In honor of November being prostate cancer awareness month, today’s post is dedicated to discussing prostate exams and how medical professionals can help make them as comfortable as possible. This is in an effort to help promote as many men as possible to have their prostates checked to reduce the incidence of prostate cancer or to identify it in the earlier stages. Before we dive right into the performance of the prostate exam, let’s review a few prostate cancer statistics to highlight the importance of the exam.
Prostate cancer is the second most common form of cancer in men (behind skin cancer) and the second leading cause of cancer death in men (behind lung cancer). This year, more than 176,000 men will be diagnosed with prostate cancer and nearly 32,000 lives will be claimed by it, making it the fifth deadliest cancer in the United States. 1 in 9 American men will be diagnosed with prostate cancer in their lifetime, 60% of which are over the age of 60. Prostate cancer originates in the prostate — the walnut-shaped gland that produces seminal fluid. Many men either do not have symptoms or ignore the symptoms that may include frequency, urgency, or difficulty urinating. A digital prostate exam and/or a blood test can be used to screen for prostate cancer. Unlike many other diagnostic screening procedures, there are no current guidelines on the regularity of prostate screenings.
Let’s be honest, a prostate exam is not something that most men look forward to. In fact, some men are so anxious about the discomfort they pose that they forgo them altogether. In the battle against invasive cancers, healthcare practitioners should be mindful of patient comfort that may contribute to the enhancement of screening and revelation of symptoms for timely diagnosis. There are several things the healthcare practitioner can do to help improve patient comfort during a prostate exam.
1. Explain everything
Men understand that the prostate exam will include the digital stimulation of their rectum to assess their prostate. However, you should explain the procedure in a medically professional way, answering all questions and paying close attention to the patient’s reactions. Assure them that you will wear gloves, use liberal amounts of lubricant and that it will be very quick. Explain the importance of the procedure and exactly what you are assessing for. During the procedure, continue to explain what you are doing, as you are doing it. Remind them to breathe and let them know as soon as you are done.
2. Be gentle and quick
A prostate exam, when performed correctly, should take less than 10 to 15 seconds and should involve minimal probing. One finger inserted no further than the second knuckle should suffice, and force should never be applied when resistance is met. Remind your patient that, although it may be difficult, if they are able to relax their sphincter, the prostate exam will be much quicker and much more comfortable. If you are meeting resistance or find abnormalities, explain that to your patient right away, do not simply continue the exam and leave them uncomfortably wondering why it is taking longer than anticipated.
3. Use lube liberally
Rectal exams are not the time to be conservative with lubricants. The more medical lubricant you use, the smoother the exam will be and the less tissue damage you will cause. Both of these features will greatly ease patient discomfort and promote the willingness for future rechecks. Be mindful to not use so much lubricant, however, that it creates a mess or discomfort from anal leakage after the exam.
The lubricant you use should be water-based to avoid staining and help with easy patient clean up after the exam. Although sterility is not required in a prostate exam, using a bacteriostatic medical lubricant may be preferable. Be sure to use a latex-free lubricant with nitrile gloves to reduce the risk of allergic reaction and glove compromise. Try HR Lubricating Jelly for a medical lubricant that is all of the above!
4. Respect their dignity
There is no reason for your patient to be completely naked for the prostate exam, so you should allow them to retain as much clothing as they are comfortable with that allows you the ability to perform the exam. If the exam room has a curtain, draw it, even if the door is also closed. Ensure you eliminate disruptions and ensure patient privacy is maintained. If a male patient is uncomfortable with a female practitioner, be sure he has access to a provider of his preferred gender. Either the patient or the medical professional may request a chaperone to be present during the exam, but be sure to explain this before inviting someone else into the room.
5. Leave the room after completion
Immediately following the prostate exam, leave the room to allow the patient to clean up and redress. If you have further business to discuss, return after a few minutes. Allowing the patient to clean and redress will minimize vulnerability and promote honest discussion. Allowing your patient to have a minute alone to collect themselves will improve their comfort and increase the chances that they will return for the next recommended recheck.
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