Impact of socio-environmental factors on the state of knowledge among teenagers aged 14 to 18 years regarding symptoms of diseases of the male genital organs

INTRODUCTION

Diseases of the male genital organs are a serious clinical problem. The most common diseases related to the structure and functioning of the male genital organs are acute scrotum syndrome, phimosis, cryptorchidism, balanoposthitis and testicular hydrocele [1-3]. These diseases affect patients aged around 4 to 17 years old and are related to the anatomical structure of the male genital organs and the patient’s physical activity. The most dangerous disease is acute scrotum syndrome, for which urgent surgical intervention is required [4, 5]. However, boys, especially during puberty, re-sist admitting to having the disease and are afraid of the physical examination, which is often conducted for the first time during a severe illness, as a result of which they hide the ailments and the circumstances of the injury, unaware of the potential significant complications, above all the loss of a testicle [6, 7]. When medical personnel provide a feeling of empathy and security, this reduces the shame and is reassuring for the patient in accepting themselves, and enables the examination to be conducted correctly with a positive feeling [8]. Issues related to anomalies of the male genital organs are relatively seldom raised in the medical environment, although the frequency of their occurrence is increasing. Monitoring and verifying for the occurrence of such anomalies in the population during preventive examinations are there-fore very important elements, as is the implementation of reliable educational programmes among adolescents.

MATERIAL AND METHODS

SETTING, PATIENT SELECTION AND ELIGIBILITY CRITERIA

A survey study was conducted among patients of the paediatric hospital in Bielsko-Biała in the period between September and December 2021. The group of respondents included patients between the ages of 14 and 18 years old admitted as outpatients in the emergency room and the surgical outpatient department. Permission was obtained from the patients’ parents, the management of the paediatric hospital for the study to be conducted, as well as from the medical director.

SURVEY DESIGN AND TESTING

The study was performed once using a diagnostic survey technique with an original survey questionnaire. The study was conducted on a single occasion, using an anonymous paper survey questionnaire given for completion during patient’s admission to the Emergency Department and the Surgical Unit of the Paediatric Hospital. Conditions for the selection of members of the research sample were: male gender and age between 14 and 18 years of age. The questionnaire consisted of 21 questions: 19 closed and 2 open. The questionnaire included questions concerning the five most common diseases of the male genital organs, determined on the basis of statistical analysis of the data of patients admitted to the paediatric hospital in Bielsko-Biała in the years 2018-2020. The questionnaire was completed by 374 individuals.

STATISTICAL ANALYSIS

All statistical calculations were conducted using the R-4.0.3 statistical software package and an Excel 2016 spread-sheet. The variable level of knowledge was measured on a quantitative scale and described using statistical parameters such as the arithmetic mean and the standard deviation. Meanwhile, qualitative variables, which were measured on a nominal scale, were presented numerically and using percentage values.
The relationship between two variables measured on the nominal scale was evaluated using a χ² test. For all calcula-tions, the adopted level of significance was p < 0.05.

RESULTS

Among all the individuals included in the research, the most numerous groups were, in order: 14 years old (25.4%, 95 people), 15 years old (21.7%, 81 people), and 18 years old (19.5%, 73 people). A comparable number of people living in cities and in the countryside took part in the research, respectively 49.2% (184 people) and 50.8% (190 people). In terms of level of education, the most numerous group comprised people from technical schools and secondary schools at 56.1% (210 people), followed by adolescents from primary school at 25.9% (97 people), while the smallest group comprised those from vocational schools (16.3%, 61 people). Not all data are presented.
Before taking part in the research, 51.3% (192 people) stated that they had a basic knowledge on topics related to the anatomical structure of the male genital organs and the most common diseases affecting them, while 48.7% (182 people) stated that they did not have such knowledge. The results obtained after the analysis of the completed questionnaire show that the age group with the broadest knowledge on the structure and diseases of the male genital organs is the 17-year-old group – almost 35% of the respondents obtained the maximum or almost the maximum number of points awarded for giving the correct answers. The poorest results were obtained by patients belonging to the age group of 14-year-olds – only 7.4% of the respondents demonstrated a good knowledge of the analysed issues. Interestingly, among 18-year-olds, the level of knowledge was lower than in the previously analysed group (Table 1). The level of education also clearly showed differences in the level of knowledge among respondents. According to expectations, people in the lowest phase of education (primary school) provided the fewest correct answers, while almost 1/3 of those from high schools (secondary school, technical school) obtained the maximum or almost the maximum number of points.
Analysis of answers to the detailed questions showed a statistically significant relationship between the type of school that the respondents attended and knowledge on the structure of the male genital organs, individual diseases related to them, and symptoms requiring medical assistance. This relationship was not confirmed in the case of only three questions, relating to the number of testicles in a healthy man, the definition of cryptorchidism, and the need for urgent medical intervention in the case of testicular pain (Table 2).
Interestingly, in the statistical analysis regarding knowledge of the above-mentioned issues in relation to respond-ents’ place of residence, none of the results fulfilled the adopted significance criterion (Table 3).
The last part of the questionnaire included multiple choice questions. The first related to the people the respondent would turn to for assistance in the event of problems regarding the male genital organs. The respondents most frequently indicated two possibilities: 58.3% (218 individuals) selected medical staff (e.g. doctor, nurse), while 54.5% (204 people) considered their parents to be trustworthy with regard to this issue (Fig. 1A). In terms of the source of information on diseases of the male genital organs, the respondents indicated above all the internet (58.3% – 218 individuals), medical staff (33.7% – 126 individuals), and parents (17.9% – 67 individuals) (Fig. 1B). In the next question, respondents were asked about the education of men regarding their anatomical structure and the most common symptoms of diseases of the male genital organs. Here, a clear majority of the respondents (68.7% – 257 individuals) stated that there was a need to implement educational activities in this area (Fig. 1C). The last question referred to the reasons for which the respondents would not seek medical assistance in the case of diseases of the male genital organs. The responses clearly show that the main barrier is shame (51.6% – 193 individuals). It is also worth underlining the fact that over a quarter of respondents (26.2% – 98 individuals) identified more than one factor that made it difficult for them to make use of medical assistance. These included lack of knowledge and fear about the disease itself (Fig. 1D).

DISCUSSION

The problem of awareness regarding the symptoms and risks of complications in the male reproductive system is becoming increasingly apparent, evidenced by the growing number of hospitalizations of teenagers and the number of urgent surgical procedures conducted in the paediatric hospital in Bielsko-Biała in the years 2018-2020. In 2018, 24,944 patients were admitted to emergency rooms, of which 694 individuals were patients with diseases affecting the male genital organs, that is 2.6%. In the following calendar year, 26,380 individuals reported to the hospital, of which 804 had a problem affecting the male reproductive system (3.0% of all patients), while in the year 2020, the hospital provided emergency room assistance for 18,053 individuals, of which 667 (3.7%) were patients with the same type of problem.
In analysing the results of our research questionnaire, a close relationship can be noted between awareness of anatomical structure and knowledge of a given disease. Of the individuals who knew about the anatomical structure, 90.8% provided correct answers to the questions related to diseases of the male genital organs. The most difficult question for the respondents turned out to be the definition of cryptorchidism – with 69.8% of respondents providing an incorrect answer. This difficulty may be related to the use of medical terminology for the disease and the fact that cryptorchidism mainly affects children aged up to 7 years old [9]. Diseases of the male genital organs and their medical nomenclature are little known among adolescents. As part of our research, after completing the questionnaire, each of the respondents had the opportunity to talk to the person conducting the research in order to dispel their doubts, which was met with significant interest among the respondents. Some of the participants asked additional questions, while others, despite being assured of privacy, felt ashamed. It is alarming that a considerable number of the respondents only found out the medical terms for certain parts of the body during the research. Analysis of the answers to questions related to knowledge of basic information regarding the anatomy of the male genital organs and the ability to recognize diseases of these organs showed that the level of knowledge in this respect is at an average level (59.6% of correct answers). This was similar to research conducted by Ryszawy et al. among 771 men as part of the Movember 2020 campaign. The research was carried out using the diagnostic survey method based on a questionnaire and related to knowledge about testicular cancer. The results revealed that as many as 63.5% of the respondents had a low level of knowledge regarding the topic of testicular cancer. What is more, a high proportion of respondents had considerable difficulty in correctly identifying symptoms indicating testicular cancer [10]. Also, another Polish study, carried out by Pietrzyk et al., focused on the level of knowledge and awareness of testicular cancer among male high school and medical students. Awareness of the signs and symptoms of testicular cancer was significantly higher among medical students than among high school students. This clearly demonstrates the need to urgently introduce education on this subject into secondary schools [11]. The results of analysis conducted by Aksoy et al. on the level of knowledge about testicular cancer confirmed this tendency. The research participants were medical students of both genders (N = 1025). The majority of the respondents (48%) showed a lack of knowledge regarding testicular cancer. Students who during their studies had already had contact with patients treated for testicular cancer coped somewhat better with the questions, as did male students (66% vs. 52%) [12]. Similarly, in 2016 Daumler and co-authors presented the results of a survey regarding medical, environmental and psychological factors associated with male infertility. Among 701 male participants, only 45% of participants were able to identify the health issues associated with male infertility [13]. Moreover, the results of a survey of 191 men and women published in 2021 on knowledge of the anatomy and diseases of the female genital organs showed that only 9% of respondents were able to answer all the questions correctly, which clearly indicates that further education in the matter of reproductive organs is essential [14].
The need to conduct educational activities with regard to the structure and diseases of the male genital organs is reflected in the results of our research – as many as 90.6% of the respondents were of the opinion that information on the above-mentioned issues should be disseminated. In research conducted by the Polish Educational Research Institute (IBE), as many as 87% (N = 1246) of respondents confirmed their interest in attending classes related to human psychoeducation and sexuality. In this research, conducted in 2015 and commissioned by the National Education Ministry, the participants were young adults – 18-year-olds. This was the first such research in Poland [15]. One possibility could be for the school nurse to provide education. In a study conducted by Pavelová et al. among 438 Slovak schoolchildren, the evaluation of adolescents’ views on who should be the reproductive health educator in schools showed an interesting correlation. Although respondents of both genders identified the sexologist as the most competent, the school nurse would be equally appreciated, although more by girls than by boys [16]. Incorporating adolescent sexual health education into nursing students’ training program could prepare them as adolescent sexual health educators. This could be one of the core competencies for nurses working not only in schools but also with families in communities [17].
Our research showed that the majority of respondents with problems related to diseases of the male genital organs first turn to medical staff (58.3%) and then to parents (54.5%). This proves that there is a high level of social trust with regards to healthcare employees. In contrast, the result of a Turkish study regarding elementary school students’ knowledge on the reproductive organs (n = 600) indicated that girls obtain information mostly from their mothers (78.2%), while boys obtain information from the media (25.4%) and friends (22.4%) [18]. Furthermore, among 842 Italian high school students, for the majority (37.9%) the main source of information was social media, while the school education was indicated by only 5.2% of respondents [19]. However, in terms of searching for basic knowledge on the anatomy or diseases of the male genital organs, respondents most frequently expressed a preference for searching for information on the internet (58.3%), followed by consulting a medical professional (33.7%). Data obtained by Knol-Michałowska also show that among patients, the internet constitutes an equally valuable source of medical knowledge as a consultation with a doctor. In research conducted in 2013 (N = 3014 adults), 72% of respondents had searched on their own for information on the internet regarding their state of health, and for 35% the internet became the source of a diagnosis with regard to the ailments they were suffering from [20]. The fact that they look for information on the internet instead of seeking medical advice is connected to some degree with the shame that boys experience in relation to health problems regarding the male genital organs. In society at large, terminology related to sexuality is still considered taboo. The multifaceted nature of these taboos may have an impact on individuals, communities, and public health. The implications for public health may contribute to disparities in access to healthcare, violation of individuals’ funda-mental rights and disinformation. To break this chain of negative emotions, it is vital to make young people aware that the need to be examined is something positive that allows them to correctly fulfil all social roles. Moreover, medical professionals should make more efforts to prioritise empathy, respect and open dialogue [21, 22].

CONCLUSIONS

The research results clearly show the existence of a relationship between the level of education and knowledge of the anatomical structure and diseases of the male genital organs. The teenage respondents were not able to correctly indicate symptoms characteristic for particular diseases. In terms of the issue analysed, the dominant feeling among respondents was shame. It is due to shame that young people are unwilling to visit a specialist for medical assistance or undergo appropriate treatment. Taking these issues into consideration, there is clearly a need for urgent implementation of educational and awareness-raising activities in schools. Parents and carers should also be educated in order to help in reducing the feeling of shame during any discussion on the issue. Meanwhile, medical staff should not forget that the issue of the health of the male genital organs is a delicate and socially difficult topic, and they should apply this knowledge during every conversation with young patients.

Disclosures

This research received no external funding.
Institutional review board statement: Not applicable.
The authors declare no conflict of interest.

References