"So tell me," I say, "exactly what happens when you become sexually aroused?"
"I can get an erection, but it's not as firm as it used to be. The last two times I tried to have sex, things didn't work out. I was embarrassed, and the girl was upset, too."
"So you're a little anxious that maybe next time the same thing will happen?"
Slowly, he nods his head.
"How many sexual partners have you had so far?" I ask him.
"Maybe five."
Five sexual partners, and this boy has just turned 17.
"What sort of relationship have you had with your past partners?"
He shrugs his shoulders. "None really—they were all just, you know, kind of casual sex ..."
"Like one-night stands?"
"You could say that, yeah."
"So you've never had any sort of emotional bond with any of your previous partners?"
"No."
I ask a few more questions to ascertain that there is no evidence of physiologic sexual dysfunction. The boy has no history of a medical condition that would compromise his sexual response. Now is the time, I decide, to launch into the small spiel that I have been rehearsing in my mind.
"I realize that a lot of young people in your age group are having sex," I say. "I don't have to tell you that sex is pleasurable"—we both chuckle—"but sex is also an intimate act, perhaps the most intimate physical act that we humans engage in."
I'm not certain that he's buying what I'm saying, but he seems to focus on my words.
"Because it's so intimate," I continue, "it's best left to relationships in which there is an established emotional bond. Sex, you see, is actually an intimate physical demonstration of love. Sometimes, if you abuse it, it might abuse you."
Miraculously, the boy shakes his head. "I think I get your drift," he says.
"Good," I say, somewhat relieved. "I expect that you don't have anything to worry about as far as your body's ability to function in the future."
I look up to find the boy staring into my face. "Any questions?" I ask.
"Could I have a prescription for Viagra?"
Suddenly, the scales fall from my eyes and everything becomes clear. A perfect setup by this savvy adolescent looking for a way to enhance his sexual prowess. What a fool I've been—me, supposedly an experienced clinician.
"I don't think that would be appropriate in your case," I tell him, with mental images of droves of adolescent males appearing on my schedule seeking prescriptions for Viagra or Cialis.
He shrugs his shoulders, hops down off the exam table and nonchalantly brushes past me on his way out the door. JAAPA
Brian T. Maurer, PA-C, practices pediatrics at Enfield Pediatric Associates, Enfield, Connecticut. He is the author of Patients Are a Virtue and a member of the JAAPA editorial board. Visit the author at http://briantmaurer.wordpress.com/.