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Restraint of the patient is unneccessary - though the cropping of this picture allows us to fantasise about that possibility if we wish to. His remaining clothing is no impediment to the erotic impact of the image. Nor is the use of instuments instead of hands.
The observer can see that this particular examination is not a standard medical procedure - we have a 'mitchmen' situation here! The typical male patient at the S+M Clinic is unfamiliar with medical procedures and he does not realise yet that the doctor's interest in his body is personal. He wonders anxiously where the doctor is going to touch him next. At the same time he struggles to blank out any enjoyment of the intimacy of the touch, fearful that his organ will react and betray him.
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