“Am I Masculine?” A metasynthesis of qualitative studies on traditional masculinity on infertility

The mediating role of sexual dysfunction knowledge in the association between sexual function and depression: a large-scale national cross-sectional study in reproductive-aged population

BACKGROUND

Sexual dysfunction (SD) and depression are prevalent issues that significantly affect both physical and mental health.

AIM

This study aimed to explore the association between sexual function (SF) and depression in reproductive-aged population and further examine the mediating role of knowledge regarding the effect of sexual dysfunction on fertility (KSDF).

METHODS

This study enrolled a total of 10 761 participants aged 20-40 from 31 regions, including 5259 males and 5502 females, with a median age of 29.0 years. Basic demographic data were collected initially, followed by clinical data acquisition.

OUTCOMES

The International Index of Erectile Function 5 (IIEF5), the Premature Ejaculation Diagnostic Tool (PEDT), the Female Sexual Function Index-19 (FSFI-19), the Patient Health Questionnaire-9, and the Disease Knowledge Questionnaire.

RESULTS

The study revealed a significant bidirectional association between SF and depression among the population. Specifically, poorer SF was correlated with higher severity of depressive (IIEF5 [β = -0.155, P < .001], PEDT [β = 0.311, P < .001], and FSFI-19 [β = -0.059, P < .001]). Conversely, higher severity of depressive was associated with poorer SF (IIEF5 [β = -0.202, P < .001], PEDT [β = 0.249, P < .001], and FSFI-19 [β = -0.191, P < 0.001]). Furthermore, in males, the KSDF mediated the bidirectional associations between SF and depression. Specifically, the mediating proportions were as follows: KSDF mediated 3.00% of the association between IIEF5 and depression, and 2.20% of the association between PEDT and depression; similarly, for the association between depression and SF, KSDF mediated 2.50% of the association between depression and IIEF5 and 2.20% between depression and PEDT. However, no such mediation was observed in females.

CLINICAL IMPLICATIONS

This provides new insights for the clinical management of these issues in the male reproductive-aged population.

STRENGTHS AND LIMITATIONS

These findings suggest that enhancing this knowledge could interrupt bidirectional association between impaired SF and depression in this demographic, potentially alleviating both conditions without requiring additional interventions. However, cross-sectional study design does not allow us to draw corresponding causal conclusions.

CONCLUSION

The current study further demonstrated a significant bidirectional association between SF and depression among the reproductive-aged population, and importantly, the KSDF was found to mediate this association in males.

Exploring men's struggles with infertility: A qualitative content analysis

AIM

To investigate the experiences of men struggling with infertility.

DESIGN

This is a qualitative study, and the report follows the COREQ checklist.

METHODS

A team of nurse researchers conducted this research in Iran to examine the experiences of 11 men with primary infertility. The participants were selected through targeted sampling and underwent in-depth semi-structured interviews. The data collected was analysed using the conventional content analysis method outlined by Krippendorff. To ensure the study's accuracy, it followed the criteria proposed by Lincoln and Guba.

RESULTS

The central theme, "the threat to masculinity," was identified upon analysis. It comprises six categories: psychological pressure of confronting reality, frustration, discomfort with others, holding out against ridicule, tolerating unwanted opinions and advice and concealment of infertility and therapy.

CONCLUSION

This study brings attention to the challenge to masculinity that men with primary infertility face as their central struggle. It highlights the importance of culturally sensitive care from healthcare professionals, emotional support, counselling services and public awareness to reduce the stigma surrounding male infertility. It can be valuable to evaluate and enhance infertility care in various settings.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

To provide the best possible care for infertile men, it would be beneficial for nurses to pay more attention to sociocultural factors. Fertility care should be respectful of patients' beliefs and backgrounds.

IMPACT

WHAT PROBLEM DID THE STUDY ADDRESS?: Infertility care has been the subject of recent research, focusing on the impact of sociocultural factors. Male-factor infertility is often overlooked in clinical care literature. There is a correlation between cultural background and men's acceptance of reproductive healthcare. WHAT WERE THE MAIN FINDINGS?: Male infertility is often avoided in discussions due to its perceived threat to masculinity. Multiple factors, including societal norms, cultural expectations and personal experiences, influence the nature of men's struggles with infertility. Providing emotional support and counselling services is crucial so that men can openly discuss their fertility challenges and seek treatment without feeling ashamed or judged. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Raising public awareness and providing education about male infertility is crucial. Nurses must exhibit cultural sensitivity while caring for men experiencing infertility. Policymakers need to implement strategies to reduce the stigma surrounding male infertility.

REPORTING METHOD

The study is reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ).

PATIENT OR PUBLIC CONTRIBUTION

No public or patient involvement.

Psychosocial Impact of Infertility Diagnosis and Conformity to Gender Norms on the Quality of Life of Infertile Spanish Couples

Epidemiological data show that human reproductive disorders are a common problem worldwide, affecting almost one in six people of reproductive age. As a result, infertility has been identified by the World Health Organization as a public health disease. Reproductive problems can take a heavy toll on the psychosocial well-being of couples suffering from infertility. This is especially true for women, who tend to be the ones who undergo the most treatment. The main objective of the present study is to find out whether a sex-based infertility diagnosis influences the quality of life of couples with infertility. Also, we aim to find out whether the degree of adherence to gender norms influences their quality of life. A cross-sectional study was conducted using the Fertility Quality of Life Questionnaire (FertiQoL) and the Conformity to Feminine and Masculine Norms Inventories in a sample of 219 infertile Spanish couples (438 participants). The results show that, in all cases, regardless of the degree of conformity to gender norms and whether the infertility diagnosis was of female or male origin, women have lower scores on the self-perceived quality of life. This suggests that being female is already a psychosocial risk factor when assessing the psychosocial consequences of infertility.