Men and Masculinities in Sexual Healthcare: Exploring Notions and Discourses among Healthcare Professionals

Abstract: Aim: Healthcare professionals (HCP) have been described as vital for men’s experiences of sexual healthcare (SHC). However, HCPs in SHC have to a low extent been included in research on men and masculinity. The aim of this thesis was to explore HCPs’ attitudes, notions and discourses on men and masculinities in the SHC context. Notions about men and masculinities were explored in Study I. How HCPs construct gendered social location in SHC was explored in Study II. Methods: Data were gathered through seven focus group interviews (n=35) with HCPs working with men’s SHC at a primary healthcare clinic and at sexual health clinics in Sweden. HCPs notions of men and masculinities were analysed using qualitative content analysis. The construction of the gendered social location in SHC was analysed using critical discourse analysis. Results: In the analysis we identified that notions of men and masculinities were elusive and hard to grasp but easy to exemplify with normative, idealised and stereotypical masculinity. Further, men and masculinities seemed to be potentially challenging, and some types of masculinities were considered more challenging and situated further from the idealised masculinity. Experienced organisational deficiencies, lack of education and training on men’s sexual health and notions of men and masculinities appeared as interrelated. Moreover, we identified that masculinity was considered as something that should be disregarded to stay gender neutral in relation to patients in SHC and that notions of masculinities were situated in a context of personal and private relationships. Romantic and sexual preferences were used to describe preferable masculinity. In the analysis of how the gendered social location in SHC was constructed we found that SHC was positioned in opposition to masculinity in society, which was described as unconducive with SHC. Furthermore, HCPs’ discourses did not reflect a shared approach to men and masculinity and HCPs seemed to lack a shared professional discourse on masculinity. We identified compensatory strategies for the lack of professional discourse. Another finding was that SHC, as an arena, was construed as predominantly feminine in descriptions of its history, practice, staff and patients. The analysis identified that masculinity was constructed as a violation of norms and as a problem that men in SHC need help with. The discourses seemed to position HCPs as agents of change with a mission to transform masculinity, and men as reluctant patients that need extra efforts. Conclusion: The findings in this qualitative study indicate that HCPs balance private and professional notions of men and masculinities in SHC, and that the discourses on men and masculinities might lead to othering, rather than including, the diversity of men. A shared approach and professional discourse to men and masculinities could contribute to the creation of a more consistent and knowledge-based treatment of men. To achieve this and to manage the experienced organisational and educational challenges health system interventions are needed, including training and education on men’s sexual health, gender and masculinities. Future studies are needed to further explore HCPs’ experiences, and in particular, how HCPs’ attitudes, notions and discourses are associated with treatment seeking and satisfaction for men in need of SHC.