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Loneliness and a need for intimate physical contact were important reasons for having sex.

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As restrictions were first put in place around three months ago, this suggests that the number of men hooking up and needing sexual health services may soon increase. Thirty per cent of respondents took PrEP before the coronavirus outbreak and, of these, two-thirds had interrupted their regular PrEP use. The most common reason for PrEP interruption was not having sex during this time — two-thirds of PrEP interrupters said this. Twelve per cent reported having accessed STI testing since social distancing measures were introduced. About a quarter tested in a clinic, whilst almost three-quarters used remote testing such as self-sampling or self-testing.

Respondents used a range of methods to get test results and any necessary treatments in person, by post, phone or video call, etc. Although current public health guidelines make it illegal to have sex at home with a casual partner , the survey findings suggest that the demand for sexual health services is likely to increase in the coming weeks. Criminalisation of sex, while being unenforceable practically, may also prevent people from accessing sexual health care during the pandemic.

Intimate contact breaches privacy[ 24 ] but the two participants above expected it to be maintained during intimate contact. Age influenced intimate contact with several participants who stated that they would have preferred an older member of staff to perform the procedure. They may have been because of their greater experience. Pateman and Johnson[ 9 ] established that men found intimate care less embarrassing from an older woman. One participant in this study claimed that he would have been more sensitive to the investigations had he been younger perhaps strengthening the hypothesis of androgyny of later life[ 25 ].

Intimate contact more often than not included exposure of the genitals and quite often exposure went beyond what was necessary. Goffman's[ 26 ] exposition on embarrassment helps to explain the discomfort of many participants especially as he asks who is likely to suffer the embarrassment the patient and who causes it the professional? The male nurses in one study[ 27 ] sought strategies to protect themselves from accusations of inappropriate touch by setting a formal tone, shaking the patient's hand prior to care, wearing a uniform and modifying techniques to minimise the need for intimate touch.

There is little in the literature explaining useful strategies for patients in this situation. Sexuality helps to define an individual and for many it is at the core of their personhood. For men masculinity is said to centre predominantly on the penis. Lawler[ 19 ] explains that the role of the body and sexual organs in the majority of social situations is invisible and its exposure is controlled.

It is likely that this exposure and vulnerability was of significance to these men because of the impact on their perception of their manhood. Interestingly, the proposition put forward regarding parasexuality is that patients represent the customer and staff, the barmaid.

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However, when examining the dynamics of intimate contact the position of barmaid and customer seemed to be reversed with the patients feeling on show and vulnerable as a barmaid might. Parasexuality relies on all participants in the scenario knowing the limits of the phenomenon.

A latent sexuality triggered many of the examples given regarding investigations. Despite conceding this the participants were at pains to stress that it remained implicit and was never expressed to staff. This could be said to be an example of a reflexive action where the participants, at risk of breaching the boundaries of parasexuality, tried to limit it by suppressing their sexuality.

So I am looking at the clock and I thought and so I come out laughing to the wife and she says what have you been up to now? In this example, M5 rapidly retrieves a situation which appears to be overtly sexual by endorsing the professionalism of the staff see below.

The quote below sums up some of the other comments in revealing the struggle against embarrassment and erection in suppressing sexuality in the presence of female members of staff. This participant was not alone in fearing getting an erection as the investigations involved touch of their sexual organs see below. Intimate touch is noted as a risky act which is open to misinterpretation[ 13 ] and the difficulties of this forced intimacy is acknowledged in the literature. This participant made health his priority, but acknowledges that in other circumstances viewing a nurse in a sexual way would be worthy of consideration.

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For some participants the link between their investigations and sexuality inhibited their ability to express themselves or gain information. This was evident with participant M6 in the Gender Role Stereotype section above. He was unable to discuss his problems of gynaecomastia and impotence with the staff ostensibly because of gender and associating an ascribed role to doctors but also possibly because of the close association of his problems with his sexuality.

The example below highlights how suppressing sexuality when communicating with staff can also suppress communication. I read, looked it up, everything.


He explained that to me, but I thought afterwards I could have talked a little bit about it to somebody, but I have never been. Suppressing their sexuality to lessen embarrassment was a common theme. Unfortunately for M4 it limited his chances of receiving accurate advice or treatment for his condition. The ability to get an erection unites male gender with sexuality and masculinity. According to Lawler[ 19 ], impotence becomes a highly stigmatising and stressful experience for some men as it can dismantle their masculine image.

Some participants spoke about their impotence but it is likely that some did not know whether this would occur following their investigations and treatment which could have caused them uncertainty and anxiety. At this point it is worth making a distinction between libido and impotence in that even if a man loses the ability to gain an erection, he may still retain his libido, or desire for sex. Suppressing sexuality was prominently related to heterosexuality, but this participant amongst others revealed his fear of being the subject of a homosexual fantasy.

But I had to kind of consciously think not to be embarrassed and not to feel awkward about the situation, whereas when I saw the guy in the hospital who was a male for the prostate thing — there was a certain amount of that but not so much you know. This supports the persistent label of male nurses as being homosexual. Interestingly, in this study homophobic views seem to have been perpetuated with several comments echoing the fear of homosexuality which were not restricted to nurses. None of the participants disclosed that they were homosexual and no homosexual encounters were described in the data.

Nonetheless, it cannot be assumed to be absent. The invisibility of potential homosexuality in patients has been discussed in the literature[ 28 , 29 ]. Interestingly, neither publication cited discusses this issue in relation to health care staff. However, there has been discussion on the suppression of sexuality by some professionals when physically examining patients[ 10 ]. The authors cite three desexualising strategies used by staff from their research: meeting the patient clothed beforehand, engaging in non-sexual joking and using medical not colloquial terms[ 10 ].

Not all participants needed to suppress their sexuality and for some this topic did not arise. However, for those that did they considered staff as professionals and they were able to make a distinction between social and professional interactions during the investigations. Viewing staff as professional was a strategy used by participants to limit any sexuality as parasexuality.

This was used in addition to the tactic of suppressing their sexuality.

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Professionalising staff reduced sexuality to the more innocuous parasexuality in order to make encounters during investigations manageable. There is some literature from the staff perspective regarding professionalism. The need for patients to professionalise staff has been little explored and this finding adds to the body of knowledge in this area. This study was limited to investigating male genitourinary investigations.

Parasexuality in genitourinary investigations: a qualitative study

Despite a wealth of literature exploring the feelings of women undergoing gynaecological examinations, particularly related to childbirth, there is little to authenticate their experiences when undergoing urinary tract procedures specifically. This is an area ripe for exploration with the opportunity to compare findings with this study. In retrospect it would have been fitting to have offered the participants a choice of female or male interviewer in keeping with the sensitivities of the topic[ 6 ].

Offering further interviews to the participants at a later date may have gleaned a deeper level of data as a phenomenological study of men post-prostatectomy found they were initially satisfied with their care and treatment[ 9 ] and only later did they give a more realistic picture of their experiences. External validity, or generalisability of the existence of parasexuality across populations is not possible following this research[ 30 ]. However, it is argued that there is adequate evidence of internal validity, or the degree to which the data support the evolving theory.

Achieving reliability in qualitative research is more challenging and is often termed credibility in qualitative research. The researchers adhered to a set of principles for ensuring rigour or credibility[ 31 ]. This study has contributed towards the plea for more studies to examine privacy perceptions of patients in genitalia-related care[ 14 ], however, it is by no means definitive. The phenomenon of parasexuality was adapted to describe the dynamic occurring between staff and patients during genito-urinary investigations.

This was a managed version of sexuality which created a common currency by which interactions between staff and patients could take place safely. As a modified, attenuated form of sexuality, parasexuality ensured that despite gender role stereotypes professional boundaries were maintained.

During intimate contact patients used strategies such as suppressing their own sexuality and viewing staff as professionals to ensure that parasexuality did not deteriorate into sexuality. Bailey warns against reifying the term parasexuality[ 18 ]. In keeping with this, there is a need to investigate the concept of parasexuality in more detail than this study has allowed such as the juxtaposition of staff as barmaid and patient as customer in the understanding of this phenomenon.

Other considerations in future work would be how parasexuality develops over the trajectory of an illness with intimate episodes and how this is learned by patients and indeed staff. It may be that the intervention in this case genito-urinary investigations becomes the key to attenuation of sexuality to parasexuality.

Nevertheless other avenues need to be explored before this can be confirmed. All authors having a nursing background. They all have a specific research interest in user experiences in health care, particularly in relation to urinary tract. Int J Cancer.

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  6. Peate I: Men and cancer: the gender dimension. Br J Nurs. Wall D, Kristjanson L: Men, culture and hegemonic masculinity: understanding the experience of prostate cancer.


    Nurs Inq. Google Scholar. Res Nurs Health. Chapple A, Ziebland S: Prostate cancer: embodied experience and perceptions of masculinity. Sociol Health Illn. Oliffe J: Constructions of masculinity following prostatectomy-induced impotence. Soc Sci Med. Jervis L: The pollution of incontinence and the dirty work of caregiving in a US nursing home. Med Anthropolgy Q. J Adv Nurs. Giuffre P, Williams C: Not just bodies: strategies for desexualizing the physical examination of patients. Gend Soc June. Services include social activity groups for those living with dementia, support groups for carers, and a national helpline.