Patient Dignity 02: But it is Sexual...

One of the things patients are told by the medical profession today is that even though a physical exam exposes and touches body parts, it is not sexual. This is absolutely incorrect.

Let's look Bates Guide to Physical Examination and History-Taking (Eleventh Edition). Chapter 13 Male Genitalia and Hernias states:

"Occasionally, male patients have erections during the examination. If this happens, explain that this is a normal response, finish your examination, and proceed with an unruffled demeanor." 

The response can be to fear and anxiety, the physical stimulation of being exposed or touched, or all of the above. The point is that along with it being an automatic reflex, it is also a SEXUAL response.

"That women can experience genital response during unwanted sex or when viewing depictions of sexual assault suggests that women's vasocongestion response is automatically initiated by exposure to sexual stimuli, whether or not these stimuli are preferred, and without subjective appraisal of these stimuli as sexually arousing or desired." (Source: Agreement of self-reported and genital measures of sexual arousal in men and women: a meta-analysis. Meredith L Chivers, Michael C Seto, Martin L Lalumière, Ellen Laan, Teresa Grimbos, February 2010)

Although the article Agreement of self-reported and genital measures of sexual arousal in men and women: a meta-analysis looked the connection between the mind and genitals during sexual arousal, that article and most of the 88 articles it cited, discuss different stimuli that produces sexual arousal both physical and mental.

This is important because as I said in my previous post we are only going to look at actions, because they can be measured. This study (along with most of the 88 articles it cited) also discussed the difficulty in measuring physical sexual arousal. Obviously it is easier in men, but still presents challenges (erectile dysfunction for example).

From this, we have to take away that there is some percentage of providers who experience some form of sexual arousal when performing exams or procedures. I am not going to argue what the percentage is, but you cannot deny, just by the number of providers in the United States, times the numbers exams or procedures that they perform each day, there are a certain number of sexual responses.

I am not saying that these responses may are intentional, they may just be a reflex from stimuli, just the way some men may elicit an erection during an intimate exam.

Here is the problem, the medical system tries to convince itself and the patients that this is not sexual. When a man has an erection, he knows that is a sexual response, the provider knows that too. Yet both say to themselves, this is not sexual. This creates a conflict without a clear resolution. This is the mental equivalent of "dividing by zero."

The same goes for a provider who may experience sexual arousal during a procedure or exam. There are studies on the anxiety doctors face from these exams, so a response of arousal may be from the fear, stress, or anxiety too.

Even though this is not (suppose to be) a sexual situation, it feels like a sexual situation. Now couple the feeling of being violated with the feelings of a sexual nature, you can further see why I contend that some patients have the feeling of having been sexually assaulted after an exam or procedure.

Addendum: Freud's Psychosexual Development, and Rape; Further Evidence that Medical Procedures are Sexual

1.) Freud's Psychosexual Development

You can read about Freud’s Stages of Psychosexual Development here, if you are not familiar with them. I am just going to refer to the Oral Stage, Anal Stage, and Genital Stage. Psychosexual Development is based on linking the mind with these "sexual regions" of the body. The breasts can also be considered part of the oral stage of development.

I am sure that everyone can accept human "sexual regions" defines as breasts, genitals, anus/rectum, and the mouth. The mouth may be questionable by some, but following Freud's theory, it fits in as a "sexual region."

Note: Do not confuse the sexual regions with erogenous zones.

A bonus to my argument is the "Phallic Stage." At this stage children learn the differences between "male" and "female" and the gender differences between "boy" and "girl". They also learn modesty and "that it is wrong to expose yourself to others." This defines their boundaries.

2.) Rape

As I stated before, I prefer the term "rape" over "sexual assault." Rape is NOT a crime of sex. Rape IS a crime of assault. Rape is about power, domination, humiliation, the infliction of bodily harm and physical damage. Sex is the weapon used in rape.

When I say sex is the weapon, by sex I mean sexual contact. Sexual contact is when the perpetrator uses the senses (visual, auditory, gustatory, olfactory, and tactile) on the victim's sexual regions. It is not only touching; see Johns Hopkins to pay $190 million for OB-GYN who secretly recorded women in examining room:

So my point is that sexual contact is the weapon used in rape (sexual assault). 

The Medical Procedure

Remember, I am taking intent out of the equation. The intent of rape is not sexual pleasure, it is assault. Sex is the weapon of rape.

Weapon is defined as: a tool designed or used for inflicting bodily harm or physical damage. 

Tool is defined as: a device or implement, especially one held in the hand, used to carry out a particular function.

So sex is the tool used to inflict bodily harm and physical damage in rape.

Many Definitions, Many Meanings. 

Words can have many meanings depending on who is using them. Just look at The Free Dictionary's definition of "call" here: There are 17 meanings as a verb and 15 meanings as a noun.

The average person thinks that "sex" is the same as "making love," but it is not. I will be defining the terms from a psychosocial and anatomical point of view. I am also taking the "intent" out of the definitions and only focussing on the observable actions.

Sexual contact is the act of manipulation of, OR using the senses (visual, auditory, gustatory, olfactory, and tactile) on the a person's sexual regions (defined above), OR contact with the sexual regions, including penetration (however slight) of any orifices in the sexual regions with a body part or object.

Making love (the average person's definition of "sex") is the consensual act sexual contact involving 2 or more people, usually for the purposes of (but not limited to) bonding, physical pleasure, intimacy, that include physical, mental, and emotional aspects of the participants. (Other purposes may include revenge, exercise, consoling, etc.)

You can see that sexual contact is an act, a motion, a tool. Depending on the use of the tool (sexual contact), the context is defined.

Sex (sexual contact) is a tool. 

In a relationship (marriage), it builds intimacy and trust. In rape, it is the weapon of assault. In procreation (dare I say animal husbandry), it is the tool to produce offspring. In nature, it is the means of perpetuation of the species. In medicine it is one of the tools of exam and treatment.

Addendum (Some info I found after completing the original post)


I found an article in the March 16, 2006 issue of Nursing Standard, (published in Great Britain),  titled "Male Urinary Catheterisation" by Willie Doherty who is a clinical nurse specialist. 

After discussing what the process is and why one does it, Doherty has a section called "The Role of the Female Nurse."

In the past, he says, only males did this procedure on males. But the result was that males had to often wait too long in pain to get the job done, so female nurses were taught the procedure. Doherty discusses the intimacy of the procedure as says now males can have the procedure done without having to wait. But, he writes:

"However, patients should always be give the choice of the gender of the nurse or doctor performing this intervention, as with any other clinical situation or intimate procedure. The patient's wishes should be foremost in the decision making process and he may not wish a female nurse to undertake this procedure." 

He does say to offer the male patient a chaperone of the same gender, and specific to our current discussion about chaperones, he writes:

"The Royal College of Nursing (2002) and the General Medical Council (1998,
2001) have published guidelines on chaperoning and intimate examinations and the nurse should be aware of local policy on chaperoning." 

These British policies indicate that patients should always be offered a chaperone of the same gender.

Doherty has a section in this article about male sexuality in which he writes:

"Male sexuality is an important consideration for female nurses undertaking male catheterisation.
Milligan (1999) stated: ‘the penis is considered by many to be the focus of male sexuality. Compared with female sexuality, male sexuality is more concerned with power and performance and more physical (Lawler 1991). This has an
impact on the practitioner and the male patient as the penis is being manipulated (Fader 1986).

 How much of this kind of psychology/sociology is even covered in doctor/nurse training? If it is covered, it seems to be set aside or forgotten soon after the doctor/nurse gets into the healthcare "system." 

Further proof of the sexual nature of medical exams and procedures.

Medical schools have training to take sexuality out of the equation for medical practioners who examine naked patients. Unfortunately, patients are not afforded the same training.

Consider the Pelvic Exam:

It is really surprising that there is still  controversy about the sexuality of physical exams. Consider the question of male doctor eroticism during a pelvic exam. The medical community recognizes it's existence. Medical textbooks (at least into the 1980's) cautioned the young male medical student that it is "inevitable and unavoidable" that erotic sensations will occur while doing a pelvic exam.

Medical students relate stories that male professors would often comment that "if you do the pelvic correctly you won't need extra lube when you do the bimanual exam." Occasionally medical journals publish cautionary memoirs about young male doctors who "fall in love" with female patients while looking at and feeling the patient's breast and genitals, the tale always ending with a warning from an older colleague.

The medical profession has frequently ordered surveys by medical school personnel to determine the extent of sexual violations during intimate encounters in the doctor's office. The published results of self-confession indicate high rates of abuse by male gynecologists, sometimes running as high as 20%.

When male gynecology developed over one hundred years ago there was no denial of eroticism for the male. The novel practice of a man examining the female anatomy was simply defended as a practical necessity - there was no female in the profession to do the job. You want good health, you go to the male doctor.

Textbooks and procedures acknowledged the sexual nature of the exam and doctors quickly set up the chaperone system to reduce the tension. It is only recently as female doctors have moved into the field.

It is an absurd notion that a male can examine a female body in the most intimate manner, and experience absolutely no sexual response. In other words, it has been discovered that male gynecologists are unique in the human species - after six million years of evolutionary development in which the male "automatically" responds to the sight and touch of the female genitals, this all can be blocked out by a couple years in the medical lab.

I am not absolving women either. One has to ask, what about the female doctors who may be lesbian/bisexual/curious? The primary sexual stimuli for women is different than that of men, but erotic sensations can occur while doing a pelvic exam. I'm sure there are just as many woman out there who enjoy it as there are males.

Even Heterosexual People can be Aroused by Homosexual Stimuli

The American Journal of Psychiatry (February, 1984, Vol. 141, No. 2) Mark Schwartz and William Masters report a survey of 120 men and women, half of them homosexual and half heterosexual, showing that people's sexual fantasies can be at odds with their sexual orientation.

Among both men and women who are homosexual, for example, heterosexual sex ranks as the third most common sexual fantasy. For heterosexual men and women, homosexual encounters rank fourth and fifth most common, respectively. 

People tend to be selective in their recall of their own fantasies. To get a full record, David Barlow, director of the Sexuality Research Program at the State University of New York at Albany, asked people to carefully monitor their fantasies for several weeks.

''Among heterosexuals about three- quarters of fantasies are of 'normal' lovemaking, and about 25 percent are sexual variations - sadomasochism, homosexuality, group sex and the like,'' he said. ''The normal pattern of sex fantasies includes a certain amount of unusual sex.''

Do you see my point? Are you thinking yet?



--Banterings