GP Stories - Army Prostate Exam

Prostate - a gland surrounding the neck of the bladder in male mammals and releasing a fluid component of semen.

Prostrate - lying stretched out on the ground with one's face downwards.

Men's prostates inevitably get bigger as they older and inevitably most men would probably need their prostate's checked. I got one such man in my clinic. He had somewhat managed to avoid anything like that until he got to 90, but time finally caught up with him.

He had been getting worsening nocturia (urinating at night), going up to 4-5 times a night. This was causing a major disruption of his sleep so wanted to get some treatment for it. He was told by his friend that it was likely his prostate so he came by for a check. 

I took his history and then told him that we would need to examine him, followed by a blood test and urine test. I asked if he ever had an examination of his prostate before. 

"Yes I have, many decades ago in the army when I was 18".

"Oh why was that?" I asked. I'm not an army doctor but I thought it would be odd for an 18 year old to have their prostate examined.

"Oh they wanted a sperm sample. They would have all the new recruits waiting outside the doctor's office and then they'd call us into the doctor's office one by one. The doctor would then put his finger up our bum to stimulate our prostate and then we'd ejaculate to produce our sample." 

😲

"What?! That shouldn't happen!"

"No that's what happened. Is that not normal?"

"No that is not normal. That is not what should happen in a medical exam!"

I then proceeded to talk him through the process of a prostate exam. Normally for male intimate examinations I usually offer a chaperone to observe but all the men I've asked turn it down (as I am also a man). For the first time though, I insisted on a chaperone and went to get one. My chaperone was a bit confused as to why they were there as it generally is a bit odd to chaperone a male doctor do a male examination, but I think it was important to cover myself in this instance. Thankfully I didn't elicit the same response as the army doctor. 

I explained the next steps and discussed his army revelation. He said he had no issues with the army doctor (he had likely passed away now) as he thought it was a normal medical procedure. Maybe it was a valid medical procedure decades ago, I didn't know. I wonder if that's why he had only come to see a doctor about his prostate now rather than years ago, thinking he was going to have that response. Either way, I have started insisting on chaperones on all my prostate exams... just in case.