You arrive for the treatment-plan visit dressed more carefully than you’d admit: soft sweater, skirt instead of jeans, as if some part of you wants to feel feminine in this space now. My nurse shows you straight to my private office instead of an exam room, and the difference makes your pulse stutter. No stirrups. No paper gown. Just my desk, two chairs pulled close, and me standing when you enter.

I close the door behind you. No white coat today—just the shirt and tie, sleeves rolled once, showing forearms you suddenly can’t stop staring at.

“Come sit,” I say, voice softer than in the exam room. You do, knees pressed together, hands twisted in your lap. I take the chair beside you instead of behind the desk, close enough that our knees almost touch.

“First,” I begin, opening a folder but not looking at it yet, “the biopsy and cultures confirmed stage-two endometriosis, focused posteriorly—exactly where I felt that nodule. The good news is it’s treatable without surgery for now. The less-good news is that the most effective first-line option is a three-month course of Lupron Depot—monthly injections that put you into temporary menopause. It’ll shrink the lesions, stop the bleeding, and give the tissue a chance to calm down.”

You swallow. “Side effects?”

“Hot flashes, mood swings, vaginal dryness, bone density concerns if we go longer than six months. Some women feel… emotionally raw.” My eyes flick to yours. “And libido can plummet. Or, paradoxically, skyrocket for a few. Every body is different.”

You feel heat crawl up your neck at the word libido.

“Alternative?” you ask, voice small.

“Continuous hormonal birth control—pill, patch, or a progestin IUD. Less dramatic shutdown, but slower results and more breakthrough bleeding at first.” I pause, studying your face. “There’s a third option we don’t put on the standard handout.”

You wait.

“Targeted, very high-dose progestin therapy delivered rectally, twice daily, for eight weeks. It bathes the posterior lesions directly, often shrinks them faster than anything else, and avoids systemic menopause side effects.” My tone stays perfectly clinical, but my gaze doesn’t waver. “It’s off-label. Intimate administration. Most patients need… guidance the first few times to ensure proper depth and absorption.”

Your breath catches. You know exactly what “rectal administration” means in this office.

I let the silence sit, then lean forward slightly, elbows on my knees. “I won’t pretend it isn’t invasive. But you already know I’ll be careful with you. And you already know you tolerate—trust—my hands there.”

Your thighs press together under the skirt. The room feels ten degrees warmer.

“There’s a fourth path,” I continue quietly. “Visceral manipulation and pelvic floor therapy combined with nightly compounded suppositories—again rectal, but smaller volume. Many patients see dramatic improvement, especially when the therapist is someone they…” I search your eyes, “…already feel safe surrendering to.”

You’re trembling now, fine ripples you hope I can’t see.

“I can’t decide this for you,” I say, voice dropping. “But I need you to choose with your eyes open. Whatever you pick, I’ll be the one administering the first several doses—here, privately, after hours if you prefer. No nurse. Just us. Because this level of treatment blurs lines, and I won’t hand you off to someone else.”

The implication hangs between us like smoke.

You stare at your hands. “If I choose the… rectal protocol,” you whisper, barely audible, “how does it actually…?”

I don’t make you finish. I reach for a small drawer, withdraw a slim, torpedo-shaped suppository wrapped in foil and a tube of lubricant, and lay them on the desk blotter between us. It’s longer than you expected—almost three inches—and thicker than a finger.

“First visit, I do it for you—slowly, with gloves, while you’re in the position that gives the medication best contact with the posterior cul-de-sac. You stay on your side or prone for twenty minutes afterward so gravity helps. Subsequent doses you can do at home, but most patients come back weekly for me to check placement, depth, and tissue response.” I meet your eyes. “I’ll examine you each time—rectovaginally—to measure progress. You’ll be this exposed to me, regularly, for the next two or three months.”

Your exhale shakes.

“There’s no wrong choice,” I say gently, covering your cold hand with mine. “Lupron is the easiest logistically. The rectal route is the most effective for your specific lesions—and the most intimate. Only you know what your body… and your mind… can handle.”

You sit in silence for a long moment. My thumb strokes once across your knuckles, steadying.

Finally you speak, voice small but steady. “I don’t want to feel like I’m in menopause at thirty. And I…” You swallow. “I trust you. More than I should.”

A flicker of something raw crosses my face before the professional mask slides back.

“Then we’ll start tonight,” I say quietly. “After the last patient. You’ll come back at seven. Bring nothing but yourself.”

I stand, help you to your feet. My hand lingers at the small of your back.

“At the door,” I murmur, low enough only you can hear, “you can still change your mind. But if you walk in, sweetheart, you’re mine to treat—thoroughly—for as long as it takes to make you well.”

You nod, throat too tight for words.

As you leave, the foil-wrapped suppository sits on my desk like a promise.

You already know you’ll be back at seven.