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Need for change

Although not all health providers see a need for a federal agency for men's health, many are calling for a bigger effort to change the way men approach wellness. To do that will require overcoming attitudes and ingrained cultural biases that influence the way men take care of themselves.

Not only do men seek less care, but they seek it later in life, said John Swartzberg, MD, a clinical professor of medicine in the School of Public Health at the University of California, Berkeley.

"Women are acculturated to seeking care because of gynecological and obstetric care," Swartzberg said. "Women get plugged into the health system at a much earlier age than males."

Swartzberg, who chairs the editorial board of the UC Berkeley Wellness Letter, doesn't see a need for a gender-specific national health office. The Women's Office on Health was established in the last decade to address a disparity in medical research and education. There's no lack of research on men's health issues, he said, and the difference in the number of men and women dying from heart disease and lung cancer has been narrowing. Still, he said, more has to be done to improve men's health, and public health nurses can make a difference.

That brings up another problem. Many men are reluctant to talk about their health and ask for advice from female health professionals. Yet nearly 95 percent of nurses are women.

That's another byproduct of acculturation, Swartzberg said. From a young age, women are accustomed to taking their health care instruction from a male doctor, so they don't suffer the same reluctance to talk about intimate body functions with someone from the opposite gender. One solution is finding more male nurses, Swartzberg said.

Shelton, who delivered a session at the Oncology Nursing Society congress on the male cancer experience, said men in general aren't comfortable talking about how they feel. They're definitely uncomfortable talking with a woman-even a nurse-about their sexual functioning.

At times, he said, female nurses feel uncomfortable as well and could project those feelings onto the patient. Nurses have to make themselves talk about sexual practices, alcohol and drug use, and other personal health issues with men. If they can't do it comfortably, they need to find someone else to talk to the male patient. But they need to broach the topic as part of their job, Shelton said.

"It's our role to get into people's lives and let them know what they need to know," he said.

Foreign territory

Laura Fennimore, MSN, RN, director of education for the Oncology Nursing Society, understands why male patients aren't comfortable talking to a female nurse. Some cancer therapies throw men into foreign territories. "Engorged breasts and hot flashes aren't things men expect to be talking about," said Fennimore, an oncology nurse for 20 years. Sometimes, the nurse isn't comfortable on her side of the conversation, especially if she's close in age to the patient, she said, but she has to overcome these feelings.

Women play a significant role in men's health, and they suffer drastic consequences when the man in their life falls ill. Fennimore's father died of prostate cancer in 2000, and she saw firsthand how her mother had to take on the family role he vacated. Not only do women nurse the men in their lives, but they also have to take on additional roles and duties when their man no longer can perform them.

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