By Dr Vic Albert, MBChB, MMed (Urology) | Specialist Urologist
Men’s sexual health is about much more than erections or sexual performance. It includes fertility, testosterone and hormonal health, ejaculation, urinary function, psychological wellbeing and the ability to maintain healthy intimate relationships.
Yet many men delay seeking medical attention because of embarrassment, misinformation or the belief that sexual problems are simply part of getting older.
According to Dr Vic Albert, Specialist Urologist, improving men’s health in Kenya starts with open conversations, early medical assessment and greater awareness of the conditions that affect male fertility and sexual function.
In this guide, we explore the relationship between lifestyle and sexual health, the causes of male infertility, the risks associated with testosterone boosters, and practical steps men can take to protect their reproductive health.
One of the most persistent misconceptions about infertility is that it is primarily a woman’s responsibility. In reality, male factors can contribute to infertility on their own or alongside female factors.
Infertility is a couple’s health concern, and both partners should be evaluated.
Male infertility can result from several conditions, including:
Low sperm production or poor sperm quality.
Reduced sperm motility, meaning sperm do not move effectively.
Blockages in the reproductive tract.
Hormonal imbalances.
Genetic conditions.
Previous infections or testicular injury.
Varicocele, an enlargement of veins around the testicle.
Certain medications and cancer treatments.
A man may have normal sexual desire, achieve firm erections and ejaculate normally while still having significant fertility problems.
This is because sexual performance and fertility are different things. Semen is the fluid released during ejaculation, while sperm are the reproductive cells contained within it.
A specialist assessment may include a detailed medical and reproductive history, physical examination and semen analysis. Depending on the findings, hormonal blood tests, genetic investigations or imaging may also be appropriate.
Both partners should ideally begin their fertility assessments at the same time, rather than allowing months of unnecessary delay or placing blame on one person.
Men can father children later in life, but male reproductive ageing is real.
As men grow older, sperm quality may gradually decline. Changes can include reduced sperm motility and increased sperm DNA damage. Health conditions such as diabetes, obesity and hormonal disorders may further affect reproductive function.
Unlike women, men do not experience a clearly defined biological menopause. However, the ability to father children should not be confused with having completely unaffected fertility.
Men should pay attention to their reproductive health from early adulthood, especially if they have risk factors such as:
A history of undescended testes.
Previous testicular surgery or injury.
Significant varicocele.
Previous fertility difficulties.
Planned chemotherapy or other treatment that may damage sperm production.
Men planning to delay fatherhood substantially, particularly those facing potentially fertility-damaging treatment, should discuss their options with a urologist or fertility specialist.
The same lifestyle choices that affect cardiovascular health can also affect erectile function and male fertility.
Important risk factors include physical inactivity, obesity, smoking, excessive alcohol consumption, recreational drug use, chronic stress and inadequate sleep.
Excess body weight is associated with hormonal changes, poorer sperm parameters and an increased risk of erectile dysfunction. Abdominal obesity can also contribute to diabetes and vascular disease, both important causes of erection problems.
Smoking damages blood vessels and is associated with adverse effects on sperm quality and sperm DNA. Damage to blood vessels can also compromise the blood flow required for an erection.
Excessive alcohol consumption can interfere with testosterone production, sexual performance and sperm production, particularly with chronic heavy use.
Diet matters, but there is no single miracle food that guarantees fertility or sexual performance.
A balanced diet, regular physical activity, a healthy weight, adequate sleep and good control of blood pressure, diabetes and cholesterol are more useful long-term goals than relying on products marketed as fertility boosters.
A practical principle: what supports your cardiovascular health generally supports your sexual health, too.
Erectile dysfunction (ED) is the persistent difficulty achieving or maintaining an erection sufficient for satisfactory sexual activity.
It is common for men to experience occasional erection difficulties, particularly when tired, stressed or affected by alcohol. Repeated or persistent problems, however, deserve medical attention.
Possible causes include:
Diabetes and hypertension.
High cholesterol and vascular disease.
Obesity and physical inactivity.
Hormonal disorders.
Certain medications.
Smoking and excessive alcohol use.
Anxiety, depression and relationship difficulties.
An erection depends on coordinated activity involving the brain, nerves, hormones, blood vessels and psychological state. Problems in any of these areas can affect sexual function.
Yes. Performance anxiety can create a cycle in which one episode of erection difficulty leads to fear of failure during the next sexual encounter. That anxiety may itself interfere with the ability to achieve or maintain an erection.
Work pressures, financial stress, relationship conflict, depression and poor sleep can contribute.
Treatment should address the underlying cause. Depending on the individual, this may involve lifestyle changes, management of medical conditions, appropriate medication, counselling or psychological support.
Erectile dysfunction should not automatically be interpreted as a lack of attraction to a partner or a failure of masculinity.
Importantly, ED can sometimes be an early warning sign of an underlying cardiovascular or metabolic condition. Men with persistent symptoms should not simply dismiss them as ageing.
The pelvic floor is a group of muscles that supports the bladder and bowel and contributes to urinary continence, ejaculation and sexual function.
Men can develop pelvic floor dysfunction after prostate or pelvic surgery, injury, neurological conditions, chronic straining or prolonged muscle tension.
A weak pelvic floor may contribute to urinary leakage, particularly after prostate surgery. Conversely, an excessively tight or overactive pelvic floor may contribute to pelvic pain, urinary symptoms, painful ejaculation and sexual dysfunction.
Pelvic floor exercises can help some men, but repeated contractions are not the answer for everyone. Men with an overactive or painful pelvic floor may benefit more from relaxation techniques and assessment by a suitably trained physiotherapist.
Persistent pelvic or genital pain, urinary leakage, painful ejaculation or unexplained sexual symptoms should be evaluated rather than automatically attributed to weak muscles.
Testosterone is important for male sexual function, muscle mass, bone health and general wellbeing. However, taking testosterone from outside the body can have a serious and sometimes unexpected effect on fertility.
Yes. External testosterone can suppress the hormonal signals from the brain that stimulate sperm production in the testes. As a result, sperm counts can fall substantially, sometimes to zero in the ejaculate.
This means a man taking testosterone may feel stronger or notice changes in sexual symptoms while his ability to father a child is being compromised.
Men who are trying to conceive should not self-medicate with testosterone injections, gels or bodybuilding hormones.
Products marketed as “natural testosterone boosters,” “male enhancement” supplements or herbal sexual-performance remedies also deserve caution. Some unregulated products may contain undeclared drugs or hormones.
Do not rely on gym recommendations or online supplements to diagnose or treat the problem. Seek a medical assessment to establish whether testosterone deficiency is present, investigate possible causes and discuss treatment options that take your fertility plans into account.
If you are planning to have children, tell your doctor before starting any hormonal treatment.
Several misconceptions prevent men from seeking appropriate care.
Myth 1: If a man can achieve an erection, he must be fertile.
Fact: Erection quality does not establish sperm count or sperm quality. A man can have normal erections and still experience infertility.
Myth 2: Producing semen means a man has sperm.
Fact: Semen and sperm are not the same thing. A man may ejaculate normally while having very few sperm or none detectable in the ejaculate.
Myth 3: Testosterone treatment improves fertility.
Fact: External testosterone can suppress sperm production. Men planning to conceive should discuss fertility-preserving approaches with a qualified clinician.
Myth 4: Erectile dysfunction is always psychological.
Fact: ED can arise from vascular disease, diabetes, medication effects, hormonal problems, psychological factors or a combination of causes.
Myth 5: Erectile dysfunction is an inevitable part of ageing.
Fact: Age increases the risk, but persistent ED deserves assessment because treatable underlying conditions may be present.
Myth 6: Seeking help for sexual problems is a sign of weakness.
Fact: Sexual dysfunction is a health concern, not a measure of masculinity. Seeking help early can improve health, relationships and quality of life.
Men in their 20s, 30s and beyond can take practical steps to protect their long-term reproductive health.
Avoid smoking and tobacco products.
Exercise regularly and maintain a healthy weight.
Eat a balanced diet rather than relying on male-enhancement supplements.
Avoid recreational drugs and anabolic steroids.
Limit alcohol consumption and avoid excessive drinking.
Get adequate sleep and manage persistent stress.
Practise safer sex and seek prompt assessment for possible sexually transmitted infections.
Do not ignore testicular lumps, pain, swelling or changes in size.
Have conditions such as diabetes, hypertension and high cholesterol assessed and managed.
Seek medical advice early for persistent erection difficulties, ejaculation problems or difficulty conceiving.
Men should also tell their healthcare professional about all medications, supplements and hormonal products they use, especially when planning a pregnancy.
Sexual health is not measured solely by how frequently a man has sex or how long he maintains an erection. It also includes reproductive function, urinary health, hormonal wellbeing, psychological health and healthy
Improving men’s sexual health in Kenya requires more than treating problems after they become embarrassing or disruptive.
Men need access to routine medical check-ups, accurate information and appropriate urological and fertility services.
Greater awareness is particularly important in three areas.
Early assessment: Diabetes, hypertension, obesity and cardiovascular disease may affect erectile function before other obvious symptoms develop.
Shared responsibility for fertility: Men should be assessed alongside their partners rather than assuming infertility is the woman’s problem.
Safe, evidence-based treatment: Online advertisements and unregulated markets can encourage men to buy testosterone boosters, herbal sexual products and erection medication without proper assessment.
Erectile dysfunction, infertility, premature ejaculation, low libido and pelvic pain are medical concerns—not failures of masculinity.
Open conversations help men seek care earlier, avoid potentially harmful products and make informed decisions about their health.
Yes. Erectile dysfunction and infertility are different conditions, although they may coexist. A man with ED may have normal sperm production, while another man with normal erections may have impaired fertility. Each concern should be assessed appropriately.
Yes. A condition called azoospermia means that no sperm are detected in the ejaculate on appropriate testing. Men with this finding require further assessment to identify the cause and discuss possible treatment or fertility options.
External testosterone can suppress the body's hormonal signals for sperm production and may cause a substantial reduction in sperm count. Men who wish to father children should consult a qualified clinician before using testosterone or hormonal bodybuilding products.
A common clinical guide is to seek an infertility assessment after 12 months of regular unprotected intercourse without conception, or after six months when the female partner is aged 35 or older. Earlier assessment is appropriate when either partner has known fertility risk factors or relevant symptoms.
No. ED may be related to blood vessel disease, diabetes, medication effects, psychological factors, hormonal disorders or several causes together. A proper assessment helps determine which factors are relevant.
Lifestyle changes such as regular exercise, weight management, smoking cessation, adequate sleep and control of diabetes and blood pressure may improve erectile function, particularly when metabolic or vascular risk factors contribute.
Men should be cautious about products marketed as male enhancement or testosterone boosters. Some contain undeclared ingredients, and supplements may delay diagnosis of an underlying condition. Persistent symptoms deserve medical assessment.
Consider a urological assessment for persistent erectile dysfunction, difficulty conceiving, abnormal semen results, testicular lumps or swelling, painful ejaculation, persistent pelvic pain or troublesome urinary symptoms.
Sudden severe testicular pain requires urgent medical assessment.
A sexually healthy man is not simply one who can achieve an erection. Sexual health encompasses fertility, hormonal function, urinary health, psychological wellbeing, intimacy and overall quality of life.
If you have concerns about male fertility, erectile dysfunction, testosterone levels, ejaculation or other urological symptoms, seeking appropriate medical advice is an important first step.
Dr Vic Albert is a Specialist Urologist with interests in endourology, complex stone surgery, urological oncology and minimally invasive urological care. He advocates for evidence-based men's health education and early assessment of sexual and reproductive health concerns.
Need a urological assessment? Contact the practice to enquire about a consultation.
Medical information disclaimer: This article is intended for general educational purposes and does not replace an individual medical consultation, diagnosis or treatment plan.