Wednesday, August 25, 2010

Male Modesty


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.

29 comments:

María said...

Have you notice that the women's thread in on number 6 (and counting!)while the male modesty one seems to be at a standstill at number 2??? There was such a thing as a Medical Modesty talk that was open to the public (with sold out tickets) and it was swamped by females. Of course it is a woman writing...

Anonymous said...

And this is the catch 22. Men have been condictioned not to say anything, they have been belittled when they did. Often attacked as sexist, so they say nothing. They say nothing so it only compounds becasue providers, esp. administrators keep pushing it for ease and economics. It is commonly held women are more verbal then men, but they have also learned to speak up due to the journey to equality they have had to fight. If there is one thing men must learn its to speak up and ask. Often the accomodation is there but you have to ask for it, not something we have learned.

Anonymous said...

We all have been conditioned...by the medical profession. 100 yrs ago doctors told women they had no choice. Then they said magically gender doesn't matter with doctors and we felt silly for caring. Then most nurses became women and magically gender didn't matter with them either.
Who's next in line to tell us gender doesn't matter and will we fall for it again?
We bought the nonsense now we have to fix it. How gullable we can be sometimes. The more you let people get away with the less human you become. Glad to see things are coming out into the open.

Anonymous said...

"Have you notice that the women's thread in on number 6 (and counting!) while the male modesty one seems to be at a standstill at number 2???"

As has been stated numerous times on these blogs, women just like to complain a lot more than men.

Joel Sherman said...

Anon, it's accepted that women are more verbal than men. Certainly in our context the willingness to speak up is a positive not a negative. Men would fare better if they spoke up more.

Anonymous said...

Joel, men have to feel comfortable to complain. Women have been raised with the assurance that their complaints, no matter how petty, will be addressed. Men, on the other hand, have been raised to believe that suffering in silence is a sign of masculinity. The same men who will carp endlessly in the secure confines of a bar will clam up in the presence of a female.

So it is necessary to grant men extra leeway when they finally break out of their shells and make their concerns felt. Chastening them as sexists, crybabies, gender warriors, whiners and other assorted shaming language will shut them up quicker than any drill sergeant. Indulge more of their less egregious rantings: for most it is the first time they've let their feelings be known, and it will likely come out in an emotional torrent. Commiserate not judge, even if you must bite your tongue to do so; these men, some traumatized, are expressing emotions that all their lives society has taught them are invalid.

That the women's thread is on pt. 6—even though women have endured far fewer modesty violations—and the men's thread is on pt. 2 is symptomatic of the problem. The way to hear men is simply to listen.
—rsl

Anonymous said...

Great advice rsl, unfortunately men know that at the least their complaints will be ignored, and more likely a complaint will make their horrid treatment and disrespect even worse. Whoever the complaint is aimed at will know be gunning for the complainer even more, and other caregivers will avoid the complainer at any cost.

I agree with you completely and I'll file a complaint when necessary, but when I do I know I need to plan to find another facility because I will never be treated well again at the current facility.

Joel Sherman said...

rsl,
I basically agree with you except for the comment that women are assured that their complaints will be addressed. Read the women's thread; a large number of women's complaints are shunted aside or minimized. We all need to know how to be assertive and persistent.

Anonymous said...

I agree with many of the reason stated here as to why men don't complain. Still, many nurses don't respect men's privacy or boys privacy for that matter. Starting when they are babies, they will change a boys diaper in view of anyone, but a girls is done quicker and more discretely. Same for little boys. Women think nothing of letting older girls see boys naked, but no so for little girls seen by older boys.

Anonymous said...

I considered myself to be a victim of female sexual abuse when I was in school. The female gym teachers would come in to our locker room and watch us shower and change. The male staff were not allowed anywhere near the girls locker room - even when we only had one male gym teacher for the whole class. I became very resentful of something I considered serious and I now carry that resentment towards all women. This is especially the case in situations where females seem to feel entitled to abuse my privacy - such as medical settings. I have even argued with female medical staff over my rights while they claim I don't get them because Im male and they have female staff.

These double standards DO have a very negative effect. I am not in the 20% of men that don't care.

Doug Capra said...

anonymous writes: "I have even argued with female medical staff over my rights while they claim I don't get them because Im male and they have female staff."

They can argue anything they want. But you do have rights, and most often those rights are written right into the Patient Rights documents and core value statements of hospitals. Having staff of one particular gender does not negate those rights. It might make it more difficult for the hospital or clinic to treat you -- but you still have those rights.
My point -- Just because medical staff "argue" a certain point doesn't mean that they are right. Patients in general, and male patients especially in situations like this, need to realize that they don't have to accept these faulty, illogical, unethical, sometimes even illegal (if you're discriminated against) arguments. Don't accept them. Keep working your way up the food chain until you reach the people who are concerned about the hospitals PR and the bottom line. You'll be surprised how quickly you'll get accommodated.
Doug Capra

Joel Sherman MD said...

This is a link to a site on male sexuality which many will find offensive as it has much male nudity. Other posts on the site undoubtedly concern homosexuality and bisexuality. So be warned.
Nonetheless I am giving the link because it has some interesting observations on nudity in America as it relates to men and how it has changed through the years, indeed, in my lifetime.

Anonymous said...

A YouTube video on male patient modesty at http://www.youtube.com/watch?v=zHzkaFdK64Y. Dr Sherman's website/blog is cited.

Ed

Joel Sherman MD said...

The following comment was posted on my Medical Privacy blog. I am copying it below.

Joel Sherman MD said...

I am a long time follower and occasional poster on medical blogs. A year ago I had a urological surgery at a local city hospital. I was absolutely stunned by the attention and emphasis that was focused upon my modesty because this is never the case. Even though I never made mention of exposure concerns they treated me like the most modest person in the world, which was good. Later I noticed my "exit scorecard" had lots of questions about them respecting modesty. It was a job measureable, not just somthing these people were doing for my own good. As a long time athlete I have become used to the undressing, showering, etc in the open, so I dont feel like I am an overly modest person. For me, the problem I have with medical personnel is the disrespect. Disrespect plays heavily in the modesty issue as well because of the way patients are treated in regard to their nudity. My time spent in athletics has also shown me this absurd stereotype of "guys are not modest" is a 125% self serving load of crap. It is an excuse for them not to have to make any effort. I know for a fact that many men are indeed quite modest. I have known a lot of guys without a stitch of modesty, and many that were very much bothered by just having to strip down to their underwear momentarily in front of other guys. Claiming modesty in men is just not somthing they need to be concerned about is another example of the disrespect. Anyway, I began experiencing big time testicular pain so my urologist orders up an ultrasound. Swell. I get sent to a "sono tech in a box" imaging center. Volumes of blog entries swam in my head as I wondered how this experience would go. In my hour plus wait I notice there are four male techs taking people back today. That made me feel a bit better knowing I had a male. Well guess who takes the opportunity to show up at my slot, the first woman I had seen since I got there.On the way back I mention, "I waited for an hour, are you the only sono tech today?" No, she says, we are fully staffed. Then confirms the nature of my visit. I take the opportunity to ask, "for personal procedures like this dont you try to match the gender of the patient and tech?" The answer will no doubt shock all of you. "Well, for women we do but you know how guys are". Actually yes I do know how guys are, they have feelings like everybody else. She takes that moment to bolt out for somthing important, obviously seeing where it was going. Like I said, its not her being a woman, or having to be exposed, its the disrespect that sets me off. As instructed I strip waist down and cover with the narrow sheet that covered just enough, but exposed the scrotum. She knocks and waits for me to acknowledge her in, closes the door and brings no assistant. All was going well. She says she will get me a towel to cover the penis, pulls off the paper sheet, throws it away, walks over to the cabinet, gets a towel, folds it at the tableside, and covers me with it. I was wondering, "what the hell is the point of covering me back up now?" Near the end, she wanted me to find the painful lump. Lying flat I couldnt, so she says try standing up. I stand up holding the towel on me to keep my penis out of the way and also to keep the gel from getting all over me while I locate the testicle lump with the other hand. She is sitting there beside me on her stool intently watching, then says "let me take that towel", and pulls it out of my hand. She then resumes her position sitting there two feet away watching me grope around for the lump. Even with a lower than average modesty level, it didnt feel right. When we were done she says clean up and get dressed, and I will take you back up front. Then stands there waiting, obviously not going to leave the room for me to do it. I absolutely felt like a slab of meat. Being treated like an unfeeling, uncaring object that possessed no human feeling what so ever. This seems to be the "standard of care" foe male health care.
Mike

Doug Capra said...

I'm curious, Mike. When you found out the clinic was fully staffed, and when you got a remark like the one you did: "Well, for women we do but you know how guys are" -- why didn't you just say you wanted a male tech? It seems to me that these are the moments when the rubber meets the road, when patients make their preferences known and either get them or walk out.

Medical Patient Modesty said...

I wanted to encourage everyone to check out a new video by a man who is concerned about male patient modesty, Male Modesty In Healthcare Setting by Argh IMO

I really appreciated the white sign that a man holds over his private parts (you cannot see anything at all) around 3:38 of the video that says “This Area is Off Limits ….. Please Send a Male Nurse. Thank You.” This was a great idea. I think that this guy did a great job addressing how important it is for nurses to respect male patients’ wishes for modesty and male nurses.

I really appreciate him encouraging people to check out Medical Patient Modesty’s web site for patient modesty issues at the end of the video.

Misty

Anonymous said...

I am a male ,I would have walked out after making it obvious to her that she was disrespectful,unprofessional and insensitive. I would have filed a complaint with the hospital administration for a start. And refused to return unless there would be a male doing the procedure.

Anonymous said...

I can never remember a female examining me when I was younger. But, more recently, I've had some urological problems, and the urologists have never seen me naked except when I had a prostate treatment, but the women in the office have seen me naked, even inserting catheters. I'm old now, and it doesn't really bother me, although I was never a real stud, and in my old age, shrinking a little! The same thing has happened recently when I had to go to the Emergency room.

NTT said...

I have always been and will be a man who will fiercely protect his modesty. It's how I was brought up as a child.

This core feeling was made even stronger the day I took my wedding vows.

Out of love and respect to my other half, I will under no circumstances at any time allow another female to have anything to do with my private areas. Those areas are hers and hers alone.

So when I go in for anything male related I've always asked ahead of time for male caregivers.

I was told by my male doctor about 5 years ago now that I should get outpatient surgery to correct a male related problem that causes me pain every day.

For 5 years now I've put off the surgery simply because the hospitals won't guarantee an all-male team for maybe three hours from pre-op stage thru PACU after surgery.

I don't understand.

I went to one hospital where I was told 3 weeks in advance it would happen. They said they'd call if anything changed.

A male met me when I got there. He took down all my info then led me back to where I would change into one of those god awful gowns. When I was done changing he made sure I was comfortable on the gurney, took my clothing then left. At this point no pre-op work had been started.

Five minutes later a very young woman walks in, introduces herself and tells me she's there to prep me for surgery.

I was livid. I didn't lose my cool.

She was about to ask permission to get started when I calmly said to her no disrespect to you but this was to be an all male team from pre-op to the end.

I asked her to go get my clothes and told her I was leaving.

She said no no. Let me go get my supervisor.

Supervisor came tried to talk me into staying. I told her no this wasn't the arrangement I made with the hospital and was told 3 weeks ago was going to happen.

They got the doctor to come in. All I told him was he blew it. He knew he blew it for not checking on things knowing I was coming in that day.

He told them to get me my clothes and let him leave. So I promptly got dress and left.

I know there's a shortage of male nurses but this is ridiculous.

I do not trust the healthcare industry. I've had too many problems with female caregivers.

So now I am back at square one. waiting & looking for another doctor and hospital that can accommodate my modesty issue.

Maybe if we're lucky, the healthcare industry might wake up to this male modesty issue and rather than ignore it like they have been for so long, start making an honest effort at solving it but I truly doubt that will happen. At least not in my lifetime.

Thanks for listening.

Regards,
NTT

Anonymous said...

I would like to ask what are your rights when you show up to a ultra scan to be confronted by 2 woman one operator and one assistant told pull trousers down and pants. Assistant had arms folded around chest bum rested on table her eye line below my waist .Procedure lasted about 15 mins. told i had a double hernia .Am i within my rights to ask assistant to leave room ?? Dare say if a woman showed up would 2 males be allowed to do same ? And they wonder why males avoid hospitals till to late .Hospital doesnt employ male assistants CLEARLY FAVOURS WOMAN .be interested to hear replys

Joel Sherman MD said...

You have the right to request any care that makes you comfortable including male personnel. They may or may not be able to satisfy your requests. If not you can refuse treatment and if possible return at another time when they can accommodate you. If they refuse to accommodate you, your best defense is to lodge complaints with the appropriate people. Refer to the article on privacy complaints.

NTT said...

Anonymous:

I was once in your situation. I needed a scrotal ultrasound.

At the time, I wasn't aware I had the final say as to whether or not to go forward & do the test. If I knew then what I know now, I would have cancelled the test & gone somewhere else.

I got no advance warning from my personal physician who knew I preferred male care givers as to what the test was all about nor was I warned ahead of time by anyone, that a young woman would more than likely be doing the test and she may be accompanied by a chaperone to protect the facilities interests.

As a result of being completely embarrassed by the affair, I dumped that personal physician and now I ask the new physician is the test or procedure male related in any way.

If it is, I do not let them schedule it. I call ahead first to see if they have male personnel available to do the testing or procedure.

If there are no men available, I thank them & keep looking until I find a facility than can & will meet my needs.

I have gone for tests where they say a guy is on staff and available so I make the appointment with him on his schedule. Then when I get there I'm told sorry he's now available right now but Suzy here is available to do the test.

At that point, I just politely say thanks but no thanks and leave & keep looking.

You have the final say as to what will and will not happen to your body.

Don't let any healthcare professional talk you into doing something you are not comfortable with.

YOU not they have the final say.

Regards to all,
NTT

George T said...

In January at my urologist office in BIRMINGHAM ALABAMA I went in for experimentation of penile injection for ED issues caused by prostate surgeries. There are 25 male urologists and 3 females and not ONE male nurse. My only option for this, since no physician there will take time to do this procedure with a patient was to pick one of 2 FEMALE nurses. One of the two was incredibly rude to me and judgmental of me some years back so she was not an option. The other was completely unknown to me. Imagine a 65 year old male who had NEVER in my life had an erection in front of a female having to endure this procedure. This was not a simple examination of the penis-- it was going to be injected to stimulate an erection and then the results would be evaluated...Can you imagine a woman having a male LACTATION coach in the hospital? Yet I was expected to just be ok with all this. I must say that the nurse was incredibly professional and empathetic but I was MORTIFIED......probably would have been so with a male as well but at least same gender treatment wouldn't have been so traumatic to me. I had to have catheter lessons from a woman, penile VED training for Peyronies disease from a woman, verapamil injections by a woman, iontophoresis electric current treatment by women....My injection sessions were 4 in number and each 2 hours long. I wanted to crawl under the table and hide on the first day...

NTT said...

George:

When enough men (who haven't got a clue what they're in for when dealing with our healthcare industry), have stood up & said in a loud clear voice "We've had enough of this way to be treated", the healthcare industry will take notice & start encouraging more men to enter the nursing & technician fields.

If men don't speak up, no change will happen. Men have the same right to same-gender care as women.

Women speak up about the issue whereas men don't.

Regards,
NTT

Bill Waser said...

In the last 3 years I have had a perineal urthroplasty (to gain access to the prostate due to strictures), bladder stone lasered, and a TURP... all at the same time. It was done by a male urologist. I also had a dumbell shaped bladder stone removed from my bladder neck area... one end in the bladder, the other in the prostate. Also, done by a male urologist. But, who cares you are under general. In both cases I had extended time with one and sometimes two catheters in place. I also had two urodynamic studies, one by male techs and one by two female techs. I also had a retrograde urethrogram done, prep by female, urologist was male. My total stay in hospital was... Turp, less than one full day and bladder stone 2 days. I always ask for a female nurse if possible. To me modesty isn't the main thing, it is the care given. Women, in general, are more nuturing, in my opinion and since they don't have the same equipment are a little more apprehensive to hurting the patient, while the males seem to be coarser, rougher.

real said...

Male modesty is real, female nurses present when a male is unrobed is taking away the masculinity of men. I don't know why but it's real.

NTT said...

Real:

You are correct and until the medical community acknowledges the fact and starts giving men the same level of respect they give their female patients, men will continue to walk away from needed healthcare and their loved ones will be left wondering why they died so young.

Men have to get past the social stigmatism on how they should always act macho and show no weakness.

If you are not comfortable being intimately exposed in front of the opposite sex, speak up before anything starts and let them know you want same gender care.

Until that happens on a consistent basis the medical community will not listen.

Regards,
NTT

real said...

Yes,you must say something at the start of your first visit, very important, I have a blockage and would not agree to a cystoscopy because doctor would not agree to have a male nurse in the OR,and would not agree to prescribe a catheter.I may have to contact NJ medical board,if they'll help I don't know , don't forget there politicians. Real