"When did the pain start?" I ask the 17-year-old boy perched on the exam table.
"It came on strong yesterday afternoon, then it got better. I slept okay last night, but it started to hurt again this morning. I figured I ought to get it checked."
"Let's have a look," I say, pulling on a latex glove. "Stand here and drop your drawers."
Reluctantly, the boy slides off the exam table and loosens his belt. I stoop down to palpate each testicle, looking for signs of tenderness or inflammation, then check for a hernia. Everything looks fine.
"You can put yourself back together," I say, stripping off the exam glove and dropping it into the medical waste container. "I don't see any signs of infection; you don't have a hernia. There's a condition called testicular torsion, which can be quite painful. You don't seem to have that either. Bottom line—if the pain recurs, don't wait. Give us a call and we'll see you right away."
The boy zips up his trousers and fastens his belt. "There's something else I wanted to talk about with you today," he says sheepishly. "I seem to have trouble ... I'm not sure, but I think ... well, I think I might have erectile dysfunction."
The phrase catches me up short. Although Bob Dole brought the concept to the fore in the mainstream media over a decade ago, erectile dysfunction is not something we commonly see in primary care pediatrics.
"How long has this been a problem?" I ask, struggling to recall a differential diagnosis from the recesses of my mind.
"Maybe a year," he says, shrugging his shoulders.
"I'm pressed for time right now," I say, thinking of the stack of patients' charts waiting in my bin. "Perhaps you could schedule a return visit where we could carve out some time to sit down and talk about this."
"Fine," he agrees, and saunters out with his hands thrust deep into his pockets.
His name appears on my schedule one week later in a consultation appointment slot. I've had a chance to read up on ED in the meantime. I've also thought about some other issues to discuss with this boy.