Contrary to stereotypes about sexual performance and masculinity, men interviewed in a large international study reported that being seen as honorable, self-reliant and respected was more important to their idea of masculinity than being seen as attractive, sexually active or successful with women.

The study published in the Journal of Sexual Medicine included interviews with more than 27,000 randomly selected men from eight countries (Germany, U.S., U.K., Spain, Brazil, Mexico, Italy and France), with about 16 percent of the men reporting erectile problems.

Regardless of age or nationality, the men more frequently ranked good health, harmonious family life and good relationships with their wife or partner as more important to their quality of life than material, self-fulfilling or purely sexual concerns. There was no significant difference in rankings of masculinity and quality of life characteristics between men who experienced erectile dysfunction and those who did not.

The study, part of the Men's Attitudes to Life Events and Sexuality (MALES) project, aimed to determine characteristics of masculinity and quality of life in men with and without self-reported erectile dysfunction, and how those ideas of masculinity might affect seeking help and treatment.

"Many meanings, positive and negative, are attached to the term, 'masculinity,'" said Julia Heiman, director of The Kinsey Institute at Indiana University and an author of this study. "To ask a large sample of men what comprises their own sense of masculinity is very useful for both the media and for research. These results suggest we should pay attention and ask rather than presume we know."

Findings of the study include:

Overall, being seen as honorable was considered the most important quality in the construct of masculinity.

Compared to men without erectile dysfunction, the experience of erectile dysfunction neither increased nor decreased the importance men placed on having an active sex life or having success with women, although men with erectile dysfunction reported less satisfaction with their sex lives.

Men who seek treatment for erectile dysfunction do not differ in their views of masculinity from those who do not seek help.

"Being seen as a man of honor" was cited as the most important attribute of masculine identity in Spain, Brazil, Mexico, United States and France, while "being in control of your own life" was the most important in Germany, the United Kingdom and Italy.

The findings emphasize that men across cultures and ages value couple relationships over purely sexual pleasure and indicate that men are particularly concerned about their partnered relationships, whether or not they report erectile dysfunction.

Co-authors include lead author Michael S. Sand, Boehringer-Ingelheim Pharma. Inc., Ridgefield, Conn.; William Fisher, University of Western Ontario, London, Ontario, Canada; Raymond Rosen, New England Research Institutes, Watertown, Mass.; and Ian Eardley, M.D., St. James's University Hospital, Leeds, United Kingdom.