BMJ  2006;333:1287-1288 (23 December), doi:10.1136/bmj.39043.717245.F7

Research

You're not going to give me the umbrella, are you?

¹ Department of Genitourinary Medicine, St Thomas' Hospital, London SE1 7EH

The "umbrella test" is a longstanding urban myth that still bothers men who present for testing at sexual health clinics

Access to genitourinary clinics is a hot topic, and we have been working to encourage more men to present for screening for sexually transmitted infections. There is a long standing urban myth that men attending such clinics have to have the "umbrella test." This myth varies little in rendition. The usual description is that something akin to a cocktail umbrella in a closed position is inserted deep into the urethra. This umbrella is then opened out and withdrawn, to the considerable discomfort of the owner of said urethra.

The origins of this myth are obscure—although, no doubt, readers will enlighten us. In fact, asymptomatic men attending our clinic are checked for urethral infections by urine test only; symptomatic men have a swab tipped with cotton inserted a short distance into their urethra, which is relatively painless.

We needed to know if this myth was still prevalent and whether it was deterring patients from accessing our services.

Methods

To determine patients' expectations and whether action to dispel the myth is needed, we gave brief questionnaires to random male patients in the waiting room, asking what, if anything, they had heard about the umbrella test.

Results

Forty six questionnaires were completed and returned. In all, 28 men had attended a sexual health clinic before. Eighteen had heard of the myth. Fourteen said that the idea of an umbrella put them off coming to a clinic. Men who had heard of the myth and believed it were more likely to be white, heterosexual, and younger than 25 years old.

More than half the men stated that more advertising and publicity were needed to encourage men to go to clinics and felt that the media was a useful tool. Most wanted reassurance that the investigations to which they would be subjected would be painless. Some men illustrated their response with a description or sketch of the legendary instrument (figure).

Descriptions of the umbrella test "a small scraping tool" "a McDonald's straw" "[the] dreadful part is the penis torture" "imagined it looking like a miniature cocktail umbrella" "something like a long probe, nothing too scary, even though I've heard it hurts a lot" "cylindrical with reversed spikes on it" "a small metal umbrella that's inserted into the end of the penis and then opened and dragged out to obtain cell samples"

View larger version (4K): [in this window] [in a new window] [PowerPoint Slide for Teaching]   Fig 1 Examples of respondent's illustrations of the umbrella test

 

Conclusion

The umbrella myth is still being promulgated. As a result of this work, we intend to focus on dispelling the myth within our clinic by putting up signs in the waiting room and ensuring that staff are aware of patients' fears. However, we feel that a wider refutation of the myth might encourage more men to seek screening for sexually transmitted infections. Although media attention has focussed much on sexual health crises in recent years, more informative advertising and media attention is needed to encourage people to attend clinics.

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Contributors: CB had the idea, oversaw the work, and wrote the paper. AE did the first draft of the questionnaire and first analysis of the results. SS redrafted the questionnaire, did the final analysis, and contributed to the final draft of the paper. TM commented on the questionnaire. All contributors distributed the questionnaire to the participants. CB is guarantor.

Funding: None.

Competing interests: None declared.

Ethical approval: Not needed.

(Accepted 28 October 2006)

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