Nothing Says Happy New Year Like... A Genital Exam?!

It's a Tuesday afternoon (the first day back from holiday vacation) and we are all in class. In preparation for the physical exam learning days to come, we watch about 2 hours straight of video. This isn't the history taking, eye exam videos of our past. No. Now, we have graduated to the "private" exams, the ones that you cringe even thinking about getting done on you, let alone doing on a complete stranger. First, comes a video of the pelvic exam (the kind of video where if any one else walked in they would think we were watching some sick form of pornography and we would be faced with much worse reactions than the one's I received studying for anatomy on the airplane). My classmates turn their heads, cringe, and try not to awkwardly giggle, while we (most for the first time) look head on at a woman's "parts". The boys seem to think this task is easy for us as we "get these exams", but we all casually point out that while we might "get them", we never "SEE them". Next, come the videos of the male exam. These seem easier to watch (and much less like broadcast theater of intimate moments), perhaps because the prostate image is actually just a drawing superimposed and not an actual video of a man's insides. The purpose of the day's videos may have been to "rip off the bandaid", but really all they did was make us more nervous.

The next day my group was scheduled for the male genitalia and prostate exam. We were the first group to go on ANY of these exams and so we had no one to compare experiences with. I was anxious (mostly because it just did not feel normal to be doing this to a stranger, even if I did sign up for it by wanting to be a physician) and ended up being the first person to arrive by a good 15 minutes. Slowly everyone else trickled in. The doctor in charge of the introduction (a urologist) made a joke that we were all "much calmer than he was when he had to learn it" and all of us just didn't respond (or put our heads down), as if to hide the fact that, like ducks, we might appear to be calm on the surface, but our feet (hearts, really) were going crazy under the water. The nervousness was broken up briefly by a few of the students walking in and thinking the school had provided us with cookies or donuts for the session, only to realize that no...the box was actually full of models of prostates for us to feel. WOOPSIE.

After the introduction, in groups of 6 we went into the exam suites. Standing in the room was our urology teaching assistant, like the gynecological one's of breast exam past, but well, a man. He would not only get 6 testicular exams and 6 prostate exams (that he SIGNED UP to GET with minor compensation), he would also be teaching us how to do it and advising us along the way. To break the ice, he said while we might be nervous/anxious/worried about doing the exam, "just think of how he feels". He then went on to explain that this was his 15th year doing this instruction section, and the ease at which he talked and answered our questions quickly made us feel better. I know a lot of us were worried about the people who signed up to be patients for these sessions (and had heard horror stories) and some others were worried that the patient might get...excited...while we were performing the exam (even our professor asked in class what we should do if a patient was aroused). There isn't much that is worse than getting a patient who signed up for this instruction session because he actually...liked it. Yes, that is something we were all worried about, though no one would say it, and my patient quickly assuaged those fears. As one of my friends who had mentioned this fear before hand said to me, "We lucked out, this guy's boss"(Boss (v.) A slang word used by a bro-type who think the word cool is below their level of cool). 

We split the exam into two parts and the testicular exam came first. Luckily, based on being one of the only two females in the group and also in my position in the room, I was closer to going last than first. The only real benefit to going first is that you get talked through everything, but really, since we aren't supposed to know much (and aren't graded or anything), it is easier to go closer to last. As my classmate gloved up, we all pulled up our "seats" to "watch" the exam (we even moved our seats for better views as the exam went on). This scene alone made me realize that I was not in the real world anymore (or even Kansas, Toto). The patient opened up his robe, et voila, we were now all staring at his genitals (at least with out the oos and aahs that one would expect in a side-show freak show). If we had thought before that doctors were privy to things that patients would not even tell their families, we quickly realized this applied to seeing things as well. Step-by-step my classmate examined and checked for hernias and before I knew it (well four people later), it was my turn.

I grabbed small gloves and for some reason my hands decided that nope, they did not want to fit in them. After fusing for a bit, I decided to "fuck it" and wear medium ones. I then decided I wanted to introduce myself to the patient (even though no one else did), because...I was about to feel him up and that just seemed appropriate. Though as everyone else went I was worried I'd slip and use slang like "balls" instead of "testicles" (while describing to the patient what I was doing), or that I would just feel awkward and forget a step and giggle, when it actually came to doing it, it somehow felt impersonal, and like a REAL exam. True, the patient was telling me if I wasn't doing it right, or that I needed to go further into the inguinal canal before having him cough to feel a hernia (like REALLY far), but it was somehow like I was back at Anatomy class and was just going through the motions to do what I needed to do (luckily this time I did not have to cut it in half). When I was done, and de-gloved, I was glad, but the anticipation of what was to come, was a bit overwhelming. While many of us have seen (etc, etc) male genitalia, few of us have really spent much time around the back.

The prostate exam. We have all heard stories about medical students and residents having to do guacs (getting stool to test for blood) and prostate exams as their only jobs, and even my brother in law explained to me that he does about 5 a week, but that did not mean any of us were really comfortable with literally having to stick our fingers....up....or well into...there. My family of doctors warned me that my little hands might not even be able to feel the prostate, and that it might be a lot of feeling around and attempting, with no success. Unfortunately for me, it did not matter that my fingers were small, as I still had to do it, and I still had to learn. There was no...calling in short...for this one.

When we began, the patient explained the many ways to make other patient feel comfortable. We received instruction on the proper lube technique (yes, really), were told not to tell the patient to "bend over" (for obvious connotations), and were even told what to say with reference to warnings about gas and feces. One of my classmates nervously responded, "so no one ever does that stuff"--referring mostly to defecation--....to which she was faced with blank stares, a few laughs, and a bit of a..."umm....you wish"...from the patient.

One by one we did what he taught us. It really only took about 2 minutes per person, but it was a nerve wracking wait to get there (like a tag team cavity search). Once again, perhaps because he was really a benign example and was more than prepared (catch my drift here?) to be examined, I, shockingly, distanced myself from what was actually going on and I just...went for it. Even though I used much more of my finger than just to the knuckle, like he told everyone else they would use, my little fingers were like the little engine that could, and did...find the prostate. I think I can...I think I can...LOOK I CAN. (OK. FINE. I didn't actually say that outloud, that would have been scary and uncomfortable for everyone around me, but that type of crazy was exactly the type of thing going on in my head.

To be honest, the male exam really was not that bad...and I sort of feel silly for worrying so much (even now....so imagine years down the road). Perhaps I should even consider a career in urology like my dad has mentioned for years (and because females make more money...creepers). But, that does not mean that I am, in ANY way less nervous or more excited or prepared for the pelvic exam exam to come. That's a whole different boat....and I'm not quite ready to rock it.