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:
Some patients are super-embarrassed, extremely uncomfortable. They may feel invaded and take away psychic damage.
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.
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:
Some are embarrassed and may cover by coming on with cheery professionalism;
Some enjoy the access and cover by the same (or a different) route.
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:
‘Well, I'm so glad you're enjoying the examination/ procedure!â€
If you can't get that to come down quickly, it may be painful when I work the catheter into place.â€
Let's try this bucket of ice water I just happen to have here.â€
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?
