Caring for Male Sexual and Reproductive Health Needs… are Important

Caring for Male Sexual and Reproductive
Health Needs…
…IN A FAMILY PLANNING
SETTING
Why Male Sexual/Reproductive Health Services
are Important
Compared to females, few sexually active male teens
have access to:
Counseling on STIs, HIV, pregnancy
Assessment for sexual health
History/counseling on contraception
Counseling on condom use
Females
61%
45%
33%
18%
Males
34%
15%
5%
7%
Burstein GR, et al. Pediatrics. 2003; 111(5):996-1001
Lafferty WE, et al. AJPH. 2002;92(11):1779-83
Men are Half of the Sexual Health Equation
Men have the right to:
y Safe sexual experiences:
no coercion,
discrimination, or
violence
y Information and access
to family planning
methods
y Access to reproductive
healthcare services
WHO: Goals of Male SRH
Promote
y Sexual health and development
y Healthy intimate relationships & responsible behavior
y Responsible fatherhood
y Access to clinical services
Prevent
y Unintended pregnancy
y STIs
y Reproductive cancers
Reduce
y Sexual dysfunction and infertility
Why See Men in a Family Planning Center?
You are experts in:
y Serving populations at risk for unintended
pregnancy and STIs
y Education and provision of contraceptive methods
y Preventing, diagnosing, and treating STIs
y Education and counseling on sexual health issues
What Services Does Male SRH Include?
MAC Guidelines (2009):
y Screening
y Health Promotion,
Education, and
Counseling
y Clinical Diagnosis
and Treatment
Screening
Pubertal development:
y Concerns about timing
and rate
y Gynecomastia
y Height
y Facial/body hair
y Size of genitalia
Screening
Sexual experience and
Behavior
y Abstinence
y Initiation of sexual activity
y Frequency
y Number and selection of
partners
y Sexual behaviors
y Contraception
y STI protection
y Sexual performance &
dysfunction
Screening
Pregnancy History
y Has he ever made a
woman pregnant?
y Planned pregnancy?
y Pregnancy outcomes
y Feelings about the
outcome
Screening
MSM
y Sexual behavior
y Homosexual
y Bisexual
y Transgender
y Questioning
y Feelings of social
acceptance or isolation
Screening
Communication about
sexuality
y Frequency
y Nature of
communication with
partners
Screening
History of Hepatitis
and Immunizations
y Hepatitis B
y Hepatitis A
y Liver disease?
y Need for immunization?
Screening
Contraception
y Basic knowledge
y Preference
y Past experience
y Both patient and partner
y Condoms
y EC
y Decision-making
Screening
STIs
y Past history
y Protective measures
y Past screenings
y Symptoms
y Fear, embarrassment in
seeking care
Screening
Sexual dysfunction
y Ability to obtain or
maintain an erection
y Premature or delayed
ejaculation
y Loss of libido
y Painful intercourse
y Prolonged painful
erection not associated
with sexual desire
Screening
Body Image
y Potentially harmful
practices
y Diet pills
y Excessive weight lifting
y Steroids
y Concerns
Screening
Family and peer
relationships
y Stressful or positive
relationships
y Influence on sexual
decision-making
y Support systems
Screening
Parenting skills
Violence and
Aggression
Screening
Emotional, Physical,
Sexual Abuse
Depression and Suicide
Screening
y Prostate cancer (40-50)
{
{
Benefits/limitations of
screening
Prior screening
y Testicular cancer (15-40)
{
{
Education
Instruction
y Colon cancer (>50)
{
{
Prior screening
Education
Screening
Tobacco and Drug Use
y Cigarettes
y Alcohol
y Marijuana
y Cocaine/crack
y Inhalants
y Injected drugs
y Steroids
Appropriate Exam and Lab Tests: Ages 13-18
Examination:
y Secondary sexual
characteristics
y Testicular exam
y Penis exam
y Rectal exam
y Prostate?
Laboratory testing:
y Chlamydia (oral,
urethral, rectal)
y Gonorrhea
y Syphilis as indicated
y HIV as indicated
y Urinalysis
Appropriate Exam and Lab Tests: Ages >19
Examination:
y Testicular exam
y Penis exam
y Rectal exam
y Prostate exam
y Breast exam
Laboratory testing:
y Chlamydia & gonorrhea
as indicated
y Syphilis as indicated
y HIV as indicated
y Urinalysis
y PSA
Education and Counseling
“Men are generally not involved
in healthcare until a crisis occurs
in their life.”
Male Advisory Committee, 2009
Anatomy and Physiology
Normal Male Sexual Function
y Sexual desire is variable
y Male sexual response
cycle
y Normal changes over the
lifespan
y Impact of alcohol, drugs,
and tobacco on sexual
function
y Prescription medication
and sexual function
y Alcohol
{
chronic heavy drinking: sexual
function and infertility
y Tobacco
{
Erectile dysfunction
y Marijuana
{
Decreased sperm count
y Cocaine/Amphetamines
{
Erectile dysfunction
y Anabolic Steroids
{
Breast development; genital
shrinking
y Heroin/Oxycontin
{
Correlated with HIV
transmission
Sexual Behavior of Men Who Have Sex with Men
y Safe sex: discuss with all
men the health risks
associated with specific
sexual behaviors
y HIV transmission
y STIs
y Social support
Fertility Awareness and Birth Control
y Female fertility
y Condoms
{
Types and proper use
y All female methods
{
{
{
{
How they work
Using them consistently
and correctly
Major side effects
Protection against STIs
Pregnancy options
counseling
Sexually Transmitted Infections
y Increase factual
knowledge base
y Explore sexual
practices/partners and
risks
y Symptoms
y Screening
y Treatment
Circumcision, Genital Health, and Hygiene
y Explore myths
y Give facts
y Relationship between
circumcision and STIs
y Relationship between
hygiene and STIs
y Cleaning and self-exam
Communication Skills in SRH
y Values and beliefs about
gender roles
y Gender and sexuality
y Expressing sexual
feelings
y Listening and sharing
Cancers Facts
y Breast cancer
y Prostate cancer
y Testicular cancer
y Anal cancer
y Colon cancer
y Risk factors
y Preventive measures
y Screening
recommendations
Environmental Factors
y Excessive heat in the
scrotum
y Hot tubs, tight clothing
y Toxins
{
{
{
{
{
{
Pesticides
Organic solvents
Lead
Heavy metals
Mercury
Radiation
Clinical Diagnosis and
Treatment
STIs/HIV
y Ability to examine both
partners in a sexual
relationship
y Ability to treat both at
the same time
y Education:
{
{
{
Both partners
Same time
Same information
Genital Skin Lesions
y Abnormal growths
{ Warts
y Itching
{ Eczema
{ Tinea
{ Intertrigo (rashes)
{ Pubic lice
y Skin changes
{ Folliculitis
y Irritation
y Bleeding
Impotence and Erectile Dysfunction
y Thorough history
y Explore possible causal
factors:
{
{
{
Substance abuse
Medications
Cardiovascular disorders
y Physical exam
{ CV system and genitals
y Lab tests
{ Glucose, prolactin,
testosterone, LH, FSH, TSH
y Treatment
Premature Ejaculation
y The most common male
sexual dysfunction
y Can occur at any age; most
y
y
y
y
common in young, sexually
inexperienced males
Embarrassment can delay
care
Psychosocial and sexual
history
Physical exam
Treatment: Pause and
Squeeze
Hernias
Varicocele
y Vein dilation found in
10-20% of men past
puberty
y Decreases circulation to
the testicle
y May cause pain or
testicular atrophy
y May be associated with
infertility
Vasectomy
y Intended to be
permanent
y Interrupts flow of sperm
to seminal fluid and to
female
y Does not alter
ejaculation or sexual
pleasure
Purpose, Policies, and Plans
Bringing Men’s Reproductive Healthcare from
Goal to Reality
WENDY GRUBE, PHD, CRNP
UNIVERSITY OF PENNSYLVANIA
SCHOOL OF NURSING
How do you envision male
RSH, and how is it
addressed in your clinical
site?
Constructing a Mission Statement
y What is its purpose?
y What needs to be
addressed in this
statement?
y How can we make it
work for us?
Mission Statement: What it really is
y It states your purpose,
your goal for existing
y It focuses your energy
and keeps you on course
y You can measure activity
and outcomes against it
y You can promote your
organization with it
Mission Statement: The Essentials
9 The PURPOSE: what are the opportunities or
needs [re: Male RSH] that should be addressed?
9 The BUSINESS: what is being done to address the
needs? [Services]
9 The VALUES: what are the principles or values that
guide your work?
Radtke, 1998, Strategic Communication for Non-Profit Organizations, The Grantsmanship
Center
Examples
y The Mission of the Family Planning Council
The Family Planning Council ensures access to high quality,
comprehensive reproductive and related health and prevention
services to primarily low-income individuals and families.
The Council develops, manages, and promotes programs that are
innovative, research-based and responsive to women, men, and
adolescents.
y http://www.familyplanning.org/mission.shtml
Planned Parenthood Federation of America
Mission Statement: A Reason for Being
y Planned Parenthood believes in the fundamental right of each individual,
y
y
y
y
y
throughout the world, to manage his or her fertility, regardless of the
individual's income, marital status, race, ethnicity, sexual orientation, age,
national origin, or residence. We believe that respect and value for diversity
in all aspects of our organization are essential to our well-being. We believe that
reproductive self-determination must be voluntary and preserve the
individual's right to privacy. We further believe that such self-determination
will contribute to an enhancement of the quality of life and strong family
relationships.
Based on these beliefs, and reflecting the diverse communities within which we
operate, the mission of Planned Parenthood is
to provide comprehensive reproductive and complementary health care
services in settings which preserve and protect the essential privacy and rights
of each individual
to advocate public policies which guarantee these rights and ensure access
to such services
to provide educational programs which enhance understanding of
individual and societal implications of human sexuality
to promote research and the advancement of technology in reproductive
health care and encourage understanding of their inherent bioethical,
behavioral, and social implications
Examples…
y Mission Statement
y The Emma Goldman Clinic is a not-for-profit independent organization
founded in 1973 by a group of women driven by feminist ideals. We exist to
empower women and men in all life stages through the provision of
quality reproductive health care that includes abortion services,
gynecology services, safer sex promotion, and active education. We
promote respectful, client-centered and participatory health care through
informed decision making, client rights, advocacy and expansion, and
support of pregnancy choices.
y We strive to provide an environment in which diversity is acknowledged
and celebrated. We are actively committed to staff diversity in employment
policies and practices. We strive to increase economic, geographic,
structural, and language accessibility for the clients we serve through
fundraising, outreach, and advocacy.
y We offer non-judgmental, quality health care services. Our goals are
inspired by our belief in the larger ideals of feminist philosophy: political,
economic, and social equality.
y http://www.emmagoldman.com/about/mission.html
What specific
services will you
provide?
Developing Clinic Policies for Male Services
y Policies define and
operationalize the clinic’s
mission
{
What will be done…
Education
Counseling
Ù Exams
Ù Treatment
Ù
Ù
{
{
Preparation
details
By whom…
Rationale
Plan: How to Put the Policies into Practice
¾ The Services:
¾ Labs, social support services and referrals, educational tools
¾ The Clinic Space:
¾ Rooms for counseling, education, and exams
¾ Gender neutral or male-appropriate environment
¾ The Staff:
¾ Trained clinicians (and back-up), counselors, educators, and
support staff
¾ Advertisement and recruitment
¾ Brochures, waiting room material, community
liaisons/outreach workers
What will the service
delivery look like as
it’s being used?
Time & Quality
Implementation: Walking the Talk
Making the clinic efficient for both men and women
¾ Convenience:
¾
¾
Appointments versus walk-in
Integrated with women’s services, or dedicated male hours
¾ Intake procedure and waiting time
¾ Reception
¾ Paperwork
¾ Financial interview
¾ Clinician/counselor availability
¾ Exit management
¾ Referrals and follow-up
Common Efficiency Problems
y Staffing: who is in the
clinic, doing what, and
when?
y Rooms adequately
prepared for the day’s
work?
y Check-in, completion of
paperwork, history, and
vital signs: what’s the
flow? Where are the holdups?
Improving Efficiency
y Identify your weak areas
y Streamline, simplify, and standardize processes for ease
and consistency
y Minimize the number of staff involved in process
y Aim to decrease waiting time between steps in the visit
y Flow Map: look critically at each step in your patient flow
process
{
Is it valuable, available, adequate, and flexible?
y Are bottlenecks continuous or episodic?
{ Explore
Review the
cycle annually
to adjust for
change
Challenges in the Clinic
y Un-gendering traditional
woman-oriented sites
y How best to integrate
male RSH services in
your site
y Staff training and
support for MRSH
y Back-up medical care
and referral sources
Shaping the Future of Men’s RSH
Style over stigma: The designer sexual health clinic that could be
mistaken for a boutique hotel.
KEYS TO SUCCESS
9Know your community
9Know your staff
9Know your resources
9Know your limits