Recently I've walked into the STD clinic for a routine medical check up. This time I was a little concerned for non healing tiny sores on my penis and perianal area. I was registered by the receptionist and after about 20 minutes of waiting I was called by a female doctor to go in. The first stage was the risk assessment and establishing which tests I would like to have (I opted for all). I was asked a series of questions like – had I had any form of risky sex, had I ever had unprotected gay sex, did I ever inject drugs etc. I was then advised of my risk level, which was estimated as moderate. Next I was guided into a small room by the doctor and asked to drop my trousers and under garments. I undressed completely, put on disposable briefs and was submitted to a very thorough physical exam. The doctor – who was very professional female in her thirties – put on blue nitrile gloves, palpated my lymph nodes and inspected my pubic area and genitals. She obtained oral and urethral swabs, then she had me drop the briefs and bend over the exam table to have an anal pap smear obtained. The doctor spread my anus with the index and thumb of her left hand so that the anoderm pouted out. Then she inserted a moistened Dacron swab into the anal canal, until it hit the wall of the rectum. It was slowly moved in and out without completely withdrawing it, while rotating it in a spiral motion and applying mild pressure to the anal wall. After several rotations, the swab was withdrawn and immediately immersed in a transport solution. The procedure had to be performed before the regular DRE, without lubrication. Thus it was painful, but bearable. Finally I was told that I had probably genital warts and subsequent evaluations as well as treatment would be required.
Indeed, two weeks later I received a call and was advised that the pap smear revealed a suggestion of the presence of abnormal cells and was invited to come in for a androscopy with anoscopy, a more thorough examination; the male equivalent of a cervical exam. Moreover, an electrocautery of suspected lesions is planned.
My exam was scheduled at 8 am, I was told to perform an enema before, take a pain killer and I reserve at least two hours. I proceeded on time, was greeted by a nice nurse who checked my BP, led to a cubicle and told to undress. I put only a short paper gown, white comfy socks and entered a bright exam room with a sophisticated table and a lot of equipment. There was the same doctor as before, dressed in a ble short sleeve scrub, short skirt and nude stockings. However, she quickly put on protective clothing: a gown, gloves, face shield and a respirator protecting from any airborne infectious agents. There was also an electrocautery device with grounding plate on the table edge. I was placed on the table in a dorsal lithotomy position with my feet in stirrups and buttocks on the plate - similar to the position for doing pelvic examinations on females. This was not the first time for me, thus I've taken my mp3 player and was not too embarassed at all. However I was totally exposed and realized why most of females put socks on while being in a gyno chair. First the penis and entire genital area with perineum were sprayed with 5% acetic acid solution and left for about five minutes to soak. Additionally, penis was wrapped with a 4 x 4 gauze pad to ensure continuing contact with the skin. A similar gauze was inserted into my rectum. Then – using a colposcope - the doctor carefully searched the entire genital area for condylomata (HPV infected lesions), which appeared white after acetic acid soaking. Then the doctor withdrew the rectal acid gaze and inserted anoscope, which resulted in mild discomfort. Using colposcope she obtained few specimens for histological evaluations.
“Ok” - the doctor said - “ Now we have to remove the warts by electrocautery. It will be not comfortable, there are many lesions, but I'll to do it as quickly as possible”. She put on a face shield and a disposable respirator. An assisting nurse, dressed in the same way, handed me stress balls. “Press it hard and put the music loud” she advised with a smile. The machine was switched on with a humming noise. I started to feel growing freight, tensed calves and curled my toes. The doctor pressed the heated electrode to my body. Probably it was the worst pain ever in my life! It was repeated many time and I was feeling a smell of burning flesh. My face was covered in sweat. Finally it was over. The treated area was washed and disinfected. The nurse helped me to get out of stirrups and made me rest for an hour.