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Continence Coach: Advocates and Educators: Proponents of Men’s Health
I am an advocate of women’s rights, particularly in healthcare, but I am aware the male gender has been relegated to second-class status relative to the other gender on any number of issues. Men may be to blame for not vocalizing or demanding health rights and access to options, perhaps because health concerns imply weakness as opposed to strength. As Americans, we still seem to perpetuate a culture that promotes fitness, sex, workouts, and muscle-building as icons of men’s health. More than 15 years ago, British researchers generated data from the British General Household Survey for 1991 and 1992 on 20,000+ women and men ages 20–59 years. The data showed the importance of separately analyzing educational qualifications, occupational class, and employment status for women and men to assess the inequities between men’s and women’s health.1 This became the rally cry for women’s health to receive dedicated resources for research, and internists began to specialize in female medicine. A decade ago, Lee and Owens2 provided a concise social psychology, drawing together the variety of arguments, controversies, and approaches in support of the field of men’s health. The authors argued that men’s health should be organized around three interrelated aspects of critics’ dissatisfaction with social psychology: its methods and claim to be a science (the paradigm crisis); its mental concepts, and especially its view of selfhood (the conceptual crisis); and its dehumanizing character and the political effects of psychological practices and knowledge (the moral and political crisis). Unfortunately, it is the very exhibition of masculinity that is considered indicative of normative behavior and thus serves as predictors of men’s inferior health-seeking behaviors.3
As a result, those of us in public health education must consciously try to steer such thinking on a more enlightened path, and you, as providers, must serve the patient community of men and women alike, free from your own potentially prejudicial thinking. In fact, part of your outreach as nurses to the underserved and the disenfranchised includes responsibility to the male gender, sending reinforcing signals that health-seeking behavior is not only OK, but it also is the right thing to do for oneself and sooner rather than later when symptoms surface.
Research shows men harbor the same myths that women do about the inevitability of bladder control problems with aging and quietly endure symptoms for years. The NAFC’s nationwide survey4 of men and women in the past decade indicate that men (43%) are as likely as women (40%) to discuss bladder control symptoms with a spouse. Slightly more men (55% of men versus 57% of women) are willing to talk to a doctor or nurse. But men (14%) are significantly less likely than women (36%) to discuss such problems with family members, and only 12% of men versus 32% of women are likely to speak to friends. Although women wait longer (6.5 years) than men (4.2 years) to seek a medical diagnosis once symptoms appear, men less frequently seek the advice or comfort of others and suffer in silence.
Why are men so inhibited? Is it because of their low health literacy? Do we really know in the US? Despite male preoccupation with prostates and penises, their knowledge of male anatomy and pelvic health appears limited, based on NAFC communications from the male gender (not that it is significantly better among women in the general population). I am saddened by how little men know about remedies for problems such as urinary incontinence and how susceptible in their ignorance they are to rumors.
For example, the artificial urinary sphincter (AUS) continues to be the gold standard treatment for stress urinary incontinence that has not responded to less invasive treatments following a radical prostatectomy for cancer. A more recently introduced option — male slings — is the preferable alternative to an AUS for patients with mild to moderate incontinence and in men who cannot manage a mechanical device such as the AUS.5 The AdVance® transobturator sling (American Medical Systems [AMS], Inc, Minnetonka, MN) does not work by compression as its earlier generation device with bone anchors and as such is optimal for patients who have sphincter control. Without bone screws, patients are less at risk for developing osteomyelitis; the most common complications are urinary tract infection, as with transvaginal slings for women, and perineal pain. Documented, isolated incidences of erosion were caused from errors in surgical placement of the sling through the urethra.6 Clinical results7 evaluating patients who had the transobturator male sling found that 63% of users were cured of leakage and 17% were improved, with an overall success rate of 80%.7 Men should be acquainted with these facts when considering a treatment plan.
In addition to the responsibility of the nursing community to educate the patient population about treatment options involving contemporary, proven technology, it is likewise the responsibility of nurse educators to dispel rumors and proliferate information. AMS recently issued a safety notice for its AdVance male slings after receiving complaints that the device’s absorbable sutures might prematurely degrade on the shelf. An internal AMS investigation discovered some sutures had degraded before their expected expiration dates, and the company could not confirm the affected production lots were free from issues. Accordingly, AMS notified, by letter and via its national sales force, all of the physicians implanting its device and all hospitals ordering the surgical device regarding the lot recall (no notice was sent to consumers) that affected products within lots ranging in number from 722024001 to 790266012 should be returned. AMS states there are little to no safety risks to patients who have the device implanted. Despite the company’s response and as a consequence of the current hostile legal environment in the US regarding surgical mesh kits for women with prolapse, unfounded associations have spread to male slings, including bad rumors that AMS has taken its male slings entirely off the market.
Clinicians: Alerting the public to potential issues is the right thing to do because it reflects the diligent attention to the quality patient care industry, healthcare, and caregivers provide. But get the facts. Give your patients the full, straight story, not hearsay. Advocate for access to safe, proven technologies that restore and protect quality of life, even in the more reticent gender. That’s where patient satisfaction begins and ends.
Dr. Muller is the Executive Director, National Association For Continence (NAFC). The NAFC is a national, private, nonprofit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence. This article was not subject to the Ostomy Wound Managment peer-review process.
1. Arber S. Comparing inequalities in women’s and men’s health: Britain in the 1990s. Soc Sci Med. 1997;44(6):773–787.
2. Lee C, Owens RG. The Psychology of Men’s Health. Buckingham, UK and Philadelphia, PA: Open University Press;2002.
3. Lyons AC. Masculinities, femininities, behavior and health. Soc Personality Psychol Compass. 2009;3(4):394–412.
4. Muller N. What Americans understand and how they are affected by bladder control problems: highlights of recent nationwide consumer research. Urol Nurs. 2005;25(2):109–114.
5. Chau VR, Maxson PM, Joswiak ME, Elliott DS. Male sling procedures for stress urinary incontinence. Urol Nurs. 2013;33(1):9–14.
6. Bauer RM, Mayer ME, Gratzke C, Soljanik I, Buchner A, Bastian PJ, et al. Prospective evaluation of the functional sling suspension for male postprostatectomy stress urinary incontinence: results after 1 year. Eur Urol. 2009;56:928–933.
7. Cornu J, Sebe P, Ciofu C, Peyrat L, Beley S, Tligui M, et al. The AdVance transoburator male sling for postprostatectomy incontinence: clinical results of a prospective evaluation after a minimum follow-up of 6 months. Eur Urol. 2009;56:923–927.
