Male Modesty at the Urologist

How Urologists Can Be More Sensitive to Men’s Modesty?
By: Misty Roberts

Most urology practices in the United States do not employ male nurses or assistants, even in larger cities. This is a serious problem because approximately 75% of urology patients are male.

Often people wrongly assume that men don't care about their modesty. In many cases, this is simply not true. Societal norms say men are not supposed to be modest; that this is a sign of weakness. From childhood males are socialized to “man up”—make believe it doesn’t bother them—when faced with an embarrassing medical exam or procedure; to acknowledge embarrassment only serves to amplify it.

Many urologists may not realize that countless male patients forego medical care or stop coming to appointments because male nurses or assistants aren’t available and these patients feel they cannot speak up for fear of being labeled weak or crazy.  

All-male staffed urology clinics in the United States are nearly non-existent.  Nowadays, women have the option of going to an all-female ob/gyn practice; men should also have this option. Every major city in the United States should have at least one all-male staffed urology clinic specifically for men. These male-specific clinics could be very lucrative because male patients who avoided or delayed medical care would consider traveling to them. 

We encourage all urologists to work on being more sensitive to male patients. Below are some tips to use as a guide. 

Tips for Urologists:  

1.) Hire at least one male nurse and a male assistant for the urologic clinic. Recruit male nurses, ultrasound technicians, and assistants at the local community college if necessary.

 2.) If no male nurses or assistants are available do as many procedures such as vasectomy as possible without assistance. 

  

3.) Encourage office staff to respect male patients’ privacy. Educate female staff about patient sensitivity and health issues. For instance: a male patient may not want to talk to the female receptionist about his health issue. 

4.) Always give a male patient the option of having his wife present for procedures.  

5.) Consider putting a ‘Do Not Disturb’ sign on the exam door so other medical personnel do not randomly enter during intimate exams.  

6.) Consider starting a private all-male staffed urology clinic geared to special interest in male patients, especially getting them to see a doctor more often. Perhaps add a male gastroenterologist to the practice. Advertise the clinic as being all-male staffed and sensitive to men’s modesty. 

7.) Many men care about their modesty during surgical procedures, especially if they are under general anesthesia. For these modest patients who require surgery at a hospital or an outpatient surgery center commit to helping them get an all-male surgical team. Be open to using local or regional anesthesia whenever possible which allows the patient to be awake and alert during a procedure. It would give that modest patient peace of mind. 

Misty Roberts is the president / founder of Medical Patient Modesty (www.patientmodesty.org), a 501c3 non-profit organization that works to educate patients about their rights to modesty in medical settings.

Unnecessary Underwear Removal For Surgery

by Misty Roberts

A number of surgery centers and hospitals across the United States, as well as in other countries, have routine policies requiring  that patients to remove underwear for all surgeries even if they do not involve the groin area or genitals. This ritual has been practiced for umpteen years.  Originally, it was an Operating Room tradition seemingly without clear medical indication

Fortunately, as of 2018, some hospitals have changed these policies and now allow patients to wear 100% cotton underwear during many surgeries. One hospital’s example of this type of policy allowing underwear: Only 100% cotton underwear is permitted. No Nylon underwear will be allowed.

The routine removal of patients’ underwear was first introduced when nylon underwear could potentially cause static electricity. Brown (1993) describes the ritual of making patients coming to the operating theatre remove their underwear as the “most illogical of rituals”. It is still practiced in many surgical units and should be stopped for the good reason that it causes embarrassment to the patient and serves no useful purpose.

It has been traditional for patients to put on clean clothing (and in some units to remove underwear) on the ward before being taken to the operating theatre. Any risk of infection from airborne spread from socially clean clothing is unlikely to be large because, in comparison with the operating team, little patient movement occurs during operations thus reducing the dispersal of microorganisms from skin and clothing.

How To Respond To Arguments By Medical Professionals:

1.)    We may need to insert a urinary catheter – Urinary Catheter is rarely needed for most surgeries that only take only a few hours. See article about unnecessary urinary catheters.  

2.)    Underwear could become stained by prep and body fluids – Most patients do not care about this and would prefer to have their underwear stained than sacrifice modesty.

3.)    Underwear could have metals in them – Most underwear does not have metals in them. Patients could simply wear 100% cotton underwear with no metals or disposable underwear.

4.)    Need for antiseptic cleaning of the groin – This is not relevant unless the groin is in the operative field. Patients routinely cleanse their entire body with a sterile-type solution 2-3 times before surgery.

5.) We need immediate emergency access to femoral vessels in case of emergencies – Underwear can be removed quickly if necessary.  There is a minimal percentage of this happening.

6.) No underwear helps to maintain a sterile environment – The operating room is not as sterile as the medical profession claims.  If the ‘no underwear’ policy helped to maintain a sterile environment, doctors and nurses should not wear underwear either. Medical professionals often carry more germs than the surgery patient because of restroom breaks as well as interactions with numerous other patients all without changing scrubs in between. Most infections that happen as a result of surgeries are due to medical professionals not washing their hands and bringing germs into the operating room.

Look at this statement from Behaviour and Rituals in the Operating Theatre – Orthoteers (http://www.orthoteers.com/(S(nstrglfrkgiwdhgw204h0aq4))/owls.aspx?section=1&article=172): A recent editorial from Canada noted no increase in infection rates in patients undergoing day-case cataract removal when the patients remained fully dressed to enter the theatre, including their ordinary shoes.

It is very disturbing that operating room personnel at some hospitals routinely remove patients’ gowns and underwear once the patient is under anesthesia and re-dress the patient before he or she wakes up. This is very unethical and deceptive. Many patients have no idea how they are completely exposed when they are under anesthesia.

We have received stories of some very heartbreaking cases. One lady who had hand surgery woke up naked before they were able to put the gown back on. There was no reason for her to be naked. She could have easily worn underwear, shorts, and bra with no metals for this kind of surgery. It would have been best if she could have opted for local or regional anesthesia and not general anesthesia.
A knee surgery patient’s genitals will often be exposed if he/she is not wearing underwear when the surgical team lifts her/his gown. Patients should be allowed to wear 100 percent cotton underwear or disposable underwear for all surgeries that do not involve genitals such as lobectomy, knee replacement surgery, etc. 

All patients should write on their consent form that they do not allow removal of underwear for surgeries which do not involve the genitals; and request a copy of the consent form with the surgeon’s signature. Patients have to stand up and break this ridiculous OR tradition which violates patients’ modesty.

If your hospital still has a policy that requires you to remove your underwear for all surgeries, you should consider starting a petition at your hospital to end this outdated policy. You can use this sample petition and modify it. 
   

Sources:

Behaviour and Rituals in the Operating Theatre - Orthoteers

Page 51 under Patient’s Clothing in Advancing Perioperative Practice

Surgical Site Infection: Prevention and Treatment of Surgical Site Infection