Condom Nation?

Viagra and penis-enlargement ads aside, discussions or information about men's reproductive-health matters are, well, hard to come by. But it's not for lack of trying on the part of organizations whose names are decidedly non-sexy.

For the past three years, the National Office of Family Planning, a division of the Office of Population Affairs, has funded 17 pilot projects nationwide to develop and implement reproductive-health services for men. One of these so-called "male initiative projects" has popped up in Vermont. The Man Phone -- a toll-free hotline with a new corresponding Web site -- is a joint product of the Vermont Department of Health and Planned Parenthood of Northern New England (PPNNE). The goal of the federally funded endeavor is to reduce the incidence of sexually transmitted diseases (STDs) and unintended pregnancies by giving guys a clue about safe sex and birth control.

The Man Phone -- 1-888-454-4244 -- was launched in 2001; http://www.themanphone.org [1] went up this April. The two-pronged approach has the potential to expand Planned Parenthood's reach well beyond northern Vermont.

Everybody who knows about "the birds and the bees" may find it odd that men traditionally have not been the targets of sex education. After all, "protection" of the penis would clearly reduce the incidence of both STDs and unwanted babies. Perhaps because women literally bear the consequences -- in the case of heterosexual intercourse -- or because of the sexist cliche that "boys will be boys" and therefore can't be held responsible for their actions, the vast majority of sex-ed research and outreach has been directed at females.

But men do have needs -- for information about their own sexual and reproductive health as well as that of their partners. With overpopulation concerns and an alarming incidence of STDs and AIDS worldwide, that should be amply evident. So what's the problem?

According to Jonathan Chiaravalle, a community educator on the male initiative project for PPNNE, men's own attention to their reproductive health is nothing short of shoddy. Most of them tend to suppress or ignore indications that something may be amiss.

"Asking for Directions," an aptly titled New Hampshire study initiated in 1998, found that, on average, men took themselves to a doctor once every 11 years. And that was only when they were in great pain or had been "nagged beyond belief" by their spouses. The reluctance factor multiplies when it comes to reproductive health. Guys generally dislike putting their privates into professionals' hands, so to speak, and they're anxious about what such an appointment might entail. So many of them go the stoic route.

"Asking for help is embarrassing," affirms Rebecca Brookes, vice president of communications for PPNNE. "Women are encouraged to seek health care, but men have traditionally been expected to be experts, or to "tough it out," she adds. Males who want to break that mold have a hard time.

The Man Phone project is "part of a sea change in family planning," Brookes explains. "We realized we were only talking to half of the population. These projects were a way to acknowledge that men are a crucial part of the equation. The more I work on it, the more excited about it I get."

To determine the most effective means of getting info and advice to men, PPNNE looked to Vermont's five northernmost counties, where the incidence of unintended pregnancies is highest in the state: Franklin, Lamoille, Essex, Caledonia and Orleans. A series of focus groups with 18- to 24-year-old men asked where the holes were in their sexual know-how, and what kind of educational program would best work for them.

Some of the men admitted they didn't know how to put on a condom. Many reported their primary source of sex-health knowledge came from porn films and Web sites -- "not good sources," Brookes notes bluntly. Many men said they needed help talking about birth control, a topic they find fraught with peril. If they carried a condom, they were seen as "expecting the girl to put out," and bad. If they didn't have condoms handy, they were seen as irresponsible, and also bad. As one participant succinctly put it, "We're damned if we do, and we're damned if we don't."

Not least, most of the young men wanted an anonymous format for their initial forays into sex ed.

PPNNE's answer: an automated toll-free hotline emceed by a youthful-sounding, tenor voice, which offers a menu of topics. The hotline is engaging, with concise, direct messages on subjects ranging from safer sex activities ("...if you notice sores or discharge from your partner around the genitals, it may be a good time to suggest a movie"), to masturbation and abstinence.

Initially only men in rural northern Vermont were targeted -- contacted through radio and TV ads and posters -- so that PPNNE could measure the results of the Man Phone outreach. "We're tracking teen pregnancies in those counties," Brookes informs. Recently the hotline opened to Chittenden, Grand Isle and Washington counties. According to Chiaravalle, making it available to all Vermonters is one of PPNNE's long-term goals.

The Man Phone is not without its glitches -- repeated calls to the hotline went unanswered earlier this week (a situation that was remedied immediately when PPNNE was notified). Guys looking for advice before a hot date can visit the Web site, though they shouldn't wait until the last minute -- http://www.theman [2] phone.org is available 24/7 but requires a little fishing around for information. The site makes good use of the Internet's interactive potential in features like a "Condom Sense Quiz," and offers straight talk on safe sex, birth control and even injury prevention of the genitals ("Hitting You There").

"I think it has good info, but I don't think it's organized in a way guys would actually read," opines one young browser. Rather than wading through a "Stud or Dud" page, he suggests, "I think most guys just want to be able to look at the page and get what they need to know."

Guys with attention deficit might find that an in-person visit is best, even if it does sacrifice anonymity. Both the hotline and the Web page invite inquirers to get more in-depth assistance by making an appointment at a Planned Parenthood center, two of which -- St. Albans and Hyde Park -- have specific hours just for men. Since launching the Man Phone, PPNNE has seen more men coming into their centers -- specifically, 58 percent more in the first quarter of this year than before the project began, says Brookes. She calls this result "astounding," especially since the focus-group men had indicated they were uncomfortable going to a facility traditionally associated with women. PPNNE will also make referrals to male doctors in the area, but some young men find they prefer a female. And interestingly, men often take twice as long as women do at their appointments because they have so many questions, Brookes reports. "This is a group that is hungry for information."

That appetite isn't confined to Vermont, of course. Planned Parenthood already has received requests to expand the Man Phone service to other states. "The lessons that we learned in northern Vermont," Brookes predicts, "will be applied throughout the country."