A sixty-one-year-old man sat across from me in my Atlanta clinic last week and, in the course of explaining a urinary symptom that had been worsening for two years, said: I haven't really looked at it in maybe forty years.
He meant his own penis. He had been showering with it, urinating through it, occasionally having sex with it. He had not, since some unspecified time in his early twenties, deliberately looked at his own genitals. He had no consistent sense of how they had changed. He had not, in his report, ever palpated his own testicles for routine self-exam. He did not, when asked, know whether his urinary stream had been declining gradually or had changed suddenly, because he had not been paying attention to his urinary stream until it became loud enough to demand attention.
This is, in my fifteen years as a urologist treating men, not an unusual conversation. It is, in fact, the modal conversation. Most of the men who walk into my exam room have, in adulthood, a strikingly remote relationship to the part of their body I am being asked to assess.
I want to write about that remoteness — what produces it, what it costs, and what we, collectively, could do about it.
The cultural script American men inherit about their own genitals is, on its surface, contradictory. The penis is, in mainstream culture, both omnipresent and unmentionable. It is the subject of constant joking and the subject of almost no serious conversation. It is, by the standards of pornographic media consumption, intensely visually familiar, and by the standards of self-knowledge, almost entirely opaque.
The script communicates several things, none of them stated explicitly:
Your genitals exist for sexual performance. The performance is the metric. The body underneath the performance is, fundamentally, instrumental.
Pain or dysfunction in this area is shameful. It indicates failure of the instrument. The appropriate response is silence.
The medical evaluation of this region is, on some unspoken level, feminizing or threatening to your status. Going to the urologist for sexual symptoms is a thing other men do not need to do.
Your own attention to this part of your body, outside of sexual contexts, is suspect. Looking, touching, palpating, examining — these are things you do not, as an adult man, do to yourself in a non-sexual way.
The cumulative effect of this script, in the men I see, is a profound under-occupation of the lower body. They live, functionally, from the navel up. The pelvis is a region they have ceded — partly to their partners, partly to the medical system when something goes catastrophically wrong, and mostly to nobody, which means the region goes effectively unattended for decades.
The cost of the unattendance is the bulk of what walks through my exam room door.
Let me describe what gets lost.
Erectile dysfunction. ED is, depending on the population studied, present in something like forty percent of men over forty and the majority of men over seventy. It is, in many cases, treatable. It is, in many other cases, the earliest clinical sign of cardiovascular disease — endothelial dysfunction shows up in the smaller penile arteries before the larger coronary arteries. A man who presents with ED in his early fifties may be presenting, two or three years in advance, with the warning sign of the heart attack he will have in his late fifties. Men who do not raise ED with a clinician miss this window. Many of them die in their late fifties of cardiac events that were, in retrospect, foretold in their bedrooms.
Pelvic pain. Chronic pelvic pain syndrome in men — pain in the perineum, the genitals, the pelvic floor — is common, frequently misdiagnosed as chronic prostatitis or interstitial cystitis, and very often a manifestation of pelvic floor muscle dysfunction that responds well to pelvic floor physical therapy. Pelvic floor PT for men is, in 2026, still vastly underutilized. Most men do not know it exists. Most men, on first hearing about it, decline to engage with the idea because the practice involves a clinician palpating muscles in a region the man has been culturally trained to refuse to discuss. The cost of the refusal is, in many cases, years of pain that could have been resolved in six to twelve weeks of skilled PT.
Incontinence. Post-prostatectomy incontinence, age-related changes in continence, even early symptoms of overactive bladder — these are routinely under-reported by men who would, in many cases, benefit substantially from behavioral, pharmacologic, or surgical interventions. Men buy adult absorbent products in significant quantities. They do not, in proportion, bring up the underlying continence problem with their physicians. They manage privately, often for years, what could be addressed clinically.
Testicular and prostate cancer. Both are, in early detection, very treatable. Both depend on either patient-initiated screening (testicular self-exam) or appropriate engagement with primary care screening (digital rectal exam, PSA, depending on guidelines and risk). Men who have been culturally trained not to examine themselves and not to discuss this region with clinicians present, on average, later, with larger tumors, and worse outcomes.
Sexual quality of life. Beyond the pathological — many men are walking around with sexual experiences that are, by any honest internal report, less rich, less connected, less satisfying than they could be, in part because they have never had a conversation with a knowledgeable clinician about their own anatomy, their own arousal, their own pelvic floor function, or the relationship between any of these and their broader emotional state. The medical system does not, in most cases, offer this conversation. The cultural script does not invite it. Most men, accordingly, do not have it.
I want to make a careful claim about gender and embodiment here.
Women, in the cultures I have practiced in, also experience cultural scripts that distance them from their bodies — and the literature on women's sexual and reproductive health under-recognition is extensive and serious. I am not arguing that men have it uniquely bad.
I am arguing that the specific shape of the male distancing — the combination of compulsory performance, prohibited examination, and stigmatized clinical engagement — produces a pattern of avoidance that medicine has been comparatively slow to address. Women, in part because of decades of feminist health activism, are more likely than men to be in conversation with clinicians about reproductive and sexual health, to be receiving age-appropriate screenings, and to have peer networks in which these topics are discussable. Men, in 2026, are still, on average, in a relationship with their own pelvis that resembles the relationship women had with theirs in approximately 1965.
The catch-up is, in part, the work of clinicians like me, who can normalize the conversation in our exam rooms. It is, in part, the work of cultural production — articles like this one, but also podcasts, depictions in mainstream media, partner-facing education. And it is, in significant part, the work of individual men, in middle age, deciding that the inherited script is no longer worth the cost.
What I want to give you, as the practical part of this piece, is permission and a starting list.
You are allowed to look at your own body. Including the parts below the waist. Including non-sexually. Including with curiosity and care. A monthly testicular self-exam takes approximately ninety seconds in the shower. The American Urological Association has clear instructions. The exam saves lives. It also, in a quieter way, communicates to your nervous system that this part of you is allowed to be attended to.
You are allowed to know your own urinary stream. How strong it is. Whether you are emptying completely. How often you go at night. Whether anything has changed in the past year. These are not, despite what culture suggests, embarrassing things to track. They are clinically useful baseline data.
You are allowed to know your own erections. The frequency of morning erections is, clinically, a useful signal of vascular and hormonal status. A meaningful change in this — particularly a sustained drop — is a thing to bring to a clinician. It is, again, data, not a referendum on your worth.
You are allowed to have pelvic-floor awareness. Most men have no conscious sense of their pelvic floor as a muscular structure. You can find it: it is the muscle group that stops the flow of urine mid-stream, and that supports the pelvic organs. You can, with practice, learn to engage and release it. A pelvic floor PT can, in two or three sessions, give you more functional awareness of this region than most men have in a lifetime. The investment, in my experience, pays out in sexual function, in continence, in pelvic comfort, and in a generally less ceded relationship with the lower half of your body.
You are allowed to bring sexual or urologic concerns to a clinician. Despite what the cultural script says, urologists see this all day. You are not, in our exam room, unusual. You are not, in any way, less of a man for being there. We have, in nearly all cases, multiple treatment options. The longer you wait, the fewer of them apply.
The scripts on this site — the conversation script for ED, the script for low libido — were built precisely for the opening conversation. They are not magic. They are sentences other men, in your position, have used, that we, in clinical practice, have learned to welcome.
If the conversation needs to happen with a partner before it can happen with a clinician — the script for raising ED with your wife and the partner-side response may help. Many men come to me, in my practice, because their partner first opened the conversation. The opening did not, in their report, diminish them. It restored them to a body they had been ceding to silence.
I want to close with a sentence I find myself saying, increasingly often, to men in my exam room when they apologize — and they routinely apologize — for the symptom that has brought them in.
I say: your body is a place you are allowed to live. All of it. Including this part. There is no part of you that is off-limits to your own attention or care. The script that taught you otherwise has cost you something. You are allowed, starting today, to stop paying it.
Most of them, the first time they hear it, look down at their hands. Several of them, in the privacy of an exam room, cry briefly. None of them, in fifteen years, has disagreed with me.
The script is a script. It is not your body. Your body has been waiting for you to come home. The door is on the inside.
If you have been postponing a urologic appointment, the scripts for talking to your doctor about ED and low libido were written for the opening line. Pelvic floor PT for men is available through most major academic medical centers and through specialized private practices; search for male pelvic floor physical therapy + your city. The Atlanta men's-issues therapist list includes clinicians experienced in the emotional dimensions of sexual health concerns. AUA self-exam instructions at urologyhealth.org. Rashida Johnson, MD, is a board-certified urologist in clinical practice in Atlanta since 2011.