I show up to the doctor's office early in the morning for my annual physical. Since I've been fasting for a blood draw, my stomach is growling. After doing some mundane paperwork, a pretty nurse breaks the silence of the waiting room by calling my name. With nervous anxiety, I rise and follow her down the hallway to room #3. In it, I see normal accouterments of an examination room - padded table with stirrups, a gooseneck lamp, a box of blue nitrile gloves, a couple of foil packets of lubrication and a flimsy cotton gown neatly folded on the paper-lined table.
The pretty nurse asks me a number of questions ranging from exercise habits to family history before the subject becomes more personal.
"I see on your paperwork you have indicated that you have a cyst on your left testicle. How long have you known about this?"
"Since I was a teenager," I reply. "I asked my pediatrician about it when I was about ten and he referred me to a pediatric urologist. He examined me a few times over a couple of years before telling me to just keep checking it regularly and notify a doctor if it ever got tender or grew larger. It never has, but I always point it out when I have a new doctor."
"That's a good idea," the nurse tells me. I'm sure the doctor will take a look at it. "Anything else we should know about? I see you had a colonoscopy a few years ago. Was that just routine?"
"Yeah, just routine. I had a rectal exam come back with a bit of blood in my stool. That, combined with my family history was enough for my last doctor to send me in for a colonoscopy. It was normal. Vasectomy about 10 years ago. Nothing special there."
"Thank you. I'll make a note of those procedures for the doctor. Now, let's go ahead and have you get undressed for me. If you want to step behind the curtain, you can remove all of your clothing except for your underwear. You can leave that on for now."
Dressed in just my crisp white briefs and an untied exam gown, I step onto the scale where she notes my weight and height.
"Have a seat on the table now and I'll get you blood pressure."
She records my blood pressure and then tells me she will be back in just a few minutes with the doctor and the exam can begin.
Sitting on the table trying to suppress the beginning of an erection, I hear a knock on the door. Before I can say anything, a doctor enters the room accompanied by the same cute nurse who had just taken my history and blood pressure.
"Hi, I'm Doctor Johnson and I'll be conducting your exam today. Feeling okay, I presume?"
"Hi. Yep. Feeling pretty good."
Doctor Johnson starts by looking in my ears, eyes and nose with a bright light before looking in my throat with a wooden tongue depressor. Moving right along, he massages the sides of my neck and where my neck meets my chest. Then he takes the stethoscope from around his neck and places the tips in his ears. With my untied gown already starting to slide off my shoulders, he applies the cold diaphragm to the back of my upper chest.
I comply as he repeatedly instructs me to take a deep breath and then exhale. He then comes around the table to face me and slips the gown off of my shoulders.
"Breathe normally now. I'm just going to listen to your heart. Sounds perfectly normal. Go ahead and lie down for me now and we'll take a look at your abdomen before going a little bit lower."
Not knowing what to do with the gown, I go ahead and slip my arms back in it before laying back in the supine position; legs slightly parted, arms by my side. Doctor Johnson then slides the gown up above my hardening nipples before applying the stethoscope diaphragm to my abdomen. He palms the diaphragm so that his entire hand is in contact with my trembling stomach as he listens to my stomach and bowel noise.
"I can tell you've been fasting," he tells me. "Pretty noisy down there."
I have no doubt he notices the ever-growing bulge in my underpants and he reaches his hand into the waistband and slides it down a few inches; revealing the top of my pubic hair.
"Just need to check a little lower. Relax for me."
He listens to a few places on my lower abdomen before removing his hand from my underpants and giving my waistband a cursory adjustment. He then grabs the back of my left knee and gently positions my leg in the frog position before once again applying the warm diaphragm to my crotch. This time he is listening to my femoral artery. When he is done with the left side, he repeats the procedure on the right side.
"Everything seems fine so far. Now we're going to need to go ahead and ask you to flip over."
I do so without hesitation; taking a few seconds to adjust the gown which is now underneath me
"Nurse, could you take his temperature while I get a few things ready for the next part of the exam?
"I would be happy to, Doctor. Okay, I'm going to go ahead and lower your underwear a bit so I can take a rectal temperature. Are you okay with that?"
Am I okay with this? Of course I am. To make things easier for the nurse, I go ahead and raise my hips off the table a bit. Taking this cue, she places a finger in the waistband on either side of my briefs and lowers my underwear to mid-thigh. I'm looking at the wall, but I can hear her slipping her hands into gloves and the faint strains of a foil packet being torn. I can also sense her shaking the mercury down before applying a dab of lubricant. Then I can feel her off-hand gently spreading my buttocks before I can feel the cool glass rod slide a few inches into my rectum. The nurse stands over me holding the thermometer in place by keeping a hand on my buttocks. After two minutes, she removes it from me and tells the doctor that it is registering a perfect 99.6 degrees.
"Okay, since you're over forty we're going to go ahead and check your prostate and screen you for colo-rectal cancer. Apparently, you've had digital rectal exams before so I'm guessing you were expecting this, right?" I nod my approval. "In that case, I'm going to have the nurse position you on your side for the exam, okay?
"Sure," I reply.
"Let's go ahead and slide your underpants all the way off," I hear the pretty voice say. "I'm going to ask you to lie on your left side and then bring your right knee up towards your chest. Are you okay with that?"
"Sure," I say as I obey her directions.
When I am on my side with my right knee up towards my chest I feel one of the doctor's gloved hands gently lift my right buttock; revealing my anus.
"Nurse, would you be so kind as to put some lubrication on my index finger?" I hear the doctor say. A moment later, he tells me what he is about to do. "I want you to take a deep breath for me and when I count to three, you're going to feel some pressure on your anus. It shouldn't hurt, but it might feel a bit uncomfortable. Okay? One...two...three...deep breath for me...."
As I take a breath, I feel his finger first on my anus and then penetrating into my rectum. He is probably about a knuckle in when he tells me he is going to apply a bit more pressure. At that time I feel his finger entering me further. I know he is in all the way because I can feel his other fingers on my exposed perineum and brushing up against my scrotum. I can feel the pad of his finger pressing on my prostate gland giving me the sensation that I need to urinate. But the feeling passes as he stops applying pressure to my prostate. As he is withdrawing his finger, I can feel him rotating it 180 degrees in each direction to assess my colon.
"You know, the prostate was smooth and symmetrical; exactly what we are hoping for. But I would like to take another look at your colon with a small instrument called a speculum. It's a cylindrical stainless steel tube that will go about 6 inches into your colon. Then I can expand it slightly and take a look. Okay?"
Before I can object, he asks the nurse to get me in something called the "knee-chest position." The nurse responds by asking me to get on my hands and knees. After doing so, she gently forces my shoulders to the padded exam table.
"I know it's not the most comfortable position, but this won't take more than a few minutes" she informs me.
"Doing okay? Alright, I'm going to go ahead and insert the speculum now. Once again, you might feel some pressure, but it shouldn't be painful. I'll warn you that it's going to be pretty cold at first."
I then get the surprise of my life as I feel the cold steel cylinder violate my anus and deep into my rectum; considerably deeper than his finger was able to penetrate. Behind me, I hear clicking as I feel the prongs of the speculum expanding and some mild cramping in my colon. I feel the weight of the instrument pulling down on my anus as the doctor briefly lets go in order to grab the small light he had used minutes before to look in my eyes, nose, ears and throat.
"Yep. Everything looks okay. But it's still a good thing we took a look. I'm going to go ahead and close the speculum and remove it now. Just relax."
I feel the cold steel being retracted from my anus and then hear him put it in the sink with a loud "clang!"
"The good news is we're all done back there. If you want to go ahead and turn over, I'll have the nurse place you in position for the last part of the exam."
Feeling sore and no longer trying to hide my throbbing erection, I slowly re-position myself so that I am once again flat on my back. The thin cotton gown is no match for my erect penis and is now dotted with multiple spots of pre-cum.
"I'm going to go ahead and extend the stirrups and then help you get your feet in them" the nurse says to me. I've never been examined in stirrups and it's probably a good thing that she's willing to help me into them. I hear metal clanking. "Give me your right foot" she says and I can feel her guiding it into a cold, steel heel support. When she is satisfied at the positioning, we repeat the procedure for my left foot. "Now I'm going to need to slide down towards me until you feel like you're going to slip right off the table. But don't worry, you won't. Keep sliding down until your buttock touches my hand."
I slide my buttocks down the noisy paper, indeed worried that I will slide off the table, until i finally feel my buttock make contact with her hand.
"Now I need you to relax your knees all the way out. As wide as you can." When she is once again satisfied with my compliance, she slides my gown up to my stomach revealing my scrotum and erect penis. "I see we don't have any issues with erectile dysfunction" she says with a playful smile. "Nothing to be embarrassed about. It happens to a lot of men." She then steps back and turns on the gooseneck lamp, shining its warm bulb directly on my nether region. "The warm lamp will help keep your scrotum loose so the doctor can get do a more thorough examination of your testicles" she informs me as she retreats.
The doctor then takes over. Standing to my side, I feel his hands palpating my abdomen; gently at first and then working deeper. He assesses my liver and appendix and reaches around to my sides to check my kidneys. I assume he is checking my bladder as he presses the area just north of my bristly pubic hair. After snapping into new gloves, he steps between my knees and grasps my penis in his hands. I can't see much of what is going on down there, but I can feel everything he is doing. He is gently palpating the shaft of my penis from base to tip. When he gets to the tip, he looks closely at my foreskin and then I feel him gently prying apart my meatus and examining the opening to my urethra. "Everything looks normal," he informs me. "I see you have a slight case of Peyronie's as your erection points slightly down and to the left." Has it always been that way?"
"Yes." I tell him that my erection has been that way since I first noticed what an erection was.
"Nothing to worry about; assuming sex isn't painful."
I tell him that it isn't
"I'm going to go ahead and check your testicles now." I feel him roll, roll, roll my right testicle between his fingers; deftly searching for a lump and finding none. His attention then shifts to my left testicle where he immediately notices my cyst. "I'd say that's about two centimeters by one centimeter. Would you agree?"
I tell him that's the assessment made by my pediatric urologist nearly 25 years ago and that it hasn't changed size or shape since the initial diagnosis.
I then feel his index finger press into my left inguinal duct as he tells me to bear down and give a hearty cough. I comply. "Feels fine." He asks me to cough again as his finger buries itself into my right inguinal duct. "Feels fine there, too. No hernia for you. I'll go ahead and have the nurse help you get out of those stirrups now. We're finished," he announces as I hear him peeling off his nitrile gloves and depositing them in the nearby garbage can. "I'd like to see you again in a year, but if you have any concerns or issues, don't hesitate to make an appointment sooner. My door is always open. So glad to have you as a new patient. When you're dressed, the nurse will lead you down to the lab where one of the techs can do your blood work. We'll give you a call when we get those results in...."