Consent And Chaperoning

Genital examination should never start without obtaining the patient's consent. It is essential to explain to the patient why the examination is necessary (Walsh et al., 1999; Fuller & Schaller-Ayers, 2000) and how it will be conducted, and to reassure patients that it is non-invasive and should not hurt. This will ensure that verbal consent is obtained. Verbal or implied consent is sufficient, and written consent is not required for a genital examination. A further examination of issues of consent can be found in the chapter on Legal Issues.

Patients should be allowed to prepare for the examination by removing any clothing or underwear. This would imply that the patient is agreeing to be examined. The nurse must never undress the patient, unless in exceptional circumstances such as disability, when undressing the patient for genital examination must be done in the presence of a chaperone.

The clinician must always offer the patient a chaperone (Epstein et al., 2000), and this must be clearly documented. If a chaperone is used, their name and designation must also be documented. Local policies regarding chaperoning vary, so always follow such policies, remembering that young men (under the age of 16) and those with disabilities will require a chaperone in all cases.

Advanced Clinical Skills for GU Nurses. Edited by Matthew Grundy-Bowers and Jonathan Davies © 2007 John Wiley & Sons Ltd

MALE GENITAL EXAMINATION MAINTAINING DIGNITY

Examination of the male genital tract needs to be conducted in a sensitive manner, and in privacy. Ensure that privacy can be maintained by locking doors, as this will prevent interruption from a third party and may also help to reassure patients. The examination room also needs to be adequately heated, because if the room is too cold the scrotal sack may contract and it may be more difficult to examine the scrotal contents.

Embarrassment is common during a genital examination (Toghill, 1994), and depending on the experience of the practitioner this procedure may cause some embarrassment for both practitioner and client. If the nurse appears nervous or embarrassed, the patient may well pick up on this and may become anxious or embarrassed too. It is always good practice to maintain conversation whilst conducting the examination, as this may help to distract clients or divert their attention. Talking about testicular cancer and testicular self-examination is always a suitable topic to engage clients with whilst conducting a genital tract examination.

Men with no previous experience of such a procedure may become aroused (Swartz, 2002), especially younger men, and it is essential that the nurse does not become embarrassed by this and offers reassurance to the client that such arousal is perfectly normal. The nurse should then complete the examination as quickly as possible and allow the patient to get dressed (Barkauskas et al., 2002).

On rare occasions some patients may try to cause embarrassment for the nurse through sexual comments or displaying sexual behaviour towards the health professional. This may be an intentional act on the part of the patient, or more often a manifestation of their nervousness or embarrassment. In these circumstances, a chaperone may be useful, and the nurse must remember to maintain professional boundaries. It is important in these circumstances to employ your clinical and professional judgement when assessing the situation. The use of gloves in all circumstances (Fuller & Schaller-Ayers, 2000) also emphasises the clinical nature of the examination (Epstein et al., 2000).

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