Open Access Original Article
DOI: 10.7759/cureus.1563
Knowledge, Attitude and Practices Regarding Benign Testicular Disorders in the Educated Young Men of Pakistan Dua Saleem 1 , Samra Muneer 2 , Rajaa Fatima Younus Khan 3 , Rohan K. Ochani 4 , Syed Saadan Ahmed 1 , Maha Begg 5 , Tariq J. Siddiqi 6 , Syed Raza Abbas 4 , Muhammad W. Naseeb 1 , Muhammad Osama Farooqui 2 , Fahad H. Shaikh 7 , Ramiz Kirmani 8 , Hurmat Ullah 9 , Kaneez Fatima 10 1. Dow Medical College, Dow University of Health Sciences 2. Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan 3. Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan 4. Dow Medical College., Dow University of Health Sciences (DUHS), Karachi, Pakistan 5. Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan. 6. Dow Medical College, Dow University of Health and Science 7. Student, Dow University of Health Sciences (DUHS), Karachi, Pakistan 8. DIMC 9. Dow International Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan 10. Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan Corresponding author: Syed Saadan Ahmed,
[email protected] Disclosures can be found in Additional Information at the end of the article
Abstract Background It has been seen that despite the increasing incidence of benign testicular disorders (BTDs), little work has been done towards its awareness among the male populace. Also, the trend of not seeking help in this regard is concerning. In this study, we aim to better perceive the level of understanding and common practices regarding BTDs among educated young men.
Methods A cross-sectional study was carried out among two groups of ages 14-20 and 21-28 years. The inclusion criterion was that of educated males in an urban setting. Data were collected through a standardized questionnaire using cluster sampling by independent interviewers. The questionnaire consisted of four parts dealing with demographics, knowledge, attitudes and practices. Chi-square and Mann-Whitney U test were used as the primary statistical tests.
Results Received 06/27/2017 Review began 07/06/2017 Review ended 07/29/2017 Published 08/13/2017 © Copyright 2017 Saleem et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and
The sample population consisted of an equal number of participants between the ages of 14 and 20, and between 21 and 28 years (n = 200, 50%). About half the participants (n = 215, 53.8%) were not familiar with the term BTDs. The majority (n = 324, 78.8%) of participants were not aware of symptoms of BTDs. Three-fourth of the participants believed that the subject is considered taboo in Pakistan (n = 307, 73.6%) while a majority of participants (n = 340, 85%) believed media coverage can help spread awareness of BTDs. A huge number (n = 268, 67%) thought that BTDs can cause fertility problems while one-third of them would not perform testicular self-examination (TSE) in case of pain or swelling in the scrotal region (n = 119, 29.8). The level of education and age were significantly associated with the knowledge regarding symptoms and types of BTDs.
source are credited.
How to cite this article Saleem D, Muneer S, Younus khan R, et al. (August 13, 2017) Knowledge, Attitude and Practices Regarding Benign Testicular Disorders in the Educated Young Men of Pakistan. Cureus 9(8): e1563. DOI 10.7759/cureus.1563
Conclusion Knowledge of BTDs and practices of TSE in the young educated men of Karachi are alarmingly poor. Therefore, there is an urgent need to create awareness at all levels using different strategies and platforms.
Categories: Internal Medicine, Pathology, Miscellaneous Keywords: benign testicular disorders, testicular self examination, karachi
Introduction Diseases that affect the testes can span from being non-malignant and painless to life threatening and agonizing. Benign testicular disorders (BTDs) are the most common noncancerous testicle problems that present as painless lumps or swellings in the scrotum [1]. However, delays in seeking help can drastically increase the chances of complications such as ischemia, necrosis, sepsis and even infertility [2]. Furthermore, in a recent study, Haas, et al. found that about 31% of all testicular cancer cases, which are classified as the most common malignancy between the ages 18 and 40 years, initially presented as a benign disorder. The study further concluded that if benign disorder of the testicles were diagnosed earlier and managed correctly, radical orchiectomy could have been prevented in majority of the cases [3]. We hypothesize that it is the lack of awareness among males which prevents them from getting an early diagnosis and treatment of BTDs. Previously, it has been shown that greater the awareness, the more likely people are to seek help [4]. Due to lack of awareness, about 39% of the people choose to delay seeking help even with obvious symptoms [5]. While there has been research done on the clinical diagnosis and management of BTDs [4, 6-7], not much work has been done regarding its awareness especially in developing countries such as Pakistan. The aim of this research was to analyze the mindset of the educated Pakistani male population regarding BTDs, the extent of their knowledge on the subject and their practices towards dealing with such situation may it arise. The secondary objective was to establish an idea about the approach of the populace to further educate people on the various disorders of the testicles so that with early recognition and treatment, further aggravation can be avoided.
Materials And Methods This cross-sectional study was carried out in Karachi, Pakistan during February 2017 after approval from the Institutional Review Board of Dow University of Health Sciences. The sample population consisted of young males between ages of 14 and 28 years. The study was conducted in areas of high socio-economic standards within the city and only men belonging to an educated background were included. Two separate groups were made based on age. The first group consisted of men between the ages of 14 and 20 years while the other consisted of men between 21 and 28 years. Men who were uneducated, not between 14 and 28 years old or lived in areas of low socio-economic standards were excluded from the study. The computed sample size was 384, however, 400 samples were taken equally divided between the two groups for convenient statistical comparison. A structured standardized questionnaire was used to collect the data. The questionnaire, which comprised of four sections, contained 29 questions. Section one was to establish demographical details while the second section was to assess knowledge. Knowledge was assessed considering the familiarity with BTDs, ability to tell the difference malignant and BTDs, ability to judge their own condition based on symptoms (lumps, uneven testicle size) and to differentiate between the different types of BTDs. The third section determined the subjects’ attitudes which
2017 Saleem et al. Cureus 9(8): e1563. DOI 10.7759/cureus.1563
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were gauged by: the ability to admit that BTDs are very serious, the ability to feel whether there is enough attention given to BTDs in Pakistan, the ability to admit that testicular health is a taboo subject in Pakistan and the awareness that BTDs can cause fertility problems. The fourth part of the questionnaire dealt with questions evaluating the subjects’ practices with regards to BTDs. The practice was assessed considering these elements within the survey: awareness of any injuries or symptoms in the groin, willingness to take action accordingly and willingness to spread awareness about BTDs amongst friends. The interviewers used standard protocol with all subjects; they were given time to fill the questionnaire privately to ensure accurate results by avoiding interviewer bias. Written consent was received from all the participants before the questionnaire was filled. The questionnaires that were incomplete were discarded and no imputation methods were used to maintain an accurate representation of the views of the sample population. Data were entered and analyzed using IBM SPSS Statistics v. 21.0 (Armonk, NY). Descriptive Statistics was used to report frequencies and proportions for the categorical responses. Chisquare test was used to check for the disparity between the categorical responses of the males belonging to two different age groups. In the case of ordinal data, the Mann-Whitney U test was used. p-values less than 0.05 were considered significant in all cases.
Results The sample population consisted of equal number of participants between the ages of 14 and 20 years, and between 21 and 28 years (n = 200, 50%). Table 1 shows trends regarding knowledge of BTDs, some of which are presented below. About half the participants (n = 215, 53.8%) were not familiar with the term BTDs. Similar proportions of subjects knew the difference between malignant and benign testicular disorders (n = 209, 52.3%). The majority of participants were not aware of symptoms of these disorders (n = 324, 78.8%). Epididymitis (n = 102, 25.5%) and torsion (n = 98, 24.5%) were the most recognized forms of BTDs.
p-
Age (years) 14-20 How familiar are you with the term Benign Testicular Disorder?
Very little
Moderately
Do you know the difference between Malignant and Benign Testicular Disorders
Do you think that unequal sized testicles are associated with a higher risk for BTDs?
2017 Saleem et al. Cureus 9(8): e1563. DOI 10.7759/cureus.1563
115
value 21-30 100
(57.5%)
(50%)
69
71
(34.5%)
(35.5%)
0.15
29
Very well
16 (8%)
Yes
98 (49%)
No
102 (51%)
Yes
78 (39%)
84 (42%)
No
122 (61%)
116 (58%)
(14.5%) 111 (55.5%)
0.254
89 (44.5%) 0.382
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Do you know any symptoms of BTDs?
Yes
No
At what age do you believe BTDs are more common?
0-18
18-36 36-54 54+
33
57
(16.5%)
(28.5%)
167
143
(83.5%)
(71.5%)
28 (14%) 99 (49.5%)
33 (16.5%)
0.002
0.14
100 (50%)
38 (19%)
46 (23%)
35
21
(17.5%)
(10.5%)
33
69
(16.5%)
(34.5%)
167
131
(83.5%)
(65.5%)
Which type of BTD(s) are you aware of? Epididymitis
Yes
No
Hydrocele
Yes
No
Varicocele
Yes
179 (89.5%) 17 (8.5%)
60 (30%)
51 (25.5%)
(91.5%)
(74.5%)
29
69
(14.5%)
(34.5%)
171
131
(85.5%)
(65.5%)
Yes
10 (5%)
10 (5%)
No
190 (95%)
190 (95%)
No
