Unequal Gender Care for Male Patients

Something that is not addressed often or really not at all is that male patients are discriminated against in the same sex gender care options.  Options—there are none.  Somewhere over 90% of hospital staff are female.  In some areas of the US, that may be even higher.  For years, men have had to suffer through having no option for same gender care even the court system has said that every patient is entitled to same gender care for intimate procedures.

How many male nurses do you see in Labor & Delivery:  How many male mammographers have you ever seen?  However, for a male needing a prostatic ultrasound, most likely the tech will be female.  If a female selects a male ob-gyn or urologist, do you think the nurse or chaperone will also be a male?  However, if a male selects a female urologist do you think a male nurse or chaperone will be present?  It is very unlikely.  Even in clinics that specialize in male health, most of the support staff will be female whereas in a women’s clinic, they even advertise the support staff will be female. 

Another difference is how intimate exams are performed on female patients versus how they are generally performed on male patients.  Once a female is escorted to the room and all the questions have been asked and/or answered, the nurse or medical assistant (MA) will give instructions for the patient to remove all necessary clothing and put on the gown provided.  As the nurse leaves the room, she tells the patient the doctor will come in a few minutes.  Usually there is a knock on the door and the doctor may ask if they can enter.  The doctor will enter with the nurse in tow and ask the patient to lie with their buttocks at the end of the table.  The nurse will put a sheet over the patient as the stirrups are readied and the patient’s legs are placed in them.  Once the exam is over, the doctor and nurse will leave giving the patient privacy to clean up and to re-dress before the doctor will initiate conversation with the patient.

For male patients, the genital exam is generally done very differently.  The nurse or MA will do the preliminary questions or maybe blood pressure.  She will leave saying the doctor will be seeing the patient shortly.  There generally is given no direction for the male patient to get undressed or don a gown.  Time passes and the doctor will enter the room with the nurse, MA, or someone in tow.  The doctor will do whatever exams maybe even having the man remove his shirt which he may or may not tell him to put back on.  Eventually the doctor will take a seat on his rolling stool and tell the man to drop his pants and underwear to the floor around his feet.  He will then conduct the front genital exam with the ritual of having the man cough.  He will then tell the man to turn around to the exam table and bend over it as he performs the rectal exam.  After the exam is finished, the male patient will be told to clean up (with the chaperone being right there to hand him the tissue) and get dressed all the while the doctor and female chaperone is still present in the room.  During this whole demeaning, clown procedure; the female chaperone only job is to watch the whole humiliating process and to hand the poor male patient a tissue. 

The above details of the genital examination paints a very vivid difference in how some healthcare aspects are delivered differently to male and female patients. For male patients, there is no pretense of allowing him to have any dignity or privacy.   If the same was done to a female patient, there would be general outrage but yet many male patients are subjected to how this exam is inappropriately handled every day.  Article after article says no medical provider should be present while a patient is undressing or re-dressing unless it is done as part of an evaluation of measuring a patient’s capacity to care for themselves.    There is a sexual connotation in the manner in which this exam is conducted as it is much akin to being a striptease performance complete with audience.

Many, many males find this ritual to be totally degrading.  Many feel violated.  Several men have told me they feel like “a deer in the headlights” especially when many of them have no idea there was going to be a female present to watch the whole act.  Many patients feel ambushed when the doctor brings an unannounced person into the room especially when there was no mention or asking permission prior to that person being present.  In today’s medical setting, often times it is no longer a RN present but rather a MA or sometimes even the office girl. 

For men who do protest, the medical “professional” usually uses several different phrases to make the male patient submissive.  “You don’t have anything I haven’t seen before”, “we have seen it all before”, or “suck it up” are some of their standard phrases.  They do nothing to address the concerns of the patient or the right of every human to have bodily privacy.  In fact, dismissing a patient’s right for bodily dignity does nothing but make the situation worse.  Furthermore, some of these very medical “professionals” do have an issue in exposing their genitals to co-workers they work with when they are placed in the same situation.  But for you, the common patient, it does not matter.

For in-hospital male patients, most intimate care will be delivered by female staff members.  Sometimes because they have no compassion or respect for your bodily dignity, they will bring another member to chat with them as you are being exposed.  Many will also expose the patient unnecessarily by rather than leaving you covered by the gown they will just yank the gown up while pulling the blanket down.  There is no need for this except many medical providers feel they have the right.  Sometimes the curtain is not drawn or the door is not shut.  Some female nurses seem to get some sort of thrill from the control and power they have over a defenseless male patient.  

Unnecessary exposure of the body parts thought of in a sexual manner is sexual abuse.  Very often patients will be unnecessarily exposed during pre-op and post-op phases of care.  I have had medical providers say you were sedated so it shouldn’t matter.  But is that true?  If a woman is drugged and sexually abused is it still a crime?  Yes.  Other reasons for unnecessary exposure is because it makes it easier and faster for the pre-op team to do their job but should that be the most important factor?  No, it should not be.  The rights and welfare of the patient should come first.  Many men have no idea they were going to be shaved and naked for a procedure especially cardiac catheterizations and have deep feelings of violation and anger.  Many will refuse to seek treatment again because of this. 

What many patients do not know is they are in charge of their body.  They should ask questions and give written directions on what they or will not accept.  You have the right to know who is involved in your treatment and how that treatment will be carried out along with what type of sedation can be used.  Details such as sedation and the prep process should be given before the day of the procedure so you have time to make your decision.  If you want same gender care, they must make every effort to provide it to you unless it is a true emergency situation.  If they can’t provide it, you have the option of going elsewhere.  If you have a chaperone, you have the right to ask they stand where you are not exposed to them.  The chaperone is on the payroll of the medical provider and they are not there for your protection but for the protection of the medical provider.  You have the right to say who does and does not view your body.  If they do not comply with your basic human rights, maybe it is time to find another provider who will.  Never be bullied or coerced into submitting to something that is not right for you.