I've had three trans-rectal biopsies and my first perineal a couple weeks ago. All were done wide awake with local anesthesia. The perineal was definitely the easiest and quickest. I was given the option of general anesthesia (since it was a different facility than the rectal), which I couldn't do because of scheduling. Turns out, it wasn't necessary. Others have described the position you're in with your feet strapped into the stirrups (I asked the nurse if that was to keep me from running away and she looked at me dead serious and said "yes, that's exactly what it's for"!). The worst part was getting the local directly into the prostate - one on each side. But that was just a few seconds; after that, I didn't feel anything. There was blood in my urine right after which disappeared by that afternoon. Blood in the semen takes much longer, perhaps a month. You will want to "take matters in your own hands" until it stops so as not to freak out your partner.