Meet Your Friendly Neighborhood Urologist

Despite the fact that roughly 35% of infertility issues are male based, I wasn't scheduled to see the urologist until 3 months into our infertility saga. I have to admit that I was not pleased to hear this news.

Why? Like most men, I don't like going to see the doctor. I prefer to wait until my illnesses or injuries reach such epic proportions that I am forced to report to the emergency room. At least this way you are in and out in 6 hours. My preferred medical course of action is as follows:

A. Rub some dirt on it

B. Put some ice on it.

C. Hope it goes away

Alas, with my expertise exhausted it was time to turn to the professionals.

When forced to see the doctor, it is no secret that the worst part of the basic male exam (at least, for those of us under 40) is the "Turn your head and cough" element (after 40 it is the "bend over" part of the exam). Is there really such an epidemic of hernias, that this needs to be done at every appointment? The idea that I needed to see a doctor who specializes in the "turn your head and cough" maneuver was horrifying. In fact, I think that in terms of "ologists', the urologist is the second worst "ologist" that you would have to encounter, running a close second to proctologist (I am sure the if you have a terminal illness or some other malady, there are worse "ologists", but they are simply not as well known).

Still, after sitting with my wife through her gynecological exam during our first visit, I now know that we men have it easy. Frankly, I need a pocket map, compass, and flashlight to operate down there, but the doctor is cruising around like a car mechanic. "Yup, ovaries feel good, but your flux capacitor seem discombobulated. I can fix it, but its gonna cost ya." Simply awful. Even as a bystander, I found myself employing many of the same strategies that I use during "turn your head and cough." For example, rule number one is make NO eye contact. Count ceiling tiles, cotton balls, whatever, but under no circumstances should you look at the doctor. I decided to focus on the images on ultrasound machine. "Oh, this is a beauty. Is this stainless steel? Wow. What type of warranty do you get on something like this?"

With my wife setting such a brave example, I knew that I could handle the appointment, but I was determined to be prepared. I would research urological exams so that I would know exactly what to expect. Using my computer research skills that have been carefully honed through years of fantasy football, I came up with... nothing (Tip: Larry Johnson's holdout in Kansas City, could have a deleterious effect on the high flying Kansas City Chief's offense).

So here it is, for the benefit of all future patients, a rundown of what to expect at the urologist:

1. In the waiting room, I generally like to peruse the magazines, maybe play some solitaire on my ipod. Not at the urologist. I was asked to take a medical history survey, 3 pages, front and back of the most horrifyingly atrocious questions that you could imagine. It was like a demented game of "never have I ever" without the cheap keg beer (which would have been useful). It starts out slow and grows increasingly uncomfortable.

#1 Do you have a penis? (Yes! So far so good).
#12 How many sexual partners have you had? (Hmmm, do you employ the rule of 3 here? For the uninitiated, this is where you lie to you buddies and say 3xs the actual number... apparently, it works in reverse for women).
#17 Any burning sensations when you urinate? (Yikes!).
#67 Do you masturbate? (Here, we go!).
#68 How often?
#127 Does your wife reach orgasm during intercourse?
#128 Really? Are you sure she is having an orgasm?

And on and on go the questions. As an aside, I found the frequency questions to be particularly confusing and not applicable to the average couple trying to conceive. How many times a week/month is deceptive. During ovulation we are together all the time, but by the end of the week you need a serious break. So the answer might be 6 times a month, but 90% might have occurred during a span of 4 days. We need some clarification here.

2. Next, you are brought back to the second "mini-waiting room." Here they take your measurements, height, weight, etc. And of course, you sit and wait again.

3. Finally, the doctor comes in and we first adjourn to her (yes, "her") office. Here she proceeds to ask all of the questions that I just toiled over in the lobby (I am still clutching the survey, like it contains nuclear secrets). Let's just say that I am amazed at how quickly I became adept at throwing around the words penis, erection, and scrotum. Usually when discussing the unmentionables, I have two modes of communication. One is "locker room" talk, where I use words and references not appropriate for the blogging community. In the other, I communicate like a Dr. Suess. "The Whozits and wuzzles seem to be okay, but when we when floobhobber, it goes sneedlehopping." Huh?

4. Next, I am ushered into the exam room where I am told to remove all of my clothes; although, I may keep on my socks (thank goodness! I am very modest). I am giving one of the "Johnny" robes and told to keep it open in the front. At this point, I always feel confused about what to do with a chain that I wear around my neck and my wrist watch. I am sure that it is not necessary to remove these, but I kind of feel like a poor man's Tony Soprano, wearing nothing but an open robe and my watch. I opt to take it off. Here I would appreciate some assistance on the behalf of the doctor's office. Why not supply a little dish to store any wallet, watch, keys, or loose change that you may have? Like the ones you get at airport security.

5. At this point the terror really kicks in. I begin to sweat profusely, with the knowledge that I am about to be examined/fondled for the next ten minutes. Now, here women need to understand that most men have a deep seated fear that certain body parts will become "alert" during a doctor's exam. This starts around age 11 when we have very little control over the actions of our body. I mean you are talking about a body part that may decide to "stand at attention" for no discernible reason at all in your 7th grade geometry class. This is why most middle school boys walk around with books in front of their crotches. This fear starts to go away when you enter your 20s, but mine came back with a vengeance after learning from a doctor friend of mine that this actually does happen on occasion during exams! Yikes. Anyway, the complete opposite occurred during the urological exam. In fact, rarely has my penis gone to such lengths to try to hide itself. Ironically, I found myself wanting to shout out to the doctor and nurse, "I was in the pool! There's was shrinkage, I was in the pool" a la George Costanza.

6. The exam itself involves lots of pushing on your stomach and "turning your head to cough." Apparently, my general practitioner dislikes "turn your head and cough" as much as I do, because the urologist brought it to a whole new level. Let's just say that she had a firm grip and at one point I actually moaned in discomfort. The most awkward part was when she asked me to "bear down." What? Yes, bear down like you are going to the bathroom. Apparently this is to test for varioceles, which are swollen blood vessels in the scrotum.

7. After leaving no stone unturned we are done, right? Wrong! In some devious twist of fate, it turns out that the prostate may come into play, so I am told that I need to "turn around, bend over, and 'brace myself' for the a digital exam." At first, I was thinking digital, as in they were going to use a digital thermometer. Nope. Digits as in the fingers on your hands are digits. She lubes up her hand and in she goes. Yelp! The pain experienced is best represented in the movie "Fletch" starring Chevy Chase. "Say, doc, are you using the whole fist?" and "Aren't you going to buy my dinner first?" Honestly, I wasn't even sure what a prostate was, but I now know that I have one, as she grabbed it and squeezed it like a stress ball. The doctor and nurse (yes, there was a witness) left the room so that I could clean myself up. Meaning, I had to mop up the Vaseline that was now pouring out of me. I know, gross.

8. So, one final meeting with the doctor to discuss the exam. In my case she thought that she may have felt a palpable varicocele (found in roughly 40% of men struggling with infertility), so I was given an appointment for an ultrasound and asked to do another semen analysis.

So there it is. Your urological exam. It wasn't fun, but I know that my wife is dealing with much worse, which makes it a little more tolerable. Somehow, it helps when you know that you are going through something as a part of a team effort. Next, entry the ultrasound.