Young men rarely discuss fertility, yet there’s a cultural assumption that ‘everything will be fine’ when it’s time to conceive. However, 7% of men across the world experience infertility according to the World Health Organization.¹

In the UK, one in seven couples have trouble conceiving, and in half of these couples, the problem may exist with the male partner.¹ Because the focus is often on women, men rarely discuss their fertility struggles, leading many to face isolation, pressure and shame. Given the serious mental health challenges men face in the UK, it’s essential to address such issues and highlight available preventative and supportive measures.

Common men’s fertility risks

Young men across the UK benefit from extensive sex education but often remain unaware of how lifestyle choices can affect their future fertility. Risk factors include being overweight, excessive drinking, STDs, genetics, pollution, smoking, drug use and even tight underwear.

While men can reproduce into an older age, those under 40 are more likely to have healthy, successful pregnancies, making age an important factor in male fertility. Many of the above risk factors can be managed. The more we engage young men in conversations about fertility, the better equipped they will be to make informed choices about their future.

While men can reproduce into an older
age, those under 40 are more likely to
have healthy, successful pregnancies.

Fertility help is available

If there are challenges for men conceiving, there are many ways medical professionals can help. Tests range from blood and urine tests to semen tests or scans, for example. Meanwhile, treatments include many hormonal and surgical options. There is also emotional support available for men, such as from Fertility Network UK’s HIMFertility group. 

Merck is a global leader in fertility and is proud to have helped over 5 million babies to be born.² We strongly believe that by shifting the narrative for young people to include the full spectrum of choices from career to lifestyle andparenthood, we can offer them true empowerment to have more choices for their future — whatever they aspire to.  

[1] World Health Organization, ‘Infertility prevalence estimates 1990–2021’. Available at: https://iris.who.int/bitstream/handle/10665/366700/9789240068315-eng.pdf?sequence=1  [Accessed Oct 2024].
[2] British Association of Urological Surgeons, ‘Fertility Problems’. Available at: https://www.baus.org.uk/patients/conditions/4/fertility_problems/ [Accessed Oct 2024].

Job code: UI-NONPR-00159
Date of preparation December 2024

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Penile prosthetics offer a transformative solution for erectile dysfunction. These devices can restore confidence and intimacy, marking a significant advancement in medical technology and patient care.

Erectile dysfunction (ED), the persistent inability to achieve or maintain an erection for sexual performance, is self-reported in 50% of men aged 40–70.¹ It can have a profound impact on men’s health and wellbeing, causing strain on relationships. It is associated with cardiovascular disease, diabetes, obesity and smoking in addition to other psychological disorders such as depression and anxiety.²

Multifaceted approach to ED treatment

ED management requires a holistic approach tailored to the underlying cause. Lifestyle modifications include a healthy diet, regular exercise, improved sleep, stopping smoking and reducing alcohol intake. Various medical options are available, including tablets, topical creams, intraurethral pellets and penile injections, as well as vacuum erection devices. Psychosexual counselling is pivotal when potential psychological factors such as performance anxiety and relationship issues are present.

Two types of devices can be
inserted inside the penis: malleable
(semi-rigid) or inflatable implants.

Impact of prosthetics on erectile dysfunction

Penile prosthetics are a surgical option, typically considered when other treatment options are unsuitable or have failed. Two types of devices can be inserted inside the penis: malleable (semi-rigid) or inflatable implants. A malleable implant is bent upwards to facilitate sexual intercourse and bent down when not required.

The inflatable prosthesis offers a more natural option dependent on a hydraulic mechanism. It is activated when a pump, located in the scrotum, is engaged. This pump moves fluid from a reservoir in the abdomen to the penile prosthesis, which inflates to provide a rigid penis.

The procedure has potentially serious risks and complications. However, in a suitable, well-counselled patient, studies have demonstrated one of the highest satisfaction rates of 80–90%.³ It offers men with ED restored erectile function, eliminates dependence on variable effectiveness of medical therapy and offers a degree of spontaneity.

Accessing ED medical interventions

Men should seek medical attention and treatment information, as it may also be the first presentation of underlying disease. As research and technology advance, the future holds promise for even more effective and accessible solutions for ED.

[1] Henry, A. et al. (1994). Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. Journal of Urology, 151(1), 54-61. https://doi.org/10.1016/S0022-5347(17)34871-1.
[2] Yafi, F. A. et al. (2016). Erectile dysfunction. Nature Reviews Disease Primers, 2, 16003. https://doi.org/10.1038/nrdp.2016.3
[3] Hellstrom, W. J. G. et al. (2010). Implants, mechanical devices, and vascular surgery for erectile dysfunction. Journal of Sexual Medicine, 7(1 Pt 2), 501-523. https://doi.org/10.1111/j.1743-6109.2009.01626.x

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Prostate cancer is the most common cancer for men in the UK, responsible for the death of one man every 45 minutes. Black men face an even higher risk.

The reasons for prostate cancer more widely impacting black men than any other race are complex, intertwined and varied.

Some reasons black men are more at risk

• Genetics: Black men have higher Gleason scores and higher prostate-specific antigen (PSA) levels than white men, indicating they are at greater risk for more aggressive forms of prostate cancer.
• Racism: Lack of representation in clinical trials and studies combined with a history of ethical malpractice and mistreatment of people of colour have led to a lack of trust. Many black men fear that their PSA screenings may not be thorough enough or their test results may be misused.¹
• Fear and cultural stigma: There can be hesitation among black men to undergo routine screenings, such as a digital rectal exam (DRE) or PSA testing. Concerns about the invasiveness of these procedures and the fear of potential diagnoses contribute to this reluctance.

There is a lack of data in
clinical trials for black patients.

Increasing awareness and trust in prostate cancer health

Although the above factors pose challenges, steps can be taken to dismantle the barriers around prostate cancer care for black men.

• Medical representation: Currently, there is a lack of data in clinical trials for black patients. A large proportion of treatment and diagnostics for prostate cancer has been based on data for white patients, which negatively impacts the healthcare of black patients.² Increasing representation from people of all minority backgrounds in trials will lead to more inclusive and trusted healthcare.
• Early detection: Given the heightened risk and aggressiveness of prostate cancer in black men, early detection and diagnosis are crucial.

The European Association of Urology has been taking steps to combat this stigma. One of the steps involves the development of a patient-reported outcome measures (PROMs) study focused on prostate cancer care for black men of African and Caribbean descent. The other will be the roundtable ‘Championing Black Health Equity in Prostate Cancer,’ which will take place on Patient Day at the Annual EAU Congress in Madrid, 21–24 March 2025.

[1] American Cancer Society, (2022), Racial disparities in Black men with prostate cancer: A literature review, Journal of the American Cancer Society
[2] Prostate Cancer Research, supra

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Men’s health is about more than curing individual diseases or solving specific problems. It requires a coherent, strategic approach.

Many of us know the statistics by now. We know how much more likely men are to develop this disease or that, or how much more likely they are to die younger as a result.

State of men’s health today

We may also know about men’s fragile mental and emotional health, the incomprehensible numbers of men taking their own lives each day and the heartbreak and devastation left behind. You may also know that men are less likely to seek support for their mental health — from doctors, services or friends. 

You do not need me to quantify men’s lifestyles, the unhealthy diets, how much they drink, the unused gym memberships, the rates of dependency and addiction. We’ve heard it before. On the off chance that you don’t know all this already, I assure you the Department of Health has known for a long time.

These issues are
intimately connected,
overlapping and consequent.

A coherent response

The problem with listing statistics is it implies these are all different problems, isolated and separate. Yet, these issues are intimately connected, overlapping and consequent. Addressing them requires a coherent, unified approach.

For many years now, the charity I chair — alongside colleagues across the male health and wellbeing sector — has campaigned for a national men’s health strategy to provide this coherence. If the isolated issues are a pile of bricks, a strategy would be the mortar that grips them together into a strong, protective wall. In calling for this, we note the progress that has already been delivered in countries like Ireland and Australia, which have similar strategies. It would also build on the welcome introduction of the national women’s health strategy, established in 2022.

Men’s health neglected

In March, Health Secretary Wes Streeting wrote that he intends to introduce such a strategy for men. It was a hugely welcome announcement, but things have since gone quiet. There was no promise in the Labour manifesto and no commitment in the King’s Speech. 

We cannot allow his promise to be dropped. For the sake of men, their families and a healthier, happier, more prosperous society we need to hold him to his word. Don’t make men reach for the statistics — not anymore.

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Men’s health is poor throughout the world. Men lead shorter lives than women and are more likely to die before the age of 50.

Globally, men are 19% more likely than women to develop cancer and 43% more likely to die from it. The suicide rate is twice as high in men. These outcomes are bad news for men, but they also impact women, children and workplaces.

Why a men’s health gap exists

Men smoke more than women, drink more alcohol, eat a poorer diet and drive faster. They are more likely to work in hazardous jobs, access health checks at lower rates and, when they are ill, it takes them longer to see a health professional. 

Masculinity, the set of gender norms that influences men’s attitudes and behaviours, is undoubtedly part of the picture. In many cultures, men are encouraged to take risks, act tough and avoid admitting weakness by asking for help. Masculinity also leads men to be providers for and protectors of their families, but when it comes to health, its influence is mostly unhelpful.

Men are largely absent from global cancer,
mental health and sexual health policies.

Delivering messages about men’s health

The way many health services are designed and delivered is also important. Too often, health services fail to take the realities of men’s lives into account. Men generally work full-time and longer hours than women, making it harder to access a service that is open only during standard office hours. Health promotion messaging about smoking, for example, is rarely ‘male-friendly’ — unlike marketing for cars, beer or gambling.

Addressing men’s health needs through policy

Finally, and crucially, men’s needs have not been reflected in policy. For instance, Global Action on Men’s Health has found that men are largely absent from global cancer, mental health and sexual health policies. Only nine countries have national men’s health policies.

National governments and global health organisations need to take proper account of men’s health needs in their policies. This, in turn, must lead to the development of easy-to-use services and better-targeted health information. Not doing so will continue to fail men, their families and societies.

White, A. (2025). Populations at special health risk: Men. In S. Quah (Ed.), International encyclopedia of public health (3rd ed., Vol. 4, pp. 792–818). Elsevier. https://doi.org/10.1016/B978-0-323-99967-0.00019-3

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Ultrasound technology is playing an important role in helping clinicians make critical diagnoses in patients and plan onward treatment strategies.

Tissue biopsies, though invasive and sometimes uncomfortable, are crucial for diagnosing conditions such as prostate cancer and liver or kidney disease. Using ultrasound technology, clinicians can decide on treatment protocols and future therapies based on collected tissue samples.

Modern ultrasound tech for prostate cancer

Improvements to ultrasound are making procedures as comfortable as possible, particularly in areas such as prostate cancer. Simon Jarvis, Segment Lead (urology and surgery) within Fujifilm’s healthcare division, explains that men identified as potentially having prostate cancer from a high prostate-specific antigen (PSA) test reading will be referred by GPs to a consultant for assessment, followed by an MRI scan.

If a lesion is found on review of the MRI scan by a radiologist, the lesion is scored and then the patient would be counselled for the next stage. Potentially, this would be a prostate biopsy performed using an ultrasound-guided probe, typically under local anaesthesia.

Recent advancements, such as a 3mm size reduction in the Fujifilm probe, enhance patient comfort. Later, Crystal technology in the probe enhances image capability; better ergonomics improve the ease of use for theatre staff and help to reduce repetitive strain injury (RSI).

If a lesion is found on review of the MRI scan by a radiologist, the lesion is scored and then the patient would be counselled for the next stage.

Accurate imaging capabilities

Ultrasound provides diagnostic imaging to identify lesions. A positive biopsy for cancer may lead to a further course of treatment.

Jarvis explains: “If you can’t see the lesion, you cannot take a biopsy or guide treatment. It’s also critical that the ultrasound probe is a comfortable size for patients because if you cannot insert the probe, you cannot take a biopsy or get a report back from pathology.”

For difficult-to-locate lesions, fusion technology — such as in the Arietta 65 IntuitiveFusion — combines established ultrasound and MRI diagnostic tools with software to direct urologists to exact targets for prostate biopsies.

Smart identification software

Ultrasound, a non-radioactive imaging modality, also supports the diagnostic pathway in liver and kidney disease with the biopsy needle guided by ultrasound. This is supported by 3D modelling software that links ultrasound and MRI images.

Furthermore, Fujifilm surgical planning software is available to surgeons to navigate the procedure by differentiating between tissue, tubes, vessels, veins and arteries and ensuring surgeons work within safe margins.

“We can use technology on ultrasound to guide incisions,” says Jarvis. “Ultrasound technology can show what is tissue, what is an artery and what is a smaller vessel. We also have similar technology with 3D modelling on open cases, laparoscopically or for robotic surgery.”

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Usually, men aren’t shy when it comes to talking about sex. However, there’s one sexual topic that remains a taboo subject that they would rather forget about completely: erection difficulties (ED).

Ways men experience and deal with erection difficulties

Erection difficulties (or erectile dysfunction) refer to the inability to achieve and/or maintain an erection for satisfactory sexual performance, and it’s more common than you might think. In the UK, one in three men will experience some degree of erection difficulty at some point in their life. It can be a distressing condition and can happen at any age. It occurs when the blood vessels in the penis are narrowed, and the blood flow is not sufficient to get and keep an erection.

Anyone experiencing erection difficulties may feel ashamed and anxious, but generally, the tendency is to pretend it’s not happening. Of 3,445 UK men experiencing ED surveyed, 56% say that sex is a very important part of their relationship, but 63% of them would rather keep their ED issues to themselves.*

Opening up the conversation about erection difficulties

People have to put aside their awkwardness and be more open about ED. Admittedly, it may not be easy. If you’re unable to get or maintain an erection, you might feel extremely uncomfortable discussing it with a healthcare professional. More recently, The Urology Foundation surveyed 2,000 UK men and found that, if they were having ED problems, 46% of them would NOT visit their doctor.

However, the bigger problem is not talking about it at all because of the several misconceptions. Many men — 63% of those surveyed by The Urology Foundation — think that ED is an inevitable consequence of ageing (it isn’t). What’s more, 78% aren’t aware that the condition could be a sign of heart disease. Of course, if you’ve had problems getting a full erection once or twice, it doesn’t necessarily mean you have ED. Still, if you have any concerns, it’s always best to speak with your pharmacist.

Managing the condition with an over-the-counter medicine

Even though some men won’t visit their doctor, there are some positive signs that people would be keen to explore solutions to manage their ED. The Urology Foundation study makes clear that 64% would consider a pill or non-prescription medicine to address the condition.

Also, studies have shown that effective treatment for ED can significantly improve sexual satisfaction for men and their partners and increase sexual self-confidence, resulting in better relationships and an enhanced quality of life.

Cialis® Together is an ED brand available without a prescription at pharmacies, and it is committed to helping men get a fulfilling and healthy sex life. Until recently, the over-the-counter treatments for ED available in the UK have only lasted up to four hours. Cialis® Together is the first non-prescription ED medicine that is effective for up to 36 hours. It works by widening the blood vessels in the penis and will help men get an erection when sexually aroused, and then the erection should subside after sexual activity.

The main advantage of having up to 36 hours to decide when to have sex is that it fits into the realities of a relationship by allowing you to decide when the moment is right for both of you, helping make spontaneous sex an option.

So, don’t be embarrassed. Pharmacists can give you advice about the appropriateness of any medication, its potential side effects and if you need to see your GP. Effective treatment for ED is a beneficial approach. That’s why we need to talk about it more.

Cialis® Together 10mg tablets. For Erectile Dysfunction in adult men. Contains tadalafil. Always read the label.

*Source: Irrational Agency, quantitative survey UK, 2021, N=10,197 adult men; 3,445 men qualified either as suffering erectile dysfunction or identified through IIEF-5 screening (IIEF – International Index of Erectile Function).

MAT-XU-2305654 v1.0 December 2023

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Benign prostatic hyperplasia — or an enlarged prostate — is not cancer, but its symptoms can be severely life-limiting. Thankfully, a safe treatment is available.

The likelihood of developing an enlarged prostate — or benign prostatic hyperplasia (BPH) — increases with age. More than 50% of all men in their sixties and as many as 90% aged between 70 and 89 will have some symptoms of BPH.

Symptoms of benign prostatic hyperplasia

BPH is not cancer and doesn’t raise your risk of developing prostate cancer. However, the symptoms can significantly change the way you live; impacting daily activities, hobbies and sleeping patterns and altering your enjoyment of life.

Normally, the prostate gland is the size of a walnut; but, when it gets bigger, it can compress the urethra (tube where urine passes). The bladder wall then needs to squeeze harder to remove the urine, becoming thicker and irritable; it can begin to contract even when it contains only a small amount of urine.

People with BPH may therefore need to urinate more frequently, especially at night. They may also be unable to urinate; strain while urinating; have a weak urine stream; have a urine stream that starts and stops; experience dribbling at the end of urinating; or be unable to empty their bladder.

PAE is usually performed as an outpatient procedure,
and no general anaesthesia is required.

Prostatic artery embolisation: a safe treatment for BPH

While BPH is common, it shouldn’t be ignored. “Left untreated, it could lead to health complications such as kidney stones, recurrent infections, lack of bladder control and complete bladder outlet obstruction or blockage,” says Clare Bent.

“If your healthcare provider determines that you have benign prostatic hyperplasia, it’s a good idea to discuss the various treatment options available, including prostatic artery embolisation (PAE).” This is a safe treatment option and, like other minimally invasive procedures, has significant advantages over conventional surgical options.

Prostatic artery embolisation process and benefits

With PAE, a tiny incision is made in your groin or wrist to gain access to your arterial system. A catheter is then guided to the vessels that supply blood to your prostate. Embolic material (particles about the size of a grain of sand) is injected through the catheter and into these blood vessels, decreasing blood flow to your prostate. This causes it to shrink, thereby improving urinary symptoms.

“PAE is usually performed as an outpatient procedure, and no general anaesthesia is required,” explains Clare Bent. “During the procedure, you’re given a mild sedative but remain awake. A year after PAE, average prostate size is seen to shrink by approximately 30%, easing urinary symptoms, sparing erectile function and increasing quality of life.”

By ensuring men are aware of all treatment options available, they can make informed and empowered health decisions.

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Mark Rochester

Clinical Director of Urology, Norfolk and Norwich University Hospital

Men are receiving robotically assisted benign prostatic hyperplasia treatment in the UK. The method has been proven to preserve continence and sexual function for patients.

A growing number of men are receiving revolutionary treatment to relieve the debilitating symptoms of enlarged prostates. The procedure utilises robotically assisted surgery and a targeted heat-free waterjet to tackle benign prostatic hyperplasia (BPH), where the prostate gland enlarges and causes difficulty passing urine.

Relieving symptoms caused by benign prostatic hyperplasia

Around 3 million men are affected by BPH, with more than 30,000 a year needing surgery, resulting in a backlog of NHS cases. However, with National Institute for Health and Care Excellence (NICE) recommendation of Aquablation therapy, surgeons are hopeful they can not only cut waiting lists using the technique but also provide better outcomes for patients. It was developed by Procept BioRobotics and available for private and NHS patients.

The procedure takes approximately one hour, has little or no impact on sexual function for men and is normally provided as a day case or one-night stay in the hospital. The treatment, also known as transurethral waterjet ablation, is being made more widely available on the NHS.

Treatment options for benign prostatic hyperplasia

Norfolk and Norwich University Hospital introduced the procedure earlier this year. The hospital’s Clinical Director of Urology, Mr Mark Rochester, says offering a range of treatments remains important as every patient is different in terms of priorities and what they want from the treatments.

One standard treatment for BPH is Trans Urethral Resection of the Prostate (TURP), which is effective in relieving urinary symptoms but can damage parts of the prostate gland essential for sexual function. Other options include a three-hour laser technique known as Holmium Laser Enucleation of Prostate (HoLEP) or using steam or stents to open the prostate to allow passage of urine.

Aquablation therapy surgically removes tissue using a robotically-assisted, heat-free waterjet to resect a channel through the prostate while preserving critical anatomy and sexual function. It’s proving to be a fast and cost-effective option with few side effects.

Rochester says: “After creating the surgical plan, the removal of tissue was robotically executed. It’s efficient use of theatre time, and we’re able to send many patients home the same day.” It can have a positive impact on waiting lists and help reduce NHS backlogs.

With Aquablation therapy, patients notice that
improvement in their waterworks after surgery
is quick, and none have had incontinence,
ejaculatory or erectile complications.

Prof. Nikhil Vasdev

Quicker recovery with fewer side effects

Professor Nikhil Vasdev, Consultant Urological and Robotic Surgeon at Pinehill Hospital in Hitchin, Hertfordshire, has recently started conducting the procedure. He says: “With Aquablation therapy, patients notice that improvement in their waterworks after surgery is quick, and none so far have had incontinence, ejaculatory or erectile complications.

One patient was back at work two weeks after the treatment while another, who had a catheter and could not pass urine, returned to work in four weeks and was catheter-free after 24 hours. “We’re seeing quicker patient recovery compared with traditional treatment, an improvement in outcomes and a reduction in side effects,” adds Professor Vasdev. “That is down to precision of the operation.”

Patients reporting on the outcomes and efficacy

One patient who underwent Aquablation therapy for BPH was retired engineer Surjit Sandhu. He was initially admitted to a hospital in Stevenage where his prostate-specific antigen (PSA) levels were found to be high, and he was placed on intravenous antibiotics before being discharged several days later.

With delays in further investigations, he made an appointment with Professor Vasdev at Pinehill Hospital, where it was confirmed that he had an enlarged prostate. “This was the first time I had medical confirmation that it was BPH and that the growth wasn’t cancerous. This was a huge relief,” says Surjit, 71. After discussing treatment options, the Aquablation therapy procedure was carried out.

“I would recommend this treatment to others who are suffering from an enlarged prostate because the recovery period is less compared to other treatments,” he says. “It’s less invasive and more precise.”

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Prof James Green

Consultant Urologist Barts Health and President of the RSM section of Urology

Testicular torsion is a time-critical medical emergency that can have serious long-term implications if not diagnosed and treated promptly.

Testicular torsion is caused by the twisting of the blood supply of the testis, leading to reduced blood flow. If left for a few hours, the testicle could become unsalvageable despite having surgery.

Criticality of testicular torsion

Delay in presentation to a hospital can result in testicular loss, which can have psychological, fertility and cosmetic consequences for young boys. Studies have found that there are several reasons for delay in receiving treatment for testicular torsion within the critical six hours. Delay over 24 hours has been shown to have a low salvage rate, and even testes that seem salvaged at surgery can still be lost within the year.

Lack of torsion education

One of the main reasons for late presentation is lack of awareness among children, parents and teachers. Education about the condition among these groups is urgently needed to explain the importance of seeking help within one hour of having testicular pain that doesn’t resolve.

Delay in presentation to a hospital can result in testicular loss, which can have psychological, fertility and cosmetic consequences for young boys.

How to improve torsion awareness

The ‘Save the Ball’ group — consisting of Professor James Green, Dr Vicky Stubbs, Miss Caroline MacDonald, Miss Nadine McCauley and Miss Shabnam Undre — has been working to promote awareness of this condition as part of personal, social, health and economic (PSHE) teaching in schools.

Fully tested and validated lesson plans and free online resources have been created in conjunction with teachers and students. The PSHE Association has endorsed this and sent out a letter to all schools in England to draw attention to this important health problem and the teaching resource.

However, uptake is sporadic as there is currently little guidance on what health conditions should be taught, so it is difficult for teachers to know which ones to prioritise. That will hopefully change when the Sex Education and Health Curriculum in Schools is reviewed shortly and teaching about torsion is formalised across the whole country.

Prioritising testicular health

Testicular health (torsion and testicular self-examination to diagnose cancer) will hopefully be chosen as highly relevant subjects to teach. Over time, we hope to see a shift in the public’s understanding of testicular torsion; recognition of symptoms; and what action to take. More children will then present earlier to a hospital and reduce the unnecessary loss of testicles that currently occurs, which is preventable. The line ‘I wish I’d known as I would have come sooner and saved my testicle’ can become a thing of the past.

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