Medical assistant's role in male reproductive treatments and patient care

Treatments for male reproductive disorders

Common treatments used for male reproductive disorders include the following:

• Circumcision: Surgical removal of the foreskin (or prepuce) of the penis. (Commonly done on infants due to parental choice and unrelated to the treatment of disease. Studies have found male circumcision reduces the rate of certain sexually transmitted infections.)
• Laser therapy: A high-energy laser is used to destroy overgrown tissues, such as prostate tissue.
• Prostatectomy: Surgical removal of the prostate. With a radical prostatectomy, the prostate, nearby lymph nodes, and tissue, including the seminal vesicles, are removed.
• Orchidectomy: Surgical removal of the testicle.
• Orchiopexy: Surgical procedure for an undescended testicle (cryptorchidism). The testicle is brought down and implanted in the scrotum.
• Transurethral resection of the prostate (TURP) surgery: A lighted scope is inserted into the urethra, and all but the outer part of the prostate is removed.
• Vasectomy: A surgical procedure for male sterilization, described in detail below.

Vasectomy

A vasectomy is a surgical procedure that is considered a permanent form of male birth control. The procedure involves cutting and sealing the vas deferens, which carry the sperm from the testicles. A vasectomy offers no protection from sexually transmitted infections.

The patient must stop taking any over-the-counter and prescription medications that may prevent blood clotting, such as aspirin, ibuprofen (Motrin, Advil), and anticoagulants (heparin, warfarin [Jantoven], enoxaparin [Lovenox]). The patient should shower the morning of the procedure, washing the genital area thoroughly. The provider may have the patient bring an athletic supporter or a pair of tight-fitting underwear to wear after the procedure to support the scrotum and minimize swelling at the site. The patient will not be able to drive after the procedure. A consent form needs to be signed after the provider discusses the procedure and alternatives with the patient.

Vasectomies are done in the ambulatory care facility, usually in urology or family medicine departments. They can also be done in ambulatory surgical centers under local anesthesia. The procedure may take about 30 minutes.

During the procedure, the provider will inject a local anesthetic into the skin of the scrotum. A small incision or a small puncture is made in the scrotum. The provider will locate the vas deferens and withdraw part of the tube through the incision or puncture. The vas deferens are cut and sealed either by tying it, cauterizing it with heat, or applying surgical clips. The provider returns the ends of the vas deferens into the scrotum and may close the hole with glue or stitches.

After the procedure, the patient will experience swelling, pain, and bruising in the area. Applying ice packs, limiting activity, and wearing tight-fitting underwear for 48 hours can minimize the pain and swelling. Sexual activity is limited for at least 1 week.

It is important for the patient to follow up with the provider. The provider will do a follow-up semen analysis 6 to 12 weeks after the surgery to ensure that no sperm exist in the semen. It is recommended that men use an alternative form of birth control during this period.

A vasectomy reversal can undo a vasectomy by reconnecting the vas deferens. Success rates range from 40% to 90%. The surgery is usually done in an ambulatory-care surgery center using general anesthesia.

Patient coaching

Most men younger than 50 years of age have not seen a provider in years. Medical studies reveal that attitude, not biology, has a lot to do with the difference between men’s and women’s life spans. Men just do not go to the doctor as often as women do and tend to ignore symptoms of disease. The solution to maintaining good health is preventive care, and the first step is establishing a good rapport with a provider of choice. As a general rule, a man in good health should have a checkup every other year in his 40s, and yearly after age 50. In addition to testing for conditions such as cancer, heart disease, and diabetes, patient education can help male patients make responsible healthcare decisions.

The medical assistant can also teach patients to perform a monthly testicular self-exam (TSE): checking each testicle for lumps, swelling, or changes in size or firmness, ideally after a warm shower when the scrotal skin is relaxed, and reporting any changes to the provider promptly.

The urinary system is a very private, personal part of the patient’s body. Patients often feel embarrassed to ask questions about how to obtain the requested urine or semen sample. The medical assistant can provide this information in a sincere, confidential manner to relieve the patient’s anxiety and worry. Diagrams, models, and handouts help the patient understand disease processes and treatments and encourage patient compliance.

Legal and ethical issues

When working in a urology office, the medical assistant must be very careful to ensure that patients have provided informed consent for ordered procedures. If the patient refuses a procedure, the assistant must have the patient sign the appropriate informed refusal forms, which are then included in the health record. The specific clinical tasks a medical assistant may perform are delegated by the supervising provider and defined by state law and medical board regulations, which vary from state to state - the controlling authority is the state statute or board guidance, not an employer job description. All patient education should be done after the provider has completed the explanation and given the assistant instructions to do so. Never diagnose, prescribe, or offer comments about a patient’s condition. Medical assistants who overstep their professional boundaries may place the provider and themselves in legal jeopardy. Remember that the patient who is legally informed and satisfied with the care received is less likely to take legal action.

Patient-centered care

Respecting a patient’s preference is a key element of patient-centered care. When a medical assistant gathers a medical history on a patient regarding a male reproductive or a urology concern, the patient may hesitate to give information. These topics are sensitive, and the patient may only want to discuss concerns with the provider. Telling the patient, “If you would rather share the information with the provider, I will let them know,” can show sensitivity. It is important for the medical assistant to respect the patient’s wishes and help put the patient at ease.