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Vaginal cream: what happened?

Vaginal cream causes a storm

Staff in an all-night pharmacy were shocked last night when a man stormed in shouting that his manhood had been insulted by a product he had been sold there. Customers stood back as the forty year-old raced to the counter brandishing a tube of cream and making the air blue with foul language.

Trainee pharmacist Ilse Bergman, 23, described the scene to our reporter: 'It was very frightening. He made straight for me at the cash till, waving his arms about and called me a number of names I shalln't repeat. The customers all moved away and many of them left the pharmacy.'

The night manager took over from Ilse and tried to calm the man down. Eventually, after a lot more shouting, the man threw the cream at the manager and said: 'Can't you **** well see that I'm a man? You **** people just taking the ****. I won't have it! **** you all.' Then he went out, knocking over a display of slimming products on the way.

The offending product, an antifungal cream, stated on the label that it was for 'vaginal use'. It appears that this was what had caused the storm.

'We do get some strange and worrying people in here sometimes,' Ilse commented. 'When you're training, you don't really expect to have to deal with such people. It was a big shock for me.'

A man was later arrested for threatening behaviour and bailed pending further enquiries.

So, how did this worrying event arise?

Any ideas?

Why had a man been sold cream, for his own treatment, with a vaginal use indication?

The answer is very simple, and it indicates both helpful service by the pharmacist who sold it, as well as a failure to understand the potential sensitivity of the transaction, and a failure of communication.

The man wanted medication for treatment of a fungal infection of his foot. The appropriate cream (ekonazol 1%) was available in small and large tubes, each of them with a specific indication, as required by regulation: the larger one had the main indication 'mycotic vulvovaginitis', since the product in larger volume was most often used for that. Judging that the patient's described symptoms required a larger volume of cream than supplied in the smaller tube, the pharmacist had sensibly offered the larger tube, containing exactly the same cream, as a convenience and sensible economy. Whether or not she had clearly explained what she was doing, and whether or not the customer was listening, are both uncertain. However, what was all too clear was that the customer did not get the message, and was deeply upset when he got home and read the label.

Lessons:

  • Never assume that things which are obvious and unimportant to you are also obvious and unimportant to patients (in this instance, you may know that the cream is the same and that 'indication' is a formal category excluding many others; the patient will almost certainly not).
  • Be aware of the extreme sensitivity of some people to things which might appear to reflect on their sexuality in any way.
  • Be aware that there are some people who will not be willing to carry home anything which could possibly be seen by a partner or family member as compromising; 'Why have you got a tube of vaginal cream, dear?' could be a real problem in some households.
  • Always ensure that you communicate clearly and check that your message has been fully received and understood.
  • Where necessary (as it probably was in this story) show the patient the evidence: point out the contents or formulation as printed on the label or the package insert; show where the range of secondary indications are listed.

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