I had to do a scrotal exam on a patient on Friday.
I tried to be gentle.
He got an erection.
It was a little awkward.
It was actually the first time I'd done one alone. We're supposed to call a third-party observer into the room whenever we do a genital exam. Not just any third-party observer, of course. Another doctor. Partly to have a witness so the patient can't claim anything inappropriate happened, and partly because we're still learning how to do these things correctly and it doesn't hurt to have a guide.
The normal practice is to ask whichever attending is supervising the clinic to come in and watch. I've been good about doing that. I was talking to a friend the other day. Apparently some of my co-residents don't bother unless they feel uncomfortable with the situation. It's a little annoying to have to find the attending and hold off on the exam until the attending is free to come help. It slows down the rest of your schedule. It can keep you there longer, which is, of course, wonderful. You have to pass through the waiting room, and when your other patients-- your waiting patients-- see you, they start asking how much longer it will be, and try to start telling you about their medical problems. So I can understand why people just want to get it over with and quickly do it themselves.
But like with blood and vomit and everything else, I kind of hate touching my patients' genitals or sticking my (gloved!) finger in their rectum, and I don't mind having someone else in the room who will sometimes offer to do it for me.
So on Friday, before doing the scrotal exam, I went to get the attending. And he was busy dealing with a patient in the waiting room who'd passed out. Not my patient, fortunately. (And in the end, he was fine.) But he told me to do the scrotal exam myself. Understandable, since he was working on something slightly more important.
And so I did the exam myself. And the patient got an erection.
"Oh, this happens all the time," I told him. "Don't worry about it."
"Yeah, but that's so weird. Because part of the problem I'm having, besides the pain, is that I'm not able--"
"This is an artificial setting, though. But I think it's a good sign, because maybe the problem is more a mental one than physical--"
"You're saying I'm crazy?"
"No, no, not at all. I'm just saying that at least now we have evidence that the physical part of it is working, so that's a good thing, and we can rule out some--"
"I'm not, like, attracted to you or anything."
"Of course not. Like I said, this happens all the time. It's the artificial environment, the rubber glove, it's totally normal, just forget about it."
"Yeah, yeah. Can you stop touching it?"
"Of course. I'm just about done with the exam. I just want to make sure I'm thorough and don't miss anything."
"Yeah, you don't have to be so thorough."
"I just wouldn't want to miss anything. I can get someone else to finish the exam if you'd be more comfortable."
"Like a woman?"
"There actually aren't any female doctors in the clinic this afternoon."
"Well, I don't want some other guy touching it too. Just hurry up and finish."
"Okay, I'm all done."
I start scribbling down my notes.
"You're not gonna say that I got--"
"Please don't worry about it. It's completely normal."
"How am I supposed to tell my girlfriend that this happened here when it doesn't--"
"It's really completely natural. We'll do the blood work and see if anything's going on, but you should try not to worry about it."
"I'm not, like, attracted to you."
"Don't worry about it. It really doesn't mean anything. I think it's just the stimulation, from anything--"
"Except my girlfriend."
"I really wouldn't obsess over it. We'll get the tests back and figure out if there's a problem, and then we'll figure out next steps."
"You're not touching me anywhere else."
"Nope, not planning on it."