Elephant in the China Shop

[hcworker]

The Elephant in the China Shop

Everybody knows he's there but everybody wants to ignore it.

I'd like to raise an issue all of us are aware of but almost nobody appears comfortable enough to want to talk about.

How do things go when you need to do intimate procedures on a patient of the opposite sex? How do you feel about it and how does the patient feel?

Most of us are female. Let's say you have a male patient on whom you have to place a Foley (or a straight cath). Or you are to administer an enema.

I've had many off-the-cuff talks with colleagues and the reaction is all over the map. Some enjoy the intimacy; some are very uncomfortable. Providers at both extremes may try to cover up their feelings by one means or another. All of us are conditioned from childhood to maintain our own body modesty and it's difficult to violate somebody else's as a matter of routine, if we have any empathy with the patient. (And if we don't have much empathy, why are we nurses??)

And what about the patient? Male or female, most of them do not know they can refuse procedures that make them feel uncomfortable. If they did, I wonder if most of them would, just to avoid embarrassment. If you're female do you tell the male patient he's free to refuse this enema or that catheter? Or that he can choose a male administrator? Or do you charge right in with the enema tube or Foley as if they have no power to refuse? Male patients are very fragile in a way. Their macho makes them feel they need to be in control and they feel so put down if they're shown to be powerless that it's toxic. Especially if they are put through procedures that make it very clear women are in complete charge of their bodies. They've been brought up to think things should go the other way around. And they're too embarrassed to complain about being embarrassed.

I'm trying to put this subject on the table so we can talk about it among ourselves, maybe find better ways of dealing with it and hopefully allow us and the patient to feel more comfortable. I didn't even bring up how you may feel if you're a female patient about to receive an intimate procedure from a male nurse, but there should be similarities.

An unscientific summary after years of observation and talk might go like this, for patients of one sex receiving intimate procedure from nurses of the opposite sex:

1. Some patients are super-embarrassed, extremely uncomfortable. They may feel invaded and take away psychic damage.
   
2. Some are exhibitionistic and enjoy the exposure, glad for a context in which it can occur where nobody can charge they are perverted for seeking (or enjoying) it.
   
3. And everything inbetween those extremes. Very few are indifferent or treat it with the psychological neutrality one would a dental procedure, which also is invasive.
   

And for the nurses:

1. Some are embarrassed and may cover by coming on with cheery professionalism;
   
2. Some enjoy the access and cover by the same (or a different) route.
   
3. Not many are indifferent, probably more nurses than patients since we do these things far more often than they encounter them. But it's been said you might as well try to be indifferent toward sex.
   

A related question is what do you do if your opposite-sex patient, in response to unavoidable genital exposure or touching (as for a catheter), shows signs of sexual excitement. I've heard about all sorts of reactions, from ignore it” (usually easier to do with a female patient) to making remarks to defuse the situation.

In the case of a male patient with a full erection:

1. ‘Well, I'm so glad you're enjoying the examination/ procedure!”
   
2. If you can't get that to come down quickly, it may be painful when I work the catheter into place.”
   
3. Let's try this bucket of ice water I just happen to have here.”
   

Sometimes men get erections just because they're embarrassed.

Also, a male patient may be embarrassed because his erection may be the result of the stimulation of his sphincter due to enema prep. He may be concerned about being considered gay and may need reassurance this also happens to straight men.

I'm posting this here to try to shine some light on an issue usually swept into a dark corner because people are uncomfortable with it. What are your thoughts? Have you found good ways to deal with the subject, whether as nurse or patient, that may help us to know about?

Talk to us.

--hcworker

[Jensmom7, BSN, RN]

This topic is incredibly creepy and smacks of an adolescent male who has been watching way too much "Naughty Nurse" Media.

I entered Nursing school in 1975. In all the years since then, I have dropped countless Foleys and administered the same number of enemas (quick quiz: anyone know what a "3H enema" is?). Not once was there an element of sexuality in any of the procedures.

Was there some embarrassment on the patients' part? Possibly, but by being matter of fact, professional and very good at dropping Foleys, it wasn't insurmountable.

I could say more, but I have a feeling that A) OP has left, never to return, or B) he's getting his jollies. Neither option interests me. I'm done.

[enuf_already]

I'm having a serious case of déjà vu reading this post. Maybe the "we" refers to the other persona that was a controversial poster about this kind of topic. Are you sure OP that you are not someone else?

That said, I am too busy caring for someone or trying to save their life to care about what their private parts look like. I provide privacy, protect their modesty to the best of my ability and move on. This goes the same for patients of either sex.

To patients who are ill enough to be hospitalized; viewing your naked body is not sexual, nor a turn on for me. If you have an erection or sexual response during a procedure, I will assume it is involuntary and not think another thing about it unless you start hitting on me.

No one likes to have procedures done or feel vulnerable but the healing process often requires some kind of intervention and nurses, like patients, come in both male and female.

[Karou]

I have a lot to say, but am not taking the bait.

We have had several posters start similar topics in the past and in the end they all seem to have the same idea: female nurses are sexual deviants who want access to men's body's. We are perverse and sexual in any contact with male patients, our thoughts are impure and our intentions malicious. No amount of debating seems to change these posters minds, and they eventually admit they have had a negative medical experience to cause them to be bias in the discussion.

My suspicion is that some of these previous posters themselves have a fetish and enjoy bringing this kind of topic up on a nursing forum.

OP, if your intentions are not to troll, then I apologize. Previous experience leads me to the hunch that this is not a discussion I want to get emotionally invested in.

[Karou]

I don't know.. It's focused more on male modesty than female and also implies that some female nurses have rather err.. different triggers for sexual arousal than the "norm". I'm sceptical as to this being homework assigned by a nursing professor.

It starts with a false premise. Everybody in the room knows that the elephant is there, but everybody wants to ignore it. "Everybody" knows no such thing. Homework wouldn't in my opinion be based on a flawed assumption.

We have had other first time posters come up with similar topics in the past. I agree that although the OP starts out with male and female mentioned, the focus becomes almost exclusively male. That's interesting, it makes me think they want the topic to appear like it applies to both genders, buy that isn't their focus.

Male modesty has been discussed at length before and those discussions often take a creepy turn by the original posters. I find it really weird how many men come to this site with intense feelings on this issue. It goes from male modesty (an important topic) to a warped accusation of nurses having lustful and perverse feelings toward their male patients.

OP saying nurses sexually enjoy inserting catheters make me hesitant to believe he is looking for a true discussion and his intentions are not innocent here.

[meanmaryjean, DNP, RN]

This topic is incredibly creepy and smacks of an adolescent male who has been watching way too much "Naughty Nurse" Media.

I entered Nursing school in 1975. In all the years since then, I have dropped countless Foleys and administered the same number of enemas (quick quiz: anyone know what a "3H enema" is?). Not once was there an element of sexuality in any of the procedures.

Was there some embarrassment on the patients' part? Possibly, but by being matter of fact, professional and very good at dropping Foleys, it wasn't insurmountable.

I could say more, but I have a feeling that A) OP has left, never to return, or B) he's getting his jollies. Neither option interests me. I'm done.

Also a nurse since the 70s. 3H has been superseded by the almighty 5H. (Fun fact: The additional Hs are 'hold it 'til they holler'!)

[Wrench Party]

Sorry...I've already seen more reproductive organs of both sexes more than I ever really planned on before becoming a nurse. I answer questions before any procedures, make sure the patient's dignity and modesty is preserved through covering up when I can, and I treat what I'm about to do as normal, because it is.

[BuckyBadgerRN, ASN, RN]

What a weird first time/new account post. I highly doubt you'll be back OP! I think you're looking to stir up something

The Elephant in the China Shop

Everybody knows he's there but everybody wants to ignore it.

I'd like to raise an issue all of us are aware of but almost nobody appears comfortable enough to want to talk about.

How do things go when you need to do intimate procedures on a patient of the opposite sex? How do you feel about it and how does the patient feel?

Most of us are female. Let's say you have a male patient on whom you have to place a Foley (or a straight cath). Or you are to administer an enema.

I've had many off-the-cuff talks with colleagues and the reaction is all over the map. Some enjoy the intimacy; some are very uncomfortable. Providers at both extremes may try to cover up their feelings by one means or another. All of us are conditioned from childhood to maintain our own body modesty and it's difficult to violate somebody else's as a matter of routine, if we have any empathy with the patient. (And if we don't have much empathy, why are we nurses??)

And what about the patient? Male or female, most of them do not know they can refuse procedures that make them feel uncomfortable. If they did, I wonder if most of them would, just to avoid embarrassment. If you're female do you tell the male patient he's free to refuse this enema or that catheter? Or that he can choose a male administrator? Or do you charge right in with the enema tube or Foley as if they have no power to refuse? Male patients are very fragile in a way. Their macho makes them feel they need to be in control and they feel so put down if they're shown to be powerless that it's toxic. Especially if they are put through procedures that make it very clear women are in complete charge of their bodies. They've been brought up to think things should go the other way around. And they're too embarrassed to complain about being embarrassed.

I'm trying to put this subject on the table so we can talk about it among ourselves, maybe find better ways of dealing with it and hopefully allow us and the patient to feel more comfortable. I didn't even bring up how you may feel if you're a female patient about to receive an intimate procedure from a male nurse, but there should be similarities.

An unscientific summary after years of observation and talk might go like this, for patients of one sex receiving intimate procedure from nurses of the opposite sex:

1. Some patients are super-embarrassed, extremely uncomfortable. They may feel invaded and take away psychic damage.
   
2. Some are exhibitionistic and enjoy the exposure, glad for a context in which it can occur where nobody can charge they are perverted for seeking (or enjoying) it.
   
3. And everything inbetween those extremes. Very few are indifferent or treat it with the psychological neutrality one would a dental procedure, which also is invasive.
   

And for the nurses:

1. Some are embarrassed and may cover by coming on with cheery professionalism;
   
2. Some enjoy the access and cover by the same (or a different) route.
   
3. Not many are indifferent, probably more nurses than patients since we do these things far more often than they encounter them. But it's been said you might as well try to be indifferent toward sex.
   

A related question is what do you do if your opposite-sex patient, in response to unavoidable genital exposure or touching (as for a catheter), shows signs of sexual excitement. I've heard about all sorts of reactions, from ignore it” (usually easier to do with a female patient) to making remarks to defuse the situation.

In the case of a male patient with a full erection:

1. ‘Well, I'm so glad you're enjoying the examination/ procedure!”
   
2. If you can't get that to come down quickly, it may be painful when I work the catheter into place.”
   
3. Let's try this bucket of ice water I just happen to have here.”
   

Sometimes men get erections just because they're embarrassed.

Also, a male patient may be embarrassed because his erection may be the result of the stimulation of his sphincter due to enema prep. He may be concerned about being considered gay and may need reassurance this also happens to straight men.

I'm posting this here to try to shine some light on an issue usually swept into a dark corner because people are uncomfortable with it. What are your thoughts? Have you found good ways to deal with the subject, whether as nurse or patient, that may help us to know about?

Talk to us.

--hcworker

[TakeTwoAspirin, MSN, RN, APRN]

Yeah, I find it extremely hard to believe that anyone who is actually in healthcare would write this. Moving on, nothing to see here.

[prncaffinated]

The formatting is odd. I'm sorry. The OP reads like some type of article or blog post.

Who is "us"?

[macawake, MSN]

I agree that although the OP starts out with male and female mentioned, the focus becomes almost exclusively male. That's interesting, it makes me think they want the topic to appear like it applies to both genders, buy that isn't their focus.

I'd say that you are 100% correct.

Male modesty has been discussed at length before and those discussions often take a creepy turn by the original posters. I find it really weird how many men come to this site with intense feelings on this issue. It goes from male modesty (an important topic) to a warped accusation of nurses having lustful and perverse feelings toward their male patients.

I agree, patient's modesty is an important subject and it's kind of sad when an important issue gets sullied by some rather strange posts.

Have you all noticed that these kind of post always start off by describing female nurses predatory behavior like it's something that we're all familiar with. Like it's an everyday occurrence in healthcare. Here it's off-the-cuff coversations about nurses proclaiming to "enjoy the intimacy" of inserting Foley catheters. And the rest of us, nurses who've worked as actual nurses for two, five, ten or thirty years feel like we've entered the twilight zone. We've never experienced that.

We try to explain that no, we've never had conversations like that nor do we have those feelings. We simply don't recognize what the various posters try to claim is rampant, or at least not unusual, in the healthcare setting. When in fact, if a coworker were to tell us that they enjoyed the intimacy of urinary catheter insertion, our jaws would likely hit the floor. But it doesn't really matter what we say or how many of us say it, they won't be convinced.

[JustBeachyNurse, LPN]

Not one of the responses to a male patient with an erection pre or intra procedure are professional or appropriate which just increases the distasteful nature of this unprofessional post inappropriately attempting to sexualize medical procedures

[icuRNmaggie, BSN, RN]

I vaguely recall similar writing exercises this year about male modesty. If this person is from a Muslim or Middle Eastern culture he needs to say so in order for us to have an intelligent discussion.