Pain relief for medical procedures

[InvisibleDragon]

Just came across this statement about use of local anaesthetic for catheterization:
The use of anaesthetic gels for catheterisation is well recognised in male patients but there is controversy over their use in female patients. EPIC (Loveday et al, 2014) and Royal College of Nursing (2012) guidance do not differentiate between male and female patients. Loveday et al (2014) recommend that an “appropriate lubricant from a sterile single-use container” is used for catheterisation. Many practitioners use lubricant gels with a topical anaesthetic (lidocaine 2%), but local policies should be followed.
www.nursingtimes.net/clinical-archive/continence/urinary-catheters-2-inserting-a-catheter-into-a-female-patient-16-01-2017/

It then lists several sources of evidence that anaesthetic gel makes the procedure easier and less painful for women.

Oh man this has annoyed me. Just another example of everyday medical sexism I guess, but the idea that men are routinely offered anaesthetic but women should just put up with pain really got my goat.

I was having a couple of basal cell carcinomas removed a short while ago.

We got talking about which anaesthetic was being used, dosages etc. The nurse practitioner was quite open about that fact that they used far more local anaesthetic on the male patients, even for simple punch biopsies.

Similarly when I had a flexible sigmoidoscopy I was encouraged to 'manage' it without sedation. Never again. A nurse told me on the way out if I had been a man I'd have been able to demand it.

Two different hospitals. One medical culture.

I think they don't want the men kicking off.

This needs the kind of digging that used to be done in the past about sexism in medical care. I remember seeing references to this a decade ago or so, but sexism is hard to address without talking about sex, of course, which makes these topics invisible again.

Yes, exactly this Spindle - why is it that men are routinely offered pain relief and women are expected to put up with discomfort and pain?

About ten years ago I had a fall and hurt my knee quite badly. It swelled hugely and I had bruising from my knee to my ankle. Went to the community hospital to have it looked at and was told it would be 'better in three weeks' and was sent home. No painkillers offered. Shortly after that a male friend went to the same hospital with a stiff knee which was painful and he was given diclofenac. His knee was fine after a few days, while mine took years to get better.

Given that he was in a desk job and I was on my feet all day, the disparity in our experience has stayed in my memory.

This isn't necessarily what it is presented to be. Personally, I would probably choose no local anaesthetic because the stinging wouldn't be worth it, although I agree women should be given the choice.

I think it's more to do with having a good explanation of the procedure. (Something that should be done anyway for consent) so that women can make an informed choice.

A male catheterisation, is less straightforward and can be painful. For most women, if a skilled practitioner inserts the catheter, reassures the woman and listens to her, it might be uncomfortable, but shouldn't be painful.

I went in for a colonoscopy, and they wanted to do a punch biopsy of my cervix. I know from past experience this is incredibly painful for me, so I asked for sedation or pain relief. The doctor firstly told me there are no nerves in the cervix and it’s not painful (!) but I continued to insist. She pressed on… it would be a couple of seconds, brief discomfort. I finally said I wouldn’t get the procedure done unless I got pain relief and she said fine, and it was abandoned. Everything was fine in the end and the biopsy turned out not to be necessary. But I do wonder if a man would have been treated the same way, and I do wonder why she was so resistant to giving me some pain relief. I was also annoyed at the insinuation I was deluded for feeling sensation in that area!

Oh well fine, women are wrong again then.

Sorry that should have read colposcopy. Stupid auto correct.

Not you, @WeeBisom our posts crossed

Here's a review from 2009: www.ncbi.nlm.nih.gov/pmc/articles/PMC2677686/

And there's a whole International Association for the Study of Pain, with a special group on gender and race:

www.iasp-pain.org/group/sex-gender-and-racial-differences-in-pain/

Quoting own post to clarify that I am referring to urinary catheterisation.

Otherwise you are dead right.

A male catheterisation, is less straightforward and can be painful. For most women, if a skilled practitioner inserts the catheter, reassures the woman and listens to her, it might be uncomfortable, but shouldn't be painful.

So it can, particularly if the practitioner is brusque or inexperienced, be painful? How is that different to can be painful for men?

It's usually an easier procedure to do in women so long as the woman is relaxed - hence the need for skill and reassurance.

It genuinely is different in males because of their anatomy, especially if they also have an enlarged prostrate.

The usual treatment of women compared with men with regard to pain is rubbish, however this particular circumstance isn't the hill to die on.

I'm a nurse and in every job I've worked in policy is anaesthetic gel for every catheterisation. I've never catheterised anyone without using it prior. I will say I accept that there are wider issues around pain relief for women but I don't feel like this necessarily falls under that