medical student / volunteer patient

they ask you to lie down and spread your legs. you’re so shy your thighs are trembling. you feel the cold air hit you where you’re wet when they pull the sheet away. they touch around your clit so gently you can feel yourself getting hard again, but you can’t help but flinch when they get a little too close. they apologize each time, asking you to rate the pain on a scale of 1 to 10. you can feel yourself getting more and more aroused, embarrassed because you know they can tell.

1800 words, 7-10 minute read. mild noncon (no sex), medical, gynecological, sedatives and restraints, no gore. This is the first story I've ever posted so enjoy! pls be nice to me about it

Part two here!

I was pleased to see my patient had folded their clothes neatly into a pile on one of the waiting chairs. You jumped slightly when you heard the metallic clinking of tools on the covered tray I was rolling in with me. I roll my stool up to the table so we are sitting arms length away and begin asking my slew of questions. It always starts simple, the basics, how much do you eat, sleep, exercise, etc. then onto the more intimate questions that make you squirm and avoid eye contact. Once I feel that I have humiliated you enough with my questions I put your chart aside and don a pair of gloves and my stethoscope from around my neck. “Sit up straight for me” You jump when you feel my gloved hand on your bare back to steady you. “Take a deep breath in for me…and out. Again, deep breath in…and out. Deep breath in…hold…and out” it seems like this goes on forever making you a little lightheaded. “Are you feeling okay? You're looking a little flushed.” I move my stethoscope to the front and slip my hand with the bell down the front of your gown, catching you off guard. I listen with concern for a moment, taking one of your wrists in my other hand to feel your pulse. “Your heart rate is higher than I’d like. I am going to run an EKG just to be safe” I say as I am setting up wires all around you. A hand on your shoulder encourages you to lean back against the table. Before you realise your gown has been folded down to expose your chest. When you reach to cover yourself my hands find your wrist firmly. “Hands by your sides” I chide and you obey. It's not long before the electrodes and wires have been placed. With a couple clicks on the monitor you hear your pounding heartbeat echoing in the room. I study the glowing screen for a couple moments before deciding out loud “I’m going to keep you on the monitor the rest of your exam just for a better picture of your health” 

You’re startled by the rip of the velcro as the blood pressure cuff is strapped on your arm, the pulse oximeter too. Trapped by a mess of wires, without pulling your gown back up you are instructed to sit up once more. I look in your eyes and ears, I take a throat culture which makes you gag and your eyes water. You are laid down again for an abdominal exam which leads to your gown being pushed down further, feeling like it barely covered anything at all. You’ve already been at my clinic for over an hour, I don’t think you realized how full your bladder was until my gloved hands were palpating your abdomen. “Is this tender?” I ask the obvious while pressing on the exact spot that made you flinch. Such a shy patient, you barely manage a nod. I let out an inquisitive hmm as my palpating hands move lower, right above your pubic bone. I hear your sigh of relief when I turn away from you, pulling off my gloves, washing my hands. I see you've attempted to cover yourself with the flimsy gown when I turn back to you, pushing the tray I brought in with me earlier, this time uncovered. I see your face drop when you see the array of shiny metal tools, one of the notable few you could identify: the speculum. The stirrups fold out from the table before you know it. 

“By your own admission, it’s been far too long since your last visit to the gynecologist. Due to the length of time that has passed, and because it will be my first time exploring your body this might feel more invasive than you're used to but I assure you this is all necessary.” You become aware of the heart monitor again as you hear it announcing your anxiety over a loud speaker. “These are just safety straps, I can’t have you moving around with such delicate instrumentation inside you. I hope you're comfortable.” I know no one is comfortable on my exam table in this position yet I say it anyway. Once I feel my patient is properly secured with the thigh and ankle straps and the one across your hips I take my seat between your legs knowing if you become difficult there are quite a few more straps at the ready under the table. I can imagine you must feel so exposed with the heat of the exam light burning where the light usually doesn’t shine. As I begin palpating your hands go up to cover your face in shame. “Arms by your side, please. The monitors you’re on are sensitive pieces of equipment, I don’t need your inability to hold still to affect the readings.” I am stern and unyielding, like the straps already adorning your lower body. “If you find yourself unable to keep still I can assist you in that.” My patient shakes their head no and lets out a weak apology. “A little bit of pressure now” You jump again as I am inserting the speculum. I sigh standing up and snapping off my gloves “I can’t work like this. I was hoping you wouldn’t be such a disruptive patient. These should make it a lot easier for you to hold still” Thankfully my patient doesn’t fight as the straps are secured to their wrists and across their chest. They do pull a little, testing the strength of their bonds. I hear another jump in heart rate as they realize how trapped they really are, their gown completely removed, fully exposed and unable to escape my scrutiny. I’m sure the thought went through your head of how easily I could decide not to release them at the end of the exam, how vulnerable you are. 

I hum a little to myself, enjoying the ability to work on you without interruption. “I’m seeing an unusual amount of vaginal secretions” I announce aloud just to watch you blush. The speculum somehow opens even wider, you let out a stifled groan. “Since it’s been so long since your last pap smear, I think it's indicated to look a little deeper than a standard exam. Take a deep breath, you might feel some cramping as I dilate your cervix” some cramping might have been an understatement but I try to avoid overly worrying my patients, I find that knowing the pain that awaits them leads to higher rates of non-compliance. I’m sure my patient is thankful for the restraints keeping them in place as their body fights to get away from me. “You’re okay. You’re doing so well. I’m almost done with this one then only two more dilators to get through.” my free hand rests on your thigh in an effort of comfort. On the third dilator I have to ask, “Would you like the nurse to bring you a sedative? You might find it easier to relax with the aid of medication.” My patient denies it. I believe you’d be more comfortable with the sedative but I’ll let you make your own decision for now. Your cervix spasms beautifully as the final dilator is removed. “I just need to gather a few uterine samples now, hang in there, we are almost done” You can’t see what I’m doing but hear the clink of metal tools and feel a deep, gut churning scraping inside. There’s a visible look of relief on your face as I release my grip on your cervix and remove the tentaculum but the speculum stays lodged in you. 

"First, I'll have you lay down on the table for a physical exam. Always wise to look you over in full. I'll have you undress and put on a gown, and then we'll begin. I'll listen to your heart, your breathing, and I'll feel along your neck to check for any inflammation. After that, I'll take a look inside your mouth. I'll use a depressor on your tongue, then put a pair of gloves on to inspect your teeth and gums." He pauses momentarily to light a cigarette, smoke leaving the corner of his mouth as he goes on.

"Next, of course, will be the breast exam. I'll help you untie your gown. From there, I'll place my hands on your breasts. It's imporant to feel them in order to check for lumps that may be cancerous in nature. Once you're cleared there, I'll have you disrobe entirely." The patient's eyes widen at that, but before any words are spoken, the dark-haired doctor goes on.

"Yes, I find that my patients are best examined without their gown to impede my work. While laying on the table, I'll check the range of motion in your hips and knees, moving one leg at a time up, down, and finally into the stirrups. Once your knees are properly positioned apart, I'll begin with an abdominal exam. Your pubic hair will also be shaved, if it hasn't been already." His white-coated form shifts in my chair. He makes eye contact while telling his patient the details of his plans for them.

"Prior to beginning the pelvic exam, I'll restrain you. This is in case you do any moving around. I find some of my patients consider the examination and the treatment somewhat stressful. The last thing I need is for you to fall off my table and hurt yourself. "

"Once properly secured, I'll begin with taking a few photos for the sake of documentation. After that, I'll proceed with your external examination. I'll be checking your mons pubis with some gentle pressing. Afterwards, I'll inspect your labia majora for any blemishes or abnormalities, afterwhich I'll do the same for your labia minora. I'll examine your vaginal opening, and feel for your bartholin glands." He pushes up his glasses, then making a little pinching motion with his hand for the purpose of demonstration.

"Assuming everything is in working order, we'll move to the internal examination. I'll insert one of my fingers into your vaginal canal. You may feel some mild discomfort, but the exam is to make sure your therapy will be effective. Once I've inserted my second finger," he holds up two fingers as he speaks, "and felt your vaginal walls and palpated your cervix, I'll remove my fingers and prep you for the rectovaginal exam. That will involve me inserting one finger into your anus and one finger into your vaginal canal. You'll feel me probe your vagina and rectum simultaneously, checking your rectovaginal septum and your ligaments. Once we're through, I'll remove my fingers and prepare you for stimulation." He takes the cigarette out of his mouth, tapping it on the ashtray he had set next to a stack of other patient's files. It was evident this was all too common of a proceedure.

"I find a mild sedative is best applied to my patients at this stage. After a quick injection, you'll feel relaxed and a little lightheaded. Then, the therapy will begin. I'll be using my fingers to stimulate your clitoris while asking you a series of questions regarding your sensation and pleasure. You're not meant to enjoy the proceedure, of course, but some of my patients do find themselves getting a little worked up. I'll be stimulating you for as long as I deem necessary. The therapy requires that you are kept here for daily treatment without being allowed to orgasm. Your psychosexual responses will be tracked and recorded. Once you're able to respond to the stimulation in a manner I deem efficient, you'll be released from my care. Treatment is known to last anywhere between a few weeks, to a few months. Though I have certainly had patients remain in my care for longer."

He smiles slightly, though the expression doesnt reach his eyes. His cold gaze remained unmoved behind his glasses, as he looks his latest patient over.

[   ] Heavy, thinking, worried about tomorrow.

or

[ X ] Glassy eyes. Brain turning to warm gloss. A voice telling you that you don’t need those thoughts anymore. The sweet weight of knowing someone else is doing all the thinking now.

Facial Masculinization (FMS) . Which includes:

Tracheal Augmentation: Creating an Adam's Apple.

Rhinoplasty: AKA a "nose-job" , while many people get these to make there nose smaller, transmasc people can also get them to make ther bridge and the overall structure larger, wider, and more prominent.

Brow Bone Augmentation & Hairline Repositioning (this usually involves adding an implant)

Jaw and Chin Augmentation (this usually involves adding an implant)

Buccal Fat Removal: Removes fat from the cheeks, to make the face less round.

Dermal Fillers: Temporarily builds volume in the chin, cheeks, or jawline without major surgery.

Beard implant: Moves hair follicles from a donor area (usually the back of the scalp or under the chin) onto the face to create a thicker or fuller beard

Vocal masculinization. Which includes:

Type III thyroplasty: lowers the pitch of someone's voice by relaxing the vocal chords.

Injection laryngoplasty: adding volume to the vocal folds using derma fillers or autologous fat. Derma fillers are temporary and fat grafting is significantly more long lasting.

Direct vocal fold testosterone injections: Exactly what it says in the tin, they inject testerone directly into your vocal chords and it lowers the pitch. This is a new procedure and we're unsure if it's temporary or permanent.

Body Masculinization. Which includes:

Body Sculpting Liposuction: Removes fat from the hips, flanks, thighs, and lower back to straighten the waistline and square the torso.

Top Surgery or chest masculization. Which includes:

Double Incision mastectomy: This is the one most people know. Two long horizontal cuts across the chest; used for medium to large chests or extra skin; nipples are typically resized and grafted back on. You can leave the nipples off if you want. There is a small chance of loosing nipple sensation.

Inverted-T (Anchor): Uses a horizontal cut plus a vertical drop down to the nipple; keeps the nipple attached to its blood supply/nerves; good for larger chests wanting to save nipple sensation.

Buttonhole: Similar to the inverted-T but without a major vertical skin removal; keeps the nipple attached on a stalk to preserve sensation.

Peri-Areolar (Circumareolar): A circular cut around the outer edge of the areola to remove tissue and extra skin rings; best for small chests with good skin snap-back.

Keyhole: A tiny cut along the bottom edge of the areola; used for very small chests (A-cup or small B-cup) with no loose skin; leaves minimal scarring.

Bottom Surgery or FTM/FTX SRS:

Phalloplasty: Builds a full-sized penis using a skin and tissue graft from the forearm or thigh, done in multiple stages and often including urethral lengthening and erectile implants (see more on erectile implants in the next section). The natal neo phallus is typically buried at the root of the phalloplasty shaft. There is unfortunately a lot of fear mongering and misinformation about Phalloplasty. Most Phalloplasty images you see shared are either mid stage (not completed) and/or haven't healed yet.

Glansplasty: This surgical procedure creates the look of a circumcised penis. A crown is added after phalloplasty for a more aesthetically typical phallus.

Glans Implant: silicone ridge added to Glansplasty to prevent flattening. To my knowledge currently only Dr. Curtis Cane performs this.

Metoidioplasty: AKA "Meta". Uses the natal neo phallus growth that develops from being on testosterone therapy to create a small (2-3 inches typically) penis, preserving full sensation, the ability to have erection without an implant or external device, and has a shorter recovery time.

Scrotoplasty: Shapes labial tissue into a scrotum and places silicone testicular implants. Avaliable with both phalloplasty and metodioplastly.

Urethroplasty: lengthen and reroute the urethra, which allows you to stand and pee. Possible with Phalloplasty, metodioplastly, and non phallus constructive vaginectomy.

Vaginectomy: Removal of the vaginal canal and labia and the the vaginal opening is sutured shut. This is not required to have Phalloplasty or metodioplastly. It is also possible to get a vaginectomy without constructing a phallus, resulting in a smooth transition from the abdomen to the groin, without any genitals. A hysterectomy is required to get a vaginectomy.

Erectile Implants for Phalloplasty. Which include:

Inflatable Implants: Fluid-filled systems (available in 2-piece or 3-piece configurations) that use a scrotal pump to inflate cylinders for an erection and a release valve to return to a flaccid state.

Malleable Implants: Aka "semi-rigid rods". Bendable silicone or wire rods laced inside the phallus that can be manually moved up for use and down for concealment.

The ZSI-475 FTM: This is the only implant designed specifically with transgender men in mind. It is an inflatable implant and has a single piece configuration. It provides an incorporated anchorage plate, in the proximal part of the cylinder, composed of stainless steel and silicone to be sealed with four non-absorbable stitches to the pubic periosteum. The pump is testicle-shaped to improve aesthetical appearance of the scrotum. It is a relatively new implant and less data on it is avaliable in comparison to other erectile implants.

Non Surgical Erectile Devices for trans men post bottom surgery:

The Elator: Consists of two silicone or expandable bands connected by plastic-coated rigid or flexible metal support rods, which hold the phalloplasty in an erect position.