The scope of a certified nurse midwife encompasses men who are in need of treatment for STDs.
When looking at the words, or thinking in the abstract about treating men, I never gave it a second thought. And then I had my first few male patients,and male exams to contend with by myself. When I watch the other providers do male exams, it’s never awkward, they’re never fumbling with unfamiliar anatomy, and they certainly don’t blush.
I have not been so smooth.
In my training I worked with a family practice doc for a few weeks. We did all kinds of exams with men, and because the Doc himself was a dude, he had lots of dude patients. I had no problem at the time, same questions, does it hurt here, what makes it better? What makes it worse? We did a fair number of annual exams, and when Dr. S got to the “take off the pants” bit, he always had me step out of the room. He made the joke to the patients, “she’s a midwife, she won’t do too much of this in practice” and everyone would have a laugh.
Well, now, here I sit on my little stool trying to figure out the least awkward phrasing for telling men, most of them roughly my age, that they need to drop their drawers, and I’m going to poke around a bit.
Even though the care of men in the limited scope of seeking out treatment and testing for sexually transmitted diseases is within my scope of practice, not one of my midwifery faculty ever talked about it. Not one of my books talked about the special way in which we must care for men in the way it talked about being involved in the care of women.
In my vast (three weeks) of experience, I have noticed that that the way in which men disclose information to me, talk about their problems, or even address me as a health care provider is very different than when I am discussing these issues with women. Women, for the most part, come in when they have had an issue almost right away. Many of the men that I see come in to see me after they have had symptoms for weeks to months. There’s less crying when you’re seeing men, but I have had not just a few men get ostentatiously angry, irritated, or have even yelled or threatened their partner when I tell them I think they have a sexually transmitted infection. That’s not to say that all of the men I see react this way, it is just more common than in the women that I see.
As someone who has, for most of her training, seen only women, discussed sexual health with women, the jarring change into seeing men has been a difficult transition. I am no gender essentialist, but when I talk to women about their bodies there is almost an understood comraderie. A “hey girl, I know what you’re going through” type feeling that makes it easier for both of us to relate to one another.
My partner told me to just think about the penis as a giant clitoris, and that all the grown men I see were once women as tiny tiny embryos. While this is true, I have noticed the stark difference in which our culture treats male sexuality and bodies versus women’s bodies, and the internalized feelings that have accompanied growing up in a highly gendered society.
For the most part, the men I see are respectful towards me, recognize my expertise in the field and are genuinely interested in the counseling I have for them. But some are not. Some say inappropriate things to me during physical exams. Some doubt that they really need the treatment that I’m giving them and ask if I’m a nursing student after I’ve already introduced myself as the Nurse Practitioner here today (and I’m wearing a big, long, white coat.). Some flirt with me, others doubt the treatment I recommend, or sometimes they do both.
It is difficult to bring a midwifery feel into the room when I know being warm and fuzzy will undermine my authority with my male patients at best or give them the wrong impression at worst. Yesterday in clinic I saw a male patient for the first time since I had a barrage of men over the weekend, and some interesting experiences with physiologic responses to examining the male genital organs.
I decided that it was time to try a new strategy when working with men, one that if I told Me the Midwifery student that I had adopted, I wouldn’t believe myself. I had to walk into that room with bravado. I know it all. I’m the shit. Quick. Curt. Professional. No asking about the rest of the afternoon. No warm smile. Drop your drawers.
And you know what? It worked. I felt more comfortable keeping the distance, and I think my play-acting at knowing All The Things made my patient feel more secure. Everybody wins.
I still have a long way to go on learning about male reproductive health, (like a review of basic anatomy would probably be a good start), but it’s an interesting growing experience, and something I never thought I’d be doing.
So here’s to caring for giant clitorises, and the diversity of men attached to them!
Note: This post only talks about male-bodied persons who also identify as men. My population is a vast majority of cisfolks and this post is not meant to dismiss the healthcare experiences of transmen and women and gender variant individuals.