What IS the problem with men?
This week, Pelvicroar and PhysiosOnline are highlighting the field of pelvic health IN MEN. When Evie talked about a pelvic health awareness week, she suggested that we start with men as they are so often left behind. I had to agree that she is right about this, but why is that? We thought it would be a good idea to look at this in more detail.
Is pelvic health centred more on women than men?
Well…yes! There is a good reason for this, to be fair. Women experience more pelvic health problems than men, mostly due to childbirth. Around one in three women leak urine at some stage, compared to one in three men. Around one in ten men or women will experience accidental bowel leakage. So, it does make sense to have some degree of focus around women’s pelvic health, and particularly around pregnancy, childbirth and the menopause.
Is this a problem?
Well….maybe! Pelvic health services, adverts, products and so on are centred around women. There is an abundance of pink, and girlie “oops” moments about bladder weakness, for example. Most men would start to feel even more isolated if they contemplated trying to get help for a bladder or bowel problem, and feeling that they had walked into female territory.
Should we reduce the focus on women’s pelvic health?
Absolutely not! It still takes an average of 6-7 years for women to seek treatment for urinary incontinence. Around 75% of women don’t get help at all! We need to raise our game and send out a clear message to men and women that leaking is “common but not normal”, and that pelvic health conditions can be treated.
Do you get men’s health physiotherapists?
Here’s the thing.
Physiotherapists tend to be much more “women’s health” than “men’s health”. The title “women’s health physio” is still in use in many places, although we are moving towards “pelvic health physios” to make sure men are included. Training is often still female focused, and most physios in this field tend to be women. There is an entire debate to be had on the issue of being models in training sessions, but that is for another day!
Physios who trained in this field some time ago may not have done any male specific training and I believe that there is a need to improve access to this. Training needs to be more accessible and affordable. There is a desperate need for accessible clinical supervision in this area too.
Male physios are incredibly challenged when working in pelvic health. Do they treat only men? This limits options, and access to training too. Do they treat women with the need to manage chaperones and the complex issues surrounding men treating women?
Suffice to say, we have some amazing male pelvic health physiotherapists, but I can name them very quickly as they are a rare breed. It takes a lot of balls (pun intended) to be a male pelvic health physio in such a female-dominated area!
Do men get pelvic pain?
Absolutely! Do we see it less than female pelvic pain or is it under-reported? Do men go to their GP to be dismissed if there is no sign of prostate cancer? Do women find it easier to seek help because they have, at least, gone for smear tests or examinations during pregnancy? Do men know they should check their testicles and have a rummage around?
I find it interesting that I know many of the answers when it comes to female pelvic health but I have many more questions about men. I do treat men, but have had much, much more experience with women and my own knowledge base is skewed. I am sure that I am not the only one.
What happens in the NHS?
My own experience, as an NHS clinical lead, is that men get the short straw. Women see midwives, GPs, health visitors, fitness instructors, gynaecologists, yoga teachers…..a plethora of individuals who may talk about pelvic health and pelvic floor exercises. It’s a start.
In my service, men are referred for pads post-prostatectomy and that is about it. We next see them in our service to care home residents! This must change!
I once took on a man in his 20’s, following acute prostatitis, with persistent pain and incredible levels of distress. He was so desperate that he had called around all the hospitals in the area to find a physio to treat him, as he could not afford more private care. No-one would take him on – either because they did not treat men personally or the service was only funded for women. (Worth noting that I am based in London, not somewhere remote!) I said that I would take him, but was honest that he was my very first male patient. I did, however, have considerable experience in female pelvic pain. He was so grateful that he was happy with my honesty and we embarked on his recovery journey together.
I then decided to post the case on a professional social media group, for some tips. To my surprise, the only comment I received was an experienced physiotherapist telling me that I was wrong to take on a complex case with no experience as I could do more harm than good. So, my choice was to abandon my patient or plough on. I am, to this day, grateful to Karl Monahan, the only relevant name I found on Google at the time. I emailed him and he talked me through the case, met my patient, and supported us both. My patient made steady progress and I learnt a lot. However, this would never have happened with a female patient!
What do we do next?
We have some wonderful links now, and a wider group of both physiotherapists in male pelvic health and male pelvic health physiotherapists! Let’s keep talking and sharing.
My two key points:
- Men have as much right to a healthy pelvis as women
- All clinicians will see their first male pelvic health patient at some point. There is no magic wand to gaining knowledge, experience and confidence. But there is a group of us who have been there, done that, got the T-shirt. Let’s help those ready to dive in and as my colleagues say…