This is a repost of my first post here at Zity: My first full body skin exam at the dermatologist.
Felt that, given how things will shift and get lost over time, that I'd put my initial post here, since it is so central to my journey of discovery.
Here it is:
I'm afraid that this will be a long story, and I might have to do it over several posts, so please bear with me
I found Zity because I was very apprehensive about my upcoming dermatology appointment. I had never had a full body skin exam before and knew that I needed one. My primary care physician had been telling me for years to get one, but I had procrastinated. Anyway, after seven years of avoiding the inevitable, I finally made an appointment after moving to a new town. As luck would have it, the earliest appointment was four months away (they said that was the case for a routine screening, but if I had anything of concern that they could fit me in during the coming week). So, four months of added anxiety as the date approached. I did web search after web search looking for what to expect at a full body skin exam - and most of it was from the provider's perspective, basically telling you to not be nervous, but never really addressing my biggest concerns. Then, I found this forum on Zity and realized exactly why I was so nervous - so glad that I found a community of people who felt the same way. What follows is a lengthy description detailing my appointment and exam. I hope that it might help others who are questioning their feelings and anxieties about upcoming medical appointments, and for those who have helped me, I hope that this post serves as some form of thanks.
So, I had my appointment on Friday afternoon - and I'm writing this on Saturday morning. Turns out, it was the last appointment of the day, which left me with mixed feelings - were they going to rush the exam just to get me done so that they could go home or go to happy hour?
I had taken the afternoon off to ensure that I wouldn't be rushed, and also to allow me to take a very thorough shower before I left for the appointment. I showed up about 20 minutes early and had already filled out all of the new patient forms. I only waited for about 5 minutes, and they called my name and took me back to a tiny exam room with an upright exam chair/table. The middle-aged nurse who brought me back asked me some questions about my history - basically going over my answers on the forms. She could tell that I was nervous and asked me if there was anything that I was concerned about. I told her that this was my first full body screening and that I had been putting it off for about 7 years. She assured me that there was nothing to worry about, that the physician's assistant was very professional and that the exam would be very thorough. She explained the process - that I would need to undress down to my underwear and put on a cloth gown. That the PA would conduct the exam, starting with a series of questions and would explain what she was going to do at each step and address my comfort level. She also explained that there would be a certified medical assistant who would be in the room to take notes and take pictures of any moles or lesions that were of note. She explained that these would not necessarily be anything to be concerned about, but that they would be establishing a baseline - a map - of my skin so that they could track any changes. When the nurse was done explaining this, she handed me the gown and told me to undress down to my boxers or briefs (boxers) and to remove my Fitbit as well, and that the PA would be in shortly.
I undressed quickly because I was afraid that there would be knock on the door and the PA would come in before I was ready. Of course, that turned out to not be the case. I undressed quickly and put on the gown pretty quickly, not getting it tied in the back, and sat on the table to wait. After about a minute, I hopped up and folded my clothes on the chair and sat back down. While I thought that I waited a long time, I did notice that the PA and the CMA knocked and came in well before my appointment time. The PA was a tall attractive brunette woman in her late thirties, and the CMA was a petite brunette woman who looked to be about my age. They introduced themselves and the PA said "I understand that you're here for a full body skin exam and that this is your first time." I said "yes" and she told me that I had nothing to be nervous about. We made some small talk - she asked me what had prompted me to schedule the appointment and if I had any specific concerns. I explained to her that I had procrastinated and that upon moving to a new town I figured that I might as well go ahead and stop procrastinating and get it done. She asked me about where I had moved to and some other small talk and then she began the exam.
At that point, it was like she flipped a switch from "make the patient feel at ease" to "medical professional." She started with my back and made comments to the CMA about what she was seeing. She circled a couple of moles with a Sharpie and had the CMA take pictures. She examined my back and then each arm. She had me slip one arm and then the other out of the gown so that she could examine my chest. She then had me slip both arms back through the gown and examined my face, my ears, and the top of my head. Then she examined my feet, between my toes, and my legs up to mid-thigh.
Then she asked me to stand up saying "I'm going to examine your backside, so please face away from me." She sat down on her little rolling stool and I did as instructed. She said "I'm going to lower your boxers so that I can check your backside and the cleft of your buttocks." She did lower the back of my boxers down to just below my butt and I felt her fingers glide lightly over my buttock and into the top of my crack. She made a few comments to the CMA and then raised my underwear back up. She then asked me to turn around and face her. All this time, the CMA was moving around the room, sometimes standing behind the PA, and sometimes at the other side of the room.
Anyway, the PA then lifted the hem of my gown up to basically the bottom of my boxers and checked my thighs. She asked me to hold the gown where it was (I did) and asked me to spread my legs a little (which I did) and she ran her fingers lightly up the inside of my thighs from my knees to the hem of my boxers, one leg at a time. Now, it was cold in the exam room, and coupled with the anxiety of having her examine my genitalia was the anxiety of having her examine my genitalia shriveled due to the cold. Anyway, with her fingers tracing up to the hem of my boxers, I felt a sudden rush of blood to my penis - not an erection, but definitely a boost to a slight "heaviness" - and I prayed 1) that I wouldn't get an erection and 2) that the exam would stop there. Of course, it did not.
She said, "I need to check your pubic area and then your genitals. Skin cancer can form anywhere - it isn't limited solely to skin that has been damaged by the sun." I swallowed and said, "Uh, okay." So, she's sitting on this little roll around stool right in front of me and says, "Please lift your gown up to your waist." I did as instructed and she said "I'm now going to lower your underwear so that I can conduct the remainder of the exam - we're almost done." So, I took a deep breath and lifted my gown as I felt another rush of blood to my penis and felt it lengthen and my balls lift and fall. A this point, the PA was sitting on her stool right in front of me with my crotch right at eye level, and the CMA was standing right behind her with her iPad. I looked to the ceiling and said a silent prayer that I would not get an erection.
I felt the PA slip her fingers into the waist band of my boxers on either side and slide them down to about the top of my pubic hair. She checked the area from my bellybutton to the top of my pubic hair, making a couple of comments and having the CMA take notes. She stopped at this point and put on some latex/nitrile gloves. Then she said "I'm going to lower your underwear the rest of the way so that I can examine your genitals" and she slipped her fingers into the waist band of my underwear again and lower them to my knees (where they promptly fell to down around my ankles). Again, I felt the hot rush of blood to my penis and felt it swell, but was thankful that it was not getting hard - just heavy. I kept my eyes on a spot above the door where the wall met the ceiling, because I knew that to look at the PA or CMA would spell disaster.
The PA started by running her finger through my pubic hair, moving left to right. She stopped moving her finger at a spot just above and to the right of my penis and used both hands to spread the hair. She took her little flashlight scope and took a closer look, leaning in very close. Again, I felt my balls rise and fall, and felt blood flow into my penis. She sat back up and said something to the CMA, who then leaned in to look while the PA kept my pubic hair spread away from the spot. The PA then took out her blue sharpie pen and marked my skin.
The PA then took the tip of my penis with the tips of the fingers on her right hand and moved it to the left, stretching it just a little - and that did it. Within about a heartbeat I had a full-fledged erection. I started to step back and said "I'm so sorry, I'm so sorry." The PA let go and sat up on her stool, rolling back a bit. She look up at me and said "Don't worry. It's a perfectly natural reaction and nothing to be embarrassed about." Then she smiled just a hint of a smile and said, "Actually, it makes this part of the exam easier." My heart was racing and I felt a flush of sweat break out across my body. The PA then very gently said, "It's okay, really. We're almost done." I glanced at the CMA who was focused on her iPad, and then I looked back at my spot above the door.
The PA rolled forward on her stool and gently took the tip of my penis in her fingertips. She moved it right, left, and then up - the whole thing taking about five seconds. Then she said "I'm going to check your scrotum now. This will only take a couple of seconds." She gently pulled the skin taut with one hand and ran a gloved finger up and down that side of my scrotum, occasionally pulling the skin taut. Then she repeated the same on the other side, switching hands.
She took the hem of the gown from my hands, pulled it out over my erection and lowered it back down. Then she rolled her stool back, started taking off her gloves and said "There, that wasn't so bad." I apologized again and she said "Nonsense. It's a perfectly natural and healthy reaction. Nothing to be embarrassed about. Please, go ahead and sit back on the table." She explained that she wanted to take a skin scraping of three different areas - nothing to be concerned about. She said that the CMA would explain the procedure and get me prepped, and that she'd be back in a couple of minutes.
After she left the room, the CMA put her iPad down on the counter, looked at me and said "This is a really simple procedure and nothing to be concerned about. We're just going to scrape some skin cells off from the areas that she wants to test and make sure that there's nothing to worry about. I'm going to numb up each area for the procedure, and that will involve an alcohol swab and a small injection of a numbing agent. It works very fast, so you'll be out of here shortly."
She started with a spot on my back. She said "This is just the alcohol wipe, it will feel a little cold." I was sitting on the table, leaning forward with my hands in my lap covering my still extremely hard penis. Then she said "Okay, just a little sting" and I felt the pin-prick of the syringe. I felt like there was a lot of tension in the room, and obviously the CMA felt it too, so she started some small talk - asked me if I had any plans for the weekend, who I thought would win the Super Bowl, stuff like that - and it worked. As we started talking, my erection started to fade. She repeated the procedure for the spot on my upper right arm and then walked around the exam chair to the counter and said "Okay, for the last spot, I'm going to need to shave a small portion of your pubic hair with these electric clippers" - she reached into a drawer and removed what looked like a small electric beard trimmer. She then said "Are you okay with that, or do you need a minute? Would you like a cup of water?" I took a deep breath and told her that I would love a cup of water.
After I took a swallow or two of water I started to apologize again, but the CMA said "It's not that uncommon." She sat down on the stool in front of me, looked me in the eyes and continued "As (the PA) said, it's a normal, natural, and healthy reaction. I know that you're probably thinking that I'm just saying that or that it should only happen to other people, but trust me, we don't find it offensive. We do this multiple times a day, every day. It happens to some guys, and not to others. I know that you probably find this stressful, but just try to relax and it will be over soon and you'll be on your way." She smiled and said "Before prep that last spot, let me check the other two to see if they're numb." She stood up and walked around behind me and said "You're going to feel me tapping on your skin. Let me know if you feel me tapping, or if you feel any sticks." I told her that I felt her tapping - turns out, she was tapping with the tip of the syringe. She repeated the procedure on my upper arm and the result was the same (that's when I saw that she was tapping me with the needle).
In a voice that had shifted from personable and caring to professional and clinical she said "Okay, I need you to lay back on the table so that I can prep the final spot." So I lay back on the table and smoothed the gown across my lap. She moved my hands up to my belly and raised my gown up to my waist. She picked up my penis with one hand and moved it over to the side, and proceeded to shave a spot about the size of a quarter just above and to the right of the base of my penis. Again, I felt a rush of hot blood flow and my penis get heavy, but I did not get erect. She put the shaver down and narrated the procedure again "First the alcohol swab - might be a little cold. Now a little sting" and I felt the needle go in. She stood up and said "(The PA) will start with this spot and then do the other two. I'm going to drape the area and ensure that you are covered. Are you doing okay?" I confirmed that I was and she put a paper drape over my crotch. It felt like she covered everything, but evidently there was an opening positioned over the shaved area. The CMA then said "I need to get a picture of this one too" and picked up her iPad. After a moment she said "We'll give that a minute or two to get numb. I'll be back shortly."
I lay on the table waiting for them for what felt like 20 or 30 minutes, but I'm sure that it was probably no more than five. During that time, I imagined the PA and the CMA out there in the hallway, office, or lounge - perhaps with other PAs and CMAs - talking about the guy in the exam room who had gotten a big old raging hard-on during the exam. This caused my heart to race and to break out in a cold sweat. Again I felt a renewed rush of blood to my penis (but no erection, thankfully).
Finally, there was a soft knock on the door and the door opened. The PA and the CMA came back into the room and the PA asked if I was doing okay. I assured her that I was and she sat on the stool and started to explain the procedure to me. "We're going to shave off a small area of skin and have it sent off to the lab to ensure that there is nothing to be concerned about with these spots." I was thinking that this was going to be more than "just scraping off some skin cells" like they had said earlier. After confirming that the spot near my groin was numb, the procedure took about a minute. Then they applied a bandaid coated with some ointment. The CMA removed the drape, once again exposing everything, and pulled my gown back down. The PA stood up and helped me sit up on the table, raising the back portion of it back up into a reclining seatback again. She repeated the procedure on the spot on my arm and then on my back - her conversation during that time was minimal, clinical, and professional - and I felt like I knew it was because of my earlier reaction.
When she was done and the samples were all in their little sample jars, the PA turned on the charm again. She explained that the samples would be sent off to the lab, but that I had nothing to worry about. She said that they had created a map of my skin and had taken photos to serve as a baseline for future exams to be able to track any changes. She said that the CMA would explain care of the sites where the samples had been taken and that she wanted me to make an appointment to come back in a year. She then left and turned the rest of the appointment over to the CMA.
The CMA explained how to care for the wounds and gave me a pre-printed sheet about it. She talked to me some about using sunscreen and wearing a hat - all of the basic preventive care stuff you would expect. When she was done she clutched her iPad to her chest like a high school girl holding her textbooks and said "You did good and you have nothing to worry about. Almost everyone has a biopsy done - it's just a precaution." I said "I'm glad that this is only done once a year." The CMA said "I know that this was difficult for you, but you did well and have nothing to be concerned or embarrassed about. You may have felt awkward for a few minutes, but it's no big deal, and it's a procedure that can help save your life. Be sure to make a follow up appointment and please be sure to come back next year. Don't let a little awkwardness this time keep you from coming back." I told her that I would keep my appointment next year. She smiled and told me that I could go ahead and get dressed and to just check out at the front desk on my way out.
As she started to open the door to leave, I said "I really appreciate your kindness and taking the time to help me through this. I know that it's stupid, but, well... I think that you went above and beyond, and I really appreciate it." She smiled and said "Thanks" and left, closing the door behind her. So, I got up, got dressed, checked out at the front desk and made my appointment for next February.
As I said at the start of this very long post - I appreciate how folks have shared here. I had a great deal of anxiety about my feelings that I did not understand leading up to this appointment (and to most of my medical appointments). While I was both intrigued and anxious about getting an exam in that level of detail - and especially by a female PA with another woman in the room observing - and I was terrified that I might get an erection (and horrified that I did) - the embarrassment was, well, exquisite.
I'm sure that I will be anxious for my next appointment, but I'm also positive that I won't skip it.