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With its fearsome needles, gag- inducing throat swabs, and antiseptic stench, the doctor's office would seem an erotic wasteland. Visits to the doctor are prompted by pain and illness-- or at best, attempts to forestall them. Medicine aims to extend the road that ends inevitably in death, but exacts often excruciating tolls for its efforts: injections in the eye, rectal biopsies, spinal taps. Gay men of a certain age-- and not just-- probably remember at least one trip to the doctor fringed with mortal terror. For many, doctors' appointments have grown tediously frequent.

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Physicians may be obliged to serve all with professional compassion. However they attend not to the Body Beautiful, but man as a creaky flesh-bag of bones, guts, and bile. Doctors may no longer, as in centuries' past, proudly garb themselves in blood-smeared smocks, the likes of butchers'. But however immaculately groomed in white coats, they are no less conversant in snot, shit, and encrustations of the flesh. Desire makes us glom onto a compelling ass, nape, or cock-- or onto our beloved in toto. But a doctor's gaze tends to look past the patient and see only, say, a bad case of psoriasis. If desire springs from health and spawns affection, the doctor must attend to sickness with clinical detachment, else be overwhelmed. Sex and medicine, surely, stand irreconcilably opposed.

Yet so often in human affairs, diametric opposites share covert affinities. If desire lies on the far side of doctoring, then for some folks, that's just the contraindicated spot where their erotic interest settles. Gays don't have a monopoly on medical fetishes-- busty uniformed nurses are a cliché of hetero porn. But, as with erotic specializations generally, it's pretty much a Guy Thing. Maybe it's because gay men are more tuned-in to their sexuality. Or maybe it's just that in the gay world's sex-charged plasma, those with shared enthusiasm connect like protons and electrons. Whatever the reason, men who play doctor are finding each other.

Not that they're exactly marching with a banner in the pride parade. "It's a taboo," says someone we'll call Dr. Sam, an actual health-care worker in New York City who's a leading player on the local scene. "At parties, guys will talk freely about blow jobs and fisting but not, 'Oh I just had this hot time with a rectal thermometer.'"

Fall in with Dr. Sam's pals, however, and you might get invited to a staged group physical, where checking temperature and blood pressure is foreplay to a hearty prostate exam or urinary catheterization-- perhaps with a cleansing enema chaser.

Most of us would politely decline the invitation-- have to get started on the 2002 tax return! But refuseniks, upon reflection, can see that sex and medicine are actually as coiled as the snakes on the profession's emblematic staff.

As we learn in childhood, going to the doctor means having to take off your clothes. Doctors touch people in places only lovers do, and some places lovers never would. Modern medicine's black bag has tools to penetrate and expose the body that leave sadomasochists and pornographers stuck in the mid-20th century dust.

Moreover, medical fetishists often get recruited at a tender age. A doc was likely first person, outside the incestuous circle of parental diaper-changers, who inquisitively fingered your genitals. A family medical guide was perhaps the first book available to whet or slake your prurient imagination. At some point mid-childhood, embarrassment likely arose (a rose was maybe the color of your cheeks) while undressing for the doctor-- and probably simultaneously for Mom. That unease was an adumbration of sex's significance, which was to hit with the hormones a few years later. Doctors' offices, like locker rooms, are gateways on the path to erotic awareness. No wonder kiddy sexual exploration is summed up by the shorthand "playing doctor."

"It was a mix of terror and pleasure," recalls George, a 36-year-old Bostonian about going to the doctor as a boy. "I was terrified of getting an instant boner as soon as I had to drop my underwear. But then I'd jerk off later thinking about having been forced, gently but firmly, to strip." Having sex even today, he says, if a partner strokes or holds his cock or balls, it's the feelings from those doctors' hands that comes back. "That's the slightly edgy pleasure that's playing inside my head."

The medical establishment insists that a bright line-- or shall we say, invoking literary license, a River Too Torrential to Forge-- separates the disrobed body as subject of medicine from that as object of lust. But like a river grown old, that boundary can meander and wind, extending its course, running shallow, expanding its bank where weeds grow sometimes so thick that the river disappears into torrid swamp.

Memorable appointment

It was in steamy marshlands hereabouts that Marc, a 38-year-old Long Islander, found himself when he was 15. He was offered a job at a summer camp as a junior counselor, but first he needed a physical. Marc had already figured out he was gay, he says, but not quite what to do about it. He also knew what he liked. And what he liked walked through the office door to prep him for the doctor.

The assistant was a medical student in his early 20s, Marc says, wearing a V-neck smock, with tufts of blond hair pouring out his shirt and sleeves-- an attribute Marc prizes. "I saw the way he looked in that top and I just wanted jump his bones," he's tells The Guide. But if Marc's dick was delighted by the situation, his mind wished he could be a million miles away-- not least away from his dick.

"The assistant told me to strip to my shorts." It was a hot day, and shorts were what Marc was wearing. He figured the executioner had granted a moment's reprieve. "No, your underwear," the assistant clarified. The boy didn't want to undress.

The reason had become obvious, even through the shorts. "He made some remark to me about 'Don't be embarrassed, don't be nervous, he's a very good doctor,'" Marc says, "and then added something ambiguous, almost an innuendo, like, 'I'll be there if you need me.'"

The medical student left and the doctor came in to do his exam-- during which, to Marc's mortification, the erection wouldn't subside. The doctor assured him this sort of thing wasn't abnormal, and went through the routine. Finished, he took his leave, saying the assistant would return to teach Marc how to check his testicles.

The assistant broke the ice. "The doctor wanted me to show you something, but apparently you might want more than that," Marc recalls him saying. "I remember mumbling 'Yeah, I do.' And he said, 'We can't, and there's a reason why we can't. But we can have a little bit of fun.'" It was a just an examination room; the door didn't lock, and the doctor and Marc's mother were on the other side.

"He played as much as he could," Marc says. "He stroked and caressed." Marc was half-propped on the exam table, watching as the assistant's hand worked his cock. "I remember looking at his college ring, trying to see the date," Marc recalls. After some five minutes of attention, Marc shot off. "He gave me stuff to clean up with, then put his arm around me and said, 'You'll be OK, and you'll meet somebody yourself and everything will be cool."

"Ever since then," Marc says, "anything to do with medical scenes has been a tremendous turn-on for me."

Mapping the genitals

Marc revisited the episode frequently in his fantasies, and a link between lust and doctors was getting wired into his neurons. So when he came down with a urinary-tract infection in his early 20s, he faced it in the spirit of the maxim, "When life gives you lemons, make lemonade."

Marc repaired to the company doctor, who he suspected was gay, and kept up a roaring hard-on through the exam. Don't be embarrassed, the doctor reassured. Marc wasn't-- he was enjoying the experience too much, and sensed that the doc was, too. "He knew it wasn't the place and time to do anything, and I wasn't going to say 'Go for it' because I was just a young kid in the company," Marc says. "It would've been a foolish move for me to make."

The doctor referred Marc to a urologist for a closer look. From the moment he got to his appointment, Marc says, "I'm aroused by looking at all these guys in the waiting room." Not that any medical exam wouldn't get his juices flowing, but the doctor's appearance didn't hurt. "He was a young, good-looking blond with wisps of hair everywhere," Marc remembers. The patient was put in stirrups on an examination table that revealed his privates the emphatic way the Mercator projection renders Greenland. The doctor injected his penis with anesthetic and inserted a scope up his urethra. But these daunting procedures didn't bother him, Marc says-- nor wither his erection, which stood through the exam like the North Pole. "My dick was bouncing like a springboard," Marc remembers, but the blond urologist remained calm and collected.

"It was a self-defeating situation-- it wouldn't go away. The more professional he was, the more it turned me on," Marc says. "I could have come on demand, without anybody touching me."

Unlike his pivotal first time, Marc left this doctor's office without bragging rights. But it further whetted the appetite that he now tries to satisfy in the medical fetish scene, where he meets guys one-on-one and also joins in group role-plays-- the varsity wrestling team getting checked for hernias, perhaps, or sailors dropping their whites for short-arm inspection. At a mock employee physical last month, Marc played physician's assistant, a shift from his preferred status as prone patient. But with real-life experiences under his belt, Marc regards role-play as second-fiddle.

A best friend from high school became a doctor, he's gay, and they remain close. "He knows all my fantasies and thinks it's hysterical," Marc says. "He gets off teasing me about it." A perfect companion to make Marc's dreams come true? Alas, he says, "Absolutely not. My friend wouldn't do it. It's not a turn-on for him."

Weapon inspector

Tom describes himself as a "happy and healthy 29-year-old gay man." He lives in Chicago, and is delighted with his nurse practitioner-assistant (PA) at his HMO.

"My PA is considerably older than myself, but not at all unattractive, with nicely graying hair and a super friendly personality," Tom tells The Guide. The morning of his recent physical found Tom feeling randy. "I'd been on a dry streak in the lovemaking department," he says. "That, along with my general lack of modesty, would make this an interesting checkup." Tom had no plans to come on to his doc. "I thought I'd just be my most relaxed, open self and see what happened." The moment the PA touched his cock, Tom says, it grew hard. "He was pushing my fully-erect eight-inch penis from side to side to roll my testicles around, and said, 'You really have no problems getting erections, do you?' I just grinned and shrugged," Tom relates. "He took his time checking me out, then had me dress and leave a urine sample." When he had to come back for a follow up, the erection returned. "As the exam ended," Tom continues, "the PA said, 'OK, you better put that away-- you're starting to make me nervous.' I didn't get it at the time, but I think that was his way of saying he was getting excited."

Feed a fever

Marc and Tom, Dr. Sam says, fall to one side of a divide in the medical fetish world. They are guys who refuse the proffered gown and happily brandish hard cocks to doctors in a state of exhibitionist bliss that may be very much their own head trip.

On the other side of the fence are those for whom the excruciating embarrassment of exposing and submitting themselves to medical attention is intrinsic to their very alloyed erotic pleasure.

Dr. Sam is in a position to know because he falls to one side of a more significant divide among medical fetishists-- someone who prefers playing doctor to patient. As it is across many gay scenes, there's a paucity of tops, and this puts him in demand.

Of course part of Dr. Sam's popularity is his pleasing bedside manner-- honed over two decades of clinical work. Part of it is the expert-- and, he insists, rigorously safe-- way he wields lance and catheter. Besides, he's an attentive, caring doc who makes housecalls and does his homework, carefully interviewing prospective "patients" before a scene to find out how best to tickle their itch.

Some of Dr. Sam's patients itch all over, some in very specific spots. One man for whom Sam plays doctor is fascinated by injections, finding in the needle a sort of über-penis that penetrates willy-nilly. Another patient loves his reflexes tested. A third is incurably ticklish-- and so Dr. Sam, podiatrist, makes a careful examination of the soles of his feet. For another patient, the rectal thermometer looms larger-than-life as a tool of erotic bliss.

During consultations, Dr. Sam sometimes finds the history behind a fantasy, as with the man made feverish by thermometers. "He was reminiscing that when he was sick as a kid, he'd always have his temperature taken rectally," Dr. Sam tells The Guide. "The doctor would come to his home, and he'd be laid out in plain view on the kitchen table or on his bed with his pants pulled down"-- scenes replayed when Sam visits him today. "He plays the role of a really embarrassed young kid, and I go through five minutes of bargaining and resistance."

But for other guys into doctor play, there's no obvious buried context. That's the case for Sam himself, who stumbled into the scene after answering a personal ad from a man wanting a physical. He pulled the exam off with aplomb, and word got around. "All I can say is that I have memories of going to doctor as a kid and sensing a very powerful energy."

Big Brother's white coat

Stroll around the pillared marble edifices of Harvard Medical School and you sense an institution seeing itself as a cross between a Temple of the Gods and the Ministry of Truth. Though Western medicine has taken its knocks-- from AIDS activists to shamanic healers-- doctors and patients still buy into its mystique. Going to the hospital can be like attending a Catholic mass conducted in Latin.

As bawling children learn who are about to get their shots, there's little chance of saying no. Adults, of course, can choose not to go to the doctor-- in the US, where medical care goes to those who can pay, for many that's a Hobson's choice. But once you're in the system, the flow of ritual and procedure carries you along.

Medicine's power shows itself in the small detail. Things happen to patients-- such as getting called from the waiting room-- with the unpredictability with which uranium emits a gamma ray. Perhaps there's some underlying logic to quantum events-- or to why a nurse in the hospital wakes you at 5:18am for a urine sample-- but you're not likely to get a clue about it. Medical procedures can render this arrhythmia on jarringly intimate terms. To have, say, a sigmoidoscopy, is to feel an ungrammatical sequence of sensations novel to even the oft-plumbed rectum.

It's telling that some of the nastiest acts committed by states look like medical procedures. From a Martian's-eye view, Texas executions appear like someone getting an IV drip. Judicially-sanctioned torture, as constitutional lawyer Alan Dershowitz proposes, would consist of the careful insertion, by men in white coats, of sterilized needs under a suspect's fingernails. The Soviet Union in its heyday-- and the US today-- lock people up in mental hospitals (for reasons of politics and sex, respectively) under the fraud that they're under physicians' care.

But because it carries such a big stick, medicine gets to talk softly. Doctor's orders are usually conveyed in dulcet tones. What doesn't fit a medical scenario is easily brushed aside-- erections are dismissed by silence, or chalked up to mere autonomic reflex, devoid of meaning. The result is plenty of ambiguity. "That in itself is a turn-on," says Marc, noting that he'll never know if his blond urologist was getting aroused behind his sphinx-like professionalism.

While medical fetish-play is a rare hothouse flower, it retains genetic code once common in homosexuality-in-the-wild. Today's open gay scenes have eclipsed a previous homoerotic world conducted less by talk than-- uncertainly-- by wink and nod. Gay men from Peoria to Prague, having learned sex from porn, now mouth during lovemaking its imbecilic inanities-- "Fuck me, baby, fuck me harder!" But in the heat of a medical-fetish scene, sometimes the only sound you hear is the crinkle of the paper on the exam table.

Do not confuse medical play, aficionados insist, with its typical representation in porn. In their endless search for fresh scenario, many directors will use a medical scene as mere prop or pretext. Complains Dr. Sam about one such video, "It starts off as a medical exam, and then it goes into a very elaborate 15-dildo sex-extravaganza, and then a guy gets an enema with a garden hose." An opera queen would sooner hear La Traviata rendered on kazoos.

Channeled flows

So are doctors thrown into stormy seas of lust in which they must always flail to keep from drowning? "In medical school, everyone uniformly says, no you don't get turned on, and it's kind of borne itself out," says Igor, a recently-minted family practitioner who's gay and lives in New York.

All right, on the job you stay focused. But what about fantasies after going home?

"It's very infrequent," Igor goes on. "I think any doctor who says that they haven't is lying, or isn't in touch with themselves." Says Igor of some his patients: "If I was lucky enough to find pictures of them on the Internet I'd find it very erotic, but when they're undressed and I'm looking at them, I'm not aroused." He notes that the doctors who have sex with patients most often are psychiatrists, who aren't checking breasts for lumps or groins for hernias. "That may just show," he says, "that sex takes place in the mind."

Dr. Sam corroborates. "Every guy I've played with wants to pick my brains about how many young hot naked men have I seen, and how many enemas I've given," he says. "That's a boundary I would never cross and never have. I don't even like to speak about it." A few years ago he says he played with a guy who had hooked up with a real doctor, and they were fucking in his office. "It blew my brain totally," he says.

Private fantasies?

The dam the medical profession builds to hold back desire's potential flood leaks here and there, but mostly holds. Dr. Sam notes that he has a few doctors come to him for "physicals." They've stored up too much erotic charge from their work and need to reverse roles, just like the alpha-male CEOs who on weekends want to be tied up and fucked silly.

And while many would say that voiding medicine of desire is the ideal, that's probably not right either. Eroticism is the wellspring of tenderness. It’s not just that eros helps doctors and nurses be sweet and gentle to patients they find beautiful. But having had the experience of erotic love can impart a tenderness that illuminates the healing arts. Medicine maybe needs a homeopathic dose of lust.

Rolling over

Instead of hydraulics, there's perhaps another metaphor for the dynamics of desire in medicine: displacement. Doctors continually displace desire as irritant, the way cilia in the lungs are always sweeping away dust and grime. And yet displacement isn't denial. In a way, it's a form of emphasis. Put a red circle a bit off-kilter atop a black one, and the red dot looks like it's jumping off the page. To those with antennas tuned to the right frequency, the displacement of sex going on in the examination room is just what calls their attention to it.

Indeed, in a deep sense, displacement is at the heart of sex. A long line of Western thinkers-- from Schopenhauer to Freud-- identified the sex drive as engine of the will. But while desire puffs up our sense of self-- and our sense of the uniqueness of a beloved-- it's really just the species' trick to make individuals do its bidding and undertake the burden of reproduction.

Sex casts its spell the way the desert conjures a mirage, displacing the illusory oasis always out of reach. An object of desire attained just clears the way to new wants. The paradox and tragedy of the will is that the more we are pumped up with it, the more we are in thrall to what's really an external force. Indeed, the ultimate insult to the will-- death-- follows from our sexual nature: asexual amebas, which reproduce on their own, can persist forever. Such paradoxes sent Schopenhauer chasing after Buddhist quietude, and made Freud pessimistic about earthly paradises.

America has seemingly triumphed over every other culture-- and it believes, most of nature. It now hubristically entertains to submit sex to the collective democratic will-- or the media spectacle that substitutes for it. Despite our Puritan roots, we allow sex freer reign than any culture in history. It projects from every screen because we think we've tamed it into meaningless, like a lion at the zoo. But simultaneously the West is wracked by sexual hysteria, as evidenced lately by the obsessive conjuring and exorcising of demonic priests and predators. In truth, this culture nurses a deep hatred and resentment of sex, which stems from the mockery desire makes of the self, the will, and consent-- all of which we've enshrined as the hallowed ground of our New World Order.

"The zones in the brain for fear and sex are close together," notes Igor. Which is why when boys he examines spring hard-ons he doesn't take it as a compliment on his looks. Sex defies our will not least by the alchemical way it transmutes fear and disgust into desire. A 10-year-old boy who find girls repugnant is almost certain at 13 to find them irresistible. A 20-year-old repulsed by the asshole is a leading candidate, at 25, to be an avid rimmer. As sex's workings transmute the rebarbative into the beautiful, it disrupts the West's mythic identification of self with will.

The doctor is symbol of disease and death, nature's means of our individual undoing. No one, no child anyway, would ever choose to go see one. By being so far outside of the desirable and pleasurable, medicine can set desire and pleasure in clear relief. As sex gets continually displaced in the doctor's office, it makes waves. Those able to surf them can get carried to shores of poignant pleasure. And for those who merely watch from the beach, medical fetishism puts sex spread-legged in stirrups on the examination table for all to see.

Author Profile:  Bill Andriette
Bill Andriette is features editor of The Guide
Email:	theguide@guidemag.com