The Meaning of Living for Men Suffering From Primary Hyperhidrosis

Illness Resignation

The participants described being unaware of the nature of their condition when they were young and believed that the symptoms would disappear once they passed adolescence. However, when it became clear later on that the disease would not reside, they had to reconcile themselves with the thought of living with the symptoms. “In adolescence you think yeah it’s a phase that you have to go through but later, you just reconcile with it and try to make the most out of the situation.” (Participant #10)

While it was not possible for the participants to overcome the sweating problems, avoiding and adapting to situations or activities that could expose the sweating was described as an example of managing the condition. “I have realised that it is not possible to, that I cannot win over this and instead I have begun to refrain from some situations.” (Participant #1)

Feeling Stressed and Anxious

The sweating problems were reported to create stress and anxiety before or during social situations or interactions. Thinking about a social activity such as a trip, a presentation, or an individual performance in front of others was often associated with anxiety. While anxiety about sweating in a specific situation was easier to manage, it was more difficult to decide about future plans such as a career or certain choices in life. These choices were described as decisively leading them down a different path had the sweating problems not existed. “It has been difficult to the extent that I believe it has affected my work and my career. I think I avoid certain things that are too difficult, certain assignments; official contexts, conferences, seminars, lectures, those situations.” (Participant #12)

Stress was often reported in situations involving social life. The ability to write on a piece of paper or grip something such as a computer mouse or a musical instrument was sometimes reduced, depending on where the sweating occurred. Other areas where grip ability could create problems were dancing, holding hands, or in sports such as wrestling, climbing, or lifting weights in the gym. Daily situations such as opening cans or shaking hands were reported to be stressful. In addition, choosing clothes to wear and finding ways to conceal sweat marks were reported as both stressful and time consuming. Both stress and sweat production were exacerbated during interactions with the opposite sex where there was a risk of exposure. “When I was younger, I didn’t expose myself to situations such as having a girlfriend and holding her hand.” (Participant #1)

Having Low Self-esteem

Continuous sweat problems affected self-esteem and reduced it so that one’s self-image became associated with attributes such as embarrassment, shame, disgust, smelling bad, being uncomfortable, and feeling wet all the time. These beliefs about one’s self-image were described as problematic and consumed both time and thought in daily life. “I always go by the mirror and take a look because I know there are sweat marks in my armpits. To look sweaty is worse than sweating.” (Participant #7)

The concern over managing situations or being a step ahead of situations in which sweating could occur reduced the motivation to participate in social gatherings or activities other than work or studies. “The sweating restricts me, and I don’t have much motivation to do things in my free time.” (Participant #14)

Being Reminded of the Disease

The symptoms of hyperhidrosis can be noticeable both to the individual and in the surroundings. Usually, sweat pearls appearing on the skin or sweat marks on clothing interfered with any activity taking place. “When I am working, I try to look through the sweat on my glasses. We do have sweatbands on our helmets but that will stop functioning after a while. Also, to have both your own clothes and protective welding overall that is fireproof makes you warm when you move. It is no fun to bath in sweat when you work.” (Participant #8)

Direct remarks about sweat marks on clothing or subtle references to such marks were reminders of the condition. “It was difficult in school, in activities when we used our hands such as dance. Someone could have commented Oh! How cold or wet you are.” (Participant #13)

Customizing the Attire to Hide

Characteristics of clothing such as color, material, and pattern were important to conceal sweat marks. Black or white colors were preferred, while light red, pink, or light blue were said to reveal the sweat marks more easily. Thicker clothes were more favored; however, they were less comfortable once they got soaked. Long-sleeved shirts or sweaters helped to conceal and stop the smell, as did wearing several items of clothing on top of each other to achieve the thickness desired. “The sweating has disturbed me pretty much in the social life. I always have to use black or white and wearing a lot of clothes on each other.” (Participant #3)

Another remark was about wear and tear on clothes since they had to be washed on a daily basis. At times, several of the same items were purchased to act as reserves. “For example, t-shirts, I can’t use it more than a day. That’s an issue. It seems like it’s nothing, but that’s an issue because you must change clothes each day. You have to do more frequently laundry.” (Participant #5)

Creating Possible Ways Out

Adapting attire and avoiding exacerbating situations were methods for managing the disease. Other methods, such as regulating the temperature inside a building, taking off shoes at work, wearing sandals, or using short breaks to change clothes, prevented an exacerbation of sweat production. Having greater freedom at work to do things at one’s own pace reduced the sweating problem and its consequences. “I am in control of my own time at work. I have an assignment to do and how I do it I decide myself. In difficult times with regard to sweating, I can work less and in other times I can work more. It is this freedom that enables the disease to stay calm somehow.” (Participant #1)

Planning ahead of an event or a trip increased the feeling of security and reduced moments of uncertainty. However, too much planning restricted the spontaneity in situations such as intimacy. “Sometimes I wanted to be close to my former partners, lay beside and hold them, but I couldn’t. I had to go and wash myself and make it dryer so that. . .You can’t do anything spontaneous.” (Participant#10)

Avoiding Exacerbating Situations

It was reported that voluntary situations outside of work or school that could cause stress and anxiety were rather avoided. Any exposure to a stressful situation could create a risk of getting caught up in a vicious circle of symptoms, anxiety, and further exacerbating symptoms that would restrict contacts with others in the proximity. “I remember when I used my bicycle to school. I was already wet when I got there although I had not put any effort into it. Then I sat in class and tried to hide myself for an hour. I went to the toilet to dry my skin, but the sweating did not stop. I went back to the class, sat there and thought about the situation which made me sweat even more. It is a vicious circle in some way. When you start sweating then it often gets worse.” (Participant #7)

A situation that was part of a job or an activity that had to be done, such as examining a patient with sweaty palms as a physiotherapist, was simply endured since no other options were possible. “It is in moments of physical contact with the patient that I feel it affects me. However, it is nothing I complain about or apologise to the patient for. I just let it be.” (Participant #2)

Feeling Vulnerable While Being Intimate

Hyperhidrosis did not prevent intimacy; however, it limited the individual’s behavior during different acts of intimacy. Using the dorsal side of the hand instead of the palm to caress and minimizing the duration of close body contact with someone were two methods for reducing sweat production. Taking a shower before being intimate did not help for more than a few minutes, while being flexible regarding postures and being able to maneuver freely in a given space were described as helpful. “Some positions work better than others. I try to have my back free, not to lay down with my back on the bedsheets.” (Participant #8)

Intimacy was also stressful if the sweating interfered in the act or in a sensitive situation. Not being able to cover the sweat during intercourse reduced self-esteem and created a feeling of unnecessary exposure. To sweat excessively in intimate situations was explained as understandable but seldom acceptable to the partners of those affected. “I have gotten remarks about my sweatings in intimate situations. It can be different, people become aware of it, but few accept it.” (Participant #4)

Feeling Odd or Singled-out

The visual effects of hyperhidrosis could draw attention to the individual, creating feelings of embarrassment and being unclean, which in turn singled-out the individual with the sweating problem. “The sweating could reach to a point where you were like under a shower, that extreme thing is not acceptable. I wouldn’t accept it to be shown in front of people which would be quite embarrassing because you would draw attention to yourself. What’s wrong with this guy?” (Participant #5)

One’s behavior, the attire worn, or the adaptations taken in the surroundings could be perceived by others as odd or strange, which could result in name calling or other unwanted comments.

“I haven’t told them at work. I would be called the sweater or such nick names and that can happen fast.” (Participant #3)

Worrying About the First Impression

First impressions were described as important for establishing contact and building up relationships with others. Shaking hands was a major problem for patients with palmar hyperhidrosis. “The first impression means so much and you often have to shake hands. It affects you to a certain degree, but you learn to live with it.” (Participant #6)

In plantar hyperhidrosis, taking off shoes to enter a house and leaving sweat marks on the floor was described as problematic for creating a good first impression, as was the smell and marks on clothing in axillary hyperhidrosis . “I very often think more about others perception than how I would look. Therefore, I try to hide the sweat and smell the ways I can.” (Participant #11)

Noticing Others’ Ignorance

Participants reported that it was difficult to talk to others about hyperhidrosis both in childhood and as adults. Some who discussed hyperhidrosis with their parents would be told that they were unfit or that the problems would recede as they got older. Others reported that their parents were not able to understand their problem since it was unknown. “I have mentioned it for mom and dad. I am ashamed. It took me 10 years to talk about it since it’s sensitive and many people regard it as disgusting. My parents have not understood to which extend it has affected me” (Participant #4)

In situations requiring social activities such as performing a joint task or being in a group, it was difficult to explain when others commented the sweating problems. “In school gymnastics I would sometimes get comments like why are you sweating? We haven’t even started yet! It was not the right time or place to explain my problems for others.” (Participant #10)

Difficulties in Finding Support

Those who were able to talk about their problem with family and friends and received a positive response reported relief in managing the disease. All participants described a delay of several years between the onset of the symptoms and telling others about the condition. “Why do we not talk about this? Well I think it’s a rare condition, No one knows how common it is. I don’t know how many people knows that such a disease exists.” (Participant #9)

Those who had come into contact with healthcare and received treatment reported that it was much easier to talk about the condition afterward. Once the sweating had ceased, no further thoughts had to be given of the consequence of telling others about the problem. “In my experience during the years that I was treated it became much easier to reveal the condition. When I have had treatment, I did not think about the condition at all.” (Participant #2)