This time of year is often busy as new patients arrive older and younger; most being referred for the first time by their insurance company or friends. For those receiving developmental exams, which consumes a majority of our referrals at this time, it’s a very overwhelming experience. While one tries to be understanding, the exam requires complete exposure and full investigation of genital functioning including prostate examination. Since it is a very busy time, the nurses assume full responsibility for taking a patients accurate weight (naked) and then urine samples followed by 3 swabs (oral, anal and penis), and an obligatory rectal temperature.

By the time I entered the room, the patient is often looking sheepish, pale and questioning what is going to take place. Because we are very busy, older men parade the exam corridors naked and holding onto enema tubes as they hurry to the bathroom oblivious to younger men. For them the sense of urgency is all that matters. Having been there, I can attest to the internal pressure that builds once one has taken an enema prep. It’s common to hear them groan as they hurry by.

Today was no different as my patient was a 23 year old man with sandy brown hair who was of slim build when I glanced at him in the waiting room. He looked quite anxious tapping his leg on the floor and haphazardly scanning his cell phone.

The next time I met with him, he was sitting cross legged and naked on the exam table, as if to hide what mother nature had provided. I introduced myself and asked if he had questions. Normally, there may be one or two or more commonly, a simple head shake “no” as most are recovering from the screening procedures. He was no different but softly asked, “Will I have to get a prostate exam?” I smiled and asked how he knew to inquire about that. He gently replied that he looked up Adult exams on Google.” I smiled and said well its part of the process along with a detailed genital exam including your erection response. He automatically tightened his legs as if to lock them in place. I did feel badly at this point, as he clearly was not expecting such an exam.

I allowed him to remain cross legged listening to his heart and lungs but then it came time for him to lay back and place his hands behind his head. He was awkwardly hesitant but with some coaching and an explanation that I needed a visual exam of his genitals as well he relented. He reluctantly placed his hands behind his head.

I began by feeling his abdomen and proceeding to check his femoral pulses while carefully moving his sack to the side. His penis, such as it was, had retracted quite substantially. I commented that this was often normal for the first time when being examined. He looked close to tears as I measured his very small member and sized his testicles. He had never recalled having this done. In fact, his doctor that he hadn't seen in years never really did much of a physical. He was surprised and shocked by what had taken place thus far.

I followed with a testicular exam rolling each one and questioning him about self exam and pain. He had not checked so I continued to roll each one as his penis started to come out of hiding. I had him spread wide and cup his sack. He clearly was sensitive. He wiggled and avoided eye contact. I told him that he would feel my fingers.

Next I gave his penis a tug and it responded in my left hand while my right hand sneakily found his anal entrance and inserted my finger. His eyes widened, he clenched, and then moaned while gaining an erection. While not a very large one, it was becoming rigid and leaking. His mouth opened as he gasped. His rectum was smooth. He had never had anyone do this nor had he experienced anal penetration. Since I had to do a hernia exam, I didn’t want him ejaculating just yet and removed my finger. He remained startled and asked if that was a prostate exam. Poor kid, he was an anal virgin for sure. He clearly knew little about his body and had him sit to check his reflexes and allow him to recover. He was relieved for sure.

When it came time to stand before me, his face blushed and you could tell he was quite anxious as his penis was semi erect. He coughed on command and when told to face the table and bend over, he shook and asked, “Why?” I explained that first I was going to look at his anus and then probe him with my finger and examine his prostate. He gasped and I had to help position him. He reluctantly took my finger; it would not have mattered as I pressed fully into him past his resistance circling his prostate. He was now fully erect and leaking. I don’t think he realized that this was precum. He shrieked that he was going to “Pee.” Such is common especially for those who are very anxious. I removed my finger and directed him back onto the table. Before doing so, I pulled down a new piece of exam paper as the previous sheet had KY stains.

I told him at this point, an erection exam was required. First I measured him and explained how my finger was going to stimulate his prostate. He should expect to fully ejaculate within minutes. He looked shocked. I inquired if he was aware of why this happened. He announced that he was a virgin and aside from occasional masturbation, he did not have experience. As he spread wide lying on his back, his erection now at full mast, I began to gently stroke him and inserted my finger until it was fully inside him. He clenched, began to breathe heavily and groan. As anticipated, he ejaculated without much effort. He squealed while doing so and shook for all it was worth. I am sure others heard him as he exploded in my hand. It was all relatively fast. He then wiped off shaking as he did but had passed his developmental exam.

He looked completely spent when he stood up as I handed him a slip for two inoculations. He nearly began to cry when told to proceed across the hall, naked, to the shot room. He clearly was stunned and still manifesting a semi erection and an occasional drip. I escorted him over as he joined several other men awaiting their shots. At this point, most have a very submissive expression and try to avoid starring at one another. Some try to cover up their genitals and hide their condition until having to lean onto the table for shots. I left as he was standing on line shaking and next to get his medication. In the hall, I heard a gasp and protest. I assume it was his bottom receiving medications. I went back to the exam room, completed my notes and peered back down the hall and saw him slink past. His penis a mere inch, if that, and two band aids on his bottom. I waived but he had his head down and was going to retrieve his clothing. Oh well, onto the next developmental!