“I cannot take time off from work to recover from the surgery. I need to provide for my family. Is there anything else that can help me?” were the words from Mr Hernandez, a 57-year-old immigrant from El Salvador with severe erectile dysfunction (ED). This led to a 30-minute conversation between the patient and his surgeon, who tried to figure out what was the best way to approach the conversation with his Latino patient. Mr Hernandez left the office, did not schedule surgery, and was lost to follow-up. Are there any specific factors that impact sexuality in Latino men? Should the surgeon take a different approach with his Latino patient in regard to penile prosthesis surgery?

El Latino is a person whose origin is from the group of Spanish- and Portuguese-speaking countries in America. The Latino culture has 3 major influences: Native American culture, European culture that strongly impacted the language, and African culture, with its main impact in Caribbean countries and Brazil. These 3 influences merged together at different ratios in each country to compose what we believe is the Latin American culture. However, we are talking about innumerable regions in over 30 different countries, each with their unique and distinct cultures, dialects, and religious and political views. Therefore, when we see a Latino man come into our urology clinic, we should at least consider his background when we try to discuss how to improve his sexual health.

Sexuality is affected and expressed differently for all individuals depending on their education, background, religious views, and social interactions. Factors that impact sexual health in Latino men include socioeconomic disparities, religion, fatalism, familism, and machismo. According to a survey conducted by KFF, an independent source for health policy research, polling, and news, 56% of Hispanic immigrants have annual household incomes of less than $40,000.¹ Secondary to these socioeconomic factors, Latino men are less likely to take time off from work for a surgical procedure or a medical evaluation, or have health insurance that will cover their clinical care.

As urologists, we constantly see how religion can impact sexuality for many of our patients. Religion and spirituality have made a strong impact in Latin American culture. El “susto,” which translates to “fright” or “fear,” comes from the concept of a “spirit attack” that can cause a specific symptom. Others believe in the “mal de ojo” or “evil eye,” which refers to the supernatural believe in a curse. I’ve seen men in my clinic who believe their ED or Peyronie’s disease is secondary to “mal de ojo.” Spirituality in Latin American culture is occasionally associated to “fatalismo” (fatalism), which is the belief that we have no control over what will happen in the future. Some men may believe that ED is “God’s will,” and this may result in a psychological obstacle for those who require more invasive treatments.

Many Latino men put their family’s needs above themselves. This is the concept of “familismo” (familism), which describes the Latin American’s dedication, commitment, and loyalty to family. We witness this regularly in our surgical waiting rooms, in which we often see extended family members making sure our patient’s major or even minor surgery went well. I once had a patient tell me they had to wait for their penile implant surgery until the following year because this year the family was focusing finances on his granddaughter’s big “quinceañera party.”

Last, but not least, we need to consider machismo, which has a strong and specific impact in our Latino patients’ sexual health. Machismo refers to a man’s strong sense of masculine pride. Some men see themselves as the invincible “alpha male.” Ever since childhood, “El macho” is taught that he needs to be strong, tough, and sometimes coldblooded. El macho does not talk about being afraid, hurt, sick, or having ED. We sometimes need to “dig out” the severity of our El macho’s ED. El macho may come to your urology clinic for ED but initially tell you or your staff that they are there for a “prostate check.” They will sometimes deny they have ED, and when asked specifically about their ability to gain or maintain an erection, they end up disclosing they have not been able to penetrate in years. In other occasions, they may seek out an extramarital affair, blaming their partner for their ED before admitting to themselves that they have a physical problem.

In my experience, when it comes to sexual health, machismo is more prominent in men from Central American countries. For example, a man of Mexican origin might not be as open about his sexual problems when compared to a man of Cuban or Dominican origin. Some “macho” men will hide their ED problems not only from their doctors, but even their lifelong partners. It is important that as urologists and sexual health advocates that we help bring up the conversation. We need to take into account these cultural factors. We need to not only have a thorough conversation about their sexual health, but also try to help our patients identify and define what they see as a successful ED treatment. Is it to have spontaneity? Something that is reliable? Know that they “can perform”? Have the “hardest erection”? Not lose any more size?

Should the urologic surgeon take a different approach with his Latino patient in regard to penile prosthesis surgery? I say yes, and at the same time, maybe not so much. Why? We need to understand that despite El Latino’s socioeconomic disparities, cultural background, language barriers, and even machismo, we are treating men with ED. It is our responsibility to remind them that we are the gatekeepers of sexual function, and we have a reliable solution for them: the penile prosthesis.