The patient came to the campus health clinic at approximately 4:00 PM and requested a physical examination. It was clearly explained to the patient that no female medical personnel were available to assist in the examination, however, the patient signed form # W-152 (Waiver for Un-aided Examination). The patient is a 20-year old unmarried female. On the day of the examination she appeared to be personally well kept, and was dressed in a sweater, blue jeans, and tennis shoes – not uncommon attire for college students at this campus. The patient was asked to provide a urine sample and to remove her clothes and cover herself with the typical gown provided.
Urinalysis indicated that there were no abnormal conditions, no drug usage, no pregnancy. I felt, however, that disrobing appeared to take more time than usual. Upon checking the dressing room monitor, I observed the patient sitting upon the chair, dressed in only her panties. Her legs were spread with one hand inside of her panties and one hand on her breasts. The patient appeared to have been masturbating and was experiencing orgasm during my observation. Shortly thereafter, she stood, placed the gown on her body, and exited the dressing room.
I met the patient in the examining room. I conducted a routine history and determined that there were no contraindications in the family history. The patient explained that she was sexually active and that it had been almost a year since her last complete examination. Weight and height of the patient were noted at 115 pounds and 66″, respectively. With the patient sitting on the edge of the examining table, vital signs were taken and noted as follows (+):
Blood Pressure – 135/80
Pulse – 78
Temperature -99.5 (*)
(*) Temperature was taken ORALLY. The patient indicated that she had drunk a cup of coffee 15 minutes prior to the examination.(+) Elevated levels may be a result of patient’s achieving sexual orgasm prior to the examination.
I asked the patient to lie on the examination table in the supine position. Her gown was lowered to just above her waist. Respiration and palpitation of abdominal organs indicated no abnormalities. The patient was asked to turn upon her left side for further confirmation of the respiration and palpitation examination.
With the patient returned to the supine position, her breasts were examined. The texture was firm and there were no abnormal masses. Symmetry was within tolerance. No discharge was noted at the nipples. It was noted, however, that respiration increased during the examination of the patient’s breasts. Further, the nipples hardened at the touch and remained hardened throughout the examination.
The patient was informed that a pelvic examination was part of the complete physical. She indicated that she had been examined by a gynecologist on a number of occasions. Further, she confirmed that she waived her right to have female medical personnel present during this examination.
The patient’s gown was removed fully and she declined my offer for covering her upper extremities and/or draping the area below her hips. The patient was asked to move herself farther down the table, placing her buttocks at the table’s edge. She complied without hesitation, and upon her buttocks reaching the table’s edge, she placed her feet in the examining stirrups.
External examination of the genitalia revealed that pubic hair had been trimmed to confine it to an area slightly above the vulva. There was no pubic hair around the labia, perineum, or anus. Left untrimmed, however, pubic hair growth appeared to be normal. The patient indicated that she trimmed her pubic hair as a matter of :
- personal preference,
- to accommodate her swim-wear, and
- to heighten sexual activity/response. There were no unusual odors or discharges and the patient indicated that she had not douched within 48 hours prior to the examination, although she douches regularly.
Internal examination of the genitalia revealed no abnormalities. However, there were sufficient natural secretions that lubricating gel was not required (although used as a matter of procedure) for the digital examination or insertion of the speculum. Bi-manual examination revealed that all reproductive organs were properly aligned. The recto-vaginal examination was conclusive. Papanicolaou’s Test was performed and the results were returned “negative” from the laboratory. The patient’s vagina accommodated a # 2 speculum.
During the pelvic examination, natural secretions continued to be emitted from the patient’s vagina. Further, upon insertion of my finger(s) into the patient’s vagina I observed that her hips raised toward insertion and the vaginal walls contracted during palpitation. Respiration increased. A similar response was received in the patient’s rectum during the recto-vaginal examination. Insertion of two fingers into the patient’s rectum was easily accommodated. The patient indicated that she was sexually active, enjoying vaginal and rectal stimulation, as well as anal intercourse. Upon removing my fingers, I noticed that the patients hips continued to gyrate while respiration decreased.
The patient was then asked to assume the dorsal recumbent position for examination of the rectum. External examination revealed no abnormalities; preliminary insertion to the first knuckle of one finger revealed a firm rectal muscle and normal response. Full insertion of the finger into the anus revealed no abnormalities or hemorrhoids. Minor impaction was noted. The patient was questioned concerning the regularity of her bowels. She responded that her bowel movements were regular, however, her eating habits were sporadic. A cleansing enema was recommended. A rectal dilator was inserted and the rectal/anal walls were observed to be consistent with the digital examination. The patient, however, appeared to be stimulated by insertion of items into her rectum as she pushed her hips toward insertion.
Due to increased vital signs observed at the beginning of this examination, the patient was asked whether she would object to her temperature being verified rectally. She responded that this verification was acceptable. With the patient straightening her knees and lowering her buttocks, a rectal thermometer was lubricated and inserted. During the thermometer’s registering, her pulse and blood pressure were again checked. The vital signs were:
Blood Pressure – 135/80
Pulse – 78
Temperature – 98.6 (!)
(!) Temperature adjusted downward one degree.Following removal of the thermometer, the patient was advised that she could get off of the table and get dressed. She explained that she was feeling a bit “flushed” and requested that she be permitted to lie on the table for a few moments. I complied and completed the required paperwork.
After several minutes, and with my back to the patient, I heard several moans coming from her. When I turned to see her, I observed the patient lying on her back. Her feet were in the stirrups, she had the thermometer inserted into her rectum, three fingers of her right hand were inserted into her vagina, and her left hand was vigorously rubbing her clitoris. As she noticed my approaching the examination table, she exclaimed, “Doctor, please excuse me. I’m cumming…..” With this exclamation, her hips began to gyrate violently as sexual orgasm increased, overwhelming her for approximately 30 seconds, then subsiding. The patient removed the finger from her vagina. I took the liberty of removing the thermometer from her rectum. Also, in the interest of medical science, I again checked her vital signs:
Blood Pressure – 120/80
Pulse – 60
Temperature – 99.5 (!)
(!) Temperature adjusted downward one degree.
THE ELEVATED VITAL SIGNS CONFIRM THAT SEXUAL EXCITEMENT AND ORGASM LEAD TO THIS NOTICEABLE INCREASE.
The patient removed herself from the examination table, got dressed, and returned to my office for post-examination consultation. She explained to me that she was “overly erotic” and that “any stimulation of [her] tits, pussy, or ass requires [her] to masturbate or receive another form of sexual gratification immediately.” The patient advised me that she masturbated almost daily, and had sexual intercourse at least 5 days a week, sometimes twice or three times daily. The patient indicated that she also enjoyed sexual relations with other females. Sexual gratification is received through oral sex and the use of various objects designed for insertion into the vagina and anus. Physical examination revealed that there was no indication of any abuse, although the topic was discussed as a matter of precaution with the patient.
My physical examination of the patient revealed no sexual dysfunction, and my psychological evaluation of the patient does not indicate any emotional imbalances. We discussed the need for adequate protection against both disease and pregnancy during sexual activity. The patient takes Lo-Ovral daily and is aware of the need for regular and consistent use of “the pill”. She requires men to wear a condom before engaging in sexual activity with them. She is also aware of the need to separate vaginal and anal sexual activities.
As noted during the rectal examination, the patient was reminded to administer a cleansing enema to herself of approximately two quarts. She indicated that she had an enema nozzle attachment to her douche bag. Proper positioning and retention was discussed with the patient.
The patient left the facility at approximately 4:45 PM.
