I am currently doing an FY2 job in general practice, way out in sunny Bolton. For those of you not native to the Greater Manchester region, its quite far on the outskirts and forms part of the Greater Manchester region, but is a very large town in its own right.
 
My job in GP-land is in a very cushty practice, with all of Bolton's wealthiest; ALL the patients drive better cars than either myself or any of the doctors, and they are burdened with typically wealthy problems; gout, obesity, alcoholic steatohepatitis (from wine, not cheap cider, mind), BCCs from years cruising round the Med. It is frankly, quite boring. All I wanted to get out of this attachment was a frankly amusing story that could make myself (and others) chuckle heartily, breaking the tedium of the above. It finally happened. 

 What began as a fairly routine encounter for me with a gentleman around retirement age complaining of tinnitus, after referring him to audiology test then took a turn for the peculiar. Affluent chap, very eccentric, snappy dresser, charismatic. Educated, but spoke in a broad Bolton accent. After sorting out his ears to his satisfaction, he leans in and beckons me forward.
"Doc? Can I have a word?"
"Erm yeah sure, another?"
"If you wouldn't mind."
"Nah go for it"
"Its about me bits"
"What about them?"
"I'm having a spot o' bother"
"In what way?"
"……mmm……hmph……erm…."
"…….You're being very coy Mr._____"
"Ok, promise, don't laugh. Or try your very best not to. What it is, a few year ago, about a decade, I were away on company business, put up in a posh hotel and that. ALLL paid for by t'company, cos y'know I'm th'boss and that. Anyways, I were missin my wife at the time…Lets say I had an itch only she could scratch. Anyroad, I decided, I'd had enough, and I ordered a bit of….y'know, a bit of blue, knoworramean?"
“I think so, but could you more explicit…?”
“A porno”
“Too explicit”
“You think THAT’S explicit, you shoulda seen the film! Anyroad, it were foreign like, what do the French say….avant-garde? It didn’t so much broaden me horizons, as bloody shatter ‘em! I was aroused, intrigued and appalled in equal measures, but inspired enough to imitate. For t’sake o’brevity, I’ll spare you the details of the film, and just tell yer what I did.”
“Ok”
“Well, I took the shoelace outta me shoe, and wrapped round my testicles, tied it off tight like, and then gave myself the old presidential handshake, knoworramean?”
“Yes, but tied how? Like actually round the testicle? Round both? Or at the top of the scrotum?”
“Erm, its difficult to explain, shall I show you?”
“NO THAT’S FINE! I’ll draw you a picture. [DRAW A SET OF BALLS]. So just point to where you tied your laces”
“There, at top o’ me testicles”
“Ok, so around the top of the scrotum, where the base attaches to the underside of you?”
“Aye”
“And how long was it there for?”
“Well, a couple of minutes. I cracked off a few [mouths the word but doesn’t make the sound] wanks, and then I untied it. They were looking a bit purple bi’then, and I had friction burns on me nob, but I tell yer, it were magic!”
“Ok, so that was 10 years ago. Why have you only just mentioned it now?”
“Well what it is doctor, for the next couple of years, every time I climaxed, I came blood”
“Blood?!”
“Blood”
“Everytime?!”
“Oh aye! I came, and it’d be all bloody, and sperm mixed in together, looked like strawberry cheesecake.”
“For how long?!”
“5 year. Give or take”
“Again, WHY HAVE YOU ONLY JUST MENTIONED IT?!”
“Well it stopped 5 year ago, but recently, I’ve been noticin that when I climax, the amount I produce….its not a lot, I mean, I used to be a tablespoon kinda lad, and now, its barely a thimble! Blood free, mind.”
“Ok. Free from blood?”
“Aye”
“Able to get erections?”
“Hang yer coat off it if yer like”
“No thanks I’ve got a hook on the door. Maintain an active sex-life?”
“Aye.”
“Pain free sex-life?”
“Yup”
“Monogamous?”
“Oh yes”
“Any more masochistic sexual misadventures since then..?”
“Well, a few year ago, we sold the nipple….Hahaha I’m joking. No. So whaddya think it could be? Have I chipped my crown jewels?”
“If I’m honest. I have no idea. But I reckon, if you manage to maintain a blood-and-pain-free-ongoing-monogamous-sex-life with your wife, you probably don’t have all that much to worry about, irrespective of how much semen you produce. But, to be on the safe side, I’ll just go chat to my supervisor, see what he reckons”
 
Cue the reiteration of the above story to my supervisor, with the same diagram again. Lots of gestures to demonstrate him wanking whilst cupping his strangulated balls. Lots of giggling. A few minutes to compose ourselves.

 
The correct response to the aforementioned anecdote, according to Good Medical Practice would be to reflect on it, and upon pondering, I suppose its quite humbling what people entrust in us as doctors; the deepest darkest little secrets, subtle nuances and idiosyncrasies that even their partners, children, parents don't nor will ever know, and in that respect, to be privy to those nuggets of information is a privilege. 
 
I'm not sure of what his diagnosis was, but I've settled on one of the two options mentioned in the title. I'll let you pick which.

Reflective practice complete; tale legitimised.