Going to the doctor with something embarrassing

Across a wide range of conditions, the interval between noticing a symptom and presenting to a clinician is the strongest determinant of outcome that patients themselves control.

The conditions people delay on

A recognisable list.

Rectal bleeding, which is usually haemorrhoids and is the main presenting symptom of bowel cancer.

Testicular lumps, where the cancer is highly curable and where delays are consistently documented in young men.

Breast changes in men, which are frequently assumed to be impossible.

Genital symptoms of every kind.

Incontinence, where the average delay is measured in years.

Erectile difficulty, which is also a cardiovascular signal.

Skin lesions in areas people do not want examined.

Mental health symptoms.

Substance use.

And anything involving the anus, which combines the highest embarrassment with some of the most serious differentials.

What actually happens in the appointment

Worth being specific, since the anticipation is the problem.

Clinicians see genital and rectal symptoms daily and have no emotional response to them whatsoever.

Examinations are brief, are explained beforehand, are conducted with a drape and with a chaperone if you want one, and can be stopped at any time.

You are not required to have prepared in any particular way, and no clinician is assessing you on that basis.

Nothing you describe will be the strangest thing they have heard that week.

And the parts you find humiliating are, to them, anatomy — which is not a claim about how you should feel but about what is actually happening on the other side.

Reducing the barrier

Practical strategies people use.

Writing it down and handing over the note, which is entirely acceptable and which many people do.

Saying at the start that you find this difficult, which reliably changes how the consultation is conducted.

Requesting a clinician of a particular sex, which is a reasonable request that services accommodate where possible.

Choosing a service designed for the problem — sexual health, continence, dermatology — where the staff do nothing else.

Using online or telephone consultation for the first conversation, which some people find substantially easier.

Booking a longer appointment.

And bringing someone, who can stay or leave for the examination.

The symptoms not to wait on

Regardless of embarrassment or convenience.

Any bleeding that is not explained: rectal, urinary, vaginal between periods or after menopause, or coughing blood.

Any new lump anywhere, including testicular and breast.

Unexplained weight loss.

A change in bowel habit lasting more than a few weeks.

Difficulty swallowing.

A mole that has changed.

A sore or ulcer that has not healed in three weeks.

Persistent hoarseness or cough.

And any symptom that is progressive rather than fluctuating.

These are the ones where time genuinely changes the outcome, and they are disproportionately represented on the list of things people are embarrassed about.

The cost of waiting

Stated plainly, because it is the argument that works.

Most of the conditions people delay on are benign, and the reason to present early is precisely that: to find out quickly and stop thinking about it.

Of those that are serious, most are treatable when caught early and considerably less so later, and the difference between the two is measured in weeks and months rather than years.

And of the conditions that are merely uncomfortable rather than dangerous — incontinence, erectile difficulty, painful sex, recurrent infections — the treatments are effective and available, which means every year of waiting is a year of an entirely unnecessary problem.

If you have already waited a long time

A note for the person who has been putting it off for years.

Nobody will comment on the delay.

Nobody is keeping score.

The consultation is the same whether the symptom started last week or in 2019.

And the most common report from people who finally go is not regret about the appointment but regret about the years before it.

General information only, not medical advice. Consult a qualified clinician about any new or persistent symptom, particularly unexplained bleeding, lumps or weight loss.