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Better care for men with genital trauma

Mental health nurse Pride Gaka-Chisoro’s award-winning research into soldiers’ experience of genital trauma led to a pathway that ensures the psychological toll is not overlooked. The pathway includes sperm salvage and psychosexual assessment. Sgt Gaka-Chisoro won a 2015 Nursing Standard Nurse Award.

Mental health nurse Pride Gaka-Chisoro’s drive to improve the treatment of genital trauma in soldiers gained national recognition in 2015 when he won the defence category of Nursing Standard’s Nurse Awards.

The Queen Alexandra’s Royal Army Nursing Corps sergeant was providing psychological support to men repatriated from Afghanistan when he decided to conduct research on men’s experience of genital injuries.

He observed their treatment plans did not address fully the effects of those injuries. ‘Patients were asking me questions about whether their genitals were intact, about their future fertility and their erectile function,’ says Sgt Gaka-Chisoro.

The men required relevant, timely and appropriate information about potential outcomes and they were worried about their future genital function.

’I discovered there is a paucity of literature on the subject,’ he says. ‘I wanted to conduct research to inform clinical practice to support these men and identify their unique psychological needs.’

In his spare time, Sgt Gaka-Chisoro applied for Ministry of Defence research ethics approval for a study. The committee agreed after being reassured about possible negative reactions in the participants being asked for sensitive and intimate details about their lives. ‘It was a challenge,’ says Sgt Gaka-Chisoro.

He devised a semi-structured interview. ‘I wanted to make sense of the men’s experiences,’ he says. ‘Then make the best use of the themes that arose to understand what was going on for them, inform clinicians and clinical practice, identify their unique psychological needs and inform a clinical pathway.’

Six men aged 18-55 were recruited to the study. Participants had to be two years post genital injury that would have some effect on function.

Picture credit: Tim George

All had been in combat or combat support roles, such as bomb disposal, in Afghanistan. Their average age was 28. They were recruited six to eight months from discharge from the military; three were in an IVF process. Four had children and four were in long-term relationships. They all expected to regain sexual function.

‘We see an element of “bargaining” in all our injured personnel,’ says Sgt Gaka-Chisoro. ‘They cope with their injuries by comparing them to their peers’. The soldiers would compare their genital trauma with facial injury or limb loss using comments such as “at least my face is okay”.

Concerns about body image, including scarring and the change in the appearance of their genitals, was a recurrent theme. The participants also identified with other men with similar trauma, discreetly seeking them out.

Among those who had other serious injuries, there was a sense of ‘let’s get that out of the way first before I can focus on the genital injury’.

Emotional reticence

The research found patients drew on the support of their families mostly for their physical problems, not the psychological aspects of their injuries. And while they would readily discuss pain with clinical staff, they would not talk about the psychological impact.

’Knowledge of their fertility status and successful sperm salvage had a positive bearing on the participants’ psychological states,’ says Sgt Gaka-Chisoro. ‘Most believed IVF would work for them.’

The psychological needs of the men were identified and addressed as they came up. The research led to the creation of a pathway for all significantly injured patients. Mental health practitioners now support them from their repatriation, throughout their time at the Defence Medical Rehabilitation Centre Headley Court and through their recovery. ‘Their injuries are identified and their needs are explored with follow up at six, 12 and 18 months,’ says Sgt Gaka-Chisoro.

How to capture patients’ experiences Picture credit: Tim George

Sgt Gaka-Chisoro conducted his study using the relatively new interpretative phenomenological analysis, which explores the experiences of participants.

His interviews were based on six areas:

Demographics

Age, marital status, education, children, time in the armed forces.

Acute physical care

How injury was sustained.

Care received at the time.

The patient’s and others’ initial reactions.

Post-injury

Care and support received since and now, including any impact of the injury.

Relationships

The meaning of intimate relationships. Past and current relationships. Whether the injury has influenced perception of those relationships.

Masculinity

‘Being a man’ and influencing factors.

Outlook

Future (family, relationships).

What the man would say to someone today who sustained the same injury.

The pathway includes ultrasounds, fertility assessment, sperm salvage, psychological and psychosexual assessment, and support as necessary at set times in their treatment cycle.

Community mental health nurse Major Ace Chitembwe, Sgt Gaka-Chisoro’s line manager, says: ‘Staff and patients are better equipped to address and talk about the physical trauma and any associated psychological issues.

‘Personnel with genital trauma have improved interventions in terms of their fertility or function.’

Information about genital trauma is now part of deployment acclimatisation and some affected personnel agreed to images of their injuries being used to reinforce the message about wearing genital protection equipment.

Pre-deployment briefings now include information on centres where soldiers can bank sperm before they are deployed.

The Nurse Awards judges called Sgt Gaka-Chisoro’s study a ‘great piece of research’.

‘This is such important and overdue work,’ says specialist judge Chris Carter of the Defence School of Healthcare Education at Birmingham City University. ‘No one really talks about things like this. It will have a great impact.’

Sgt Gaka-Chisoro says: ‘The men chose to speak to me and it is my role to understand their problems before finding a solution that will bring about a better outcome for them’.

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