Samuel and Véronique had a problem. They had been very busy with their studies and careers, and had postponed children. Now, at 35, they were realizing that having children was not as simple as it looked. They had been trying for two years, to no avail.

The obvious solution was to enroll in an infertility treatment program in their city, which would be covered by “social security” and their additional “mutuelle” private insurance. While the process would be nearly cost-free for them, it was cumbersome — the overall feeling was that they had waited too long already. Friends advised them to look for private clinics in Spain. Searches on forums indicated that Clinica X*** was highly regarded: very professional, French-speaking staff, and also testimonies that they don’t push for expensive procedures — if the issue can be solved by simple means they will help implement them.

Clinica X*** had a convenient process for couples from afar. Instead of doing one examination, then another, and diagnosis, which would be impractical unless living in the same city, they would first do a number of non-invasive examinations, for both members of the couple. Then, depending on the results, some treatment could be implemented, or some more invasive examination suggested.

Prior to the examinations, Samuel and Véronique had to fill a questionnaire, each separately (the documentation insisted on this). They could be filled at the clinic, but, to save time, it was also possible to fill them online.

Véronique’s questionnaire was extensive: age of first periods, regularity of periods, menstrual pains, history of illnesses of the genitals (including vaginal thrush, the questionnaire said), history of contraception, and so on. Véronique indeed recalled the embarrassment of that episode of thrush, when she had to show her sore genitals to her GP. Then the questionnaire went on to current contraception (why would would-be parents trying to conceive be using condoms, wondered Véronique, but the questionnaire specifically asked that question), and finally sexual habits (frequency of penis-in-vagina intercourse, does ejaculation happen in the vagina, and so on).

Samuel’s questionnaire followed the same principles: age of puberty, of first ejaculation, any difficulties with ejaculation or urinating, history of illnesses of the urinary and genital apparatuses, use of contraception, sexual habits…

Then came the day of the appointment. The clinic’s documentation advised to schedule it outside of menstrual periods, if possible, though if periods came the examination was possible. No intercourse, no introduction of sexual aids into the vagina, no masturbation to ejaculation for the male for 3 days before the examination — the documentation had been quite explicit.

The clinic indeed seemed very professional. The welcome staff handed payment and paperwork and gave instruction sheets. Samuel and Véronique were to visit the toilet prior to examination, empty their bladders and attempt « exonération », which they understood as medical speech for defecation.

They were instructed to go to an examination room where Dr Purificación Lopez Sánchez welcomed them. The physician, a woman in her fourties, spoke French, albeit with a strong accent. An examination table complete with stirrups stood ominously. Because they had filled in the forms online in advance, there was no need for a lengthy interrogation. They sat shortly while the doctor double-checked a few items, including frequency of intercourse and methods for detecting ovulation.

“You use the temperature method, you said?

— Yes. I mean, we have intercourse regularly, as I said, but we make sure we do it when I ovulate. I keep a chart on my computer.

— Excellent. What kind of thermometer do you use?

— Electronic.

— How many decimals does this thermometer have?

— Two. It’s a model for women who apply the temperature method.

— Where do you take it? Orally, rectally?

— Rectally.”

Dr Lopez Sánchez nodded approvingly. The temperature method was difficult to apply, whether for contraception or for deliberately having intercourse on the day of ovulation, but it seemed that Véronique was doing everything right. Neither Véronique nor Samuel commented that, often, it was Samuel who took Véronique’s temperature, sometimes following up with sex; that would have been “too much information”.

“Well, I guess it’s time for your examination. Your husband can stay here or wait outside, at your choice.

— Oh, he can stay.”

Dr Lopez Sánchez in general approved of examinations conducted with the spouse present, unless of course there were specific difficulties — it was possible to tick boxes in the questionnaire hinting at disagreements or other circumstances that would lead to the doctor not ask the question and instead ask for the husband to leave.

“Very well. Please disrobe behind this screen. Pants and panties off.”

As Véronique emerged, the doctor told her to get in position in the stirrups.

The doctor first conducted a quick external examination. Fertility issues sometimes arise from sexual diseases, and one must always first rule out what can be easily diagnosed. Furthermore, signs of injuries could point to abuse. Véronique had nothing to be noticed. The doctor took a couple swabs: one between the labia, one at the entrance of the urethra.

The doctor then picked up a metal speculum. Véronique knew such devices, but Samuel had never seen any. He watched with interest as the doctor inserted the device, then opened it and had a look inside with a flashlight. The cervix looked perfectly sane. Of course, a swab was to be taken, again with the idea of looking for infections or other issues that could prevent procreation.

Then it was the time of the digital vaginal examination, and the bimanual examination. Dr Lopez Sánchez was trying to feel the ovaries. Then, she picked up a device and covered it with what looked like a condom, then some lubricant.

“I’m going to do a transvaginal ultrasound…” she explained, and pushed the device in. The probing that ensued was not too pleasant. The doctor was trying to see details. “I don’t see anything unusual with your uterus and ovaries…”

Then, the doctor had a quick look at Véronique’s anus and announced. “If you don’t mind, I’ll now conduct a digital rectal exam.” Véronique had never had one… The doctor’s order to “push” as her gloved and lubricated finger rested on her anus reminded her of when her mother gave her suppositories when she was a child. The finger entered effortlessly, then came some deep internal probing.

Samuel had watched all this with interest. It was surprisingly exciting to see his wife being probed by the doctor’s fingers and by instruments. At the same time, he feared that showing prurient interest would make him look like a “weirdo” for the doctor, and could perhaps displease his wife. Or would she be really displeased? After all, it was her who asked him, on some days, to take her temperature in her bottom… In short, Samuel did not know how to act and where to stand.

Véronique’s examination was now complete; the doctor handed wipes to her. “I see nothing special. Of course, there could still be problems with your ovaries… We’ll have the swab results by this afternoon. You can get dressed… Sir, you may get undressed. Same thing, pants and briefs off.”

Samuel and Véronique soon emerged. It was implicit that if Samuel had watched Véronique’s examination, then the converse would apply.

Dr Lopez Sánchez motion Samuel towards the table. Samuel laid on his back on it, as he would usually at the doctor’s (though it was the first time when he did so without his briefs on). With a brief smile, the doctor announced that he, too, would need to take position in the stirrups. Samuel was uneasy; the position was very exposing!

The doctor had a brief look at Samuel’s genitals. Again, with the policy that issues that were easy to detect should be detected first, she pulled back his foreskin, which yielded with no resistance; the glans and folds looked clean; he likely cleaned it in the morning when showering. By that time, with Samuel and Véronique’s answers and their consistency, she did not doubt that they had intercourse on a regular basis, and even specifically just after ovulation.

Yet, there were couples whose uneasy answers led to doubt; for instance, one month before, a husband reported bi-weekly intercourse with ejaculation while his wife had reported monthly episodes. Examination, which because of this was conducted separately and starting with the husband, had shown that the husband suffered from severe phimosis. Discussion with the wife had shown that he generally could not keep up his erection long enough during intercourse to reach ejaculation: erection was painful and also the fear of not maintaining it long enough would stress him, leading to even more difficulty. The doctor had explained possible remedies: dilatation of the foreskin using special creams to make the skin softer, or surgery. This was a rather exceptional case, it must be said, but if it takes just two seconds to check for it, why not do so… Furthermore, the clinic’s policy was to check for sexually transmitted diseases, at least those checks that could be done easily.

The doctor then felt each testicle, while making a form of small talk.

“Do you check your testicles for lumps?

— No…

— You should. Even though testicle cancer is more intense in younger males, it can happen in middle-aged men. You should definitely check for these at least every month… or have you checked by your wife. Anyway, I feel nothing unusual. I’m now going to do an ultrasound.”

The doctor could have probably dispensed with the manual testicle examination; any lump or tumor would have shown on the ultrasound. Yet, she thought it important to remind men and their wives of the need to check these at home. She sometimes wondered what proportion of the men who visited the clinic and got examined in front of their wife or partner would then have to endure monthly checks at home from their significant other.

Samuel found the testicle examination a bit unpleasant, but not more than that. Nothing abnormal was shown.

The doctor changed gloves and prepared lubricant. Samuel knew what to expect, after seeing his wife. Furthermore, he had heard about prostate examinations in older men, and expected he would be getting one since the instructions to go to the toilet and attempt defecating before the examination. He just had not envisioned to be spread open in stirrups.

Samuel complied with directions to “push.. like going popo”. The finger entered and searched for something.

“How do you feel when I press here?

— I feel like… peeing.

— No pain? (the doctor pushed again)

— No…”

By that time, however, with all this handling of genitals and anus, Samuel’s penis was half-hard, sometimes jerking a bit. The doctor pretended not to see it. Véronique had seen it to, and was frowning a bit.

“Now time for your transrectal ultrasound.”

The protocol was more or less the same as for Véronique’s transvaginal: a probe covered with a kind of condom, and a rather generous dose of lubricant, was inserted. Samuel’s penis, still half-hard, occasionally jerked.

“I do not see anything abnormal with your prostate… nothing mechanical that would obstruct semen. Now for the last part of your examination… You’ll have to make a semen sample. You can do it alone… or masturbated by your wife. This is a condom, you’ll have to ejaculate in it and deposit it in this jar; try to be careful and not to spill any of the content, we’ll weigh it. There are wipes over there for cleaning up. Ring this bell when’re you dressed and done. Remember, you have another appointment at 4PM for the results.”

The doctor wiped Samuel’s glans with an antiseptic wipe. He looked clean anyway, but this was the procedure.

“Madam, are you staying?

— I guess so…

— If you need a glove and lubricant for prostate stimulation, they are here. ”

Véronique and Samuel’s eyes widened. The doctor, with a smile, left the room.

Not all doctors at Clinica X*** would suggest this. The proposal of having the female partner “help” with the sample was standard at the clinic — it made for a less clinical experience, for more bonding, for solidarity, in the same way as attending each other’s examination. Dr Lopez Sánchez, however, like the idea that at least some of the women she saw would stimulate their partner’s prostate during the semen sample, and some would perhaps keep this practice for playing at home.

Dr Lopez Sánchez was a feminist. Gynecological examinations were a necessary evil, often the cause of shame, discomfort, even humiliation. Childbirth was about staying spread open in front of a variety of medical staff. Sex with a man was generally about penetration, about feeling his finger, his penis, in the vagina, in the mouth, sometimes in the anus. So it seemed to her that some equalization was in order; that a man receiving his woman’s finger in the rear would perhaps understand her feelings, her vulnerability during sex, better. Would Véronique take the hint? Dr Lopez Sánchez was curious, but knew better than to ask too many questions.

Véronique was wondering what to do about the suggestion. To gain some time, she began masturbating her husband with her hand, getting him fully hard, then installed the condom. She breathed hard, grabbed a glove and put it on. She then lubricated her finger. “Push!”, she said, imitating the doctor. She had never done such a thing. To her surprise, her finger entered easily.

“Where was she feeling? Was it there? There?

— There!”

She was happy to have found her husband’s prostate. With her other hand, she quickly felt his testicles (she’d have to learn how to check for lumps, she thought, but that would wait for another occasion), then began masturbating him. She could feel his anus contracting and relaxing around his finger, and how this jerked his penis a bit.

He did not need much time before spending himself in the condom. Véronique removed the condom carefully, placed it in the jar and closed the lid. Then she wiped his penis and his bottom.

Later that day, Dr Purificación Lopez Sánchez explained her findings to Samuel and Véronique. There did not seem to be “mechanical” difficulties or any form of abnormality. It was impossible to check for correct ovulation without invasive procedures, which the clinic did not do before less invasive actions had been tried. However, there was definitely some motility issue with Samuel’s sperms. There was a treatment for it, consisting in iinjections and pills. She would write a prescription.

Six months later, Véronique’s pregnancy test showed two blue bars. Thank you, doctor.