["Affected by the touch": Meanings attributed to prostate cancer prevention practices among men]. / "Afectados por el tacto": sentidos atribuidos por hombres a las prácticas de prevención del cáncer de próstata.

The aim of this study was to identify and analyze meanings attributed to practices related to prostate cancer prevention among men. A qualitative methodology was employed, with semi-structured interviews being conducted with 21 men in the city of Vitoria da Conquista, Bahia, between July and August of 2017. Data analysis was based on a dialectical hermeneutic approach. We found that practices related to prostate cancer prevention were based on scarce information and permeated by a sense of fear of the disease, which was thought of as a death sentence. Additionally, these feelings were compounded by the repercussions of rectal examination, perceived as a violation of one's masculinity. We were able to observe that practices devised to prevent prostate cancer reflect the repercussions of conceptions of masculinity regarding men's health care, where manliness and toughness can be susceptible by the touch.

El objetivo del estudio fue identificar y analizar los sentidos atribuidos por hombres a las prácticas relacionadas con la prevención del cáncer de próstata. Se realizó un estudio cualitativo, con entrevistas semiestructuradas, en el que participaron 21 hombres del municipio de Vitória da Conquista, Bahía. El período de recopilación de información fue entre julio y agosto de 2017. El análisis de los datos se basó en los principios de la hermenéutica-dialéctica. Se percibió que las prácticas relacionadas con la prevención del cáncer de próstata se elaboran con escasa información y permeadas por sentidos que remiten al miedo a la enfermedad, asumida como una sentencia a la vida, y a las repercusiones del tacto rectal, asimilado como una violación de la condición masculina. Se constató que las prácticas elaboradas para prevenir el cáncer de próstata reflejan las implicancias de la masculinidad en el cuidado de la salud de los hombres y, sobre todo, que la dureza masculina puede sentirse interpelada a partir de un tacto.

Differences in teaching female and male intimate examinations: A qualitative study.

CONTEXT: Teaching intimate examinations to medical students has been recognised as difficult because of the anxious feelings that the students may experience. For their professional development, previously incorporated understandings need to be relearned: how to transgress boundaries that regulate intimacy and physical closeness, learning to examine and touch other peoples' bodies, and talking about things that are otherwise taboo. OBJECTIVES: This paper compares how students learn to perform two intimate examinations: (i) the digital rectal examination (DRE) of the prostate, and (ii) the bimanual pelvic examination (PE) and analyses how norms and expectations affect how students learn to approach them. METHODS: This study is based on ethnographic work: in-depth qualitative interviews with two urologists and nine medical students in semesters four, eight and 11 of a medical education programme in Sweden, observations of three learning sessions where 16 students performed the PE on professional patients, and 2 days of observations at a urology outpatient clinic. RESULTS: The educational approach to the PE and DRE differ. The PE is taught as sensitive and to be handled with care, using a well-documented learning concept including interpersonal and technical skills. The patient's exposed position in the gynaecological chair, possible previous negative experiences of PE or sexual exploitation are taken into account. In contrast, there is no educational concept for teaching the DRE. The students perform their first DRE on a clinical patient. The DRE is also handled with care, but with less sensitivity. The patients' possible previous negative experiences are not discussed and are thus made invisible. CONCLUSIONS: Well-established routines in performing the PE help doctors and students to be attentive to patients' emotions and previous experiences, and remind them to perceive the examination as sensitive. Aligning the teaching of the DRE with that of the PE will improve how the male prostate patient is approached.

"Afectados por el tacto": sentidos atribuidos por hombres a las prácticas de prevención del cáncer de próstata / "Affected by the touch": Meanings attributed to prostate cancer prevention practices among men

RESUMEN El objetivo del estudio fue identificar y analizar los sentidos atribuidos por hombres a las prácticas relacionadas con la prevención del cáncer de próstata. Se realizó un estudio cualitativo, con entrevistas semiestructuradas, en el que participaron 21 hombres del municipio de Vitória da Conquista, Bahía. El período de recopilación de información fue entre julio y agosto de 2017. El análisis de los datos se basó en los principios de la hermenéutica-dialéctica. Se percibió que las prácticas relacionadas con la prevención del cáncer de próstata se elaboran con escasa información y permeadas por sentidos que remiten al miedo a la enfermedad, asumida como una sentencia a la vida, y a las repercusiones del tacto rectal, asimilado como una violación de la condición masculina. Se constató que las prácticas elaboradas para prevenir el cáncer de próstata reflejan las implicancias de la masculinidad en el cuidado de la salud de los hombres y, sobre todo, que la dureza masculina puede sentirse interpelada a partir de un tacto.

ABSTRACT The aim of this study was to identify and analyze meanings attributed to practices related to prostate cancer prevention among men. A qualitative methodology was employed, with semi-structured interviews being conducted with 21 men in the city of Vitoria da Conquista, Bahia, between July and August of 2017. Data analysis was based on a dialectical hermeneutic approach. We found that practices related to prostate cancer prevention were based on scarce information and permeated by a sense of fear of the disease, which was thought of as a death sentence. Additionally, these feelings were compounded by the repercussions of rectal examination, perceived as a violation of one's masculinity. We were able to observe that practices devised to prevent prostate cancer reflect the repercussions of conceptions of masculinity regarding men's health care, where manliness and toughness can be susceptible by the touch.

Conhecimento, comportamento e práticas em saúde do homem em relação ao câncer de próstata / Knowledge, behaviour and health practices of men concerning the prostate cancer / Conocimiento, comportamiento y práctica en salud del hombre en relación con cáncer de próstata

Objetivo: Descrever o conhecimento, o comportamento e as práticas em relação ao câncer de próstata em adultos. Métodos: Estudo quantitativo, realizado com 130 homens. A coleta de dados ocorreu no primeiro semestre de 2015, por meio do Modelo de Crenças em Saúde. Resultados: Embora relatem conhecimento sobre o câncer, 30% realizam a dosagem do Antígeno Prostático Específico e 17,6% o exame de toque retal anualmente. A maioria percebe a susceptibilidade e a severidade do câncer e acredita que é capaz de fazer algo por si mesmo, beneficiando-se com esses cuidados. Quanto às barreiras, 16,9% apresentaram comportamento não preventivo. Conclusão: O medo da dor, a vergonha e a falta de coragem para realizar o exame constituem barreiras a esses indivíduos. A equipe de saúde deve oportunizar abordagens considerando esses aspectos, utilizando estratégias que ampliem o acesso dos homens ao serviço de saúde e estimulem a prática do autocuidado

Objective: The study's purpose has benn to describe the knowledge, behavior and health practices regarding the prostate cancer in adults. Methods: It is a cross-sectional and descriptive study with a quantitative approach, which had 130 participating men. Data collection took place from March to April 2015, using the Health Belief Model. Results: Although they report having knowledge about cancer, only 30% had done the prostate-specific antigen dosage and 17.6% the rectal examination annually. Most comprehend the susceptibility and severity of this cancer, and believe that they are capable of doing something for themselves and benefiting from such care. Regarding the barriers, 16.9% had non-preventive behavior. Conclusion: Fear of pain, shame, and lack of courage to take the exam are barriers to these individuals. The health team should opportunistically approach these aspects by using strategies that increase men's access to health care and encourage self-care practices

Objetivo: Describir el conocimiento, el comportamiento y las prácticas en relación al cáncer de próstata en adultos. Métodos: Estudio cuantitativo, realizado con 130 hombres. La recolección de datos ocurrió entre marzo a abril de 2015, a través del Modelo de Creencias en Salud. Resultados: Aunque reportan conocimiento sobre el cáncer, el 30% realiza la dosificación del Antígeno Prostático y el 17,6% el examen de tacto anual. La mayoría percibe la susceptibilidad y la severidad del cáncer y cree que es capaz de hacer algo por sí mismo y beneficiarse con esos cuidados. En cuanto a las barreras, el 16,9% presentó comportamiento no preventivo. Conclusión: El miedo al dolor, la vergüenza y la falta de coraje para realizar el examen constituyen barreras a esos individuos. El equipo de salud debe oportunizar enfoques considerando estos aspectos, utilizando estrategias que amplíen el acceso al servicio de salud y estimulen la práctica del autocuidado

Prostate cancer screening: what do men know, think and do about their risk? exploring the opinions of men in an urban area in Lagos State, Nigeria: a mixed methods survey.

INTRODUCTION: Prostate cancer (PCa) is the leading cause of cancer-related deaths in men aged 40 years and older. Incidence and mortality rates are higher in African men. PCa is amenable to early detection by screening which can prevent and reduce cancer deaths. Late-stage presentation and diagnosis often occur due to poor screening practices. This study assessed the knowledge, attitude, prevalence and barriers towards PCa screening among males in an urban area in Nigeria using a mixed method approach. METHODS: This cross-sectional descriptive study used quantitative and qualitative methods among men aged 40 years and older. A pretested structured questionnaire was used to interview 344 respondents through multi-stage sampling. Additionally, two focus group sessions were held using a pre-tested guide. RESULTS: Respondents were between 40-89 years with a mean age of 52.8 ± 9.9 years. Majority (54.9%) had poor knowledge of prostate cancer and its screening methods however, 65.7% expressed positive attitudes towards screening. Only 73 (21.2%) had ever been screened. The focus groups showed that respondents expressed a willingness to undergo PCa screening. The main barriers to screening were the fears of a positive result, ignorance and financial constraints. Participants preferred male physicians during digital rectal examinations. CONCLUSION: Respondents showed poor levels of knowledge. They expressed positive attitudes towards screening. However, this was not translated into practice. Public health interventions should educate men about benefits of early detection while addressing fears of positive findings and gender biases during rectal examinations. Efforts at providing low-cost alternatives for PCa screening are needed.

The psychological impact of prostate biopsy: Prevalence and predictors of procedure-related distress.

OBJECTIVE: Many men undergo prostate biopsies each year. Most data on consequences of prostate biopsy for men pertain to physical after-effects and/or come from clinical trial populations. We quantified prevalence of, and identified factors associated with, procedure-related distress in men having prostate biopsies in routine clinical practice. METHODS: Men who had undergone prostate biopsy for follow-up of a raised prostate specific antigen test result and/or abnormal digital rectal examination in 6 centres in Ireland completed questionnaires. Biopsy-related psychological distress was measured using the Impact of Event Scale. An Impact of Event Scale score ≥ 9 was considered significant biopsy-related distress. Logistic regression was used to identify predictors of significant distress. RESULTS: Three hundred thirty-five men completed questionnaires. Overall, 49% had significant biopsy-related distress; this was higher in men whose biopsy result indicated cancer (59%) and those who did not have a definitive result (54%) than those with a negative result (35%; P < .001). In multivariable analyses, the odds of significant distress were 3 times higher in men with cancer (OR = 3.33, 95% CI, 1.83-6.04) and more than twice as high in men without a definitive result (OR = 2.61, 95% CI, 1.43-4.78) compared to men with a negative result. Men with intermediate (OR = 3.19, 95% CI, 1.85-5.53) or high (OR = 7.10, 95% CI, 3.45-14.57) health anxiety (propensity to worry about one's health) also had significantly increased odds of biopsy-related distress. CONCLUSIONS: Significant distress is common after prostatic biopsy. Some men, including those who are highly health anxious and those awaiting definitive results, may benefit from additional support around the time of and/or following prostate biopsy.

The Cuban Institute of Oncology and Radiobiology experience on the beliefs and opinions about digital rectal exam in urological patients. / Creencias y opiniones sobre el examen dígito rectal en pacientes urológicos: experiencia en el Instituto de Oncología y Radiobiología (Cuba).

OBJECTIVE: To describe the beliefs, knowledge and opinions that influence the practice of digital rectal examination in a group of urological patients. METHODOLOGY: A descriptive study was conducted using convenience sampling and an anonymous questionnaire with 15 questions. The questionnaire was divided in three blocks: socio-demographic variables; delay in going to the urology clinic and taking the rectal examination; evaluation of patients’ perception of pain and discomfort during digital rectal examination and the impact of discomfort on potential future screening compliance. Percentages were used for the descriptive analysis. RESULTS: Eighty-five surveys were conducted at the Institute of Oncology and Radiobiology of Cuba. The results showed that 70.24% of participants to some extent had information about prostate cancer and 64.29% about prostate specific antigen. Only 27% thought that the digital rectal examination would be helpful, while 66.66% delayed their visit to the urologist in order to avoid the digital rectal examination and 79.76%, to elude the biopsy. It was observed that 52.39% and 36.90% of men complained of moderate and severe pain, respectively. Digital rectal examination was deemed traumatic by 61.9% of the surveyed men. A high number of patients responded they would repeat prostate exam the following year (88.09%) and 94.05% would encourage a friend to have the prostate exam. CONCLUSIONS: More than half of the sample claimed to know about prostate cancer and prostate specific antigen; however, they did not consider helpful to undergo digital rectal examination. The main reasons for not assisting to the urologist was to avoid biopsy and the digital rectal examination. Nonetheless, in most patients traumatic digital rectal examination was performed and responders said they would repeat it in the future.

OBJETIVO: Describir las creencias, los conocimientos y opiniones sobre el examen dígito rectal en un grupo de pacientes urológicos. MÉTODOS: Se desarrolló un estudio descriptivo transversal donde se evaluó un cuestionario anónimo con 15 preguntas, dividido en tres bloques: 1) variables socio-demográficas; 2) retraso en ir a la consulta de urología y su inconformidad con la práctica del examen dígito rectal; 3) percepción de dolor y malestar durante el examen dígito rectal. El cuestionario fue aplicado a una muestra de conveniencia. RESULTADOS: Se analizaron 84 encuestas aplicadas en el Instituto de Oncología y Radiobiología de Cuba. Los resultados mostraron que 70,24% de los participantes conocían en cierta medida sobre el cáncer de próstata y 64,29%, sobre el uso del antígeno prostático específico. Sólo 27% encontró útil realizarse el examen digito rectal. Los mayores impedimentos para asistir a la consulta del urólogo fueron: no someterse a una biopsia (79,76%) y evadir la práctica del examen dígito rectal (66,66%). Además, se observó que 52,39% y 36,90% de los hombres se quejaron de dolor moderado y severo respectivamente, siendo traumático el examen dígito rectal en 61,9%. Sin embargo, 88,09% de los pacientes respondió que repetirían el examen al siguiente año y el 94,05% animaría a un amigo para someterse al él. CONCLUSIONES: En la muestra de individuos estudiados, más de la mitad afirmó conocer sobre el cáncer de próstata y el antígeno prostático específico, sin embargo, no consideró provechoso someterse a un examen dígito rectal. Evitar someterse a una biopsia o al examen dígito rectal fueron los principales impedimentos para su asistencia al urólogo. A pesar de que en la mayoría de los pacientes, realizarse el examen dígito rectal fue traumático, estos consintieron en repetírselo en el futuro.

"Our people has got to come to terms with that": changing perceptions of the digital rectal examination as a barrier to prostate cancer diagnosis in African-Caribbean men.

OBJECTIVE: African-Caribbean men in the United Kingdom in comparison with other ethnicities have the highest incidence rate of prostate cancer. Psychosocial aspects related to screening and presentation impact on men's behavior, with previous studies indicating a range of barriers. This study explores one such barrier, the digital rectal examination (DRE), due to its prominence within UK African-Caribbean men's accounts. METHODS: African-Caribbean men with prostate cancer (n = 10) and without cancer (n = 10) were interviewed about their perceptions of DRE. A synthetic discursive approach was employed to analyze the data. RESULTS: Findings illustrate that an interpretative repertoire of homophobia in relation to the DRE is constructed as having an impact upon African-Caribbean men's uptake of prostate cancer screening. However, the discursive focus on footing and accountability highlight deviations from this repertoire that are built up as pragmatic and orient to changing perceptions within the community. CONCLUSIONS: Health promotion interventions need to address the fear of homophobia and are best designed in collaboration with the community.

As representações da masculinidade na adesão do toque retal como prevenção contra o câncer prostático / Representaciones de masculinidad en miembro del tacto rectal comoprevención contra el cáncer de próstata / Representations of masculinity in adherence of rectal examination as prevention against prostate cancer

The objective of this study is (re) thinking health actions transiting in that territory, and, in fact, such actions include the entire universe of feelings, doubts and uncertainties that permeate male thinking when it comes to the rectal exam. Method: the method is the design of test characterized as a reflective exercise on a theme, seeking a new way of looking at the subject. Results: masculinity is constructed by the influence of the social imaginary, and cannot ignore symbolic aspects that affect the decision to take the examination. This examination does not only affect the prostate, it touches on the symbolism of the aspects of what is “being aman”. Conclusion: it is for health professionals to understand what happens in the “man’s world” in order to think health actions to reduce morbidity and mortality rates of this disease that has been affecting the health and quality of life of men...

El objetivo del estudio es (re)pensar las acciones de salud en tránsito en dicho territorio, y, de hecho, este tipo de acciones incluyen todo el universo de los sentimientos, las dudas e incertidumbres que impregnan el pensamiento masculino a la hora de la prueba rectal. Método: el método es el diseño de la prueba que se caracteriza como un ejercicio de reflexión sobre un tema, en busca de una nueva forma de ver el tema. Resultados: la masculinidad se construye por la influencia del imaginario social, no se pueden ignorar los aspectos simbólicos que influyen en la decisión de realizar el examen. Este examen no solo afecta a la próstata, ya que atañea es un símbolo de lo que significa “ser un hombre”. Conclusión: es para los profesionales de la salud para entender lo que sucede en el “mundo de hombres” con el fin de pensar en las acciones de salud para reducir la morbilidad y mortalidad de esta enfermedad que ha estado afectando la salud y calidad de vida de los hombres...

O objetivo do estudo é re(pensar) as ações de saúde que transitam nesse território e se, de fato, tais ações contemplam todo o universo de sentimentos, dúvidas e incertezas que permeiam o pensamento masculino quando se trata de realizar o exame de toque retal. Método: o método empregado é o desenho de ensaio, caracterizado como um exercício reflexivo acerca de um tema, buscando uma nova forma de olhar o assunto. Resultados: a masculinidade é construída por influência do imaginário social, não podendo desconsiderar aspectos simbólicos que interferem na decisão de realizar o exame. Tal exame não toca apenas na próstata, ele toca em aspectos simbólicos do que é “ser homem”. Conclusão: cabe aos profissionais da saúde compreender o que acontece no “universo masculino” a fim de pensar ações de saúde para reduzir as taxas de morbimortalidade dessa doença que vem afetando a saúde e qualidade de vida dos homens...

Pediatric Rectal Exam: Why, When, and How.

The digital rectal examination (DRE) is performed in children less often than is indicated. Indications for the pediatric DRE include diarrhea, constipation, fecal incontinence, abdominal pain, gastrointestinal bleeding, and anemia. Less well-recognized indications may include abdominal mass, urinary symptoms, neurologic symptoms, urogenital or gynecologic symptoms, and anemia. Indeed, we believe that it should be considered part of a complete physical examination in children presenting with many different complaints. Physicians avoid this part of the physical examination in both children and adults for a number of reasons: discomfort on the part of the health care provider; belief that no useful information will be provided; lack of adequate training and experience in the performance of the DRE; conviction that planned "orders" or testing can obviate the need for the DRE; worry about "assaulting" a patient, particularly one who is small, young, and subordinate; anticipation that the exam will be refused by patient or parent; and concern regarding the time involved in the exam. The rationale and clinical utility of the DRE will be summarized in this article. In addition, the components of a complete pediatric DRE, along with suggestions for efficiently obtaining the child's consent and cooperation, will be presented.

Percepção dos homens sobre o exame toque retal / Men's perception about the rectal exam

Objetivo:compreender a percepção dos homens em uma Estratégia de Saúde da Família quanto à realização do exame de toque retal. Método:estudo de caráter qualitativo e abordagem interacionista simbólica. Foram incluídos homens na faixa etária acima de 40 anos. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa, protocolo do CEP/SOEBRAS: 01627/11. Resultados:a grande maioria dos entrevistados possui idade entre 51 e 60 anos, não concluiu o ensino médio, são católicos, casados, relataram que consultam o médico para consulta preventiva anualmente. Percebe-se que grande parte dos mesmos possui poucas informações a cerca do exame, e tem muita vergonha do procedimento. Conclusão:considera-se que ainda uma barreira física e social a serultrapassada diante dos estigmas masculinos; e que as pesquisas podem auxiliar na suspenção precoce de fatores de risco das populações.(AU)

Objective: understanding the perception of men in a Family Health Strategy regarding the realization of rectal exam. Method: a qualitative study of symbolic interactionist approach. Men aged over 40 years old were included. The research project was approved by the Research Ethics Committee, the CEP/SOEBRAS protocol: 01627/11. Results: the vast majority of respondents is aged between 51 and 60, have not completed high school, are catholic, married, reported consulting the doctor for preventive consultation annually. It is noticed that most of them have little information about the exam, and are very ashamed of the procedure. Conclusion: it is considered that even a physical and social barrier to be overcomed before the male stigmas; and that research may aid in the early suspension of risk factors of the population.(AU)

Objetivo: conocer la percepción de los hombres en una Estrategia de Salud de la Familia en cuanto a la realización de un examen rectal digital. Método: estudio cualitativo y enfoque interaccionista simbólico. Fueron incluidos los hombres del grupo de edad de más de 40 años. El proyecto de investigación fue aprobado por el Comité de Ética de la Investigación, el protocolo CEP/SOEBRAS: 01627/11. Resultados: la gran mayoría de los encuestados tienen edades entre los 51 y 60, no han terminado la escuela secundaria, son católicos, casados, informaron consulta preventiva al médico al año. Se observa que la mayoría de ellos tienen poca información acerca del examen, y tiene muy avergonzado del procedimiento. Conclusión: se considera que incluso una barrera física y social que hay que superar antes los estigmas del sexo masculino; y que la investigación puede ayudar en la suspensión temprana de los factores de riesgo de la población.(AU)

Cáncer de próstata: ventajas e inconvenientes del cribado diagnóstico / Prostate cancer: Advantages and disadvantages of diagnostic screening

El cáncer de próstata (CaP) es la segunda neoplasia mas diagnosticada. En España corresponde a la tercera causa de cáncer en hombres (excluyendo los tumores de piel no melanoma). Aun así, la evidencia actual ha llevado a organismos internacionales a contraindicar su cribado por el poco beneficio que se puede generar en cuanto a mortalidad sopesando los riesgos que conlleva el diagnóstico y el tratamiento. El objetivo de este trabajo es una revisión bibliográfica sobre las potenciales ventajas e inconvenientes del cribado con PSA a partir del consenso basado en la evidencia científica publicada en la literatura. Para ello se realiza una revisión de la literatura examinando las recomendaciones del cribado con PSA de los diferentes organismos urológicos americano y europeo, evaluando los ensayos clínicos aleatorizados y no aleatorizados en los que se basan sus recomendaciones. Se examinaron los posibles beneficios en cuando a mortalidad, los riesgos y prejuicios condicionados al cribado y el tratamiento del cáncer de próstata. Estipulamos nuestra recomendación basada en la evidencia actual (AU)

Prostate cancer is the second most frequently diagnosed cancer. In Spain only is the third leading cause of cancer deaths, yet evidence has addressed some international associations to stand against PSA screening declaring that screening´s harms outweigh the benefits of such procedure. The objetive of this paper is searched the literature about potential benefits and harms that PSA screening can generate. We also stipulated a consensus based on the scientiphic evidence. We reviewed guideline publications from the European and American urological institutions about PSA screening recommendations. We examined both, randomized controlled and non-randomized trials in which its recommendations are based. We reviewed the possible advantages and benefits related to PSA screening and prostate cancer treatment stipulating our consensus based on the evidence (AU)

Digital rectal examination skills: first training experiences, the motives and attitudes of standardized patients.

BACKGROUND: Physical clinical examination is a core clinical competence of medical doctors. In this regard, digital rectal examination (DRE) plays a central role in the detection of abnormalities of the anus and rectum. However, studies in undergraduate medical students as well as newly graduated doctors show that they are insufficiently prepared for performing DRE. Training units with Standardized Patients (SP) represent one method to deliver DRE skills. As yet, however, it is little known about SPs' attitudes. METHODS: This is a qualitative study using a grounded theory approach. Interviews were conducted with 4 standardized patients about their experiences before, during and after structured SP training to deliver DRE competencies to medical students. The resulting data were subjected to thematic content analysis. RESULTS: Results show that SPs do not have any predominant motives for DRE program participation. They participate in the SP training sessions with relatively little prejudice and do not anticipate feeling highly vulnerable within teaching sessions with undergraduate medical students. CONCLUSIONS: The current study examined SPs' motives, views, expectations and experiences regarding a DRE program during their first SP training experiences. The results enabled us to derive distinct action guidelines for the recruitment, informing and briefing of SPs who are willing to participate in a DRE program.

The impact of prostate cancer on men's everyday life.

Prostate cancer impacts on the daily lives of men, particularly their physical and emotional health, relationships and social life. This paper highlights how men cope with disease and treatment and the strategies they employ to manage their diagnosis alongside daily life. Twenty-seven men were interviewed at different stages in their disease pathway: nine men prior to radiotherapy, eight men at 6-8 months post radiotherapy and 10 men at 12-18 months post radiotherapy. A grounded theory approach was used to collect and analyse the data. Regardless of the point at which they were interviewed four areas emerged as important to the men: the pathway to diagnosis; the diagnosis; the impact of prostate cancer and its treatment on daily life; and living with prostate cancer. Prostate cancer was diagnosed using the prostate-specific antigen (PSA) test, rectal examination and biopsy. Many men did not understand the consequences of a high PSA reading before they undertook the test. Painful investigative biopsies were viewed as the worst part of the disease experience. Radiotherapy was considered less invasive than other treatments, although preparatory regimes were associated with stress and inconvenience. Men used various strategies to deal with treatment-induced threats to their masculinity in the long term.

Attitudes of UK doctors to intimate examinations.

Medical culture has portrayed intimate examinations as important in maintaining the sexual and reproductive health of patients. Intimate examinations have also been at the centre of high-profile scandals. Existing literature suggests there is considerable heterogeneity in the use of intimate examinations, as influenced by underlying attitudes. This study sought to ask how doctors make decisions to perform intimate examinations and negotiate the emotional aspects. In-depth interviews were conducted with 38 doctors of different grades and from different areas of clinical practice in the South East of England. Data were analysed thematically using NVivo 9, adopting a constructivist approach. Findings indicate that doctors' emotional constructions of intimate examinations coalesce around feelings of embarrassment, fear and anxiety, and vulnerability. Understandings of gender, sex and power also influence emotional constructions. Doctors utilise varying methods to negotiate emotions, some of which may be detrimental to patient care. These emotional constructions lead doctors to attribute values to intimate examinations and to chaperones that extend beyond responding to indications or following guidelines for examination. Doctors who resolve their own feelings of embarrassment, anxiety and vulnerability may be more likely to perform intimate examinations when indicated, to use chaperones appropriately and to offer the best standards of patient care.

Medical students' experiences learning intimate physical examination skills: a qualitative study.

BACKGROUND: Intimate physical examination skills are essential skills for any medical graduate to have mastered to an appropriate level for the safety of his or her future patients. Medical schools are entrusted with the complex task of teaching and assessing these skills for their students. The objectives of this study were to explore a range of medical students' experiences of learning intimate physical examination skills and to explore their perceptions of factors which impede or promote the learning of these skills. METHODS: Individual semi-structured interviews (N = 16) were conducted with medical students in years two to five from the University of Newcastle, as part of a larger research project investigating how medical students develop their attitudes to gender and health. This was a self-selected sample of the entire cohort who were all invited to participate. A thematic analysis of the transcribed data was performed. RESULTS: Students reported differing levels of discomfort with their learning experiences in the area of intimate physical examination and differing beliefs about the helpfulness of these experiences. The factors associated with levels of discomfort and the helpfulness of the experience for learning were: satisfaction with teaching techniques, dealing with an uncomfortable situation and perceived individual characteristics in both the patients and the students. The examination causing the greatest reported discomfort was the female pelvic examination by male students. CONCLUSIONS: Student discomfort with the experience of learning intimate physical examination skills may be common and has ongoing repercussions for students and patients. Recommendations are made of ways to modify teaching technique to more closely match students' perceived needs.

Leveraging virtual humans to effectively prepare learners for stressful interpersonal experiences.

Stressful interpersonal experiences can be difficult to prepare for. Virtual humans may be leveraged to allow learners to safely gain exposure to stressful interpersonal experiences. In this paper we present a between-subjects study exploring how the presence of a virtual human affected learners while practicing a stressful interpersonal experience. Twenty-six fourth-year medical students practiced performing a prostate exam on a prostate exam simulator. Participants in the experimental condition examined a simulator augmented with a virtual human. Other participants examined a standard unaugmented simulator. Participants reactions were assessed using self-reported, behavioral, and physiological metrics. Participants who examined the virtual human experienced significantly more stress, measured via skin conductance. Participants stress was correlated with previous experience performing real prostate exams; participants who had performed more real prostate exams were more likely to experience stress while examining the virtual human. Participants who examined the virtual human showed signs of greater engagement; non-stressed participants performed better prostate exams while stressed participants treated the virtual human more realistically. Results indicated that stress evoked by virtual humans is linked to similar previous real-world stressful experiences, implying that learners real-world experience must be taken into account when using virtual humans to prepare them for stressful interpersonal experiences.

Experience and attitude of interns to pelvic and sensitive area examinations during their undergraduate medical course.

OBJECTIVE: To explore the experience of interns in sensitive area examination during their undergraduate medical course and identify factors interfering with such examinations. METHODS: A cross sectional study was carried out from May to June 2010. Interns (n=315) at King Saud University College of Medicine were invited via email to complete a web-based questionnaire developed using surveymonkey.com. RESULTS: Out of 315 interns, 211 completed the questionnaire; 60% males and 40% females. The mean percentage of interns who never performed any of these examinations was 28.9% for digital rectal examination, 17.5% for breast, 43.1% for female pelvic examination, 13.3% for inguinal (hernia), and 34.6% for male external genitalia. Compared to females, male students conducted more rectal examinations (87 versus 63, p<0.005), and male external genitalia examinations (112 versus 26, p<0.001). On the other hand, compared to male students, females conducted more pelvic examination (68 versus 52, p=0.03) and breast examinations (92 versus 82, p=0.27). The most common reasons for not performing sensitive area examinations included patient's refusal (33.1%), and examining patients of opposite gender (27.6%). Confidence in performance of these examinations was correlated to increased frequency of the examination. CONCLUSION: This study highlights that most common factors interfering with the students' conducting sensitive area examinations are patient's refusal and examining patients of the opposite sex. There is a strong correlation between increased frequency of conducting an examination and student's confidence in performance.