31 years old and never had a complete physical exam before

Patient

Q: Hello, I'm a 31 y/o male, 6'2, 275 pounds and I have been experiencing various erectile dysfunction problems over the last couple of years. I also have issues with my testicles ascending up into my body often. I'd say they are up there about 90% of the time, the rest of the time one or both may be present, sometimes they will occasionally appear with one testicle in front of the other one in my scrotum. I recently started seeing a new doctor and explained some of the issues I have been having (trouble getting and maintaining erections mainly). The doctor took some blood tests and my testosterone levels came back in the low 300's so the doctor has been having me come in every other week for the past month to administer testosterone shots. In response to my testicle situation, the doctor said that was not uncommon and that I just am having cremasteric reflexes and not to worry about it.

All that said, I've never had a doctor look at my genitals. I feel like it's probably something that I should have had done by now at some point, but in every physical I've ever had, one with this doctor and numerous with my prior doctor, they have never had me disrobe to check my genitals during a physical. I'm also nervous during physicals and don't really know how to bring it up during my physical because I don't want to come across as just seeking out to have my penis and testicles groped like a pervert or something. I thought when I saw this doctor last month and explained some of the issues I was having that they would inspect it, but they did not. I just feel like I should have a healthcare professional that knows what they're looking for and at give me an examination down there, but I don't know about how to get that to happen I guess.

A couple other things I was too embarrassed to tell my doctor is that over the past few years my erections seem to have gotten smaller and thinner. My stretched length used to be just under 5 inches in length and about 4.5 in girth, with a nearly 3 inch flaccid penis. Now my stretched penis length is slightly less than 3.5 inches with 3 inch girth, and is only about 1.5 inches flaccid. I don't know how to bring up these issues with my doctor. I was also curious if underwear choice or masturbation frequency could affect any of this (I didn't masturbate for the first time until I was 18, and now currently have trouble getting it erect often times when I try to). I do get erections in my sleep and in the morning right after I wake up fairly often.

All that said, is there a way to tell my doctor a lot of this stuff, and have them actually examine my genitals for the first time ever without coming across as some creep who is just trying to get a rise out of the situation or something? I honestly don't know why or how it has never been done before, especially after being a new patient with this doctor and asking for a physical and explaining some of my issues downstairs to them. I go in for my next testosterone shot next Thursday and was wondering if there is a non-awkward way to bring up my dilemma to them. I also have not told them this yet either, but was planning to do so next Thursday, but after being on the testosterone shots for about a month now, when I am able to find and feel my testicles, it feels as though they may have gotten slightly smaller and harder as well.

Thanks for taking the time to read this and sorry about the length of my question.

Symptoms:  Erectile dysfunction, ascending testicles, low testosterone
Doctor

A:   Hello,
Thank you for your medical query at AskTheDoctor.com
I understand your concern.

" Trust " is an extremely important part of a doctor-patient relationship and sometimes the entire process is based on how the patient is comfortable with his physician which lets him open up about his problems. When you go for the physician check-up, you can request your doctor to check your genitals, and the doctor will definitely oblige. Please do not worry about the healthcare professionals having other intentions, the doctor will just be trying to check for any abnormality. You can mention your testes size appears different and it also feels a lot harder. This will ensure your physician examines the penis and the scrotum.

The loss of full length in erection seems to be related to the testosterone levels, and once it is corrected, the erections will be better too. Testosterone helps with the size, avoid premature ejaculation and erectile dysfunction, and gives confidence to the man. The doctor has started you on medicines, so, kindly wait for 3 months, and the erections will be back to normal. For the time being you can talk to your physician and take Paroxetine. 12.5 mg paroxetine at night has to be taken and this shows good effects. Normally one should try until 25mg of Paroxetine. If paroxetine is not effective then Dapoxetine is an option. It has to be given 1 hour before having sex and will prolong the sexual interval.

There is no sure shot immediate cure but with time this problem settles down.
I can assure you the length will further improve on the testosterone levels coming up, which starts happening within 1-3 months of receiving the treatment.

Hope this was helpful,
Feel free to discuss further,
Regards.

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