Wednesday, August 25, 2010
Male modesty is a subject that’s generally ignored in our society. Very little documentation is available to even discuss it intelligently. I know physicians who believe that their male patients are more modest than the ladies, yet almost nothing is written about this. To be clear, let me clarify that I am talking about modesty concerning ones own body. A recent study has touted that male modesty is looked down upon by society, but they were referring to the trait of humility or a perceived absence of aggressiveness, especially in the business world. But medical modesty isn’t respected either. What percentage of men are modest in a medical situation? It would perhaps be clearer to ask a similar question, what percentage of men are embarrassed by being exposed in a medical situation? I would guess that over half are, but it is rarely a subject for discussion.
Is this any different from the situation that women face? There is no doubt that exposure in medical settings is common for both male and female patients. On the whole though, the medical establishment is far more sensitive to female modesty than to male modesty. Examples can be found on the other blog. One poster related that he had a testicular ultrasound done by a female technician. As he was leaving, the tech told a waiting woman that her ultrasound was to be done by a male technician, but she could wait until the women tech was again free. No such courtesy was offered to the male patient. Obviously men are at a disadvantage in that medical personnel outside of physicians are overwhelmingly female. But little attempt is made to offer gender choice to men when available. Even in most Urology offices, men are given no choice of personnel for intimate procedures. I once questioned my urologist about this. He freely admitted that many men are clearly embarrassed when a woman assists on a urologic procedure. He even observed that the embarrassment was more pronounced when the assistant was a young woman. When I asked why they didn’t hire men, he explained only that they couldn’t find any to hire. Clearly though the practice had made no concerted effort to hire men.
The concept of medical modesty also needs to be amplified to include respect as they go hand in hand. As an example, I would be angry about being given a gown open in the back and paraded in the hall. I personally would not be that embarrassed, but I would be angry about being treated with so little respect that no one thought to close the gown in back. When exposure is necessary, respectful care with thorough explanations can frequently make a patient comfortable with embarrassing situations. It is vital that the patients’ feelings be taken into account whenever possible. For many patients, both men and women, the loss of independence is the most embarrassing part of the situation. That is a much bigger factor for men though.
We need to be clear that not all men prefer male assistants for medical procedures. At least 10-20% prefer women and many more will accept either gender. The reasons why some men prefer female nurses or techs vary. Some believe that a woman’s touch is gentler, others are homophobic, and still others have a sexual fetish about being treated by women. Some are childhood victims of sexual assault, usually committed by a man. This is a very significant segment which is poorly acknowledged. Best estimates are that boys are assaulted at 25-50% of the rate that girls are (Finkelhor, Current Information on the Scope and Nature of Child Sexual Abuse, The Future of Children, Summer Fall 1994). No matter the reason for a preference, patients should be given a choice whenever possible.
Another very important variable is age. Adolescents are far more subject to embarrassment than mature adults. I’ve seen it estimated that 90% of adolescent girls prefer a female gynecologist. The analogous figure is less for boys as many are used to female pediatricians. Still it is a major factor. It should be assumed that an adolescent is embarrassed by exposure. Any necessary exposure should be done as discreetly as possible. Chaperones should be only used when necessary and desired by the patient, and priority should be given to same sex chaperones, which almost never happens for boys.
Why do we hear so little about male modesty? It’s hard to say. First of all, men are much less likely to protest than women are. It’s just not macho to be complaining about the presence of women, whereas the reverse situation is much more acceptable. Nurses are taught in training to respect a patient’s modesty. In this regard, they are better trained than doctors. I think any female nurse would tell you that many of her male patients are embarrassed when they have to give intimate care. Yet it is rare indeed that they would offer to find a male nurse. The reverse situation is not rare by the way. Many male nurses will offer to find a female nurse to provide intimate care for their female patients. Numbers are against men here, but there may be other factors. Some nurses just get jaded and want to do their job and get on with it. Others will tell you that the men prefer female nurses. But most men either don’t care or would prefer a male for intimate care. The nurses don’t ask, so they can’t know how any individual would feel about this. Some nurses may be reluctant to admit that there is a need for more male nurses.
These issues are important. Men seek far less medical care than women and die younger. The reasons for this are poorly studied, but clearly a very significant part of this is that men are too embarrassed to seek care. It’s common to see occasional advertisements offering screening exams for prostate cancer which are totally run by female nurses. One can’t even imagine the analogous situation, a breast screening program totally run by men. Is it any wonder that many men are turned off by this? The majority of hospitals and cities have clinics and practices that specialize in women’s health. They are nearly always run solely by women. It is rare to find a men’s clinic anywhere. Even Urology clinics don’t make men feel comfortable. You might have to explain your potency difficulties to the young woman at the front desk.
More information is urgently needed to know how to deal with these problems. Please add your comments. Further discussion on this topic can be found at the discussion blog.
Posted by Joel Sherman MD at 4:19 PM