href="https://doi.org/10.1089/cyber.2017.0375">body dissatisfaction, eating disorder symptoms and thoughts about using anabolic steroids</a>. Sexually diverse men have also reported engaging in <a href="https://doi.org/10.1136/bmjopen-2014-005205">intensive anaerobic training, the use of protein powders and the use of anabolic steroids</a> to achieve their desire to become muscular. </p>
<p>Ethnicity can also intersect with body image for sexually diverse men. <a href="https://doi.org/10.1016/j.bodyim.2013.03.006">In one study</a>, Black, East/Southeast Asian, South Asian, Latino/Brazilian gay and bisexual men report skipping meals, vomiting and taking steroids to achieve bodies that cultural messages and images define as the most masculine. </p>
<h2>Potential danger</h2>
<p>Anabolic steroids can be viewed by men with body dissatisfaction as <a href="https://doi.org/10.1001/jama.2016.17441">a way to achieve this idolized masculine body</a>. Now SARMs, which are not steroids per se but <a href="https://www.uspharmacist.com/article/recreational-use-of-selective-androgen-receptor-modulators#:%7E:text=Discovered%20in%20the%20late%201990s,and%20facilitate%20recovery%20from%20exercise.&text=SARMs%20are%20not%20anabolic%20steroids,to%20androgen%20receptors%20">act in a similar way</a> by increasing muscle mass and strength, are perceived as a safer alternative to steroids and are easily purchased online: A potential danger for those desperate to achieve these hyper-muscular bodies.</p>
<figure class="align-right ">
<img alt="A black dumbbell with drug capsules in the foreground" src="https://images.theconversation.com/files/354706/original/file-20200825-18-1edejsp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/354706/original/file-20200825-18-1edejsp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/354706/original/file-20200825-18-1edejsp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/354706/original/file-20200825-18-1edejsp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/354706/original/file-20200825-18-1edejsp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/354706/original/file-20200825-18-1edejsp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/354706/original/file-20200825-18-1edejsp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Anabolic steroids can be viewed by men with body dissatisfaction as a way to achieve the idolized masculine body. Now SARMS may be viewed as an alternative to steroids.</span>
<span class="attribution"><span class="source">(Pexels)</span></span>
</figcaption>
</figure>
<p>SARMS have been researched for more than 20 years as treatments for medical conditions including cancer, osteoporosis, Alzheimer’s disease and muscle-wasting, but no SARMs are approved by the FDA for any medical condition yet and they are not authorized for use in Canada. In fact, Health Canada released a <a href="https://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2020/72293a-eng.php">public health advisory</a> in March 2020 advocating against the use of SARMs, and reported a seizure of various SARMs from stores in Alberta.</p>
<p>We know little about the safety and toxicity of these drugs, which is what makes them risky. A 32-year old male recently suffered <a href="https://doi.org/10.14309/crj.0000000000000370">severe liver injury</a> after taking a SARM for two weeks, suggesting there are indeed health risks.</p>
<p>A factor that may have contributed to this case is that recreational steroid users often take <a href="https://doi.org/10.1210/jc.2018-01706">much higher doses than what is prescribed for medical patients</a>. SARMs, like other drugs, can have <a href="https://doi.org/10.1111/bcp.13316">dose-dependent effects</a>. If men are taking high doses to achieve the dominant image of a masculine body, it is likely that their health risks are higher as well. </p>
<p>Although SARMs may end up being safe drugs when properly used for medical conditions, there are still major <a href="https://doi.org/10.1080/13543784.2020.1777275">health concerns</a> involved with taking SARMs currently, including liver damage, cardiovascular issues and testosterone suppression. Furthermore, the purity of SARMs bought online is currently <a href="https://doi.org/10.1002/dta.2908">highly questionable</a>.</p>
<h2>What can we do?</h2>
<p>In light of these safety concerns, the <a href="https://www.congress.gov/bill/116th-congress/senate-bill/2895/text">SARMs Control Act of 2019</a> was introduced to the United States Congress, which seeks to tighten regulatory control over these drugs. This act effectively equates SARMs with anabolic steroids on a regulatory level. This type of regulation is necessary to help contain a drug with health risks and potential for abuse.</p>
<p>Thus, we have a storm brewing. On one hand we have unrealistic masculine body image standards for gay men, which promote and even demand the use of anabolic drugs to reach that goal. On the other hand, SARMs promise the idolized body and are easily available over the internet.</p>
<p>We need to honestly discuss the dangers of promoting unattainable masculine body image standards for men of all sexual orientations and warn about easily accessible SARMs that may not be safe to use and almost certainly not safe to abuse.</p><img src="https://counter.theconversation.com/content/144249/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Idealized standards for muscular, fat-free male bodies may be fuelling the use of SARMs, or selective androgen receptor modulators, unapproved muscle-building drugs that are easily available online.Stefan Heinze, Graduate student in Pharmacology, Dalhousie UniversityPhillip Joy, Assistant Professor, Mount Saint Vincent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1351582020-04-16T14:53:12Z2020-04-16T14:53:12ZCoronavirus: does testosterone really make infectious diseases worse in men?<figure><img src="https://images.theconversation.com/files/328359/original/file-20200416-192725-1jqreae.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5197%2C3462&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/middle-age-hoary-senior-man-wearing-1295474197">Krakenimages/Shutterstock</a></span></figcaption></figure><p>The COVID-19 pandemic has had a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103991/">bigger toll on men</a> than <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsinvolvingcovid19englandandwales/deathsoccurringinmarch2020#characteristics-of-those-dying-from-covid-19">it has on women</a>. There has been <a href="https://www.theguardian.com/world/2020/mar/26/men-are-much-more-likely-to-die-from-coronavirus-but-why">a lot of conjecture</a> about why this might be. <a href="https://www.dailymail.co.uk/health/article-8210435/Why-does-Covid-19-kill-men-women.html">One theory</a> is that the male sex hormone, testosterone, has a dampening effect on the immune system, making men more susceptible to the novel coronavirus. But just how plausible is this theory?</p>
<p>An overview of the scientific evidence suggests that oestrogen (the main female hormone) can improve the immune system and increase immune inflammation whereas testosterone (the male sex hormone) reduces or <a href="https://www.ncbi.nlm.nih.gov/pubmed/30210492">dampens the response</a>. As a result, women often have less severe infections than men and have significantly stronger immune responses to vaccinations (which are essentially less potent versions of a virus). Men with higher levels of testosterone may have weakened immunity and have been shown to produce the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24367114">lowest antibody responses</a> to annual flu vaccinations. </p>
<p>So is there a natural susceptibility of men to suffer more severely from viruses and bacterial infections as a result of testosterone? Such a conclusion is not so clear cut when you look a little deeper into the scientific evidence. </p>
<h2>Trade-offs</h2>
<p>Many of the studies that describe the suppressing effect of testosterone on the immune system have focused on a single immune function or individual immune cell types. But the immune system is a complex arrangement of many different cells, organs and tissues that direct an elaborate response to infections. It can broadly be sorted into two categories: innate immunity and adaptive immunity. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/PzunOgYHeyg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Innate and adaptive immune systems explained.</span></figcaption>
</figure>
<p>Innate immunity is rapid (within hours) and non-specific, meaning it is a frontline defence that is more generalised, targeting any invaders and slowing infection until adaptive immunity is developed. </p>
<p>Adaptive, or acquired immunity, is more complex. It takes a longer time (several days) to process and recognise a foreign invader before making specific antibodies to target it. After the threat has gone, the adaptive immune system “remembers” it, which makes future responses to the same pathogen faster, more efficient and powerful.</p>
<p>Adaptive immunity may also be thought of as more energetically demanding on the body. This means that in males with high testosterone, where energy-consuming actions such as increasing muscle strength, sexual appetite and risk-taking behaviour take precedence, adaptive immunity is not necessarily prioritised. Fitting in with this, when men have infections or illness, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075254/">their testosterone levels decrease</a>, possibly to move energy away from all those high-energy tasks to allow instead for most energy to go into strengthening the immune response. </p>
<p>A trade-off may also happen between different immune actions. When one part is highly effective, other functions may be turned down. In a normal situation, the ability to produce a quick response to local infection or tissue injury by activating the innate immune system is more useful in high-testosterone men. This is because, from an evolutionary perspective, they are more likely to experience trauma as a result of aggressive physical competition, roles in hunting and heavy manual or dangerous activities. So it’s not likely that testosterone would reduce all parts of immune function equally.</p>
<p>Despite its overall immune system suppressing effects, looking a little more closely at testosterone over a wide range of immune functions shows it can be immune system suppressing, strengthening and even sometimes have no effect on immune function at all. With such different effects in different investigations, it becomes clear that measuring only certain immune features in relation to testosterone does not truly reflect the overall immune capabilities of a man. </p>
<h2>Disease and age</h2>
<p>A major factor in how severe an infection may become is whether a person has underlying disease. While this is easy to understand, what is not so clear is the effect that the reduced levels of testosterone that happen during illness have on the likelihood of the infection developing into something more severe in men. It has been recently shown that COVID-19 reduces testosterone levels in men by <a href="https://www.medrxiv.org/content/10.1101/2020.03.21.20037267v2">altering the functioning of the gonads</a>. So could the increased severity of the disease in men be due to lowered testosterone?</p>
<p>Complicating things further is the influence of age. We know that the occurrence of additional diseases <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890129/">increases with age</a>. Age is a major risk factor for COVID-19 <a href="https://www.thelancet.com/action/showPdf?pii=S1473-3099%2820%2930243-7">in both genders</a>. As men age, their testosterone levels decrease, offering the possibility that increased severity of infections in elderly men may be due to lower levels of testosterone rather than simply the presence of testosterone. For example, men with lower levels of testosterone who had chronic kidney disease <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733882/">were more likely to have to go to hospital because of infections</a> than men with higher levels. What may be relevant here to COVID-19 is that most of these infections were respiratory infections.</p>
<p>To find out how it influences the immune system, it would be necessary to look at testosterone effects on various functions of both innate and adaptive immunity in a variety of men with different health statuses and ages. Such investigations don’t exist at the moment. So for now, it would be wise to conclude that testosterone <em>can</em> modulate the immune system. But the way it does this and the outcome it has depends on many other factors that influence whether there may be a negative or a beneficial effect on the severity of infectious diseases, such as COVID-19, in men.</p><img src="https://counter.theconversation.com/content/135158/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel Kelly does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The science is not so clear cut.Daniel Kelly, Lecturer in Biochemistry, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/996312018-07-11T09:26:49Z2018-07-11T09:26:49ZIs shrinking penis syndrome a delusion or a real thing?<figure><img src="https://images.theconversation.com/files/227050/original/file-20180711-70042-14iwxro.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In the medical culture of the Bugis and Makassar peoples in Indonesia the word _koroq_
means that the penis is actually shrinking, or retracting, but the Dutch in the 19th-century East Indies did not believe it was real.</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p><em>The author has presented his paper on koro and traditional healing practices in Indonesia at the <a href="https://www.aipi.or.id/index.php?pg=detilberita&nid=157">History of Medicine in Southeast Asia</a> Symposium, 27-30 June, 2018 at the Indonesian Academy of Sciences.</em> </p>
<hr>
<p>In the 19th century, the Dutch, who ruled over the then Netherlands East Indies (now Indonesia), encountered curious phenomena known as <em>amok</em>, <em>latah</em> and <em>koro</em>. </p>
<p>They were intrigued and puzzled, and proposed that these were psychiatric syndromes specific to the local culture. <em>Amok</em> is understood as an uncontrolled outburst of anger and <em>latah</em> as an exaggerated startle reflex, with Indonesian cultures modifying and interpreting these phenomena in specific local ways. </p>
<p><em>Koro</em> is the least known of these three syndromes, being largely localised to South Sulawesi. In the medical culture of the Bugis and Makassar peoples, the word <em>koroq</em>
means that the penis is actually shrinking, or retracting, but the Dutch did not believe this was real. </p>
<p>While they knew the penis was retractable on exposure to cold, they did not accept that other forms of retraction were possible. They adopted the word <em>koroq</em>, leaving out the glottal stop at the end of the word, and defined it as a delusional condition in which the patient mistakenly believes his penis is shrinking. This became the prevailing view in the international literature and appears in major psychiatric texts around the world.</p>
<p><a href="http://www.who.int/classifications/icd/en/">The International Classification of Diseases</a> (ICD), maintained by the World Health Organisation, is based on universal human biology rather than culture, so these peculiar culturally localised syndromes are listed in an appendix outside the main classification. </p>
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<p>
<em>
<strong>
Baca juga:
<a href="https://theconversation.com/got-a-cold-in-coin-rubbing-indonesians-trust-79270">Got a cold? In coin rubbing Indonesians trust</a>
</strong>
</em>
</p>
<hr>
<h2>Delusion or state of anxiety?</h2>
<p>In 1985, American psychiatrist Ronald Simons <a href="https://link.springer.com/chapter/10.1007/978-94-009-5251-5_13">proposed</a> that retraction of the penis in <em>koro</em> attacks was a protective reflex in fight-or-flight situations. A slight penis retraction, which normally occurs in anxiety states, can turn into a major panic attack with an extreme degree of retraction, due to a positive feedback loop – retraction causes anxiety, then anxiety causes more retraction, and so on.</p>
<p>Penis retraction as a protective reflex keeps the penis safe from injury in fight-or-flight situations in animals. In Simons’ model this reflex is partially preserved in humans.</p>
<p>Simons’ theory also offers an explanation of <em>koro</em> in terms of universal human biology rather than in culture. This proposal has not been widely accepted, however. The definition of <em>koro</em> as a kind of delusional disorder <a href="https://en.wikipedia.org/wiki/Koro_(medicine)">is still entrenched in the international literature</a>.</p>
<p>In Indonesia, <em>koro</em> is treated by traditional healers, called <em>dukun</em>, who are often semi-literate villagers. </p>
<p>The <em>dukuns</em> certainly do not read the international medical literature and simply follow the healing methods of local oral traditions. Evidence from the practice of these healers fits better within Simons’ panic attack model than with the concept of a delusional disorder.</p>
<p>When a patient arrives in a state of panic saying his penis is shrinking, the <em>dukun</em> takes the complaint at face value. He administers his treatments, thus relieving the panic and allowing the retracted penis to return to its normal condition.</p>
<p>If <em>koro</em> is understood as a panic attack, this recovery is not surprising since panic attacks normally escalate to a peak and then rapidly subside, so the <em>dukun</em> is simply facilitating a natural resolution.</p>
<h2>Where else in Indonesia?</h2>
<p>These retraction panic syndromes occur in several regions in Indonesia. The first records are from South Sulawesi where <em>koro</em> was described in 1859. Only in the last few decades has significant evidence emerged in other regions. </p>
<p>In west and central Flores the retraction panic syndrome is known as <em>ru’u pota</em>, “shrinking magic”. The local newspaper Flores Post reported an <a href="https://www.academia.edu/5870814/Curing_Koro">epidemic of hundreds of cases in Ende from October 5 to 7, 1999</a>. </p>
<p>In eastern Sumba it is known as <em>hei lulu</em>, “everything goes up”. In the Belu district of Timor it is known as <em>lulik oan subaran</em>, “the little sacred thing is hiding itself”. Reports of these conditions appear in local newspapers or the reports of local anthropologists, but never in medical journals.</p>
<h2>Story of a <em>koro</em> healer</h2>
<p>Because of the uncertainty surrounding Simons’ theory, when I heard in 2002 of a Sumbanese <em>dukun</em> on the outskirts of Waingapu, who was well known for curing <em>koro</em>, I decided to pay him a visit.</p>
<p>Umbu Hina Panjarra was a pig farmer and a big fan of Megawati, the previous president of Indonesia, and he was keen to talk. He told us that not just ordinary villagers but also important government officials would be driven urgently to his humble earthen-floored house, often with a string tied around their penis to prevent it disappearing.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/227043/original/file-20180711-70066-lcmj22.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/227043/original/file-20180711-70066-lcmj22.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=446&fit=crop&dpr=1 600w, https://images.theconversation.com/files/227043/original/file-20180711-70066-lcmj22.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=446&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/227043/original/file-20180711-70066-lcmj22.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=446&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/227043/original/file-20180711-70066-lcmj22.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=560&fit=crop&dpr=1 754w, https://images.theconversation.com/files/227043/original/file-20180711-70066-lcmj22.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=560&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/227043/original/file-20180711-70066-lcmj22.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=560&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hina Panjarra of Waingapu, a <em>dukun</em> and fan of former president Megawati Soekarnoputri, in his home with his special massage oil.</span>
<span class="attribution"><span class="source">David Peter Mitchell</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Hina would give a vigorous massage, working upwards from the calf and thighs, and downwards from the abdominal muscles, as if driving some bodily energy towards the shrunken penis. It was essential to work vigorously, he explained, and apply painful levels of pressure. </p>
<p>His style was that of an enthusiastic showman. He liked to have his patient stripped naked as he worked so that the improving state of the penis could be seen, and the drama of removing the string was a sign that both healer and patient were now confident the crisis was passing.</p>
<p>This was fascinating material. But it is anecdotal and does not prove Simons’ thesis. </p>
<p>Hina did not have any measurements or photographs or records of any kind.
His language was that of a charismatic healer rather than the language of an objective, carefully self-critical observer. </p>
<p>But his story does suggest that there is a retraction reflex worthy of proper physiological study.</p>
<p>I had been easily able to find Hina Panjarra in Sumba because I had been the head of the government health services in West Sumba in 1968-69, but I was just a visitor in 2002 and no longer in a position to arrange for collecting observational evidence on Hina’s patients. I was persuaded, however, that it was worth collecting more information on this topic. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/227052/original/file-20180711-70039-17ynhso.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/227052/original/file-20180711-70039-17ynhso.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=451&fit=crop&dpr=1 600w, https://images.theconversation.com/files/227052/original/file-20180711-70039-17ynhso.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=451&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/227052/original/file-20180711-70039-17ynhso.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=451&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/227052/original/file-20180711-70039-17ynhso.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/227052/original/file-20180711-70039-17ynhso.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/227052/original/file-20180711-70039-17ynhso.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In Ende, Flores <em>dukun</em> Jeremias Ima, a <em>ru u pota</em> expert, here is treating a headache.</span>
<span class="attribution"><span class="source">David Peter Mitchell</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Baca juga:
<a href="https://theconversation.com/why-health-research-rarely-influence-policy-in-indonesia-90545">Why health research rarely influence policy in Indonesia</a>
</strong>
</em>
</p>
<hr>
<h2>New evidence</h2>
<p>Recently, new evidence has emerged from doctors in Cairo, Egypt, using botox injections in men who are embarrassed by a retracting penis. They have published measurements of <a href="https://www.ncbi.nlm.nih.gov/pubmed/19686423">the degree of retraction and improvements achieved by botox</a>. </p>
<p>Following local leads, I have visited Ende and later Makassar, and located local healers in both places, treating the local <em>ru’u pota</em> and <em>koroq</em> syndromes. </p>
<p>Although cultural beliefs differ from one place to the next, as do the styles and curing methods of the <em>dukuns</em>, all three of the healers I have spoken to insisted on two things: that retraction was real, and that as long as the patients made it safely to the <em>dukun’s</em> home, they could all be cured and the penis restored to its normal condition.</p>
<p>Although <em>koro</em> was discovered in Indonesia, recent international publications on <em>koro</em> come from India, Africa and many countries around the world, but none originate in Indonesia. </p>
<p>Perhaps the time has come for Indonesian medical anthropologists and medical researchers to reclaim the subject of <em>koro</em>, taking advantage of the continuing practice of <em>dukuns</em> in this field.</p><img src="https://counter.theconversation.com/content/99631/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Peter Mitchell tidak bekerja, menjadi konsultan, memiliki saham, atau menerima dana dari perusahaan atau organisasi mana pun yang akan mengambil untung dari artikel ini, dan telah mengungkapkan bahwa ia tidak memiliki afiliasi selain yang telah disebut di atas.</span></em></p>Koro is widely believed to be a culturally localised delusion. But a theory that it’s a fight-or-flight reflex might be corroborated by studying traditional healing treatments in Indonesia.David Peter Mitchell, Adjunct Senior Research Associate, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/844142017-11-01T10:57:26Z2017-11-01T10:57:26Z‘It made me feel less of a man knowing I may never be a dad’: the hidden trauma of male infertility<figure><img src="https://images.theconversation.com/files/192663/original/file-20171031-18704-je5ikd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>There has been a lot of alarm in recent years about the <a href="https://theconversation.com/huge-drop-in-mens-sperm-levels-confirmed-by-new-study-here-are-the-facts-81582">declining fertility rates of Western men</a> and the potential problems this may pose. </p>
<p>It is estimated that infertility affects <a href="https://www.ncbi.nlm.nih.gov/books/NBK327771/">one in six heterosexual couples</a>, making it a common issue for those of reproductive age. For 40% of couples who can’t conceive, the problem lies with the man. But despite this, fertility remains something that is traditionally viewed as a “woman’s problem”, with male infertility rarely spoken about.</p>
<p>This focus solely on women’s bodies and perspectives, often leaves men feeling unable to speak out or even talk about their own infertility and the impact it <a href="https://theconversation.com/huge-drop-in-mens-sperm-levels-confirmed-by-new-study-here-are-the-facts-81582">has had upon their lives</a>. And our <a href="http://journals.sagepub.com/doi/abs/10.1177/1359105316644038">previous research</a> has shown infertility can be a very <a href="http://journals.sagepub.com/doi/abs/10.1177/1363459316649765">difficult and stressful experience</a> for men to go through. Many men find fertility diagnosis and treatment highly traumatic. A time which was often likened to a “rollercoaster” – with a lot of men reporting feelings of sadness and despair.</p>
<p>Our <a href="https://www.youtube.com/watch?v=hNYKBwBbHLU">latest study</a> has built upon these findings to delve deeper into men’s experiences. And we found that many men were deeply affected by infertility – with some identifying it to be the most difficult experience of their lives. </p>
<h2>Getting to the truth</h2>
<p>Working with <a href="http://fertilitynetworkuk.org/?gclid=EAIaIQobChMIktaLteea1wIVo7ztCh1J2wPvEAAYASAAEgJp5vD_BwE">Fertility Network UK</a> – the national fertility charity – we designed and distributed a questionnaire with a series of open-ended questions which allowed men anonymously to tell us about their infertility journeys. </p>
<p>Despite infertility still being seen as a <a href="https://theconversation.com/declining-sperm-quality-in-older-men-puts-the-issue-at-the-centre-of-fertility-debate-43752">taboo topic for men</a>, we received a large number of completed questionnaires, offering rich, detailed accounts. Most respondents said it had affected their psychological well-being, mentioning anxiety, depression and stress-related ill health in their accounts. </p>
<p>In this way, the inability to conceive was often likened to grief, and many of the men felt that it took time and considerable emotional energy to manage such feelings of loss. One man explained how it had impacted his life: </p>
<blockquote>
<p>It’s in our DNA to make babies. That’s the purpose of sex when you are older is to make babies. It made me feel worthless that I couldn’t have kids. </p>
</blockquote>
<p>Many respondents framed the impact in gendered terms, which is perhaps to be expected given the traditional associations between masculinity, fertility and fatherhood. One man said:</p>
<blockquote>
<p>It made me feel less of a man at the time knowing I may never father a child.</p>
</blockquote>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/192664/original/file-20171031-18686-1ctdf2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/192664/original/file-20171031-18686-1ctdf2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/192664/original/file-20171031-18686-1ctdf2w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/192664/original/file-20171031-18686-1ctdf2w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/192664/original/file-20171031-18686-1ctdf2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/192664/original/file-20171031-18686-1ctdf2w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/192664/original/file-20171031-18686-1ctdf2w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Infertility can leave many men feeling very alone.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>This sense of emasculation was compounded by the widespread assumption that reproduction for men is a simple, natural process – as another man detailed:</p>
<blockquote>
<p>For a while I thought less of myself as a person and as a man. I felt it was nature’s way of telling me there is something wrong with me and that’s why I am not able to have kids.</p>
</blockquote>
<p>Such challenges to men’s identities – which are linked to dominant ideals of masculinity – can be difficult and often make men feel further isolated when dealing with fertility issues. </p>
<h2>Silence and stigma</h2>
<p>Clearly, an ongoing stigma surrounding men and infertility contributes to men’s suffering. And this leads to many men coping with infertility in silence. Infertility can also create challenges within relationships between couples, further adding to the burden many men feel. </p>
<p>But the situation is slowly beginning to change, with more <a href="https://www.youtube.com/watch?v=v86rcQyPV6Y">men coming forward to tell their stories</a> and share experiences – often on online support forums. Using these online spaces to get help and advice is often valued by men, not only because they are anonymous, but also because many men find it hard to get support “in real life”. </p>
<figure>
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</figure>
<p>In this way, sharing with others who understand and have been through similar experiences can help men feel less isolated. And it can also provide support, understanding and camaraderie not encountered (or sought) in their interactions within health care settings.</p>
<p>But ultimately, as our research shows, men’s perspectives and emotions need to be recognised more during the process of fertility diagnosis and treatment. And more should be done to make sure they are well supported and given advice that is gender sensitive. </p>
<p>By starting conversations and educating people about fertility, it will become easier for men to speak out and to access the support they may need when going through a highly emotional and challenging time in their lives. This is important because the silence that exists around infertility in society is very real and can be very damaging for so many men.</p><img src="https://counter.theconversation.com/content/84414/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Infertility is not just an issue for women.Esmée Hanna, Researcher in health promotion, Leeds Beckett UniversityBrendan Gough, Professor, Social Psychology, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/851492017-10-05T11:01:11Z2017-10-05T11:01:11ZMacho myth busting: working class men aren’t all too tough to seek help<figure><img src="https://images.theconversation.com/files/188952/original/file-20171005-9767-803nz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success">GNTStudio/shutterstock</a></span></figcaption></figure><p>Men are bad at <a href="https://www.theguardian.com/lifeandstyle/2009/jun/10/men-doctors">looking after their health</a>, or so the received wisdom goes. Indeed, evidence has shown that men have significantly higher death rates than women from cancer due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385983/">delays in seeking medical help</a>. </p>
<p>These doctor-avoiding tendencies have also been shown to be more common among working-class men – who are thought to place more emphasis on “<a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-9566.2010.01300.x/abstract">toughness</a>” and are more inclined to take risks when it comes to <a href="http://journals.sagepub.com/doi/abs/10.1177/1363459311403943">smoking and drinking</a>. But <a href="http://journals.sagepub.com/doi/pdf/10.1177/0891243205278639">there is evidence</a> that questions some of these “macho” stereotypes. Men are beginning to look to support groups for help and our own research has pointed to a subtle change in workinmg-class masculinity. </p>
<p><a href="https://edgehill.cloud.panopto.eu/Panopto/Pages/Viewer.aspx?id=72e55305-0278-4fa0-ba60-e69220b3b169">Our study</a> was based on the findings from three focus groups conducted with 15 men, aged 23-68, from three cities in northwest England. The men attended different support groups and experienced disadvantage because of low income and/or mental health difficulties. We asked them to take photographs of what “health” meant to them to aid discussion and we received more than 100 images.</p>
<p>The study found that experience of disadvantage because of low income and mental health issues had encouraged men to engage in what have been called “<a href="https://www.amazon.co.uk/Situated-Learning-Participation-Computational-Perspectives/dp/0521423740">communities of practice</a>”. These communities emerged within various support groups that were organised around football and mental health, being a father and for people trying to manage on lower incomes. They provide opportunities for men to support each other “informally” outside official, medical and care environments. They also provided opportunities for the men to think as a group about their mental and physical health. </p>
<p>Attitudes observed within these communities suggest a broadening of working-class masculinity that recognises the value of emotional expression and mutual support. They also encouraged group members to question the mental health advice they were receiving from doctors and dominant ideas about healthy eating. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"908379496327368704"}"></div></p>
<h2>Challenging stereotypes</h2>
<p>Men, particularly those in working-class communities, <a href="https://www.samaritans.org/sites/default/files/kcfinder/files/Samaritans_Men_and_Suicide_Report_web.pdf">face pressures</a> to be strong: to be “breadwinners” and to control their emotions. But one man who took part in the study – Geoff, aged in his early 50s and from Merseyside – used photographs of his achievements in a football and mental health support group to talk about his recovery from severe mental health problems. He said he recovered thanks to the emotional support available in his community group:</p>
<blockquote>
<p>I have no shame whatsoever talking about mental health. Until we can talk as openly about mental health as we do physical health, there will be a stigma and if I can talk about… the dark times… hopefully that touches someone else and makes them reach out for help. One of the most difficult things to say is – like coming out – ‘that’s what it is’. It’s making that admission. Football has been a huge part of my life. It was always where I could be myself. The lads are like any other football team but we take it one step further because not only do we care for each other, we actually counsel each other.</p>
</blockquote>
<p>Geoff’s words show how this support group has normalised talking about fears and anxieties. His use of the metaphor “coming out” shows the importance of owning one’s emotional vulnerability. This is a far cry from “manly” suppression of or distancing from so-called “feminine” emotions. Geoff also spoke of the group as helping men to express their authentic emotional selves. </p>
<p>Indeed, Geoff said that for group members football was “their medication”. This was echoed by another study participant. Mike, aged in his early 20s, compared the benefits of the support group in helping him to face bereavement with “the doctors who just give you pills”. And referring to a photograph of himself making papier-maché figures with his children, Darren (early 40s from Manchester) described how sharing thoughts within a self-help group for dads had “helped me bond with my kids” and had helped him “become the dad I am now where I can play with the kids and then get on with housework”.</p>
<p>Community groups can help men facing disadvantages to develop emotional resources. Their stories also show how health is a collective rather than a purely individual enterprise. </p>
<h2>Places to relax</h2>
<p>Another significant theme appeared in stories about men’s favourite places to relax. Referring to a photograph of his bike on New Brighton Promenade, overlooking the Liverpool waterfront, Daniel explained:</p>
<blockquote>
<p>I’ll often peddle to New Brighton. Nine miles there, nine back and it’s just sea and sand all the way. You feel like you’re abroad. So, that’s nice mentally rather than physically. I just look back at the city where I grew up and think about life and it really helps.</p>
</blockquote>
<p>Daniel’s words suggest freedom and the view of Liverpool provides emotional as well as physical distance: a space of escape to consider his life’s journey. In all focus groups, men contrasted such places to unhealthy “mean streets” that represented urban blight, hostility, disconnection and social problems. </p>
<p>Contrary to the stereotype, working-class men who belong to support groups are no strangers to seeking help. It’s clear that support groups are helping men get the help they need and they could be key in taking steps towards reducing male <a href="https://www.samaritans.org/sites/default/files/kcfinder/files/Samaritans%20suicide%20statistics%20report%202016.pdf">suicide rates</a> and addressing wider health issues. But more needs to be done to raise awareness of these groups and more funding needs to be set aside to make them accessible for all.</p><img src="https://counter.theconversation.com/content/85149/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Working-class men have a reputation for repressing their emotions but a new study suggests that might be changing.Paul Simpson, Lecturer in Applied Health & Social Care, Edge Hill UniversityMichael Richards, Lecturer in Applied Health and Social Care, Edge Hill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/683672016-11-10T09:25:07Z2016-11-10T09:25:07ZPlace plays a vital role in how boys learn to become men<figure><img src="https://images.theconversation.com/files/145228/original/image-20161109-19047-1tn0w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Who you can become is shaped by the history of your home.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-97319867/stock-photo-all-in-your-hands.html?src=vgTbtX-6XCaVlOPn7Udmjg-1-41">luxorphoto/www.shutterstock.com</a></span></figcaption></figure><p>Since the late 1970s, how young people transition to adulthood has been <a href="https://www.ucu.org.uk/media/6185/Engaging-young-people-not-in-education-employment-or-training-The-case-for-a-Youth-Resolution-Feb14/pdf/ucu_youthresolution_report_feb14.pdf">shaped by changes in global industry</a>. As job opportunities in the UK have moved away from industrial roles, young people have become <a href="http://www.independent.co.uk/news/education/university-record-numbers-a-level-students-place-clearing-results-a7196731.html">more likely to remain in education</a> than ever before, and <a href="https://www.theguardian.com/education/2016/nov/10/schools-focus-struggling-white-working-class-pupils-uk?CMP=share_btn_tw">increasingly strive to gain educational qualifications</a> to enable them to compete in a <a href="https://www.theguardian.com/business/2015/oct/14/uk-labour-market-figures-employment-up-why-earnings-growth-down">shrinking labour market</a>. </p>
<p>However, these changes have been accompanied by an <a href="http://projects.huffingtonpost.co.uk/building-modern-men/">increasing anxiety in the UK</a>, the <a href="http://promundoglobal.org/resources/engendering-men-evidence-review/">global north and elsewhere</a> about the position of boys and young men. There is still concern that boys are <a href="http://www.tandfonline.com/doi/full/10.1080/09540253.2014.953918">underachieving in school</a> compared to girls, that they are suffering from <a href="http://www.independent.co.uk/life-style/health-and-families/features/teenage-mental-health-crisis-rates-of-depression-have-soared-in-the-past-25-years-a6894676.html">high rates of suicide</a> and <a href="https://www.theguardian.com/society/2016/nov/05/men-less-likely-to-get-help--mental-health">poor mental health</a>, and that boys are increasingly involved in <a href="http://www.telegraph.co.uk/women/womens-life/11342408/Are-men-natural-born-criminals-Prison-numbers-dont-lie.html">offending and anti-social behaviour</a>. </p>
<p>Policy makers, the media and social commentators have suggested that the problem is down to young men suffering from a lack of male role models – although there is often frustratingly little detail offered as to <a href="http://www.open.ac.uk/blogs/beyondmalerolemodels/">what a role model is</a> or what a suitable candidate might offer to young men. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/145265/original/image-20161109-19089-1m0xp1e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/145265/original/image-20161109-19089-1m0xp1e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=379&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145265/original/image-20161109-19089-1m0xp1e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=379&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145265/original/image-20161109-19089-1m0xp1e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=379&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145265/original/image-20161109-19089-1m0xp1e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=477&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145265/original/image-20161109-19089-1m0xp1e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=477&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145265/original/image-20161109-19089-1m0xp1e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=477&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Industrial towns are still standing while their labouring legacy may be long gone.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-235941127/stock-photo-young-man-overlooking-seaside-town-from-the-hill.html?src=tGZIAZ2ECNRV2U729Y8hAA-1-34">Krizek Vaclav/www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>These problems are often framed as outcomes of a “war” on boys – or as MP Diane Abbott put it, a <a href="http://www.bbc.co.uk/news/uk-22530184">“crisis” of masculinity</a>. But men still tend to hold the key positions of authority and control throughout society, and across the world, so how real is this problem? </p>
<p>“Boys” – and girls – are extremely diverse, and there are multiple ways of being a boy. What we really need to be thinking about when we talk about these issues, is which boys and which men are struggling. </p>
<p>In reality it is those boys and young men from working-class backgrounds who live in de-industrialised places who are most likely to be struggling. These men are the ones who are most often associated with the “crisis” and with public fears of <a href="http://www.tandfonline.com/doi/abs/10.1080/13676261.2012.671933">disorder, disrespect and delinquency</a>. </p>
<p>Due to economic restructuring over the past half century, working-class young men are no longer likely to be learning to labour, working in mines, factories or elsewhere like their fathers, but learning to “serve” in the growing service industry.</p>
<h2>From labouring to learning</h2>
<p>So how do young men from post-industrial communities adapt and change in insecure times and make sense of their position as they transition into adulthood? When young men are left with the legacy of industrial labour, do they perform and articulate masculinity in different ways or by different means? In terms of education, do academic or vocational pathways impact upon specific classed identities? What are the broader social and spatial networks within their communities that mediate the identities of these young men and how do space and place impact on who they are and who they can become? </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/145244/original/image-20161109-19081-1m2k1h7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/145244/original/image-20161109-19081-1m2k1h7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145244/original/image-20161109-19081-1m2k1h7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145244/original/image-20161109-19081-1m2k1h7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145244/original/image-20161109-19081-1m2k1h7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=542&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145244/original/image-20161109-19081-1m2k1h7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=542&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145244/original/image-20161109-19081-1m2k1h7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=542&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Towns and villages like Llwynpia in south Wales grew up around industry.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-244401457/stock-photo-llwynpia-south-wales-a-colliery-village-built-up-around-a-coal-mine-photo-taken-during-the-british-coal-strike-of-1910.html?src=xoYGOiVlXBbKDA_EYhuSwA-1-0">Everett Historical/www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>To address some of these questions, I <a href="https://www.timeshighereducation.com/books/review-from-labouring-to-learning-michael-ward-palgrave-macmillan">followed a group of about 30 young working-class men</a> living in the de-industrialised south Wales valleys for two and a half years. I shadowed them from their last week of compulsory schooling, up until some of the young men started university. I spent time as an active participant in school lessons, playgrounds, assemblies, dinner halls and parents evenings in order to understand their school lives. </p>
<p>As the boys grew older, I also followed them beyond the school gates: hanging out in the cars they drove, the fast food places they ate in, the pubs and nightclubs they drank and danced in, at university open days, and their places of work. I attended sports events, went shopping, to the cinema and to 18th birthday parties. On one occasion we visited a lap dancing club. On another, I attended the funeral of a young man after a tragic car accident. </p>
<p>What I learnt is that life for these modern young men is not as simple as the media and policy portray it to be. They are seen as feckless, out of control and educational failures, lacking aspiration – but this is simply not true. In fact, for this group of young men in a community of social and economic deprivation, expectations and transitions to adulthood are shaped through the industrial legacy of the region. This legacy has an impact on class and gender codes and what it means to be a man – and what behaviour is deemed acceptable and what is not. This then plays a huge part in educational decision-making and future life chances.</p>
<p>We simply cannot classify young men’s issues into neatly defined categories. Really we need to look at how their lives are shaped within <a href="https://theconversation.com/king-hits-young-men-masculinity-and-violence-22247">specific contexts and localised cultures</a>. It is these issues which need tackling if some of the concerns surrounding young men are to be resolved. Home life, street life, individual neighbourhoods, regions and nations all shape the performance of different masculine identities. And it is these local expectations of manhood that are a huge influence on who they are and the possibility of who they can be.</p><img src="https://counter.theconversation.com/content/68367/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Ward received funding from the Economic Social Research Council for the study.</span></em></p>Masculinity is defined by more than just manliness.Michael Ward, Lecturer in Applied Social Science, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/464882015-10-07T04:10:42Z2015-10-07T04:10:42ZChanges in gender norms are making initiation safer for South African boys<figure><img src="https://images.theconversation.com/files/97434/original/image-20151006-7337-1g5gtvb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Initiates undergoing the traditional passage to manhood in Qunu, in the Eastern Cape, South Africa. Many either die or get maimed during the winter practice. </span> <span class="attribution"><span class="source">Reuters/Siegfried Modola</span></span></figcaption></figure><p>At least <a href="http://www.news24.com/SouthAfrica/News/Initiation-Government-wants-to-do-away-with-traditional-surgeons-20150909">30 initiates</a> are known to have died by the time the traditional male initiation season ended in South Africa this winter (2015). Most were from Xhosa communities in the Eastern Cape province. </p>
<p>Male initiation is a rite of passage from boyhood to manhood for some ethnic groups in South Africa. <a href="http://www.tandfonline.com/doi/pdf/10.1080/13691050701861447">Ritual male initiation</a> includes circumcision and the initiates spending about a month or longer in seclusion in the bush. </p>
<p><a href="http://tcn.sagepub.com/content/20/4/395.full.pdf+html">Initiation</a> is deemed a necessary rite of passage marking a developmental phase for boys to adulthood among the <a href="http://www.sahistory.org.za/people-south-africa/xhosa">amaXhosa</a>, <a href="http://www.bapedikingdom.co.za/history_bapedi.html">Bapedi</a>, <a href="http://countrystudies.us/south-africa/47.htm">Basotho</a>, <a href="http://www.gaabomotho.co.za/tswana.html">Batswana</a>, <a href="http://repository.up.ac.za/handle/2263/17089">amaNdebele</a>, <a href="https://intercontinentalcry.org/indigenous-peoples/vhavenda/">VhaVenda</a>, <a href="https://vatsonga.wordpress.com/about/">VaTsonga</a> and <a href="https://books.google.co.za/books?id=vRU9AAAAIAAJ&pg=PA7&dq=Amaswazi&hl=en&sa=X&ved=0CEQQ6AEwCTgKahUKEwj7zpuRsa3IAhVBohQKHW5gAUA#v=onepage&q=Amaswazi&f=false">amaSwazi</a> ethnic groups. The initiation process is typically run by the family, with the boy’s father directing proceedings.</p>
<p>Traditional initiation involving circumcision remains an important topic in South Africa for several reasons. At the top of the list is the public health discourse and debates around prevention of initiates’ deaths. But initiation is also important because the practise is still relevant and employed in a range of urbanising communities across the country.</p>
<p>Deaths of initiates resulting from botched circumcisions, related infections and dehydration during this rite of passage are <a href="http://dx.doi.org/10.1016/j.socscimed.2009.11.016">nothing new</a>. And there is some evidence that they may be <a href="http://www.dailymaverick.co.za/article/2015-07-30-sa-is-making-progress-on-making-initiation-schools-safer/#.Vb9jeE8w_4Y">declining</a>.</p>
<p>Deaths of initiates have attracted heightened attention from the government, civil society and the traditional custodians of the <a href="http://dx.doi.org/10.1016/j.socscimed.2009.11.016">practice</a>. </p>
<p>Save for girls, who are related to and who cook for the initiate, women are generally not involved in the traditional process. Women’s role could be described as that of cheer leaders. They participate significantly in the ceremonies to welcome the new men back home. Discussions around the meaningful involvement of women in the initiation process have been met with resistance from custodians of <a href="http://www.sciencedirect.com/science/article/pii/S0277953609008119">culture</a>.</p>
<p>But gender politics, changes in family formations and the high number of single mother households are increasingly pushing some of the traditional boundaries around initiations. </p>
<h2>Role of women</h2>
<p>South Africa has a higher rate of single, women-led families than households led by men. Most South African children under five live with <a href="http://www.statssa.gov.za/?p=2007">only their mothers</a>. </p>
<p>As a result, the practises around male initiation are changing and beginning to encompass women.</p>
<p>We conducted interviews in the Eastern Cape to understand people’s perceptions and experiences of sexual and reproductive health rights. </p>
<p>The study is conducted in collaboration with the AIDS Foundation of <a href="http://www.aids.org.za">South Africa</a>, a non-governmental organisation that supports community-based initiatives to strengthen men and women’s access to sexual and reproductive health rights. </p>
<p>We interviewed men and women of different ages, but older that 16, in single-sex focus group discussions. We also interviewed key stakeholders such as officials in the departments of health, education, social development, a traditional healer and a traditional leader in the Flagstaff district of the Eastern Cape. The people of Flagstaff identify as <a href="http://www.sahistory.org.za/places/pondoland">amaPondo</a> and their traditions slightly differ from those of amaXhosa in the Eastern Cape. </p>
<p>Our study (yet to be published) found people have mixed feelings about initiation. Some feel it is good but that the tradition has changed. Some felt as soon as an initiate required medical attention and went to hospital, they were no longer considered a traditional initiate. </p>
<p>They attributed the change and the undesirable outcomes to:</p>
<ul>
<li>underage initiates, </li>
<li>incompetent traditional nurses, and </li>
<li>substance use at the <em>Ibhoma</em>. The <em>Ibhoma</em> is a temporary hut built for the initiate in the <a href="http://tcn.sagepub.com/content/20/4/395.full.pdf+html">bush</a>. </li>
</ul>
<p>Some problems were related to what the community perceived to be uncanny behaviours by the new men. For example, engagement in violent behaviour, disrespect for adults and increased alcohol drinking and use of other substances. One of the major findings was a concern about the health impacts of the initiation, chief amongst these the death of the initiate.</p>
<h2>Dealing with the death</h2>
<p>Our study shows that men and women are demanding that the government protect the boys and curb the death of initiates. One of the participants explained: </p>
<blockquote>
<p>We are trying to end these deaths out there. I am saying everybody (should) start at (the) hospital and then go (their) separate … ways where a person is going to learn his own isiko (custom).</p>
</blockquote>
<p>The custodians of traditional practices are speaking out against distortions or misinterpretations of culture that threaten young men’s lives. </p>
<p>The House of Traditional Leaders in the Eastern Cape has started advocating for <a href="http://www.gov.za/speeches/leadership-visit-initiation-schools-lusikisiki-18-jun-2015-0000">safe initiation</a>. In one case, traditional leaders openly endorsed and supported women’s involvement in pre-initiation camps to educate and socialise boys and ensure stakeholder commitment to the legal and safe operation of initiation lodges.</p>
<p>Historically, boys who died at initiation lodges or camps were buried there. The boy’s father would take care of the burial ritual while his mother would find solace knowing her husband had buried their child. These deaths were less likely to be reported to the general community. </p>
<p>But as times have changed, so has this practice. As burial rituals, including funerals, have been modernised, bereaved families wish to see and bury their loved ones.</p>
<p>We found that in the event of a death, the mother now demands to know how her child died, to see his body and hold the funeral in the community. The circumstances surrounding his death are now disclosed, despite the fact that the custom stipulates that initiation should not be discussed with the female relatives. </p>
<p>Historically, a father would know what cultural instruction had been imparted to his son during initiation. He could sanction disrespectful behaviour towards women. Research shows that in the absence of male authority figures and role models, women are speaking out against this and demanding that boys are taught respectful and risk-reducing behaviour. </p>
<p>This study’s findings are important in crafting a way for more research to better understand the role of women and mothers in initiation. As society changes, so are there changes in our cultures. </p>
<p>Dialogues are needed at a community level to find ways to include women in the initiation process. These dialogues should involve men and women, children and parents and custodians of culture, in particular the duty bearers within the House of Traditional Leaders.</p><img src="https://counter.theconversation.com/content/46488/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mzi Nduna receives funding from the National Research Foundation and the COE-HUMAN</span></em></p><p class="fine-print"><em><span>Anele Siswana works for Dr George Mukhari Academic Hospital. He receives funding from the Canon Collins Legal Trust. He is affiliated with the Father Connections Study Team at Wits University.</span></em></p><p class="fine-print"><em><span>Deborah Lesley Ewing is affiliated with the AIDS Foundation of South Africa.</span></em></p><p class="fine-print"><em><span>Esmeralda Vilanculos is affiliated with the University of the Witwatersrand </span></em></p>The practices around the traditional passage to manhood in South Africa are changing and beginning to encompass women as family patterns change. But, there are mixed feelings about the changes.Mzi Nduna, Associate Professor in Psychology, University of the WitwatersrandAnele Siswana, Clinical Psychologist, University of the WitwatersrandDeborah Lesley Ewing, Visiting Scholar, School of Human and Community Development, University of the WitwatersrandEsmeralda Vilanculos, Research Assistant: Sexual and Reproductive Health rights, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/446192015-07-15T11:39:44Z2015-07-15T11:39:44ZWhy aren’t we worried about the ‘beach body’ message we’re sending to men?<figure><img src="https://images.theconversation.com/files/88378/original/image-20150714-21738-58ji31.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>A man’s identity was once largely drawn from work, family and perhaps sport. Today, men are given the task of <a href="http://www.tandfonline.com/doi/abs/10.1080/17405900701768638#.VaPOVFjbLIU">designing and maintaining an identity</a> from a multitude of alternatives offered by products they can buy and images they are shown in the media. The supposed reward for all this is social and psychological well-being. As many marketers would have it, “look good, feel good”.</p>
<p>But this shift has brought the kind of pressure to conform to a certain image and body shape that was previously directed at almost solely at women. Recent adverts for Protein World weight-loss products that featured a highly toned, bikini-clad model <a href="http://www.theguardian.com/media/2015/apr/29/beach-body-ready-ad-faces-formal-inquiry-as-campaign-sparks-outrage">were criticised</a> as an attempt to exploit women’s body insecurities and shame them into buying the products. These were accompanied by similarly revealing but largely unnoticed ads for men. While these don’t carry the same sexist legacy of women’s objectification, they do replicate some of the same body shaming issues.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/88510/original/image-20150715-17796-1hqtdpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/88510/original/image-20150715-17796-1hqtdpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/88510/original/image-20150715-17796-1hqtdpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=882&fit=crop&dpr=1 600w, https://images.theconversation.com/files/88510/original/image-20150715-17796-1hqtdpm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=882&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/88510/original/image-20150715-17796-1hqtdpm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=882&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/88510/original/image-20150715-17796-1hqtdpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1108&fit=crop&dpr=1 754w, https://images.theconversation.com/files/88510/original/image-20150715-17796-1hqtdpm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1108&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/88510/original/image-20150715-17796-1hqtdpm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1108&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Beach body ready?</span>
<span class="attribution"><span class="source">Protein World</span></span>
</figcaption>
</figure>
<p>Men have always been concerned with their appearance to some degree. Some <a href="http://jls.sagepub.com/content/9/4/257.short">sub-cultures</a> such as the Teddy Boys and Mods have been particularly interested in their appearance, donning snappy suits and Brylcreeming their hair. But what distinguishes the modern era is the breadth and depth of this fascination. Grooming and fashion products aimed at men today far exceeds in number what was available to their forefathers and are used far more extensively by a greater age range of men from all <a href="http://www.sunypress.edu/p-4601-the-metrosexual.aspx">socioeconomic backgrounds</a>.</p>
<p>The market for male grooming products has <a href="http://www.mintel.com/press-centre/beauty-and-personal-care/beauty-personal-care-product-launches-increase-substantially">boomed in recent years</a> and has only slowed more recently thanks to the <a href="http://www.telegraph.co.uk/men/11098869/Growth-of-the-beard-hits-male-grooming-industry.html">popularity of beards</a>. Though industry reports should be treated with a degree of scepticism, <a href="http://www.loreal.co.uk/sites/default/files/cms/2010.03.25_loreal_mens_grooming_report_final.pdf">market research</a> by cosmetics manufacturers suggests a majority of men place a high degree of importance on their appearance. And doing so is thought to be more acceptable today than in previous generations.</p>
<p>Men’s products have also entered domains once thought to be the preserve of women, such as self-tanning, body hair removal and make-up use. Men can now buy shine-reduction powders, lipstick-shaped concealers, eyelash glazes with mascara wands, shape-and-shine nail sets and tinted shimmer face bronzers. In order for men to consume these typically feminised items they tend to be labelled “for men” and have masculine names that emphasise performance and technical characteristics. The companies that manufacture these products have in some cases seen sales <a href="http://www.nytimes.com/2010/09/02/fashion/02skin.html">triple or even quadruple</a> over the last decade.</p>
<p>Although we are lacking research to provide a definitive answer for why this culture shift has happened, various explanations have been put forward: fashion and image influences from the growing visibility of <a href="http://www.marksimpson.com/male-impersonators/">gay cultures</a>; equality pressures from <a href="http://www.tandfonline.com/doi/abs/10.1080/09589236.2011.542023#.VaPakFjbLIU">feminist movements</a>; <a href="http://bod.sagepub.com/content/16/1/193.short">marketers seeking</a> new avenues to sell products by confronting men on a daily basis with <a href="http://bod.sagepub.com/content/11/1/37.short">stylised images of other men’s bodies</a>. Prominent pictures of the likes of David Beckham and other muscular celebrities in their underwear have helped to firmly establish the presence of the men’s bodies as objects to be eroticised and consumed.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/88377/original/image-20150714-21711-1kfruhb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/88377/original/image-20150714-21711-1kfruhb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/88377/original/image-20150714-21711-1kfruhb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/88377/original/image-20150714-21711-1kfruhb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/88377/original/image-20150714-21711-1kfruhb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/88377/original/image-20150714-21711-1kfruhb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/88377/original/image-20150714-21711-1kfruhb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">All Beckham’s fault?</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/leeziet/2789416849/in/photolist-bEFBf-nNhXD8-rj4hpJ-5fuurX-3wLcWs-H1ghy-CWhsH/">leezie5/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>This cultural change may well have come at a price. The number of men <a href="http://bmjopen.bmj.com/content/3/5/e002646.full">diagnosed with eating disorders</a> such as anorexia and bulimia has risen <a href="http://www.theguardian.com/lifeandstyle/2015/jan/18/are-more-men-getting-eating-disorders">by nearly 30%</a> in the past 15 years. Plastic surgery among men also rose <a href="http://www.theguardian.com/news/datablog/2014/feb/03/uk-plastic-surgery-2013-most-popular">by almost 60%</a> between 2008 and 2013. It declined by 15% again last year but <a href="http://baaps.org.uk/about-us/press-releases/2039-auto-generate-from-title">plastic surgeons blamed</a> this trend on the increasing popularity of beards and a more rugged look.</p>
<p>Research suggests that of those men who do seek plastic surgery <a href="http://www.sciencedirect.com/science/article/pii/S0033318201704586">up to 33%</a> may suffer from body dysmorphic disorder, a condition where sufferers become obsessed with what they see as defects in their appearance. These mental health issues have complex origins but it is difficult to ignore the correlation between their popularity and the growing pressure on men to look a certain way.</p>
<p>In search of the ideal body some men are opting <a href="http://informahealthcare.com/doi/abs/10.3109/14659891.2014.911977">to use prescription medications</a>, often with dangerous consequences. The internet provides easy access to prescription drugs such as steroids and hormones, often at a low cost. Unsupervised use of these drugs can lead to a wide range of <a href="https://theconversation.com/anabolic-steroids-a-serious-global-health-problem-amid-boom-in-cosmetic-use-24238">adverse health effects</a> from vomiting and high blood pressure to liver damage and increased risk of heart attacks. There are also mental health effects such as <a href="https://theconversation.com/more-young-men-using-steroids-but-do-they-know-the-harms-3021">mood swings</a>, depression and <a href="https://theconversation.com/taking-gym-steroids-can-affect-your-learning-and-memory-44327">memory loss</a>.</p>
<p>We don’t have the data to know exactly how many men take body modification substances, which can include non-prescription drugs such as laxatives and large amounts of caffeine. But research suggests as many as 25% of male gym users in the US have done so within the last <a href="http://www.sciencedirect.com/science/book/9780123849250">three years</a>.</p>
<p>To challenge these practices and protect men from the negative health impacts of body pressures we need more information to be available about safe and healthy methods of image management. We also need to see more bodies in the media and marketing that don’t fit with the “beach ready” ideal.</p>
<p>The Advertising Standards Agency recently ruled the Protein World ads <a href="http://www.theguardian.com/media/2015/jul/01/protein-world-beach-body-ready-ads-asa">were not socially irresponsible</a>, prompting objections from those who argue the campaign objectifies women. But we should also to take seriously the effects on men of being bombarded with so many pictures of musclebound models in their underwear.</p><img src="https://counter.theconversation.com/content/44619/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Hall does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The growing pressure on men to have the perfect body is too often forgotten but could be having serious health consequences.Matthew Hall, Research associate, Division of Health Research, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/432642015-06-17T13:04:04Z2015-06-17T13:04:04ZSometimes it’s hard to be a man<figure><img src="https://images.theconversation.com/files/85363/original/image-20150617-23239-1jfof2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bad stats ...</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-103782935/stock-photo-stressed-asian-business-man-due-to-the-of-amount-of-work-he-has-to-do.html?src=pp-photo-96021902-1&ws=1">Man pain by Shutterstock</a></span></figcaption></figure><p>Men should take better care of themselves. We die at an earlier age than women, despite women suffering more health conditions and making greater use of health services. Life expectancy differences may be different because of biology, but we also know that men engage in riskier activities, including poorer lifestyle choices. Men are more likely to drink excessively and smoke, both of which are associated with serious health conditions and increased <a href="http://www.hscic.gov.uk/article/6338/Smoking-attributable-rate-of-hospital-admissions-twice-as-high-amongst-men-than-women">hospital admissions</a>. </p>
<p>Most worryingly, <a href="http://www.ons.gov.uk/ons/rel/subnational-health4/suicides-in-the-united-kingdom/2013-registrations/suicides-in-the-united-kingdom--2013-registrations.html">men are more likely to commit suicide</a>, where they are <a href="http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/">three times more likely</a> to take this route – percentages as high as 75% in the UK and 79% in the US <a href="http://www.theguardian.com/science/2015/jan/21/suicide-gender-men-women-mental-health-nick-clegg">have been recorded</a>. </p>
<p>Campaigns such as <a href="https://www.menshealthforum.org.uk/mhw">Men’s Health Week</a> and the seasonal sprouting of facial hair in support of <a href="https://uk.movember.com/">Movember</a> aim to get men more involved in their health. Men are less likely to talk about their health concerns because masculinity is commonly associated with being stoic rather than emotional. But to improve our health it’s time to start talking, and acknowledging pain is a good place to start.</p>
<h2>Common pains</h2>
<p>Pain is a signal that demands our attention – it tells us to take note and take care. It is common, yet complex in nature, and up to <a href="http://www.ncbi.nlm.nih.gov/pubmed/16095934">19% of Europeans are reported to be in chronic pain</a>. </p>
<p>Pain is associated with high levels of disability – the latest figures from the <a href="http://bit.ly/1FUZRPU">Global Burden of Disease Study</a> group show that lower back pain is associated with the highest years lived with disability. Other types of pain also appear in the top 20, including neck pain (fourth), migraine (sixth), osteoarthritis (13th).</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/85365/original/image-20150617-23259-3weaat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/85365/original/image-20150617-23259-3weaat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/85365/original/image-20150617-23259-3weaat.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/85365/original/image-20150617-23259-3weaat.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/85365/original/image-20150617-23259-3weaat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/85365/original/image-20150617-23259-3weaat.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/85365/original/image-20150617-23259-3weaat.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Neck pain: fourth leading cause of years living with disability.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-184308455/stock-photo-rear-view-shot-of-a-young-businessman-massaging-his-sore-neck.html?src=wXPSI9JDeu5SDt3HIagsJw-2-47">Neck by Shutterstock</a></span>
</figcaption>
</figure>
<p>Pain also shows <a href="https://theconversation.com/do-men-have-a-higher-threshold-for-pain-or-are-they-just-a-bit-emotionally-repressed-25681">gender-related differences</a> – women report more pain compared to men, are more likely to use analgesics and visit a pain specialist. However, this doesn’t mean men are immune from pain and related disability. </p>
<p>Data from the <a href="http://www.hscic.gov.uk/catalogue/PUB09300">Health Survey for England in 2011</a> found 37% of women and 31% of men reported chronic pain, and figures from <a href="http://www.ncbi.nlm.nih.gov/pubmed/25267013">a recent US study</a> found 21.6% of women and 16.2% of men reported persistent pain (which is frequent pain that lasts for more than three months). Both studies illustrate that men are not far behind in terms of the levels of pain they experience.</p>
<h2>Painful silence</h2>
<p>Despite the general focus on men’s health through events such as Movember, this has not yet translated to what we specifically know about men’s pain. There are clearly conditions that affect men, where pain may play a role, for example <a href="http://www.nhs.uk/Conditions/Prostatitis/Pages/Introduction.aspx">prostatitis</a>, a prostate-related condition that can include pain. Embarrassment around such symptoms may prevent men seeking help. </p>
<p>There are also differences in pain behaviour, in that women report using a wider range of coping techniques, including social support. It is less clear what men do. Reporting pain and suffering is likely to be a problem for some, especially if they believe they should be strong, and not show signs of vulnerability. </p>
<p>Lab studies have shown that <a href="http://www.ncbi.nlm.nih.gov/pubmed/22434689">gender-based beliefs affect pain</a> reporting, with pain tolerance levels higher in those with a strong masculine identity. But is this effect due to reduced pain sensitivity, or an unwillingness to show pain? Pain can also affect male gender identity, especially if men feel unable to meet expectations about what it is to be male. <a href="http://www.ncbi.nlm.nih.gov/pubmed/25485954">Pain can affect sexual function</a>, which in turn can affect gender identity and contribute to depression.</p>
<h2>Gender differences</h2>
<p>While research into men’s pain exists, it is still somewhat limited. We should build on the general interest in men’s health, and see if we can develop it in the context of pain. We still need to discover what the key mechanisms are for explaining why men and women differ in pain. </p>
<p>There is <a href="https://theconversation.com/do-men-have-a-higher-threshold-for-pain-or-are-they-just-a-bit-emotionally-repressed-25681">a general reluctance</a> in research to look for sex and gender differences. We are trying to change this through our own studies - <a href="http://www.bath.ac.uk/research/news/2015/06/15/mens-health-pain/">we are currently inviting men and women to tell us more about their pain</a>. </p>
<p>There will be important similarities, but differences too, and it is here we need to find out what is specifically relevant to men and women’s pain. It would seem sensible to know whether gender differences in pain are due to a reluctance in men to seek help. </p>
<p>We also need to know whether there are some approaches that are better suited to help men to deal with their pain. For example, can those interested in pain management learn from the men’s health literature, and develop initiatives to help men find better ways to talk about pain? A “<a href="http://menssheds.org.uk/what-is-a-mens-shed/">men’s sheds</a>” approach, which provides a physical space for men to meet and learn new skills, can be used to reduce isolation and improve health awareness – could be one approach to take.</p>
<p>Ultimately, we need to look beyond the idea that pain is a sign of weakness, and ask how men can use pain to stay fit, healthy, and alive for longer. Frank and open discussions about other notions of masculinity will also drive healthier behaviour in men.</p><img src="https://counter.theconversation.com/content/43264/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Edmund Keogh receives funding from Reckitt Benckiser Healthcare (UK) Limited, and Engineering and Physical Sciences Research Council.</span></em></p>Why men need to start taking care of themselves.Edmund Keogh, Reader in Psychology, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/99962012-11-13T00:03:53Z2012-11-13T00:03:53ZSpermatorrhoea, the lesser known male version of hysteria<figure><img src="https://images.theconversation.com/files/17465/original/43p24f56-1352432401.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Spermatorrhoea was said to be 'the most dire, excruciating and deadly maladies to which the human frame is subject.'</span> <span class="attribution"><span class="source">Guillaume Duchenne</span></span></figcaption></figure><p><em>MEDICAL HISTORIES - The second instalment in our short series examines how the spermatorrhoea epidemic changed the scope of medicine.</em> </p>
<hr>
<p>Every period arguably invents its own illnesses, medical disorders with symptoms that reflect the particular circumstances and anxieties of the time. The spermatorrhoea epidemic of the mid-to-late 1800s, like the much better known epidemic of female hysteria of the same time, is one such disorder that left a lasting legacy.</p>
<p>In contrast to hysteria, which has been the subject of analysis by medical historians and feminist scholars alike, spermatorrhoea occupies a very obscure position both within the history of medicine and of masculinities. </p>
<p>But for Victorian physicians like Albert Hayes, director of the Boston Peabody Medical Institute, and author of <a href="http://archive.org/details/scienceoflifeors00parkuoft">The science of life: or, Self-Preservation. A medical treatise on nervous and physical debility, spermatorrhoea, impotence and sterility, with practical observations on the treatment of diseases of the generative organs</a>, (1868) the disease was amongst “the most dire, excruciating and deadly maladies to which the human frame is subject.” </p>
<p>The term spermatorrhoea, or spermatorrhée, was coined in 1836 in the first volume of the French physician Claude François Lallemand’s <a href="http://example.com/">Des pertes séminales involontaires</a> (1836-42), where it was used to refer to “an excessive and involuntary discharge of semen”. </p>
<p>Considered a form of sexual dysfunction or venereal disease, spermatorrhoea was associated with an oozy and incontinent seminal leakage. And because semen was identified as the source of men’s “vital heat,” the disease was thought to produce a whole series of debilitating bodily effects.</p>
<p>As physician John Skelton wrote in <a href="http://www.biblio.com/books/445773034.html">A Treatise on the Venereal Disease and Spermatorrhoea</a> (1857), sufferers</p>
<blockquote>
<p>of spermatorrhoea become fretful and peevish; their memory fails; they lose their courage, and indignities, which they would formerly have resented, they now endure with patience. They become confirmed hypochondriacs; are unfit for either business or serious reflection, and are disagreeable to themselves and the whole world.</p>
</blockquote>
<h2>Causes and consequences</h2>
<p>Causes of the disorder were thought to vary widely, but were generally attributed to an overly-domesticated and unmanly lifestyle – feather beds, soft trousers, excess reading of sentimental literature, and sedentary pursuits were all cited as possible causes. But most physicians agreed with Robert Bartholow (<a href="http://archive.org/details/spermatorrhoeait00bart">Spermatorrhoea: Its Causes, Symptoms, Results and Treatment</a>, 1879) that “the vice of masturbation is undoubtedly the chief cause.”</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/17439/original/5psz2b4f-1352421923.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/17439/original/5psz2b4f-1352421923.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1051&fit=crop&dpr=1 600w, https://images.theconversation.com/files/17439/original/5psz2b4f-1352421923.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1051&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/17439/original/5psz2b4f-1352421923.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1051&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/17439/original/5psz2b4f-1352421923.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1321&fit=crop&dpr=1 754w, https://images.theconversation.com/files/17439/original/5psz2b4f-1352421923.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1321&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/17439/original/5psz2b4f-1352421923.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1321&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Did physicians and quacks stop to think that corsets may have been a problem?</span>
<span class="attribution"><span class="source">Haabet/Wikimedia Commons</span></span>
</figcaption>
</figure>
<p>Spermatorrhoea rendered public and shameful men’s private loss of self-control, and his inability to live up to the expectations of dominant nineteenth-century masculinity. It provided a new diagnostic category in which nineteenth-century concerns about masculinity, virility and self-control could be read in the sexual anatomy of the male body.</p>
<p>Treatments for spermatorrhoea followed one of two approaches. The first was to focus on improving the general health and vigour of the body. In <a href="http://www.worldcat.org/title/practical-remarks-on-the-treatment-of-spermatorrhoea-and-some-forms-of-impotence-reprinted-and-enlarged-from-the-original-papers-in-the-lancet/oclc/38312862">Practical remarks on the treatment of spermatorrhoea and some forms of impotence</a> (1854), John Milton suggested, “Few means of controlling spermatorrhoea could be devised so simple and natural as exercise, especially gymnastics.”</p>
<p>The patient was encouraged to participate in his own treatment and might </p>
<blockquote>
<p>do half the surgeon’s work if he will rise at five or six o’clock, sponge with cold salt water, use the dumb bells for half an hour, and follow this up with a brisk walk. It will not be long before the eye grows brighter, and the skin clearer; before he sleeps sounder and again feels comfort in existence.</p>
</blockquote>
<p>If self-discipline failed, however, medical intervention was deemed necessary, and its severity demonstrates how dangerous spermatorrhoea was seen to be. Treatments included acupuncture of prostate and testes, blistering of the penis, and forced dilation of the anus.</p>
<p>“I have had excellent results from stretching the sphincter ani,” Bartholow wrote. “The operation causes considerable pain, and may rupture the sphincter if incautiously carried too far … but it has seemed the most useful in the cases of simple spermatorroea.”</p>
<p>The brutality of these treatments attests to a strong determination to discipline the male body, in order to prevent its dissolution into a pathological ooziness.</p>
<h2>Structural change</h2>
<p>The consequences of the spermatorrhoea epidemic were profound and led to an institutional shift in the structure and practice of medicine. It was as a direct result of this epidemic that professional medical practice was extended to include the treatment of sexual diseases and genitor-urinary specialisations for the first time.</p>
<p>As Angus McLaren notes in <a href="http://press.uchicago.edu/ucp/books/book/chicago/I/bo4343146.html">Impotence: A Cultural History</a> (2007), urology was for a long time “tainted by its association with venereal disease and impotence,” and doctors “who discussed such issues were acutely aware of their apparent unseemliness.”</p>
<p>There’s a concentrated effort to challenge this in the spermatorrhoea literature and to make the treatment of sexual disorders a part of the practice of mainstream medicine. Dr Pickford was one of dozens of physicians who protested that, “It is … this inexcusable neglect in medical men, which drive[s] the [sufferer] into the hands of nostrum-vendors and infamous quacks.” (1854)</p>
<p>An editorial in an 1857 edition of The Lancet exhorted, “Let honourable and scientific men take possession of the field now occupied by these vagabonds.”</p>
<p>It should be noted that this self-representation of the medical profession reluctantly turning to the neglected and distasteful disease of spermatorrhoea in order to save suffering men from the dangerous ministrations of quacks is primarily a rhetorical strategy – mainstream doctors and quacks offered similar, sometimes identical, treatments.</p>
<p>But the rhetoric was mobilised in the interest of affecting structural change, strengthening the professionalisation of this area of medical practice by prompting legal action to formally exclude and delegitimise the practice of quacks and restructuring general medical practice to include the treatment of sexual diseases, disorders and dysfunctions for the first time.</p>
<p>By the early 1860s, a spate of texts on “true and false spermatorrhoea” began to emerge. “False spermatorrhoea” was identified as being diagnosed by quacks, and “true spermatorrhoea” was redefined as a much rarer condition only a licensed physician could detect. This signalled the beginning of a rapid decline in spermatorrhoea diagnoses, and within a few short years, this epidemic had died away as quickly as it flared up.</p>
<p>Having transformed what had previously been known as “secret diseases” into something understood under the rubric of “sexual health,” and produced a series of corollary structural changes in the profession and practice of medicine, spermatorrhoea appears to have served its cultural purpose. Although it’s now an obscure footnote in the history of medicine, spermatorrhoea’s significance and effects remain important.</p>
<p><em>This is part two of Medical Histories – click on the links below to read the other articles:</em></p>
<p><strong>Part One:</strong> <a href="https://theconversation.com/hypochondriac-disease-in-the-mind-the-guts-or-the-soul-10176">Hypochondriac disease – in the mind, the guts, or the soul?</a></p>
<p><strong>Part Three:</strong> <a href="https://theconversation.com/culture-and-psychiatry-an-outline-for-a-neglected-history-10430">Culture and psychiatry: an outline for a neglected history</a></p><img src="https://counter.theconversation.com/content/9996/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Stephens receives funding from the ARC.</span></em></p>MEDICAL HISTORIES - The second instalment in our short series examines how the spermatorrhoea epidemic changed the scope of medicine. Every period arguably invents its own illnesses, medical disorders…Elizabeth Stephens, ARC Research Fellow and Deputy Director of the Centre for the History of European Discourses, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/85172012-08-08T20:37:52Z2012-08-08T20:37:52ZInfant male circumcision: stop violating boys’ human rights<figure><img src="https://images.theconversation.com/files/13951/original/xdv4cyyd-1344315845.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Infant male circumcision violates aspects of international human rights law, which Australia is bound to uphold.</span> <span class="attribution"><span class="source">Chris Woods</span></span></figcaption></figure><p>In an article published recently on this site, “<a href="https://theconversation.com/male-circumcision-policy-ignores-research-showing-benefits-8395">Male circumcision policy ignores research showing benefits</a>”, the authors stated some alleged benefits of infant male circumcision and argued the Royal Australasian College of Physicians’ <a href="http://www.kids.vic.gov.au/downloads/male_circumcision.pdf">policy</a> (that infant male circumcision is not warranted in Australia and New Zealand) is misguided and not based on evidence. </p>
<p>The article itself ignores not just research and good policy, but also law – in particular, international human rights law, which Australia is bound to uphold.</p>
<h2>The importance of holistic policy</h2>
<p>Developing good public health policy is more than simply making conclusions based on risks and benefits to physical health. It requires consideration of what is meant by health. The World Health Organization <a href="http://www.who.int/governance/eb/who_constitution_en.pdf">defines</a> health as not only physical, but also mental and social well-being. Any debate about infant male circumcision should take into account the potential long-term trauma (conscious or subconscious) of such a procedure, as well as the sense of violation it engenders.</p>
<p>And if scientific research is used as justification for a medical procedure, it should be applicable to the context. The research cited as showing the utility and benefit of male circumcision for disease prevention is limited exclusively to developing countries, including HIV/AIDS-prevalent societies. This doesn’t make infant male circumcision a necessary procedure in Australia. </p>
<p>The <a href="http://www.kids.vic.gov.au/downloads/male_circumcision.pdf">Royal Australasian College of Physicians</a> (the policy paper of contention in the article in question), the <a href="http://www.kidshealth.org.nz/circumcision">Paediatric Society of New Zealand</a>, the <a href="http://bma.org.uk/-/media/Files/PDFs/Practical%20advice%20at%20work/Ethics/Circumcision.pdf">British Medical Association</a>, the <a href="https://www.cpsbc.ca/files/u6/Circumcision-Infant-Male.pdf">Canadian Paediatric Society</a>, <a href="http://pediatrics.aappublications.org/content/103/3/686.full.pdf+html">American Academy of Pediatrics</a> and the <a href="http://www.acog.org/%7E/media/For%20Patients/faq039.pdf?dmc=1&ts=20120803T0840172025">American College of Obstetricians and Gynecologists</a> all deem infant male circumcision for religious, appearance or even perceived preventative medical reasons as unnecessary medical procedure. They all consider it to be either elective or non-therapeutic surgery.</p>
<h2>Human rights</h2>
<p>Male circumcision and infant male circumcision both ultimately boil down to choice – and that is a human rights issue. At the heart of human rights is the concept of human dignity, and rights such as those <a href="http://www2.ohchr.org/english/law/ccpr.htm#art7">to physical integrity</a>, <a href="http://www2.ohchr.org/english/law/cescr.htm#art12">to the highest attainable standard of physical and mental health</a>, and, in the case of children, <a href="http://www2.ohchr.org/english/law/crc.htm#art3">the obligation to act in their best interests</a>. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/13949/original/32h4kbyn-1344315616.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/13949/original/32h4kbyn-1344315616.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/13949/original/32h4kbyn-1344315616.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/13949/original/32h4kbyn-1344315616.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/13949/original/32h4kbyn-1344315616.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/13949/original/32h4kbyn-1344315616.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/13949/original/32h4kbyn-1344315616.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Lack of informed consent makes infant male circumcision a violation of human rights.</span>
<span class="attribution"><span class="source">Matthew Kebbekus</span></span>
</figcaption>
</figure>
<p>These are not only protected under <a href="http://www2.ohchr.org/english/law/crc.htm">international human rights law</a>, but are entrenched in criminal law systems in various forms. Criminal laws consider interference with the physical integrity of another human being as the most serious of offences.</p>
<p>Human rights law reflects the importance placed on such violations and a forced medical procedure on an individual is in breach of a number of human rights. Circumcision without consent or any immediate medical necessity on a healthy adult male would clearly be in breach of his human rights. So how is infant male circumcision without consent any different? </p>
<p>Children are entitled to the same basic rights as adult individuals. Indeed, they have special protections that recognise their unique vulnerability, as made clear under the <a href="http://www2.ohchr.org/english/law/crc.htm">Convention on the Rights of the Child</a>, which Australia has <a href="http://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-11&chapter=4&lang=en">ratified</a>.</p>
<h2>The rights of parents?</h2>
<p>While parents and legal guardians provide consent on behalf of children for necessary medical procedures (such as immunisations) the removal of healthy, functioning genital tissue from an infant (many years before any purported protections from sexual disease are even relevant) is clearly not a necessary medical procedure. </p>
<p>Parental consent to infant male circumcision is insufficient justification in contemporary Australia. It also ignores doctors’ duties to the child to do no harm, is arguably an inconsistent interpretation of the limitations of parental consent and a breach of the child’s human rights. If the purported benefits are, on balance, enough to warrant a male circumcision, then this is a decision for which he, whether as an adolescent or an adult, is solely entitled to.</p>
<h2>Religious rights</h2>
<p>For some, the medical benefit debate is irrelevant. Infant male circumcision is seen as a fundamental ritual in the practise of religion, which is also a human right. While some may interpret the right to freedom of religion as including the right to practise infant male circumcision, it has clearly been accepted under international human rights law that one individual’s right to freedom of religion does not trump another’s right not to have their bodily integrity interfered with. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/13948/original/k5zf9gtq-1344315411.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/13948/original/k5zf9gtq-1344315411.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/13948/original/k5zf9gtq-1344315411.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/13948/original/k5zf9gtq-1344315411.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/13948/original/k5zf9gtq-1344315411.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/13948/original/k5zf9gtq-1344315411.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/13948/original/k5zf9gtq-1344315411.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Circumcision of Christ (1521), Chartres Cathedral France.</span>
<span class="attribution"><span class="source">Walwyn</span></span>
</figcaption>
</figure>
<p>In the seminal United States child rights case <a href="http://www.law.cornell.edu/supct/html/historics/USSC_CR_0321_0158_ZO.html"><em>Prince v Massachusetts</em></a>, the Court held that “[t]he right to practice religion freely does not include liberty to expose the… child to ill health or death… Parents may be free to become martyrs themselves. But they may not make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves”. </p>
<p>And in May this year, the regional court of Cologne in Germany applied the same reasoning in a case about infant male circumcision. It <a href="http://adam1cor.files.wordpress.com/2012/06/151-ns-169-11-beschneidung.pdf">said</a> “the right of the parents to raise their child in their religious faith does not take precedence over the right of the child’s bodily integrity and self-determination” (<em>translated from German</em>). </p>
<p>Restricting male circumcision to informed adolescents and adults is in no way a restriction on the freedom of religion. If anything, it’s upholding the child’s right to that freedom.</p>
<p>Whether for perceived medical benefit, religious or cultural reasons, until the informed consent of the individual can be freely given, infant male circumcision is plainly, and simply, a violation of human rights. It ignores the child’s rights to bodily integrity, to physical and mental health and to freedom of religion. </p>
<p>Advocates for infant male circumcision in Australia are failing to act in the best interests of Australian children.</p><img src="https://counter.theconversation.com/content/8517/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In an article published recently on this site, “Male circumcision policy ignores research showing benefits”, the authors stated some alleged benefits of infant male circumcision and argued the Royal Australasian…Claire Mahon, Adjunct Clinical Professor of Law, University of MichiganAlexandra Phelan, International Health and Human Rights Lawyer, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/83952012-07-26T20:09:15Z2012-07-26T20:09:15ZMale circumcision policy ignores research showing benefits<figure><img src="https://images.theconversation.com/files/13449/original/7jw44wr3-1343267006.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Circumcising boys in the neonatal period using local anaesthesia maximises benefits and safety.</span> <span class="attribution"><span class="source">TheGiantVermin/Flickr</span></span></figcaption></figure><p>For some time now, all the departments of health in Australia have based their policy on male circumcision on reviews of the scientific literature carried out periodically by the Royal Australasian College of Physicians (RACP). But the lack of a strong basis on evidence means the government should reconsider this reliance. </p>
<p>An RACP policy statement in 2004 argued that the available evidence didn’t justify infant male circumcision being carried out to prevent illness. But when a <a href="http://www.ncbi.nlm.nih.gov/pubmed/16502947">withering critique</a> of that 2004 policy was published in the Australia and New Zealand Journal of Public Health in 2006, the authors of the 2004 report didn’t even attempt to defend their work. This is generally considered an ominous sign in science.</p>
<p>In 2010, the RACP published its most recent policy <a href="http://www.racp.edu.au/page/paed-policy">Circumcision of infant males</a>. Again, the policy argued that the evidence didn’t justify infant male circumcision being carried out to prevent illness. But the 2010 policy statement was not quite as strongly opposed to infant circumcision as the 2004 policy had been.</p>
<p>We have just published <a href="http://www.ncbi.nlm.nih.gov/pubmed/22805686">a comprehensive evaluation</a> of the 2010 RACP policy in the College’s <a href="http://www.racp.edu.au/page/publications/internal-medicine-journal/">Internal Medicine Journal</a>. All nine co-authors of the paper, including ourselves, are public health and public policy experts. </p>
<p>Our critique concludes that the RACP policy is not a fair and balanced representation of the literature on male circumcision because it is not based on research evidence. Instead, the RACP policy ignores, downplays, obfuscates or misrepresents the considerable body of research that shows circumcising males offers strong protection against a number of diseases. </p>
<p>Benefits include reduced <a href="http://www.scirp.org/journal/PaperInformation.aspx?paperID=17415">childhood urinary tract infections</a>, which are common, painful and often cause permanent kidney damage. Male circumcision also provides some protection against many common, as well as not so common, <a href="http://rd.springer.com/chapter/10.1007/978-3-642-14663-3_54">sexually transmitted infections</a>, including the epidemic of cancer-causing types of human papillomavirus and genital herpes, <a href="http://www.scirp.org/journal/PaperInformation.aspx?paperID=17415">genital ulcer disease</a> and <a href="http://www.tandfonline.com/doi/abs/10.1080/09540121.2012.661836?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed">HIV</a>, among others.</p>
<p>Circumcision also helps protect against <a href="http://www.ncbi.nlm.nih.gov/pubmed/16925903">penile candidiasis</a> (thrush), <a href="http://circinfo.net/inflammatory_dermatatoses.html">inflammatory skin conditions</a> and <a href="http://circinfo.net/penile_hygiene.html">inferior penile hygiene</a>. It can help those with <a href="http://circinfo.net/physical_problems.html">physical problems</a>, such as a tight foreskin that interferes with passing urine, and an inability to return the foreskin after it is retracted. It virtually eliminates the risk of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113366/?tool=pubmed">penile cancer</a> that occurs in one in 1,000 uncircumcised males over their lifetime. And there may also be some reduction in the <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=morris%20bj%202012%20prostate">risk of prostate cancer</a>. </p>
<p>Women with circumcised male partners are protected to varying degrees against cancer-causing <a href="http://www.ncbi.nlm.nih.gov/pubmed/22734435">human papillomavirus infection</a>, <a href="http://rd.springer.com/chapter/10.1007/978-3-642-14663-3_54">genital herpes</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/18976733">bacterial vaginosis</a> (Gardneralla), and <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113366/?tool=pubmed">cervical cancer</a>. Although the RACP’s policy statement claims otherwise, complications of infant male circumcision <a href="http://www.ncbi.nlm.nih.gov/pubmed/20158883">are uncommon</a> and virtually all <a href="http://www.biomedcentral.com/1471-2431/12/20/abstract">minor and easily treated</a>.</p>
<p>The RACP policy statement claims that “the foreskin has a functional role” and “is a primary sensory part of the penis”. However, extensive <a href="http://circinfo.net/circumcision_sensitivity_sensation_sexual_function.html">high quality research</a>, including <a href="http://www.ncbi.nlm.nih.gov/pubmed/18761593">randomised controlled trials</a>, show no adverse effect on <a href="http://www.ncbi.nlm.nih.gov/pubmed/18761593">sexual function</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/17419812">sensitivity, sensation</a> or <a href="http://www.ncbi.nlm.nih.gov/pubmed/18761593">satisfaction</a>. </p>
<p>Instead of citing good research, such as large meta-analyses and randomised trials, the RACP policy selectively cites a <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=kim%20d%202007%20619%2099">poor quality study</a> that has been <a href="http://www.ncbi.nlm.nih.gov/pubmed/17437447">criticised</a>. The RACP’s claim – without support from a literature-based risk-benefit analysis – that the currently available evidence does “not warrant routine infant circumcision in Australia and New Zealand” is misleading. </p>
<p>A <a href="http://www.scirp.org/journal/PaperInformation.aspx?paperID=17415">risk-benefit analysis</a> by a number of us who also wrote the Internal Medicine Journal article was published recently in the <a href="http://www.scirp.org/journal/ojpm/">Open Journal of Preventive Medicine</a>. We found that the benefits of male circumcision were considerable and exceeded risks by a large margin; the risks are virtually all minor, while conditions prevented are often serious. </p>
<p>The RACP policy fails to explain that circumcising boys <a href="http://www.biomedcentral.com/1471-2431/12/20/abstract">in the neonatal period</a> using local anaesthesia maximises benefits and safety, is convenient and offers <a href="http://www.ncbi.nlm.nih.gov/pubmed/20090910">cost savings</a>.</p>
<p>Our Internal Medicine Journal article concludes that because the RACP’s policy “is not a fair and balanced representation of the current literature it should not be used to guide policy.” We recommend that an extensive, comprehensive, balanced review of the scientific literature and a risk-benefit analysis should be conducted to formulate policy, in the interests of public health and individual well-being. </p>
<p>Such a review was recently undertaken by the <a href="http://www.circumcisionaustralia.org/">Circumcision Foundation of Australia</a>. Health bodies, governments, doctors and the general public should use this evidence-based policy statement as a reliable guide to decision-making and health policy development.</p>
<p>Facing rising health costs, the federal government has recently increased its emphasis on prevention. Infant male circumcision is a good example of how difficult it can be to implement preventative measures. The process starts with basing policy fairly and squarely on evidence and continues with overcoming obstruction from groups opposed to policy based on evidence. Watch this space.</p><img src="https://counter.theconversation.com/content/8395/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For some time now, all the departments of health in Australia have based their policy on male circumcision on reviews of the scientific literature carried out periodically by the Royal Australasian College…Brian J. Morris, Professor of Molecular Medical Science, University of SydneyAlex Wodak, Emeritus Consultant, St Vincent's Hospital, DarlinghurstLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/65512012-04-23T02:55:56Z2012-04-23T02:55:56ZMonday’s medical myth: testicular self-examination is a waste of time<figure><img src="https://images.theconversation.com/files/9766/original/dymgpdyw-1334806137.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's important men can identify potentially cancerous lumps in their testes.</span> <span class="attribution"><span class="source">xddorox</span></span></figcaption></figure><p>Testicular self-examination is turning men into “<a href="http://www.afr.com/p/lifestyle/mens_health/no_need_for_groping_Xzlg45mnKqzKd38xGMwRVJ">ball-watching neurotics</a>” – that’s the view of Keith Hopcroft, a GP from Essex in the United Kingdom. It’s unnecessary, he explained recently in the <a href="http://www.bmj.com/press-releases/2012/03/28/private-screening-and-self-examination-doing-more-harm-good">British Medical Journal</a>, because it won’t necessarily detect cancer and it needlessly induces anxiety.</p>
<p>So, is it time to stop groping your gonads – or to start?</p>
<p>Testicular cancer might be a rare disease, diagnosed in about 690 Australians <a href="http://www.aihw.gov.au/publication-detail/?id=6442472459">each year</a>, but it’s the second most common cancer in men aged 18 to 39.</p>
<p>The cure rates, however, are among the highest of all cancers, with about 95% of men surviving testicular cancer and going on to live full and active lives – even in advanced cases.</p>
<p>The usual symptom is a hard lump in either testis. The lump can be painful or tender in around one in ten men. Other lumps can also be found in the scrotum, outside the testes, but these are most likely non-cancerous.</p>
<p>As the causes of this cancer are largely unknown, many clinicians recommend testicular self-examination as a means of early detection, particularly in men at <a href="http://www.urologyhealth.org/urology/index.cfm?article=101">higher risk</a> due to undescended testes in childhood, previous testicular cancer or family history. </p>
<p><a href="https://www.andrologyaustralia.org/testicular-cancer/">Testicular self-examination</a> involves feeling the testes, one at a time, using the fingers and the thumb. It’s normal for one testis to be slightly bigger than the other and the left testis often hangs lower than the right.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/9781/original/gyvkzyv8-1334817415.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/9781/original/gyvkzyv8-1334817415.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/9781/original/gyvkzyv8-1334817415.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/9781/original/gyvkzyv8-1334817415.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/9781/original/gyvkzyv8-1334817415.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/9781/original/gyvkzyv8-1334817415.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/9781/original/gyvkzyv8-1334817415.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A self-examination involves feeling each testis for lumps.</span>
<span class="attribution"><span class="source">jakub_hla</span></span>
</figcaption>
</figure>
<p>To date, there’s <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007853.pub2/abstract">no evidence</a> to suggest that death rates are reduced by testicular self-examination. A randomised trial to assess this question would need to be very large, given the low incidence of testicular cancer, and such a study is unlikely to ever happen.</p>
<p>Nonetheless, there is no evidence that this practice causes harm and Dr Hopcroft’s <a href="http://www.bmj.com/content/344/bmj.e2120">recent comments</a> that it could cause obsessive testicular checking or trigger “incapacitating anxiety” are unfounded. In fact, most studies have <a href="http://www.sciencedirect.com/science/article/pii/S0094014307000043">shown</a> rates of testicular self-examination are low, although there has been some increase in recent years, possibly due to <a href="http://www.sciencedirect.com/science/article/pii/S0090429510003572">greater awareness</a> of testicular cancer.</p>
<p>The <a href="http://www.sciencedirect.com/science/article/pii/S0094014307000043">benefits of early detection</a> of testicular cancer – before it has spread – are a higher survival rate and a reduced likelihood of toxic treatments, such as chemotherapy or major abdominal surgery. Surely that’s worth checking for.</p>
<p>There’s no need for GP-based screening for testicular cancer, but self-examination can help educate young men to identify the normal feel of their testes so they’re aware when there is a change in consistency. Most lumps found in the testes will be cancerous, but other lumps in the scrotum are often benign. If men understand the feel of the normal scrotal structures, they may be able to distinguish between these differing types of lumps.</p>
<p>A key issue is that while some men will present with pain, many men delay seeking a medical opinion due to embarrassment or other factors. Some men will wait until their testicle is the size of a grapefruit before seeking medical attention – and that has to change. </p>
<p>Male sexual health is a significant part of overall good health and the male reproductive system plays a role in many areas of well-being. The more men know about their bodies – the way they work and how to check on the “bits below the belt” – the better. </p><img src="https://counter.theconversation.com/content/6551/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Frydenberg works as a urologist and uro-oncologist within the multidisciplinary urology group Australian Urology Associates, as well as at Monash Medical Centre. He is a board member of Andrology Australia (Australian Centre of Excellence in Male Reproductive Health). </span></em></p>Testicular self-examination is turning men into “ball-watching neurotics” – that’s the view of Keith Hopcroft, a GP from Essex in the United Kingdom. It’s unnecessary, he explained recently in the British…Mark Frydenberg, Head of Urology at Monash Medical Centre and Associate Professor of Surgery, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/38012012-02-08T00:36:59Z2012-02-08T00:36:59ZBoys aren’t immune to body image pressures – and never have been<figure><img src="https://images.theconversation.com/files/6510/original/px29yj9s-1324007855.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Men's pursuit of muscularity, leanness and youthfulness aren't new.</span> <span class="attribution"><span class="source">The Shark</span></span></figcaption></figure><p>Male beauty and body image receive far less attention in the media and academia than the female body. That’s despite buff, lean and muscular male bodies becoming an increasingly popular features of <a href="http://www.imdb.com/title/tt1570728/">blockbuster films</a>, magazines and <a href="http://www.abc.net.au/radionational/programs/backgroundbriefing/boys-and-the-buff-culture/3582746">popular culture</a>. </p>
<p>But just like the female body, the male body has been depicted, evaluated and scrutinised as an aesthetic product since ancient times. </p>
<p>So how have portrayals of the ideal male body changed over time? </p>
<p>The perceived attractiveness of muscular men has grown since around the 1950s, alongside the muscularity of male models. The body size of male Playgirl models <a href="http://www.ncbi.nlm.nih.gov/pubmed/11135340">gradually increased</a> from the 1950s to the late 1990s with an increase in muscle and lean body mass rather than body fat. The same trend is also reflected in action figure heroes such as GI Joe, who have become more muscular, with physiques comparable to advanced bodybuilders. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/5391/original/Rodimuspower.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/5391/original/Rodimuspower.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=822&fit=crop&dpr=1 600w, https://images.theconversation.com/files/5391/original/Rodimuspower.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=822&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/5391/original/Rodimuspower.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=822&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/5391/original/Rodimuspower.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1033&fit=crop&dpr=1 754w, https://images.theconversation.com/files/5391/original/Rodimuspower.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1033&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/5391/original/Rodimuspower.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1033&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Big guns: GI Joe.</span>
<span class="attribution"><span class="source">Rodimuspower</span></span>
</figcaption>
</figure>
<p>The pursuit of muscularity is closely tied to Western cultural views of masculinity and the masculine gender role, which prescribe that men should be powerful, strong and get things done. </p>
<p>This preference for a muscular male body is present across men’s lifespan and appears to develop early, at around seven years of age. More than <a href="http://dro.deakin.edu.au/view/DU:30002226">half of boys at this age</a> already desire to be more muscular and may become preoccupied with exercise for the purpose for building muscles.</p>
<p>As boys in Western cultures grow into young men and are exposed to increasing media depictions of the muscular ideal, as many as <a href="http://www.ncbi.nlm.nih.gov/pubmed/11408837">nine out of ten</a> wish they were more muscular. </p>
<h2>Muscle mania</h2>
<p>The muscular ideal is not a modern notion. Muscularity has been admired throughout history, particularly in ancient Greece and Rome, and this is evident from the art and literature of the time. Well-proportioned males were idealised for their defined muscles and low body fat. Think of the great historical and mythical heroes of the time – Achilles, Odysseus, Alexander the Great, and Julius Caesar. All were all described as both muscular and powerful.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/6507/original/xpsjvbqk-1324006536.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/6507/original/xpsjvbqk-1324006536.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=848&fit=crop&dpr=1 600w, https://images.theconversation.com/files/6507/original/xpsjvbqk-1324006536.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=848&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/6507/original/xpsjvbqk-1324006536.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=848&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/6507/original/xpsjvbqk-1324006536.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1065&fit=crop&dpr=1 754w, https://images.theconversation.com/files/6507/original/xpsjvbqk-1324006536.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1065&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/6507/original/xpsjvbqk-1324006536.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1065&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Michelangelo’s David/San Diego Shooter</span></span>
</figcaption>
</figure>
<p>Muscularity was also highly valued during the Renaissance when there was a return to classical ideals. This is most clearly seen in Michelangelo’s representation of David, who is youthful, strong, symmetrical, and muscular but lean.</p>
<h2>Leanness</h2>
<p>Modern men don’t just have to be muscular – the ideal man should also be lean. <a href="http://www.sciencedirect.com/science/article/pii/S1471015311000407">Studies show</a> women perceive men with body mass indices toward the lower end of the normal weight range as more attractive. </p>
<p>Similarly, researchers who have used <a href="http://en.wikipedia.org/wiki/Figure_rating_scale">Figure Rating Scales</a> to assess men’s ideal body fat have <a href="http://www.mendeley.com/research/oh-lean-muscular-body-image-ideals-gay-heterosexual-men/">found</a> that men generally select figures that represent low to moderately-low body fat (figures four to five on a nine-point scale).</p>
<p>One of the main reasons for a greater focus on leanness in recent years is the rising prevalence of obesity. This has increased our awareness of the risks associated with excess weight and has also promoted a culture which values leanness for both health and aesthetic reasons. </p>
<p>As a result of these cultural shifts, <a href="http://www.ncbi.nlm.nih.gov/pubmed/14979769">studies show</a> that more than 30% of adolescent and young adult men are concerned about their weight and try to shed excess kilos through purging, the use of laxatives or less extreme strategies, such as skipping meals and increased exercise.</p>
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<img alt="" src="https://images.theconversation.com/files/6482/original/s45z69xj-1323928671.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/6482/original/s45z69xj-1323928671.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=875&fit=crop&dpr=1 600w, https://images.theconversation.com/files/6482/original/s45z69xj-1323928671.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=875&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/6482/original/s45z69xj-1323928671.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=875&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/6482/original/s45z69xj-1323928671.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1100&fit=crop&dpr=1 754w, https://images.theconversation.com/files/6482/original/s45z69xj-1323928671.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1100&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/6482/original/s45z69xj-1323928671.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1100&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<h2>Metrosexuals</h2>
<p>The modern metrosexual is a prime example of the image-conscious man for whom leanness and youthfulness have become important standards of male beauty. </p>
<p>The metrosexual man spends considerable resources and time on appearance and lifestyle. He is considered the fashionable man who is highly focused on the sanitised body which should, according to him, be free of hair, sweat and odour. </p>
<p>As with women, the media are guilty of promoting these images. But men who are persuaded to adopt these ideals are also guilty of perpetuating the metrosexual stereotype. And so it becomes a vicious cycle with more and more men drawn in to the fray. </p>
<p>In an attempt to improve their attractiveness and perception of cleanliness, <a href="http://www.sciencedirect.com/science/article/pii/S1740144508000508">almost two thirds</a> of young adult men from the United States and Australia have removed their body hair (below the neck) at least once.</p>
<p>But the metrosexual is not a modern invention. Early Egyptian men were also metrosexual, and they valued both leanness and youthfulness. Egyptian men (and women) regularly used oils and creams to keep their skin soft and supple, and to prevent cracked dry skin. These cosmetics were so highly valued they were often accepted by workers as part of their wages. </p>
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<img alt="" src="https://images.theconversation.com/files/6519/original/7r429qf2-1324015270.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/6519/original/7r429qf2-1324015270.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/6519/original/7r429qf2-1324015270.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/6519/original/7r429qf2-1324015270.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/6519/original/7r429qf2-1324015270.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/6519/original/7r429qf2-1324015270.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/6519/original/7r429qf2-1324015270.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>Egyptian men and women carefully watched their weight and tended to eat more fruits and vegetables than meats. On the whole, men tended to be relatively thin and even frail-looking. </p>
<p>Interestingly, they also valued hairlessness. Men usually had a thin moustache or goatee, and they preferred their faces, chests and even leg hairs to be shaven, as they considered an abundance of hair a sign of impurity and uncleanness.</p>
<h2>Modern pressures</h2>
<p>The pursuit of muscularity, leanness and youthfulness are clearly not new aspirations for men. But what has emerged in the past two decades is an ever increasing range of media (magazines, films, television, and the Internet) that promote a profoundly image-conscious society. </p>
<p>With increasingly sophisticated technologies and marketing strategies, the male body is becoming more exploited and commodified, and this is <a href="http://www.ncbi.nlm.nih.gov/pubmed/17162642">giving rise</a> to higher levels of body image and appearance concerns among young men. </p>
<p>Men should be discouraged from adopting or internalising these unrealistic standards as the “yardstick” by which their own body image should be measured. </p><img src="https://counter.theconversation.com/content/3801/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lina Ricciardelli receives funding from the ARC</span></em></p>Male beauty and body image receive far less attention in the media and academia than the female body. That’s despite buff, lean and muscular male bodies becoming an increasingly popular features of blockbuster…Lina Ricciardelli, Associate Professor of Psychology, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.