I had both transrectal (4 years ago) and trans perineal (this week). Mayo Rochester only does trans perineal, so I did not have a choice to make. Neither was that big of a deal for me. The trans perineal was done with local anesthetic only, surely was scarier and a bit more unpleasant (I have a low tolerance for pain and would not call it painful, just unpleasant). The worst part is waiting for results. Well, I also made the mistake of looking back at the aftermath once I stood up...do not do that! Reminded me on the prom scene from the movie Carrie. 🙂