My new patient, 24 year old Victor Villalobis, has been having issues getting a sound night’s rest and has only been able to achieve 3 hours of sleep each night. A complete adult physical examination is called for and I will be on the look out for specific issues that might cause this condition. I instruct Victor to remove all of his clothing in preparation for his exam.

As I busied myself with organizing his paperwork, I can see that Victor has been able to maintain a fairly decent athletic form. It is obvious that he keeps his body in a natural state as evident by the dark mat of hair covering the expanse of his pectorals, descending in a straight line down the center of his abdomen before disappearing into the waistband of his shorts. Victor also has an extensive amount of underarm hair which I noted as he pulled his shirt off. He reached for his belt, undid it and slid down his walking shorts to reveal his navy blue briefs. Modestly, he turned his back to me before shucking down his briefs. I instructed him to also remove the dark ankle socks that he had worn today. He mounted the exam table and settled in.
Victor is uncut; his penis dangles in a flaccid condition, approximately 4 inches in length. Upon taking his blood pressure, which I noted that it was a bit high, and while still looking for causes to his sleep disorder, I was informed that he had a recent death in his family and has been under more stress at work. I noted, upon listening to his chest, lungs and bowels; all sounds appear to be normal. Palpating his chest and abdomen, I found him to be in very good overall condition. His black hairs were soft to the touch and easily parted to allow me to make direct contact with his skin.

As I neared the abdominal region, his penis began to involuntarily twitch and then it began a sideward journey, snaking up his thigh. Victor’s eyes were closed and I can only assume that he was thinking “this is not the time for me to get an erection”. His penis was now pointing towards the ceiling, curved in a large arch. The foreskin retracted fully and exposed the tender corona. Victor has an ample scrotum, probably one that would best be described as “low hangers”. I examined each testis, upon locating them in the loose folds of skins and let my fingertips wander over the surface of each before requesting that he stand to allow me to continue.
His penis jutted out a bit from his body and through my manipulations, for the purpose of examination, I was able to get him fully aroused. I re-directed my attention to his scrotum and again examined each testis before securing a double dose of coughing from the patient while checking for a hernia condition. Turning him around, I palpated his spine before directing him to return and mount the exam table, resting onto his hands and knees.

In contrast to his front, Victor has a faint dusting of hair covering his buttocks and which I noted upon parting his buttocks, also in the crevice surrounding his anus. I palpated his spine, from shoulder region to his waist and allowed myself to re-examine his dangling scrotum that swayed between his legs. Reaching for the lubricant, I informed Victor that I would take a rectal temperature next. Giving him advance warning regarding the coolness of the lubricant, I was able to wiggle the device into his rectum.
You might remember having a rectal temperature taking when you were a baby, I asked of him. He replied that he also had one at age 18 for a sports physical. Really, I replied, were you also at that time, given a prostate examination ? No, replied. At that point, I informed him that I would do a prostate examination next. Lubricating my finger, I took aim and eased my finger into his tight rectum. Victor was able to remain calm, listening to the sound of my voice, coaxing him into some deep breathing exercises to keep him calm. After a few short moments, I was able to lodge my finger fully extended within his rectum. Then I began a serious of gentile rocking, back and forth, over his prostate and upon inquiring, found out that he was indeed feeling a bit of sexual arousal. His penis was approximately half way erect at this point.

Turning him about, I instructed him to recoil his legs, drawn up to his chest and to assume a wide open spread to allow me to continue. Applying additional lubricant, I inserted my finger again, watching the reaction on his face, noting his eyes were closed as I tapped against his prostate a few moments longer. Satisfied that he had sufficiently endured enough, I withdrew and then instructed him to lay back with his arms folded behind his head. I retrieve a cotton tipped applicator and moved forward, grasping his penis and informed him that I would take a urethral culture next. He obviously knew that it would cause a bit of discomfort and he was already starting to squirm a bit on the exam. To add a bit more to his discomfort, I kept the applicator inside for a slightly longer period than necessary to retrieve the required specimen.
To conclude the office visit, I informed Victor that he would be required to produce a semen sample. I provided him with lubricant and owing to the thick mat of chest and abdominal hair, I suggested that he use the petri dish to deposit his specimen. He took matters into his own hand and in no time, he was able to produce several long rope-like specimens collected into the petri dish.
I hope to have Victor return as I would like to fully explore options to cure his sleep depravation.