It has surely been busy on my new rotation offering developmental evals to young men. Most of them tolerate the examination with a degree of embarrassment and slight protest during the genital, rectal and prostate exams. It makes me remember that time in life when arousal was a sure bet. I still provide exams to older men but there is something rewarding about evaluating a younger man and knowing he is likely to be highly reactive.

While being completely naked is minimally unexpected and met with embarrassment and failed attempts to cover genitals, they do obey but cringe when being weighed by our nurse. There is the realization that they are bare and exposed to her and others passing by. The next shock has to do with obtaining swabs from three orifices; mouth, penis, and rectum. Only one of them is met with a calm demeanor. Of course, the rectal temp makes them feel like a child again despite how they react to the deeply inserted probe.

The exam moves forward without undue difficulties. Despite their anxiety and reluctance, they obtain erections and are stimulated to provide a semen sample without undue difficulties. Here are some of my observations:There is marked variability in how they respond to the genital exam ranging from shrinkage to gradual erection or those who become hard as soon as their testicles and penis are touched. The speed of erection has little to do with their subsequent ejaculation response. Here I am interested in the strength of the erection and reaction to stimulation both direct and indirect via prostate massage.For many this is their first rectal examination and it is an intimate time for them, namely, being naked, bending over or lying on their side, as I spread and probe their passage and examine their genitals. I have observed those who cringe, clench and struggle to allow my finger to penetrate them. They tend to rise up on their toes, if standing bent over the table, and will groan or protest as I push past their resistance. Others feign modest confidence but will still gasp as I penetrate their rosebuds. A few spike a semi erection, especially if lying on their sides as one manipulates their scrotum and penis.

The following is a brief characterization from a patient: “This was my first exam and I was totally unprepared for it. Until now, I had seen my doctor but there was minimal exposure or focus on my genitals aside from a hernia exam for sports.Today I was required to remove all clothing; get weighed completely naked; and experience receiving a humiliating rectal temperature which made my penis react. The doctor was reassuring and was told that having an erection was normal. I was told me lay on my back as he skillfully felt my penis from the base to my meatus and took a swab which made me cringe and screech. Never before have I had something enter my penis! It stung and took me time to recover. The one placed up my rectum was irritating for sure. The one to swab my mouth was fine but clearly not all that was to happen.The subsequent testicle exam was gentle and added to my feeling aroused and reactive. It made the paper under my bottom crinkle. When he had me spread and lay back with my legs wide spread, my erection stood out and throbbed as he then fingered my rectum. I gasped loudly as he probed deeply and then did so again with me lying on my side. The pressure felt like nothing I had ever experienced. It didn’t lessen when he made me stand and receive yet another finger pressing deeply into me. I shook and groaned.He went onto to doing my hernia exam with my penis fully erect and felt my sack from behind. I felt pressure building and then was told that an erection exam was next. I must have blushed all sorts of red as I lay back on the table and felt him stimulate my hardened penis. I felt my breathing hasten and the tip of my penis leaking as I began to react. Groaning turned to loud moans and thrusting of hips and I immediately climaxed when his finger probed my rectum causing me to screech. He skillfully collected the sample. The fact that I ejaculated very quickly did not make me feel very robust but then again, I was an anal virgin until today. He assure me that this was normal and common when having a first time developmental exam.The exam ended by my receiving two inoculations; sadly in my bottom which was oozing ky. I left feeling totally explored and embarrassed. At least I wasn’t alone as I passed others going down the hall to exam rooms. One poor naked chap had a tube dangling down between his butt cheeks as he hurriedly moved down the hall to a bathroom. I found out that he was there for a follow up exam and wonder what that involved. I am due to return again this month for my yearly follow up and trust I will be okay.”Having read patient accounts, it's reassuring that most do not hesitate to be seen again though likely will have a different reaction if scheduled for an anal examination. Most of my patients including myself are very reluctant to get enemas and have an anuscopic exam but we have no choice. The humiliation factor only intensifies if examined by a female doc as well as nurses that provide enemas. The developmental exam just has the poor lad to stripping down for the nurse and getting his rectal temp. For those receiving more advanced exams, the nurse is present throughout! It does dwell in my mind for sure and likely for others receiving these exams.