Implementation of Men’s Reproductive and Sexual Health Services into the Primary Healthcare Level in Ukraine: A Conceptual Vision and Approaches

Abstract

Men are one of the most vulnerable population groups regarding premature mortality, low adherence to preventive measures, and late presentation for medical care. In Ukraine, these issues have been exacerbated by the demographic crisis and the full-scale war, which are accompanied by a growing burden of chronic diseases, psycho-emotional disorders, and sexual and reproductive health impairments. Purpose is to substantiate the feasibility of integrating men’s sexual and reproductive health services into the primary healthcare system of Ukraine and to propose a conceptual framework and implementation approaches, taking into account international experience, current clinical guidelines, and the specificities of the functioning of the national healthcare system. Materials and Methods. The study is conceptual and analytical, carried out in three consecutive stages. At the first stage, national demographic and medical-statistical information was analyzed (data from the State Statistics Service, the Ministry of Health of Ukraine, the Ministry of Social Policy, the National Cancer Registry, the National Health Service of Ukraine, as well as GBD 2023 data and WHO reports). At the second stage, a targeted search of scientific literature and regulatory documents for 2018–2025 was carried out, based on which three countries with a high level of integration of men’s health services into primary care were selected for comparative analysis: Australia, the Netherlands, and the United States. At the third stage, a five-component conceptual framework for a unified service model and a three-level concept of approaches to its implementation (educational, protocol, and financial levels) were developed. Results. The analysis showed that men’s sexual and reproductive health can be viewed as an indicator of general health status and an important component of non-communicable disease prevention. A conceptual framework is proposed, which includes five interrelated areas: early diagnosis of erectile dysfunction and lower urinary tract symptoms using the validated IIEF-5 and IPSS questionnaires; preconception counseling; prevention, diagnosis, and treatment of sexually transmitted infections, including counseling regarding pre-exposure prophylaxis for HIV; risk-oriented counseling for early detection of prostate cancer; and mental health screening using the PHQ-9, GAD-7, and PCL-5 questionnaires. A three-level implementation concept is proposed, covering the educational component (training of physicians within the continuous professional development system), the protocol component (development of clinical pathways and digital checklists integrated into the electronic health system), and the financial component (adaptation of the mechanisms of the Program of Medical Guarantees to incentivize the provision of relevant services). Conclusions. The statistical profile of men’s health in Ukraine indicates a systemic crisis that requires a structural response from the primary care level. Men’s sexual and reproductive health is a “window” to their overall health status: erectile dysfunction, infertility, and sexually transmitted infections are markers of systemic disorders rather than isolated problems, and their detection at the primary care level allows for the diagnosis of pathological processes at early stages. The proposed five-component framework and three-level implementation concept can be implemented within the existing primary healthcare infrastructure in Ukraine, provided there is appropriate training, protocol support, and a financial mechanism. The use of standardized screening tools, family physician training, digitalization of clinical processes, and improvement of financial mechanisms create preconditions for early disease detection, increased accessibility of preventive services, and improved men’s health indicators. A promising direction for further research is assessing the readiness of family physicians to implement the proposed model and identifying their educational, organizational, and regulatory needs.