I graduated from nursing school in 1984. Part of any nursing program includes learning how to do physical assessment. Most schools teach you to everything but pelvic and rectal exams on other students – mannequins were used instead. We were tested on all aspects of the exam and our instructors suggested that we practice on each other and on our significant others.
Angie, my 19 year old girlfriend at the time, was very helpful and somewhat naive (a great combination). She was always willing to allow me to practice procedures on her body. She was very pretty – about 5’5, 115 lbs., with light brown shoulder length hair that curled in at the tips. Anyway, I don’t think she realized that gynecological examinations were part of my training. (We hadn’t even had full blown sex at that time – just some petting). When I told her that I needed to do a complete gyn exam on her she became very reticent. She was also very embarrassed. She said that she had never had a gyn exam and that her doctor had only looked at the outside of her “privates”.
After telling her that I’d just have to find another girl who would be willing to let me do the examination she agreed to be my patient. I booked an exam room at the nursing school – several were set aside each evening for students to practice in. I had always been fascinated by gynecological procedures and had prepared for Angie’s exam by re-reading our physical exam text and by watching the school’s gyn exam training videos again. I had also watched a number of gyn exams during clinical rotations. I checked out the necessary equipment, with the exception of speculums and KY – which I brought with me, and proceeded to our specified room.
The exam rooms were relatively small but contained a completely equipped exam table, an exam light, a cabinet containing equipment, and a sink for washing up. I asked Angie to undress completely and to put on the exam gown that had been provided. She did so, but only after she made me leave the room for a few minutes. I had her sit on the table and proceeded to explain to her the various parts of the exam.
She blushed throughout my explanation and actually had a tear or two run down her cheeks. I elevated the back of the exam table to about 30 degrees so that I could see Angie’s face throughout the exam. I then pulled out the stirrups, extending and elevating them to what looked about right. I had Angie slide down so that her bottom was even with the edge of the table, then lifted the gown so that her entire perineum was visible. (Note – besides the obvious erotic aspect of the exam it was actually a learning experience for me as well. I conducted the exam in a professional and careful manner while doing my best not to startle or hurt Angie). (This was also my first time seeing her “privates”.
I began the exam by looking over her mons and pubic hair, then moved down to her labia majora. I used my fingers to gently push and palpate as I worked my way from top to bottom of both sides. Next, I separated her labia majora to look at her smaller lips, the labia minora. (Her entire vaginal area had a wonderful clean fragrance). Her labia minora were very pink and had a wet appearance from her vaginal secretions. They were also delicate and completely hidden by the labia majora when not spread apart.
With her inner lips separated I first examined her prepuce (covering over the clitoris), then the clitoris itself. Her clitoris was well hidden, but pink and healthy looking when exposed. I used my fingers to palpate her labia minora as I moved down towards her vagina. Her lips were smooth and slick. I proceeded to inspect her vestibule (the area between her inner lips) starting with the urethra and Skein’s glands then moved down to the vaginal opening. I spent a lot of time examining Angie’s introitus (vaginal opening).
I used my fingers to push and probe every surface and gently squeezed the area of her Bartholin’s glands (at the 4 and 8 o’clock positions around the vaginal opening). (As I mentioned before – Angie and I had fooled around but she was still a technical virgin having never had intercourse). I was surprised to see that her hymen was still partially intact. It formed a partial crescent across the lower portion of her vaginal opening. Angie had been using tampons for several years and many times the hymen will be torn or pushed aside during their use. I used my index finger to put a little pressure on her hymen to see if it caused her any pain. She said it didn’t hurt but that it was uncomfortable.
After spending about 20 minutes just looking at Angie’s vaginal area she asked me if I were done. I explained to her that I still had to do an internal examination. She didn’t like the sound of that. I explained to her that I would use an instrument called the speculum to open up her vagina so that I could see into it and view her cervix.
She began crying a little which really made me feel bad. I told her I would be using a very small speculum and that it wouldn’t hurt (only partially true). I chose a Pederson’s adolescent speculum which has long, narrow blades that cause a minimum of stretching at the vaginal opening. The speculum was metal so I warmed it up as best I could. I applied KY jelly to it and, while holding her vulva apart with the fingers of my left hand, slowly inserted it into her vagina.
She winced at the intrusion but said that I should continue. I continued inserting the speculum until it bumped against her cervix. I gradually opened the speculum, with the exam light shining directly into her vagina, and found that I hadn’t quite placed it over the cervix. I closed the blades slightly, gently withdrew the blades about an inch, then re-inserted it. This time I opened the blades and her cervix was perfectly centered.
Her cervix was a very light pink with a narrow slit which the os (opening into the uterus). I used a cotton swab to collect some of the secretions on her cervix and in the vaginal pool at the base of the cervix. Angie told me that the speculum was beginning to hurt so I cut my examination short. I gently closed the blades slightly and looked carefully at her vaginal walls as I slowly withdrew the speculum. Her vagina was very pink and slick and had a myriad of little folds (rugae).
As the speculum came out a little dribble of her secretions followed and ran down her perineum. I used some tissue to wipe it away. I asked Angie how she was feeling and she said that she was very sore (meaning her vagina). It was obvious that I wouldn’t be able to do the bi-manual and rectal examinations, which I hadn’t told her about yet, that night so I wound up scheduling another exam room later that same week.
