Sensitive Issues for Men
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patient modesty

Given that the home page for this website prominently mentions the well-known male tendency to avoid medical treatment, I was extremely surprised that my search on the terms "modesty" and "privacy" yielded no results. There's a growing awareness that one of the major reasons men stay away from health care providers is the fact that their needs for modesty and bodily privacy are seldom respected. There is no such thing as a male mammographer, but the vast majority of scrotal ultrasounds are performed by female technicians. It's unthinkable for a female patient to end up undressed in a room with a male doctor and a male assistant. But the reverse happens all the time: more and more female physicians and NP's are bringing in so-called "chaperones" when performing intimate examinations and procedures on their male patients, and those chaperones are almost always female. Usually, men in these situations say nothing about their feelings of embarrassment, exposure, anger, and/or humiliation -- but when they do, their responses are usually dismissed. Not always, but far more often than not: "You don't have anything we haven't seen before." "We don't have modesty here." "Do you have a problem with women?

Since my goal is to initiate some discussion of this topic here, I'll share an "ambush" experience of my own. I've posted about this on other blogs, so if you follow the subject already you may have seen this before.

I’d been seeing a female NP for 5-6 years so thought I had a good working relationship with her. Then I had my first “intimate” exam with her — regarding a mass I’d noticed on one of my testicles. After the initial discussion, she left while I undressed, lay down on the exam table, and covered myself with a drape as she instructed. But when she opened the door again, one of the intake nurses (also female) was right behind her. Without a word to me, they positioned themselves directly across from each other at my hips. Then the NP pulled the drape completely off me, and I was exposed to both women from waist to ankles. I was so shocked and embarrassed I literally couldn’t speak – the NP hadn’t said anything beforehand about bringing in a witness, never explained why it was necessary, and never asked my permission for it (which I certainly would not have given). Before this encounter, I had never even heard of “chaperones,” and had never been undressed in a doctor’s office for anyone but that doctor. The whole encounter left me feeling insulted, disrespected, and humiliated; I had trouble sleeping and focussing at my job, and ended up seeing a therapist for a few months.

As mentioned, I have discussed this encounter on other websites, so I'm not necessarily seeking feedback for myself. I would be interested in hearing about similar experiences from other men, and how you responded to them. The more visible this issue becomes, the more likely things are to change.

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I can understand the modesty issue but in the context of the circumstances you are requesting a service from a health care professional to diagnose and treat your condition. You have to rationalise their status as they are under pressures of trying to serve your clinical needs whilst observing all the associated rules like Health & Safety general NHS procedures. Sometimes they do fail to communicate all that is going on for your benefit as time is another pressure on their shoulders but I have been almost a professional patient of the NHS since 1948 and found that polite questions usually elicit a reasoned explanation. I owe my existence to the ministrations of the service and give them my trust and so far it has never been betrayed. We have to give the tolerance and respect to those despite our natural modesty concerns from those of us who have never been naturists.

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From your response, it sounds as though you're in the UK. I'm writing from a US perspective. While I appreciate your concern for the pressures on providers, there is (on this side of the pond, at least) a long-established and worsening trend of disregard for male patients in particular. Our medical community has learned to address the modesty needs of women, so the problem is not simply one of time demands.

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Two weeks ago here in the States, my brother was told he needed a scrotal ultrasound.

Nothing about how it's done or who does it was explained to him ahead of time. He and his wife drove to the facility to get it done. On medical visits my brother and his wife accompany each other.

So they get there and he's called to the back to get tested. As they are going through the door to the hall leading to the exam rooms, they cut his wife off at the pass & tell her she's got to wait out in the waiting room. That didn't sit well with either of them and it heightened my brother's awareness and he said an internal warning went off inside him.

They took him back with no introductions. She gave him a hospital gown & told him to strip from the waist down & lay on the exam bed then she left.

Ten minutes later she comes walking in & she's got a chaperone with her.

Needless to say my brother was po'd. he stopped everything in its tracks. He asked where the male tech was. she told him there is no male tech we don't have any on staff. She told him to lay back & don't worry he doesn't have anything we haven't seen a hundred times before.

He said he no. He told her that if a chaperone was needed his wife would come in she's out in the waiting room. She replied it's not facility policy to use spouses that they only use other staff members.

So he replied okay bring in a male staff member.

Sorry, we only have female staff was her reply.

My brother replied fine, everyone out I'm getting dressed this test is over. He pointed to the door they came in. She was about to say something when he said out again so then they turned around & left.

He got dress, went to his wife who was waiting & they left. He called his doctor when he got home & reemed them out for not warning him ahead of time about the procedure.

He called me two days later and told me he's thru with healthcare. He won't go anymore as they cannot be trusted.

The American healthcare system at it's best. Still trading men's lives for the almighty dollar.

Regards,

Soul

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I applaud everything your brother did... except for swearing off health care. Making one's modesty requirements known and not backing down is the only way to prevent unacceptable situations from occurring. But maybe he could ask that doc to help him find a more responsive ultrasound provider. Most docs are willing to work with their patients, and genuinely want them to have what they need. My mistake was not calling a halt to the proceedings like your brother did, but I complained loud and long after the fact, and also got some good advice about making my requirements known in advance. I now inform any new provider of what I will and will not tolerate. Providers rarely consider male modesty on their own, but most are willing to oblige if it's brought to their attention. Best of luck to both of you.

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Spoke with my brother at length last night & he's still upset over the fact that they didn't ask first about the chaperone nor did they tell him a young woman would be doing the testing.

I told him its called ambushing. They do it to male patients all the time.

For the time being, he's decided to walk away from healthcare. I told him that's his decision but if he should decide to try again, I'd be willing to go over things he needs to know to navigate thru all the hidden traps.

We need some legislation out of Washington to force change on the healthcare industry before too many more guys decide to just walk away. His wife and daughters are upset he's not getting the care he needs.

Take care all,

Soul

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I'm concerned for him as well. He needs to know that he can take back control of his care, something it took me awhile to realize. He can kick anybody out of the room that he doesn't want there, and if the doctor doesn't like it he can reschedule (my own policy in such cases is to demand a refund and instruct my insurance company not to pay because the visit wasn't completed). He can interview doctors and care teams ahead of time to make sure his wishes are known. Hopefully, this is just a temporary reaction.

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My wife is a Nurse and I told her I felt a little uncomfortable with the 'chaperone' being present during my recent treatments, resulting in circumcision. She said it is more to protect the Doctor than you. Fair enough, but as you say it would be more professional and at the least politeness to explain what was going on. At my last exam' before discharge I am sure it was the Consultant's secretary who stood there while he inspected my Penis. At that point so many people had seen and inspected me I was past caring. A few seconds explanation goes along way and the patient should always be given the option.

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Thanks for responding. If something happens during your care that you don't like, you have every right to register a complaint -- at the time or after the fact. I waited a couple of months after my experience to say anything about it (and I had to threaten the practice with reporting them to the state medical board to get them to respond), but their top managers did eventually sit down with me. They apologized for the incident, they told me I could always a) stop the exam, b) insist that the chaperone leave, or c) request a different provider if the one I was with refused to examine me without a witness. BTW, they ended up retraining their entire staff on more considerate "chaperoning" protocols, and actually thanked me for bringing the problem to their attention.

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skydog you are not being helpful. Generally I prefer a male Doctor whilst being examined intimately. Firstly, because I feel he will have more empathy to my situation and also less chance of getting an embarrassing erection.

My last check up following circumcision was with a young, female, attractive, trainee GP. I chose her because our Surgery gave the option and as few people said yes the appointment was quick. Also by this time I had been 'inspected' by all and sundry and was passed caring. I can tell you as she felt around with her face inches from my penis I had to concentrate on the random notices on the wall to control myself.

So think on.

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jaglad, you don't need to explain or defend yourself against oddballs like this guy. He's a troll and an idiot.

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Jaglad - Skydog is a troll. I've seen him on other threads addressing this subject. He doesn't want to be helpful, he just wants attention. Ignore him and he'll go away.

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modestguy: Like your experience, and soulstealer's brother, I had almost the exact same thing happen to me with a scrotal ultrasound. The only difference was that my wife wasn't with me, and I suffered through the whole embarrassing thing instead of having the nerve to get up and leave like soulstealer's brother did. When scheduling the ultrasound, I specifically asked if a male would be doing it, and I was told that they would put that request through for me, and make sure a male technician would do the test. A woman took me into the room and told me to remove everything from the waist down, lay down on a table next to the ultrasound equipment, and to put a sheet over me that she handed to me. She said someone would be with me shortly. I just assumed that someone would be the man that I had requested. I couldn't believe it when a female (probably in her mid 30's) came in the room with another female, who could not have been any older than 21 or 22. The female in her 30's told me her name, and introduced me to the younger girl. She told me the younger girl was a "trainee", and she would be observing the exam today. I said that I had requested a man do the test, but she told me he had called off that day, so she would be doing it, along with the trainee. I about died, but made the mistake of keeping my mouth shut. The only other woman who has ever seen my penis and testicles is my wife. I am definitely not very well endowed, and the thoughts of these women seeing my "junk" almost sent me into a panic attack. Not that I would have felt any different even if I were well endowed, but I'm extremely self-conscious of my size, making sure to put a towel around me in locker rooms, etc. To make a long story short, I suffered through the whole thing, and with as much rubbing that is done back and forth over the testicles with the end of the sonogram unit that has jelly or some type of lubricant on it, I ended up with an erection. I felt like it was a complete betrayal to my wife, but with that kind of stimulation, how could any man keep from getting aroused. I was completely and totally mortified and embarrassed. I told my wife about the two females, but just couldn't bring myself to tell her that I got an erection. I still have guilt about that to this day. I think your initial post about patient modesty for males is "right on target". I guess the medical profession thinks all men are OK with stripping down in front of females, and have no issues with it. They certainly wouldn't treat a female like that. Talk about a double standard.

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YOU have absolutely nothing to feel guilty about. Physiological reactions are not under one's control, and certainly don't constitute betrayal.

For future reference (forgive me if you know this already), you as the patient have the absolute right to refuse any treatment, any provider, and any extra personnel in the room for any reason -- in fact, you're not even obligated to give a reason, but in these instances it would be helpful in getting the general message across about male modesty. Telling a "trainee" or student to leave should not even hold up the procedure (and if it does, complain to the state medical board). Many providers insist on "chaperones" for legal reasons, and they can refuse to examine or treat you if you decline that legal witness, but you can always reschedule with someone who will honor your wishes. There is no actual law requiring "chaperones" with adult patients, so if a provider tells you that, they're lying.

If I were you, I'd complain even now, after the fact. It took me more than two months to work up the nerve to register a complaint, and another two months of phone calls and emails before the clinic management agreed to sit down and talk to me, so you do need to be willing to persevere.

Here's the link to another website, an extremely informative and supportive blog moderated by a practicing physician and med-school professor who is campaigning for better modesty recognition:

bioethicsdiscussion.blogspo...

Thanks for your post. Best of luck with future encounters.

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For perspective: I've had three scrotal ultrasounds in the past year. All three were with women techs, but no additional witnesses or trainees were ever in the room, and I was treated very respectfully -- my penis was always covered with a drape which they gave me to hold onto (that helped me feel a little more "in control"), and even my thighs were covered. During one session, the tech had to get up in the middle and check on something, and she even pulled the drape down over my scrotum while she was not actually examining me. Treatment guidelines recommend limiting exposure to ONLY the area being examined, and only WHILE being examined, but obviously not all providers adhere to what they're taught.

If you went to the trouble of prearranging a male tech and that tech called out, they should have notified you to reschedule. That's just common sense, not to mention common courtesy.

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Hi NoCurve. Your story really hit me. I'm the same kind of man. I'm 48 and lost my virginity to my wife, so no other woman has seen me nude, and I don't know what your definition of "definitely not very well endowed" is, but I'm pretty darn sure I'm well smaller than average and every time I need an exam, male or female, I'm embarrassed.

I had the same exam not long ago. My tech was a female as well, but I have yet to ever have a chaperone with any procedure. The woman how did my ultrasound was nice and never really paid much attention to my genitals, only to look over once in while. When she went up to look at my bladder, she completely recovered my genitals.

I have a lot of surgical history over the past 7 years. The biggest was a kidney transplant. During that surgery they placed a catheter to accurately measure urine output. Honestly, my biggest worry about that huge surgery was that I was going to be exposed to who knows how many and how embarrassed I'd be. My wife is always trying to calm my nerves about my thinking that everyone, especially females are going to be making fun of my smaller penis and joking, etc. Which I'm sure they weren't, but that was (and still is) my issue no matter how much my wife tells me to stop worrying.

Anyway, speaking of patient modesty, right after the surgery in ICU my penis started burning like crazy. I had to call for the nurse and she cleaned around the catheter. That wasn't as bad as when a doctor was doing his rounds with all the students and he pulled off my covers and lifted my gown for a mix of men and women, all in their 20's and showed them everything. I was freaked out, I couldn't believe they did that! In fact, every time someone came to see me, they all did that! I was like what the hell????!!!! I had very little privacy and there were so many nurses (male and female) that took care of me, I started to get used to it. I will say though, no one made any kind of expression or anything else that made me uncomfortable. The nurse that took my catheter out was so freaking cool, we both laughed and she made me feel so comfortable!!

Since then I have had dermatological issues and most centered around my armpits and groin, I've had two different female dermatologists that have had to do procedures around my genitals, both are young and attractive, but have been fantastic. My current had to inject and drain a cyst on my leg under/side of my scrotum, she ended up calling a nurse in so she could hold my penis and scrotum out of the way! Holy cow, I thought I was going to die! But, they were both totally awesome, and I've that nurse several times since and everyone acts like nothing happened. In fact, that same situation is likely going to happen today, same cyst in the same spot.

I will admit, though I've never had a full erection, I do feel it grow when they are handling it. I'm grateful I haven't had one, but again, like your story above NoCurve, it probably isn't the first time and won't be the last time.

Overall, in my case, I have suffered a lack of privacy, mostly in the hospital after my transplant, but everywhere else I find that everyone, male or female, is very professional, kind, and understanding.

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Dadog & modestguy, Thanks for your support, but I am not explaining myself to the likes of skydog, more trying to encourage others not to be embarrassed while also hoping Health Professionals give some thought to there Patients dignity.

Cheers

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this happen to me this happen to me when I went to a urologist. I got the same response from the female physician who said owed you have a problem with women I said no I have a problem with you not respecting my privacy. I held my ground. We must do this more often

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Vitruviusman -- I'm sorry you had the additional disrespect to deal with when you protested. In fairness, I have to say that the responses to my complaint were consistently courteous -- but from what I've read, I think I'm in the minority. Absolutely, we must speak up -- and we must not accept browbeating when we do.

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