The internet and economic transformations have created major ethical challenges in sexual medicine, including non-evidence-based information, exploitation of male anxiety about penis size, unregulated dietary supplements, and significant barriers to accessing sexual healthcare globally.
Key Findings
Results
The internet has promoted non-evidence-based sexual health information that can contribute to sexual dysfunctions, sexual exploitation, and cyberbullying alongside its valuable contributions to sexual health education.
The review was conducted through wide searches in PubMed and Google and on global websites relevant to the topic, including the World Health Organization and the United Nations
The paper identifies the internet as a dual-edged tool: valuable for disseminating sexual health education while simultaneously enabling harm
The internet has contributed to sexual exploitation and cyberbullying as specific harms identified in the review
Content was reviewed by all authors, with disagreements discussed and additional perspectives and literature incorporated
Results
An internet-based industry promoting dietary supplements for sexual health has risen, with products ranging from ineffective to dangerous due to adulteration.
Liberal, unfettered marketing has enabled dissemination of products that 'at best, do not deliver the desired result, and at worst, are adulterated and become a threat to individual and public health'
The review identifies this supplement industry as a specific ethical concern in the field of sexual medicine
The rise of this industry is framed as a consequence of major economic transformations in the field
Adulterated products are characterized as a threat to both individual and public health
Results
Advertising of penis enlargement techniques exploits male anxiety about penis size without evidence to support the efficacy of these techniques.
Men's anxiety about penis size is specifically identified as being exploited in the context of false advertising
The review states there is no evidence to support the efficacy of advertised penis enlargement techniques
This exploitation is framed as an ethical issue within the broader context of non-evidence-based practices in sexual medicine
The concern about genital performance and aesthetics is identified as one of the major transformations in the field of sexual medicine in recent years
Results
Economic barriers significantly impede men's access to sexual healthcare across many parts of the world.
Three specific barriers are identified: lack of coverage by health plans, lack of trained professionals, and costs of exams and treatments
These barriers are described as impeding access to sexual healthcare 'in many parts of the world,' indicating a global scope
Economic transformations are identified as having increased barriers to both better care and sexual education
The lack of trained professionals is listed alongside financial barriers as a structural impediment to care
Conclusions
The review recommends that doctors inform patients of the risks of non-evidence-based practices and that the International Society of Sexual Medicine produce publicly accessible evidence-based information and work toward solving economic barriers.
Two specific recommendations are directed at physicians: informing patients of risks of non-evidence-based practices
The International Society of Sexual Medicine (ISSM) is specifically called upon to produce evidence-based information accessible to the general public
The ISSM is also called upon to 'seek to work toward finding solutions to existing economic barriers'
These recommendations emerged from a narrative review conducted under the Fifth International Consultation on Sexual Medicine (ICSM 2024)
What This Means
This research paper, produced as part of the 2024 International Consultation on Sexual Medicine, reviewed the ethical and economic landscape of sexual medicine today. The authors found that while the internet has helped spread sexual health education, it has also become a vehicle for harmful misinformation, exploitation, cyberbullying, and a largely unregulated industry selling dietary supplements for sexual health. Many of these supplements are ineffective, and some are contaminated or adulterated in ways that pose real health risks to consumers. Advertisers have also specifically targeted men's anxieties about penis size, promoting enlargement techniques that have no scientific evidence supporting their effectiveness.
The paper also highlights significant economic and structural barriers that prevent people — particularly men — from accessing legitimate sexual healthcare. These barriers include the cost of medical exams and treatments, lack of insurance coverage, and a shortage of properly trained healthcare professionals, problems that affect people across many regions of the world. These systemic issues mean that people who cannot access quality care may be more likely to turn to unregulated internet-based products and information.
This research suggests that the medical community has a responsibility to actively counter these trends. The authors call on individual doctors to counsel patients about the risks of non-evidence-based treatments and urge the International Society of Sexual Medicine to create trustworthy, publicly accessible sexual health information and to advocate for solutions to the economic obstacles that limit access to proper care. The findings point to a need for better regulation of health product marketing and greater investment in sexual healthcare access globally.
Glina S, Pearlman A, Sharlip I, Edler Zandoná P, Ghanem H, Abdulcadir J, et al.. (2025). The ethical and economic aspects of sexual medicine: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024).. Sexual medicine reviews. https://doi.org/10.1093/sxmrev/qeaf028