Introduction to Men's Health Physiotherapy

Original Editor - Stacy Schiurring based on the course by Pierre Roscher
Top Contributors - Stacy Schiurring, Jess Bell, Tarina van der Stockt, Kim Jackson and Lucinda hampton

Introduction[edit | edit source]

Disclaimer: This page aims to provide an introductory discussion of men's health physiotherapy. Please note that further training is required through a reputable pelvic health education company before attempting the techniques discussed in this page. See the Resources section at the bottom of this page for links to pelvic and men's health special interest groups.

The term sex is used to refer to a person’s biological maleness or femaleness, and the term gender to the nonphysiological aspects of being male or female– the cultural expectations and roles for femininity and masculinity.[1]  

This article will focus on the specialisation of men’s health physiotherapy, the treatment of male anatomy and physiology, and related mental health and wellbeing. The term “men” will refer to biological males and “women” for biological females for the remainder of this page. For more information on women's health or pelvic floor physiotherapy please read here. For transgender considerations, please read here.

Men’s Health: an umbrella term that refers to any issue, condition, or problem that can impact a male’s health or wellbeing.[2]

Masculinity and Healthcare Utilisation[edit | edit source]

Research has shown that men have shorter life expectancies and a greater likelihood of premature death due to disease than women. However, men are more resistant to access preventative medicine and health services. Concerns surrounding threats to masculinity and emotions such as embarrassment, guilt, and shame have been cited as barriers to accessing the healthcare system.[2] [3] 

Stereotypical traits of masculinity such as “being tough and self-reliant” are other cited barriers to the use of health services.  Rejecting positive health behaviours such as seeking medical or physiological help add to the “manly masculine identity construct” according to a 2021 article by McGraw et al.[4] When looking between generations, this study found that Generation Z and Millennials are more likely to conform to traditional masculine identity constructs than Generation X and Baby Boomers, and that specific masculine norms play a complex role in whether men will access healthcare services. The researchers recommend health care providers use gender-sensitive approaches which highlight specific masculine norms to encourage positive outcomes in men’s health.[4]

Please view the following 4-minute video. It is an excellent example of how to tailor information to a specific male age group.

[5]

What is Meant by Men’s Health[edit | edit source]

Traditionally, men’s health-focused on cardiovascular health and erectile function. More recently, men’s health concerns include but are not limited to:

  1. Bladder health
  2. Rectal dysfunction
  3. Sexual health and sexual function
  4. Pelvic pain
  5. Penile and scrotal pain
  6. Prostate cancer
  7. Breast cancer
  8. Osteoporosis
  9. Mental wellbeing and mental health

[2][6]

There are many important health conditions that can affect men over their lifetime. The American Urological Association created a checklist which provides a breakdown of issues by decade of life and how to screen for those issues.[7]

Physiotherapy and Men’s Health[edit | edit source]

Currently, there is little formal training to specialise in men’s health physiotherapy. Most physiotherapists entering this rapidly growing field have a background in women’s health / pelvic floor therapy and or a musculoskeletal treatment background.[2]

Places for informal learning:

  1. Online continuing education
  2. In-person continuing education
  3. Mentorships
  4. New research


Foundational knowledge in men’s health:

  1. Pelvic floor anatomy and physiology
  2. Pelvic kinematic relationship with the rest of the body
  3. Sexual health to include but is not limited to erectile dysfunction, ejaculation issues, and pain and incontinence during orgasm
  4. Pelvic pain aetiology and management
  5. Incontinence issues involving both bowel and bladder
  6. Knowledge of common regional problematic diagnoses such as prostate cancer

Physiotherapy Scope of Practice[edit | edit source]

According to the American Physical Therapy Association, physical therapy scope of practice has three components: professional, jurisdictional, and personal.

The professional scope of practice is grounded in the profession’s unique body of knowledge, supported by educational preparation, based on a body of evidence, and linked to existing or emerging practice frameworks.

The jurisdictional (i.e. legal) scope of practice is established by a state's practice act governing the specific physical therapist’s license, and the rules adopted pursuant to that act.

Personal scope of practice consists of activities for which an individual physical therapist is educated and trained, and that he or she is competent to perform. [8]

Men’s health physiotherapy is a new and emerging field of specialisation. Most practising physiotherapists did not receive the needed in-depth education and training in this speciality field during their entry-level education. Access to and training on speciality equipment is another important aspect of successful and competent care.[2]

There are other medical professionals who share the similar scope of practices in relation to men’s health, including:

  1. Urologists
  2. Continence nurses
  3. Medical sexologist

[2][6]

Clinical Competence[edit | edit source]

There are currently no formal clinical guidelines for men’s health physiotherapy specialisation. A 2020 study by Slade et al.[9] discusses attributes of expert physiotherapy continence clinicians. These skills include:

  1. Knowledge of male pelvic anatomy and physiology[2]
  2. Technical skill, training, and experience[2] [9]
  3. Clinical reasoning[9]
  4. Mentoring[2] [9]
  5. Research co-partnerships[9]
  6. Consumer-focused care[2] [9]

Informed Consent[edit | edit source]

According to the World Confederation for Physical Therapy, informed consent is “based on the moral and legal premise of patient/client autonomy, whereby a patient’s/client’s decision to participate in examination/assessment, evaluation, diagnosis, prognosis/plan, intervention/treatment and re-examination, as well as in any research activity, is freely given by a competent individual: who has received the necessary information; who has adequately understood the information; and who, after considering the information, has arrived at a decision without having been subjected to coercion, undue influence, inducement, or intimidation.”[10]

Competent individuals should be provided with detailed information about the proposed physiotherapy, to include:

  • The planned examination/assessment
  • The evaluation, diagnosis, and prognosis/plan
  • The intervention/treatment to be provided
  • The risks which may be associated with the intervention
  • The expected benefits of the intervention
  • The anticipated time frames
  • The anticipated costs
  • Any reasonable alternatives to the recommended intervention

[11]

Due to the intimate nature of men’s health physiotherapy, clear and detailed information is paramount. Clear and specific language is important to ensure patient understanding.  Important issues to review prior to a men’s health appointment include:

  • What to wear
  • Will they need to get undressed
  • What body areas may be exposed
  • Possibility of an internal examination
  • Possible treatment techniques to expect

This information should be provided in various formats such as your clinic website, social media, and flyers or handouts left with referral sources. Time should be spent answering all questions and addressing concerns prior to starting treatment. The patient may need time to process this information and be given the needed time and space to make their own clinician decisions. Consent should be formally given in writing prior to initiating therapy services.[2][12]

This video provides an example of informed consent for pelvic floor physiotherapy for either sex.

[13]

Infection Control[edit | edit source]

COVID-19 has brought this aspect of professional practice front and centre in the minds of potential patients. In addition, this speciality of therapy practice may involve bodily fluids. Appropriate barriers and protective equipment are required. Demonstrate proper hand hygiene prior to patient contact and as appropriate throughout the session. The clinic should also have proper cleaning and disinfection protocols in place between patient sessions.[2]

Room Setup Recommendations[edit | edit source]

  • Private treatment and consultation areas with closable doors
  • Align the plinth so that the patient’s legs are away from the door
  • Have sink for hand hygiene
  • Utilise proper draping techniques

[2]

Resources[edit | edit source]

  • The American Urological Association checklist for male lifespan health issues.[7]
  • This video provides a more in-depth introduction to men's health physiotherapy by an American physical therapist who specialises in this area of practice.

[14]


Professional Associations and formal continuing education courses:

References[edit | edit source]

  1. Lips HM. Sex and gender: An introduction. Waveland Press; 2020 Apr 10.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 Roscher, P, Men's Health. Introduction to Men's Health.  Physioplus. January 2022.
  3. McGraw JC, Russell-Bennett R, White KM. “He’s too much of a man to do that”: The role of masculine identities and self-conscious emotions in men’s help-seeking in preventative health. Frontiers in Service. 2019 Jul 19.
  4. 4.0 4.1 McGraw J, White KM, Russell-Bennett R. Masculinity and men's health service use across four social generations: Findings from Australia's Ten to Men study. SSM-Population Health. 2021 Sep 1;15:100838.
  5. YouTube. Orlando Health Taboo Topics: Men's Health. Available from: https://www.youtube.com/watch?v=xha73zMwwkg [last accessed 18/02/2022]
  6. 6.0 6.1 Miner MM, Heidelbaugh J, Paulos M, Seftel AD, Jameson J, Kaplan SA. The intersection of medicine and urology: an emerging paradigm of sexual function, cardiometabolic risk, bone health, and men’s health centers. Medical Clinics. 2018 Mar 1;102(2):399-415.
  7. 7.0 7.1 American Urological Association. Men's Health Checklist. Available from https://www.auanet.org/membership/publications-overview/mens-health-checklist (accessed 18/02/2022).
  8. American Physical Therapy Association. Scope of Practice. Available from: https://www.apta.org/your-practice/scope-of-practice (accessed 17/02/2022).
  9. 9.0 9.1 9.2 9.3 9.4 9.5 Slade SC, Hay-Smith J, Mastwyk S, Morris ME, Frawley H. Attributes of physiotherapy continence clinicians: a qualitative perspective. Physiotherapy. 2020 Mar 1;106:119-27.
  10. World Physiotherapy. Informed consent: Policy statement. World Confederation for Physical Therapy, 2019.
  11. World Confederation for Physical Therapy. Informed Consent. Available from: https://world.physio/sites/default/files/2020-04/PS-2019-Informed-consent.pdf (accessed 18/02/2022).
  12. Copnell G. Informed consent in physiotherapy practice: it is not what is said but how it is said. Physiotherapy. 2018 Mar 1;104(1):67-71.
  13. YouTube. What to Expect at a Pelvic Floor Physical Therapy Appointment | Pelvic Health & Rehab Center. Available from:https://www.youtube.com/watch?v=TKIH1hBNnZg [last accessed 18/02/2022]
  14. YouTube. Pelvic Floor Physical Therapy for Men. Available from: https://www.youtube.com/watch?v=P86CfBh2xvM[last accessed 18/02/2022]