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Are Women Afraid of Treating Men in Pelvic Rehab? Let’s Talk About It.

Fears about treating men’s health conditions are limiting access to care or are creating potential for harm in the field of pelvic health. Many cisgender women (women whose gender identify matches the sex likely assigned at birth) express concerns about working with cisgender men beyond a lack of knowledge about conditions related to prostate issues, urinary leakage, or genital pain. Are these fears warranted, are they fair? Rather than assert that ciswomen should simply move beyond their concerns, the field of pelvic health and the patients with whom we work may be better served by digging in and talking more openly about such fears. Following are some of the concerns or comments I have heard expressed by cisgender women within the context of treating men’s health matters:

  • (Regarding palpation of the penis:) “Is that legal?”
  • “I worry about being alone in a room with a man.”
  • “What if he gets an erection?”
  • “My husband doesn’t want me to work with other men for pelvic health stuff.”
  • “I’ve never seen a man’s genitals before and I’m not comfortable with it.”
  • “My religion teaches that I should not touch a man other than my husband.”
  • “I don’t know what to say when men make suggestive comments.”
  • “My supervisor is forcing me to do this work with men when I don’t want to.”
  • “I only treat them in side lying because then I don’t have to see their stuff.”

Rather than a reader making a judgement about the above comments, we should ask ourselves as a profession if the above topics have been properly addressed in our training or if we are encouraged to work through this area of professional and personal intersecting concerns. We could view the concerns expressed through the lens of providing equal care, in other words, are we discriminating against someone based on their genitals? Or through a lens of safety- is there an actual (as well as perceived) threat from a cisgender woman who is alone in a treatment room with a cisgender man? If that’s potentially true, how are we mitigating this risk? Where does the anatomical line end between personal beliefs such as “I can touch another man’s shoulder, but not perineal area”? Are we practicing ethically if we are denying access to care or providing less than comprehensive care? Is a therapist truly worried about their primary relationship by doing this work because their partner does not approve? And more importantly, can we provide needed guidance or support to address some of the above obstacles?

I commonly have the opportunity to work with men who have seen other self-identified female therapists first. Here is what I often hear:

  • “I could tell that they weren’t comfortable talking to me about this issue.”
  • “It didn’t seem like they knew what to do with me.”
  • “I got switched over to another therapist after asking some questions about using a penile pump.”
  • “I felt really shamed about my condition because they would change the subject.”
  • “I called many places and they rejected seeing me because I’m a man.”
  • “When I asked if they were going to examine where the pain is [genital area] they said it would be a last resort.”
  • “No one ever examined me, just gave me a biofeedback sensor to put in.”

This information is not shared to shame the caring professionals in our field. What needs to happen, however, for elevating the inclusiveness of care, is a continual dialogue and recognition of the support needed to work with sensitive conditions and the vulnerabilities of both patients and providers. It is potentially harmful to reject patients based on gender, or to provide lesser care based on genitals. To further this conversation, the Institute has partnered with author and educator Leticia Nieto, who holds a degree in psychology and who wrote Beyond Inclusion, Beyond Empowerment: A Developmental Strategy to Liberate Everyone. Join Leticia and me (Holly Tanner) for our first 3-hour discussion that emphasizes talking, feeling, and thinking through some of the above concerns and challenges. The class will focus on discussion more than lecture, and will aim to provide a space within which we can speak openly about how to move forward with the goal of improving comfort when working with men’s health issues and improving access to much needed pelvic health care. Note: this class is welcoming to all people with any gender identification, however, the emphasis will be on the topics discussed in this post.

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