I shared this in an email to a friend (and an excellent play doc who I had the pleasure of submitting to once upon a time), and per his encouragement, I'm sharing this here. Having had a number or role play exams--some excellent, others not so much--I started writing a script that turned into a composite of the best exams I personally experienced and experiences and what I fantasized about experiencing. And having met a few guys interesting in playing the doctor role, but who had never actually acted on it, when I first started this, I think I also saw it as a prefab road map to help the guy in the dominant role determine how play could build up and progress. (That said, there are certain, higher risk activities that I've only fantasized about--namely forms of urethral insertion--and would only ever consider doing with a person who I trusted and knew what he was doing. And even then, knowing what could go wrong, it causes as much worry as it does excitement.) I also saw it as a full list of options--not necessarily everything I wanted to experience in every play exam. I think part of the fun is a doc picking and choosing what he wants to do and when so that the patient can be left guessing as to what will be coming next. So, what am I missing?
- The patient agrees that the doctor is granted full access to his body within the limits mutually agreed to prior to the exam. Keeping within said limits, the doctor agrees to examine patient, employing any number of procedures at his discretion and pleasure.
I. Preliminary Interview and Initiating the Exam
- Doctor sits down with patient and asks questions about the patient's health history. Questions focus primarily on the patient himself, with few to no questions about extended family.
- Doctor instructs patient to go into a separate room and undress either down to underwear or completely nude.
- Doctor knocks before entering to begin the exam
- Doctor does an initial visual inspection and tells patient to walk around the room, squat, do quarter turns, reach for the ceiling, etc.
- Doctor tells patient to bend over and touch the floor so that he can inspect the patient's spine.
- Doctor may also measure patient's height as well as chest and waist measurements. He may also decide to measure the patient's penis at various points in the exam as the patient goes through various states of arousal: soft, semi-hard, and hard. If the patient is totally erect for the duration of the exam, the doctor may apply an ice pack (or other, similar means) to the patient's genitals so that the penis may be measured in an extreme flaccid state.
- When was your last physical exam?
- How tall are you? How much do you weigh?
- Any current medical conditions I should be aware of?
- Any past medical conditions or surgeries?
- Are you currently on any medications?
- Do you smoke/drink/take recreational drugs? (If yes, how much/how often?)
- Do you have any concerns you would like me to specifically address during the course of this exam?
- Prior to the exam, the doctor may wish to offer pre-exam prep instructions to the patient via text or email in the days or hours leading up to the exam. Prep may include type of underwear to wear, how much water to consume (if any at all), how long to abstain from masturbation, etc.
- Doctor may have a preference as to how the patient should refer to him, i.e., “Dr. [PREFERRED NAME HERE], “Sir,” or another form of address appropriate to the situation.
- If patient is asked to strip nude, patient may disobey orders and instead strip to underwear. On entering, doctor expresses his aggravation and either makes patient remove underwear or do it himself.
- If hair trimming/grooming is to be a part of the exam, the doctor, on seeing the patient nude, may remark that the nurse was supposed to instruct the patient to shave prior to the appointment or remark that the patient did not properly prepare for the exam. Doctor's irritations can fuel rougher, more invasive style of examination.
- Doctor leads patient to the bathroom
- Doctor instructs patient to stand over the toilet where the patient will either void his bladder into a cup or directly into the toilet.
- When done, doctor leads patient into exam room.
- Do you have trouble urinating?
- Do you ever experience pain or burning?
- Doctor intermittently instructs patient to start and stop stream, observing patient's muscle control.
- Doctor may instead decide to take a urine sample by inserting a catheter into the patient and having the patient fill a bag. This may be done at a later point in the exam, at the doctor's discretion. In exploring this scenario, in lieu of having the patient ingest water prior to coming in for the exam, the patient may be asked to withhold from drinking anything until after he is catheterized, at which point the doctor has the patient drink water until a desirable sample has been collected. Doctor may also see fit to administer a water pill in the interest of having the patient void as much liquid as possible.
- Doctor takes patient's temperature orally using a thermometer and advises that temperature will be taken in three ways over the course of the exam: orally, rectally, and through the urethra.
- Using a blood pressure cuff, doctor takes patient's blood pressure and does a pulse reading
- Have you ever had issues with high blood pressure or hypertension?
IV. Head, Eyes, Ears, Nose, Throat
- Using a pen light, doctor inspects the patient's eyes, ears, and nose
- Using a tongue depressor or gloved finger, doctor inspects patient's throat. If using a gloved finger, doctor may run his finger along inside of patient's cheeks and along the gum line to check for any abnormalities, and then inspect the tongue.
- Doctor locates and palpates lymph nodes in the jaw and neck area, asking if patient experiences any discomfort in these areas.
- Placing hands on either side of patient's neck, doctor asks the patient to swallow, feeling for any lumps or bumps and asking if patient feels any discomfort. Doctor may tell the patient to swallow multiple times, as he sees fit.
- With patient's legs dangling over edge of exam table, doctor checks reflexes by using a hammer to tap on the patient's knees.
- Doctor tells patient to place hands on knees and uses hammer to tap elbows.
- Doctor tells patient to hold out arms. Doctor places his hands on patient's forearms, instructing patient to resist the doctor's pushing downward.
- Doctor feels patient's arms, flexes arm at the elbow noting muscle tone and range of movement.
Opportunity for doctor to make small talk and/or narrate what he is doing and why
Doctor may decide to do a more thorough oral and dental exam and use a bite block on the patient to ensure that his mouth remains open, allowing for a thorough examination to be be performed. A more invasive oral exam may be done in addition to a preliminary, cursory oral exam—and may be best done when the patient is lying back on the exam table.
V. Heart and Lungs
- Using a stethoscope, doctor listens to patient's heart and lungs, telling patient to relax and take deep breaths, when to inhale, when to exhale, when to hold his breath, when to breathe normally, etc. Doctor may direct patient where to look: at wall, ceiling, directly at him, etc.
- Do you ever have pain or difficulty breathing?
- Doctor may ask patient to do jumping jacks, other exercises designed to elevate heart rate
- After listening to the patient's heart and lungs under normal conditions, with the patient lying down on the table, the doctor gives poppers to the patient in order to listen to the heart when there is a drop in blood pressure. Doctor may either instruct the patient how to take a dose or, without explanation, place the bottle under the patient's nose, instructing him to take a deep breath. After listening for himself, the doctor may allow the patient to put on the stethoscope to listen to his own heart. Doctor holds the chest piece against patient's chest while patient listens to his normal heartbeat and, if the doctor desires, his heartbeat after a second inhalation of poppers. Poppers may, however, be put to more practical use at other points in the exam where the doctor needs to promote relaxation prior to the patient undergoing certain procedures (rectal exam, sounding, urine sample via catheter, etc.).
VI. Abdominal Exam
- Doctor tells patient to lie back on the exam table and to place his hands behind his head. Doctor may use his hands to help guide the patient's body back on the exam table if desired.
- Doctor does an initial visual inspection of the patient's body and verbalizes his observations about the patient's distribution of body hair, scars, moles, and any other marks that might require medical inquiry
- Doctor locates and palpates lymph nodes in armpit area
- Doctor works down the patient's torso, percussing the chest and palpating the abdomen.
- With the patient in this position, the doctor may begin to ask more personal questions as he works down the patient's body.
- Doctor may use stethoscope here to listen to the patient's heart again and to listen to lower abdomen. May also use on the groin and scrotum as doctor sees fit.
- If trimming or shaving is to be a part of the exam, doctor informs patient that, for the exam to continue, he will need to trim the patient's pubic area and shave his scrotum. If this is being skipped, role play continues with genital exam.
- How did you get this scar?
- Have you noticed any changes in your skin since your last exam, specifically any new or changes in existing moles? (As doctor examines patient's body, he may identify spots that may be problematic or that he would advise getting checked out by a dermatologist, as he sees fit.)
- Do you have any issues with heartburn or acid reflux?
- Have you always been circumcised?
- When did you hit puberty?
- When did you begin to grow leg hair? Underarm hair? Pubic hair? Chest hair?
- At this time, the doctor may also examine the patient's nipples. This may entail measuring the diameter of the patient's nipples—noting size, shape, color, and articulating to the patient how he compares to other men. The doctor may also use suction devices on the patient's nipples, assessing sensitivity and connection between nipple stimulation and the patient's sexual response.
- Doctor takes trimmers and trims back patient's pubic hair
- Doctor instructs patient to bring knees to chest so that scrotum is fully exposed and neatly lies against the body. (Unless an exam table with stirrups is being used to keep the patient's legs spread and genital area well exposed.)
- Doctor lathers up the scrotum and shaves off all hair
- Opportunity for doctor to make small talk and narrate what he is doing and why
VIII. Genital Exam
- This may be done with the patient lying down, standing up, or, if the doctor thinks it necessary, the exam may be done in each position.
- Doctor visually inspects and palpates the patient's penis shaft and examines the meatus
- Doctor inspects patient's testicles, asking patient if he performs monthly self exams
- Doctor takes second of three temperature readings, inserting the tip of a sheathed thermometer in the tip of the patient's penis.
- Depending on the patient's physical response, this may also be a prime point for the doctor to take another measurement of the patient's genitals.
- If patient has been examined lying down up to this point, the doctor may ask the patient to hop off the exam table and again examines the shaft, palpates the testicles, and checks for hernias.
- Doctor may ask patient to demonstrate a testicular self exam to ensure the patient is using proper technique at home.
- Do you have any problems getting or maintaining an erection?
- When did you begin having erections?
- Are you sexually active?
- One partner or multiple partners? Are they men or women?
- Tell me about your first sexual encounter.
- Patient may ask what changes to his genitals he might expect as he ages. As a part of this explanation, doctor may unzip and show his own genitals and pubic region, pointing out any aesthetic changes that patient might expect (e.g., graying pubic hair, darkening of the skin, etc.). If there is an anatomical difference between doctor and patient (i.e., one is uncut and the other is circumcized), doctor may take this opportunity to discuss these anatomical differences.
- If doctor wishes to measure the patient's penis at its smallest size, he may ask the patient to lie back on the table after completing the testicular exam, and then apply an ice pack to the patient's genitals. After measurement is taken, a hot face cloth may be applied to the patient's genitals to relax the skin and return the penis to a semi-erect state.
- If agreed upon beforehand, sounding may be introduced during this part of the exam.
IX. Rectal Exam
- The rectal exam may be preceded by the administration of an enema. The enema may be administered with the patient lying on his back or while on all fours—completely at the doctor's best judgment and discretion. Patient may be asked to expel enema into a bedpan or be escorted to the bathroom to expel enema into the toilet.
- Doctor asks patient to bend over table for the first of three rectal exams. Using a thermometer, he takes a third temperature reading, noting it on the patient's chart.
- Doctor asks the patient to lie back on the exam table and hold knees to chest for a second rectal exam. During this process the doctor may discuss the patient's sexual health.
- Doctor asks patient to get on all fours on exam table for a third rectal exam. From this position, the doctor may again assess the penis and scrotum, noting state of arousal, taking samples of pre-ejaculate, etc.
- During sex, are you the giving or the receiving partner?
- When did you first have anal intercourse?
- If receiving: How do you prepare for sex? (Doctor reiterates risk of damaging tissues, proper precautions to take, etc..)
- How many partners have you had for anal intercourse?
- How would you describe the size of your typical sexual partner? Have you had any sexual problems?
- Doctor may progressively insert multiple fingers or progressively sized toys (e.g., plugs) into the patient's rectum to give the patient a sense of what a penis of small, average, and large girth feels like and so that the patient knows his own physical limits.
- Doctor may also use a speculum and anoscope to do a more in-depth rectal examination.
- Doctor may use finger or swab to apply localized anesthetic or a numbing lubricant so that the patient can better withstand the full range of procedures.
X. Nervous System
- Doctor instructs patient to lie back on table and to place his hands behind his head. Doctor may help guide patient's body back onto the table.
- Doctor may apply gentle but firm pressure on patient's lower abdomen to ensure that the patient remains flat on the exam table.
- Using an instrument such as a Whartenberg pinwheel or other stylus, doctor touches points on the patient's body, asking patient to identify where he is being touched (e.g., left inner thigh, underside of right foot, right side of penile shaft, urethra). If patient is unable to identify a body part by its correct name (i.e., using slang in lieu of proper anatomical terminology), the doctor will correct the patient.
- To further test nervous system response, doctor may use a TENS unit on the patient's genitals, observing sensitivity and pain threshold. Doctor should take a final measurement of the patient's genitals once electrostimulation has achieved maximum effect.
- TENS unit may also be used to get the patient to produce a semen sample. If TENS is not being used, or if it is ineffective in getting the patient to produce a semen sample, the doctor will manually bring the patient to orgasm.
- Exam concludes.
- Opportunity for doctor to make small talk and/or narrate what he is doing and why
- * Patient may be blindfolded for part or all of this portion of the exam
- * Patient's wrists and ankles may be secured to the exam table. Alternatively, in addition to wrist restraints, legs may be restrained so that they are held close to the patient's chest and leave the scrotum and anus fully exposed. Doctor may continue to examine the patient's rectum while electrostimulating the genitals.
- * Poppers may be administered—ideally via a disposable oxygen mask—throughout this section of the exam to relax the patient and heighten sensitivity and sexual responsiveness.
I. Photography. The doctor and patient may agree to have the exam documented via still photography or video. After the doctor has the patient produce a semen sample, the doctor may require the patient to remain disrobed as he reviews photos of the exam with the patient. After review, the patient may be inclined to produce a second semen sample.
II. Chaperone Scenario 1. Doctor invites a chaperone or medical assistant to be in the exam room. This person can be a passive observer or someone who aids doctor in certain portions of the exam. If photography is to be a part of the exam, this person may also serve as photographer or videographer. The doctor may require the patient to remain disrobed after the exam has concluded as he reviews photos of the exam with the patient. After the review, the patient may be inclined to produce a second semen sample.
III. Chaperone Scenario 2. The patient is taken to the doctor's office by an uncle/cousin/etc. because the patient has gone for so long without a physical exam. The third person observes the entire exam and remains fully clothed. This person may escort the patient into the secondary room to watch the patient undress and wait with the patient until the doctor enters to start the exam. This person may also observe the patient provide a urine sample in lieu of the doctor. During the genital exam, the third person may be asked to expose himself by the doctor, who uses the third person's anatomy to discuss differences in anatomy (e.g., presence of foreskin), changes the patient may expect in his genitals as he ages, etc. Alternatively, the third person may be asked to submit to a physical exam and both he and the first patient are examined together.
IV. House Call Scenario 1. The patient is unable to get to the doctor's office (e.g., due to a bad knee, hurt ankle, etc.) and a third person arranges for the doctor to come over. Before the exam, the doctor advises the state of undress the patient should be in upon the doctor's arrival, and any other instructions and the third party makes sure the patient complies (e.g., how much water to drink and how long before the exam to consume the water, how many days to abstain from masturbation, etc.). As the patient waits in the bedroom, the third person meets the doctor at the front door. They have a preliminary meeting before the third person leads the doctor into the bedroom and the exam begins.
V. House Call Scenario 2. If role play is only between one doctor and one patient, doctor will give pre-exam instructions (e.g., how much water to consume, how far to disrobe, etc.). Patient will leave front door open and wait in bedroom and wait for the doctor's arrival.
VI. Teaching Exam 1. Multiple medical students are invited to observe the doctor administer a physical exam, observing the various techniques and procedures used. Doctor may call on medical students at his discretion to help with certain parts of the exam. Perhaps best done in a hotel or a club venue that has a bench or table suitable to use for a physical exam.
VII. Teaching Exam 2. The doctor is teaching medical students how to administer a physical exam and needs the patient to undergo three physicals so that each group of students can learn proper technique. First exam is very basic, forgoes the pubic trimming and shaving portion of the exam and stops after the rectal exam. Second exam includes pubic trimming, and also stops after the rectal exam. Third exam is a full exam and includes genital trimming and shaving, nervous system tests, and requires that the patient produce a semen sample. In all exams, doctor may call on medical students to participate in various parts of the exam.