Valentine’s Gift…A Prostate Exam? What ever happened to flowers and candy?

This will probably be TMI  (too much information) but I think  it will make a point nicely. When I was a urology resident in 1983, my wife was pregnant with our second child Bess. As a medical student, I had done a rotation in Savannah, Ga in obstetrics. I must have delivered about twenty babies and checked hundreds of women at various stages of pregnancy. One of the things you are taught is to determine how close a women is to delivery after the patient’s water breaks. What you do is a mini-pelvic exam to see how  far apart the cervix has spread. No spreading means that the birth is not imminent. If the cervix is 10 centimeters and thin, then birth is very close. You place two finger in the vagina, find the cervix, spread your fingers to the width of the opening then estimate the distance. I had done it hundreds of times over the course of my rotation and felt I was good at it. At one time I wanted to be a obstretcian, because my mother had always told me she loved her “baby doctors.” I wanted to be the doctor that mothers loved just like my mother loved hers. Savannah talked me out of that idea, but that is another story. So…

In 1983 we live in Martinez, Ga which is about twenty minutes from the hospitals in downtown Augusta. One morning my wife who is very near to the “expected day of conceiving” tells me she thinks her water has broken. She was not sure. ” Will you check me John and see if I need to go to the hospital?” What she was thinking was that if I could tell if she was not that far along, she could at her leisure  make an appointment with her doctor and maybe be seen later in the day without the drama having a baby you see so often on television.

“I don’t know Karen. I don’t know about that.”

Anyway against my better judgement and after her making a compelling case that me checking would help both  of our schedules for that morning logistically, I consented.

I checked. To me I felt that the cervix was closed. In other words, things were not imminent, there was some dilating of the cervix to be done and she had time to see how things progressed and maybe make an appointment later in the day for her “real” doctor. I had a surgery that morning and left to go to the hospital. I had a bit of pride about the situation.  I had a M.D. degree but had not really practiced medicine. I felt like that I had learned something about pregnancy in Savannah and that I had put it to practical use.

About forty minutes later, I am in surgery at the Talmadge Memorial Hospital and a nurse comes in with message from my wife’s doctor.

“Dr. Echols just called.  He said that you wife began having contractions and drove herself to the hospital. He plans to deliver in the next thirty minutes if you want to be there.” 

So…a rectal exam by a man’s wife or girlfriend to see if there is a lump or something…I don’t know about that. It won’t hurt anything.

• If they think something is abnormal and it prompts a doctor visit…no harm there.
• If they think it is normal and as a result don’t have exams or PSA then that’s an issue.
• You can’t hurt anything…it would be unusual for the rectal mucosa to be “injured.”
• The normal prostate feels like the thenar emminence (that pad on the base of the thumb.)
• If there is no lump, one can have prostate cancer anyway. You have to have a PSA…so that is a doctor visit anyway.
• Wonder how the Otis Brawley’s of the world feel about this…it’s screening isn’t it?
• To my knowledge nurses don’t do rectal exams. Why aren’t nurses doing prostate exams.?
• Maybe as a gift certificate for Valentine’s day, a urologist could come to the home…is that where this is going?
• Summary statement: Anything that increases awareness and prevents the tragedy of those men diagnosed in their fifties of the kind of prostate cancer you can’t do anything about…is a good thing.

Valentines Day Self Exam-What?