Care takers dealing with erections... play doctor with me.
We think of doctors playing with needles, stethoscopes, specula and other toys. Here is a chance to do some real medicine with no equipment. This story starts two years ago. Give me your feedback and, in about a week, I’ll describe what was actually done, and the result.
There is in town a cerebral palsy victim, quite severe, in his early twenties. He is unable to use his legs and his arm movements are quite spastic and he can rarely reach below his waist. He has caregivers for a few hours each morning and evening who do transfer to and from his wheelchair, perform hygiene, change the bed and administer medications as necessary – frequently needed for urinary tract infections or inflammation under his foreskin. He spends five or more hours each day in distance learning – on-line, video, some reading with an automatic page turner. He is also an avid rugby fan. Friends and family are around parts of each day and often spend the night with him and take him for outings. I do not know him; he is followed by one of my colleagues in this clinic.
The caregiver team is three women, one of whom visits each morning and evening on a rotating schedule. Two are rather matronly women in their late fifties or early sixties and one, a twenty-nine year old. The last is a patient of mine whom I have known, as a physician, since her first gyn exam thirteen years ago. She is an only child who lives with her 60+ yo parents and would be described as “rather plain.” Not unattractive, but wears no make-up, ties her hair back quite severely in a bun and wears clean and serviceable, but never stylish, clothes. She has never had a date and has led a very sheltered life.
During an annual visit she expressed to me some embarrassment and dismay about caring for the patient. “He frequently has an erection and sometimes there are spots on the sheets. I think it is that stuff that men make when they have sex” (big blush). “He often winces and pulls back when I wash his penis but says it does not hurt.” The only adult penis’ she has ever seen or touched are her patients, mostly elderly; this is the only penis she has ever seen with an erection.
You are now in my shoes. What actions would you take or what recommendations would you make to her?
Brandye
Replies:
lol...That gave me a fond memory of a client i worked with for over 2 years....
he was 67 and was bedridden my job included bed bathing... my 1st day
was awkward being introduced to the extended family the whole 25 of them....
then seeing this old man with tubes etc hanging out of everywhere and a very sad face ...made me very nervous... his daughter a RN gave me everything I needed and said she
would be in the other room if i needed help (she had given birth to her little girl just 8 hours ago)
So i started top half first.. all going very well... both of us quiet and shy..
then the bottom half went well untill i reached the genital area..he said to me he was uncomfortable about it and i assured him i had done this plenty of times and i have seen all shapes and sizes....
as soon as i touched him he got an erection.... He said " F### Me I havent had one of them in atleast 6 years" I looked at him and he had a massive smile on his face and looked so proud.... all i could do is laugh.. we laughed so much it bought his daughter in to see what was happening....
she said "oh Dad how embarrasing"....
for 2 years .. 4 hours a day.. 7 days a week i looked after him we became best of friends... he got erections at least once a week and would always say
"mind yah eye" which always made us laugh so hard....
he's been gone 5 years now... his daughter is my best friend .. his family and friends all still refer to me as "the willy washer" which he called me when
introducing me to his many visitors ...
nuttychick
It sounds like this young woman has lead a very sheltered life. From her quoted statement she seems to be lacking sex education about the birds and the bees. If true, I believe she needs some quick enlightenment and some coping skills with regard to how she interacts on the matter with her patients.
I'll have to give your question some additional thought as to what recommendations to make.
dancingdoc2
I have to say the one I had to deal with did not end pretty...I think Doc is right. What happens when she gets sexually involved w/him? Or to an extent? Then to loose him? Deal w/frustration since she does not know what she is getting into & is so innocent???
The Quad I speak of...his home care nurse fell in love w/him...yet she was older [experienced] and, well, knew the outcome. She knew what she was getting into and what she would be in for...and she buried him & know how much she loved him.:(
sera300
Brandye it sounds as if this (not so) young adult woman might need a bit of orientation about sex and life from another woman who is knowledgeable and experienced in both.
I shall follow this thread closely. Just this morning I was listening to a report on the radio about a local association dedicated to sexual education and equality for physically and mentally challenged people.
dlb
Sera,
I would not describe her as fragile. She is the only child of a couple who have protected her from the realities of the world - specifically with regard to sex. The only sex talks with her mother had to do with how messy and uncomfortable.
Nutty,
Nice story! Thanks
DLB,
As this unfolds you will see many reasons that a local association is advocating for the handicapped.
Brandye
Just the other day there was an episode on Dr. Phil dealing with life in and out of a FLDS {Fundamentalist Mormon cult). The featured guest who was able to leave the confines of the compound was relating to the audience that girls do not receive any sex education and some are married off in arranged marriages as early as 13 or 14. She did not go into much detail, although enough to say that the honeymoon was a considerable and traumatic shock. Asked if she knew where babies came from, she was told by the elders that they are a gift from God. The discussion led me to believe that if parents do not talk to their (many) children, are they left to believe in immaculate conception?! OK, fair enough, but I wonder if they ever talked about the stork when it came to delivery. Surely with as many women and children as there are in the compound someone sometime must have seen a expectant mother, wondered, and asked.
The matter of menstrual cycles was not discussed on the show.
The guest did say that it was up to the new husband to instruct his bride. In such a closed society I wonder what he/they would say.
Brandye, I hope you added to her (limited?) education and talked to her about how a woman's body works, a man's body, and perhaps even a bit of what we discuss here most often--relationships and how they work and how to best keep them working.
dancingdoc2
The sad thing about the company I work with is
in our "Policies" it is stated that..... If a male client who is unable to
wash his genital area and you are having to do this...And he becomes aroused
you are to cease immediatley and contact our office.... this is a form of
sexual harrassment and will not be tolerated.....
I had bought this up at a training day.. and asked if indeed it was
a serious issue.... oh yes it was and there had been quite a few complaints laid.... I voiced my disgust on such a pathetic attitude towards the matter
and the subject was closed very quick.
After the meeting I was taken aside and told very sternly that if this matter
arised in my day to day work i was to report it immediately.... lol I giggled at the "arised" part and said "I sure will".....NOT
In the car park after my lecture (lol) I was met by 10 of the other employees who had similar occurances with their male clients and did not
like or agree with this "No Erection" rule....
We are now campaigning to get this rule changed.. It has been 7 months now and we now have 256 employees backing us but still no joy ... but on the other hand no more complaints have been laid
nuttychick
This is how I proceeded and encourage discussion whether supportive or against my approach.
Initially, I simply described how and why he was getting erections and reassured her that this was perfectly normal. Then, I spoke with the patients physician and was appalled with what I was told. The two older caregivers were difficult for him to deal with and did essentially what they wanted with respect to the patient’s urinary tract infections and inflamed penis. This was., at each visit they pulled the foreskin back, dabbed on anti-bacterial ointment and let it go. They “did not want to deal with that part of him.” When anti-bacterial ointment is on the skin for more than a few days, the skin begins to break down. They were actually making the situation worse and had instructed the younger woman to deal with his penis the same way. I asked the physician why he was tolerating this and his response was a weak, “They are the only home care-givers available.”
I suggested what I describe below and he said that a few ejaculations would be good for his prostate and likely reduce infection – but he would not give the treatment instructions.
I had the pharmacy tech in our clinic mix up a potion of Nivea oil and sulfa powder – what was used for infection before antibiotics were available. The two older women were told to simply wash his penis and dry it well. No more ointment of any type from them. I then discussed the treatment with the younger woman, described earlier, and told her exactly what to expect. On her four visits each week (the family provided all the care on Sunday) she was to apply plain Nivea twice and the medicated, twice. She was to rub it in well for at least twenty minutes (yes, he would never last that long). I explained to her exactly what would be happening and showed her a video of an ejaculation to emphasize the need for a tissue in her free hand. Simply, I was teaching her to jack him off along with the medicating. He would be getting four handjobs a week – better sex life than many men have!
Within a fortnight, the inflammation disappeared and his doctor told me later that he went for several months without a urinary tract infection. Other issues surfaced. I met the care-giver on the High Street one day and she wanted to talk. The CP patient, while she was treating him, had asked to see her breasts. This, I emphasized, was a decision she had to make as a woman. Was she willing? She said she had a sheer bra she sometimes wore to “feel more feminine,” “Would that be OK?” I again emphasized that he likely had never seen real breasts and that would be her decision as a woman and not as a nurse’ aide. And I asked her if she had matching sheer panties. Her eyes got very wide. She also asked if she needed to wear the surgical gloves when she was using the plain oil. I also suggested another variation would be to put the oil in a condom and put that on him while rubbing it in. She said she could not consider buying condoms in town so I walked across the street and got her a dozen. Then had to show her how to unwrap one and roll it on.
The family called while his physician was on holiday about pressure sores developing on his butt. I visited the next evening that Margaret was caring for him. He looked crest-fallen when I walked in with her until I explained that I would only be there briefly to check his sores. As the two of us transferred him from the chair, I noted that she was wearing no bra.
Brandye
Brandye,
That was an awesome solution. The applying of the ointment and then instructions to rub it in for 20 minutes was pure genius. I can only imagine the hell someone with those physical disabilities goes through, but that doesn't mean they cannot have desires and wants and with physical limitations, he cannot provide relief for himself. And it is most likely helping this young nurse as well explore her own sexuality. However, I wonder how the family feels or are they not aware. And then what happens later on after seeing her breasts he wants more, like seeing her lady parts? Even if it progressed to the point of him actually wanting intercourse and was possible, then what? I'd hate for her to lose her license. Just my thoughts on the subject. Keep us informed.