The Case Of The Blue Balls

After chatting to my brother and sister, I am inspired to record here for posterity yet another amazing medical case seen in the ER in the wee hours of the morning some months ago.

He came in complaining of a "discomfort down below", the triage sheet said, which immediately provoked a deep sigh in me, because I generally don't enjoy dealing the southern states in my line of work. In any case, far be it from me to cherry-pick my patients - so I picked the chart up and, somewhat hopefully, asked the nurses to get a urinalysis. Maybe I'd get lucky and it would come back positive, thus establishing the diagnosis of a urinary tract infection without my having to cross the equator.

A half hour later, however, the nurse handed me a printout with a sympathetic look. "Sorry, you're shit out of luck," she said. "The urine was pristine."

"All right," I sighed. "I suppose when all else fails, one must see the patient."

So off I went to see my patient. He was a middle-aged man who sat somewhat nervously in the room fidgeting with his hands as I introduced myself with title included. (I have come sadly to realise that I typically only whip out this title whenever I am faced with manbits - otherwise, I simply introduce myself using my first name and explain I am a physician).

"What seems to be the problem?" I asked, in the most non-commital fashion possible.

"I have an.... uh - a discomfort down below," my patient said, as he wrung his hands in his lap.

"OK," I said in an even tone. "What kind of discomfort, and how did it start?"

"Well, doctor... it's like this.... I have a girlfriend in Russia...."

His voice trailed off and he wouldn't meet my gaze at that point, but I simply waited him out.

"... and anyway, she came to visit me two days ago - and you see, my mother is in town and uh... so, you know..."

"Keep going," I smiled encouragingly, though I didn't feel very encouraged by this story thus far.

"Well, you see, it's not nice to, you know - my girlfriend and my mother - anyway, so I've been sleeping on the couch."

Since I highly doubted that sleeping on the couch was the cause of his "discomfort down below", I merely arched my eyebrows and made one of those grunts they teach you in medical school, the kind that sounds like "mmmmhmmmm?"

"Well - anyway my girlfriend and I, we wanted to - well, to do it," he said, speaking faster and faster now - "but anyway at the last moment before I - you know - well, we stopped."

At this point, my smile was becoming somewhat fixed, but again I made my noncommital grunt.

"And well, that happened the next night as well. And tonight too. And I have this discomfort." He was now speaking in rapid-fire mode. "I don't know what it is, it just feels - well, it feels tight."

Be the doctor. Be the doctor. Be the doctor.

"Mmmm. Tight," I repeated.

"Yes!" he said, seemingly cheered by my appearance of understanding. "Tight - and I don't know why."

So we ran through a brief sexual history - no discharge, no pain, no high-risk sexual activities. Nothing concerning for infections or other pathology. And then I plastered on the straightest face I could muster and proceeded to examine him.

It was at this point that I realised just how sexually naive my patient was. I never like examining manbits as I have already said, so I have a bad habit of going to my happy place in my head while doing said task - much of medicine can be learned through rote - algorithms that guide decision-making which help but shouldn't be relied upon. In any case, I was clearly not paying attention, because what happened next was unforgivable.

"I'm going to get you to retract the foreskin," I said without thinking. Only to realise, as the words issued forth, that my patient was circumcised.

If my mistake had been unforgivable, my patient's actions were incredible.

Incredulously, I watched as he valiantly tried to follow my instructions by retracting the remnants of his foreskin which, sadly, had long ago been sutured into place.

There are a few moments in a patient encounter when you suddenly learn something about a patient which no amount of history taking will ever elicit, and this was one of those moments.

This was a moment of enlightenment for me, the AHHHH moment in which you perceive a Great Truth. And it was this: my patient didn't have a fucking clue. Quite literally too.

I wanted to laugh but I understood at the same time, that here was a man who - and how awful that he should have done this! - had gone through his life without ever having learned very much about sex or sexuality. And that was no laughing matter, especially given that he wasn't a teenager or even a young man. He was fifty.

I bit my tongue, finished the exam. And then I covered him back up, sat him down and took out a pen and paper. I drew for him his anatomy - it was a quiet night anyway, so I could afford to take the time for some patient education - and explained to him that he was suffering from a classic case of "blueballs" - that becoming aroused by his girlfriend and engaging in foreplay without progressing to orgasm created the "tight" feeling he described. He took it all in, and when I was done, he seemed to get the idea.

Which left just one problem: "But, doctor," he said, "how do I get rid of this "tight" feeling then if I can't be with my girlfriend for the next few days?"

And so - for the first and hopefully last time in my life - I prescribed my patient a course of masturbation.

Never let it be said that I have a boring job.