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My First Time... Down There

Benferguson72x723Ben Ferguson -- This is my penultimate post for the unforeseeable future, as I have run out of stories and also must graduate at some point.

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Thursday, 6pm. Outpatient gyn clinic exam room. 10x10, maybe. Professional attire. Me, five female classmates, a female attending, a female resident, and... the patient, half naked.

It did not start well. “I’ve been at two other schools today, had about two dozen fingers up there so far, so be gentle, okay? I’m a little chafed by now, you know?”

No. As a matter of fact, I didn’t know.

The ladies in the room cringed. I cringed, too, out of a combination of imagination and extrapolation. She chuckled, intending to keep things on the light side rather than the morbid. I doubted any of us students had performed gynecological exams before med school, but I felt especially unprepared not having lived for more than two decades with a vagina of my own. All of the other students almost certainly had had multiple exams performed on them, so they at least had that going for them.

The resident instructed us on the various parts of the exam while the attending looked on: how to choose the appropriate speculum and how to manipulate it in practice, how to apply lubricant and how much to use (a lot), how to remove the speculum, that it’s important to warm up your hands, how much lubricant to use for your fingers (even more), where to expect to feel the ovaries, what to expect to feel, what to look for. The focus, though: what things to say (and how to say them), or, more aptly, what things not to say (or, worst-case scenario, how not to say them). For example, use proper anatomical terms rather than slang; always explain what you’re about to do to the patient using such terms before beginning; do not make off-color comments about sexual activity or really anything else that would cause any awkwardness (above and beyond what the both of us were already undoubtedly experiencing, of course). The list was long but seemed sensical enough.

Not ever having had to spread my legs to reveal my non-existent vagina to a gynecologist, it was much more difficult than I expected to place myself emotionally in the seat across from me. When you don’t have a vagina and have thus never had your vagina examined by a stranger, it’s incredibly hard to anticipate what will offend a patient and her vagina and what will be taken as a benign statement. Honestly, on paper, it really shouldn’t be that difficult, but when you’re nervous, and you’re of the opposite sex, and you’re examining someone’s genitals with seven female escorts scrutinizing you, and it’s a generally uncomfortable situation and would be even without the escorts, and literally the first interaction you have with this patient consists of inserting a clear plastic object with a mound of lube on top into her vagina -- well, that changes the game a bit.

I think I did okay, though. I was sweating profusely the entire time, which was both rather embarrassing and a bit cumbersome since my hands happened to be doing other assorted things at the time, but I managed not to get slapped by any party present (though I was insulted to hear that, despite having relatively large hands, my fingers weren’t quite long enough to perform a comfortable bimanual exam). The point of the exercise was not only to learn how to perform such an exam, but to learn how to perform such an exam while also conducting oneself professionally and to correct mistakes that one didn’t initially (or ever) realize one was making. And, despite my classmates’ aforementioned anatomy, we all made many, many mistakes, some of them repeated by every single one of us, giving me slight schadenfreude in that I wasn’t retarded in the absolute sense, just in the relative sense.

Then, it was over. I couldn’t tell you how to perform a gynecological exam today, nor would I want to do another before having a thorough refresher. But, the experience did teach me a little about how important it is to always watch what I’m saying to patients, how what we all say can often be misconstrued as offensive or off-putting, how ovaries are supposed to feel like walnuts and that I should just take their word for it if I can’t feel them, and how I should always use more lubricant than I ever thought necessary.

September 11, 2008 in Ben Ferguson | Permalink

Comments

What a hilarious and awkward post!

Posted by: Jared at The Doctor Job | Sep 11, 2008 11:21:35 AM

Great post!

I've been putting off scheduling my Pelvic Lab. But it'll have to be done within the next two quarters so this post got my interest.

Posted by: Jeff W | Sep 11, 2008 1:22:28 PM

Great post! I haven't heard the word vagina uttered so many times and so closely together since the vagina monologues. And don't worry about being nervous. As the proud owner of a vagina for some 29 years, I still sometimes get nervous about performing a pelvic exam on a stranger!

Posted by: Kendra | Sep 12, 2008 3:59:22 AM

Walnuts? Really? From the inside or out?

Posted by: Amanda | Sep 12, 2008 10:27:13 AM

We get to do these starting second year of medschool at my school (Jagiellonian University School of Medicine in English). You don'y have to worry about being so 'professional' because malpractice lawsuits are rare and uncommon. This provides the students with a handful of opportunities and an earlier understanding of clinical practice.

Posted by: Matt | Sep 16, 2008 1:06:27 PM

LOL!!!!!!!!!!! Too funny! And don't feel bad. I'm female and still felt super awkward when I had to do my first pelvic exam. To be that close to anyone's genitals (male, female, whatever) with people staring at you can only be described as traumatizing

Posted by: | Sep 16, 2008 1:16:26 PM

For our small group pelvic lab, one of the residents made the males in the group get up into the stirrups and scoot to the end of the table. Then she instructed them to, "Just relax and let your knees fall apart." She drove the point home by reminding them if they felt conspicuous now, imagine also being half naked. She then talked about professionalism and how vulnerable the patient can feel up on the table. She also talked about how we as doctors need to remember that no matter how many pelvics we do, recognize that our patient is, at the very least uncomfortable, to possibly very anxious and fearful; they always deserve gentleness and respect. Needless to say is was a difficult experience for the men, but nearly all of them appreciated the insight and lost some of the nervousness they originally felt.

Posted by: Elizabeth | Sep 16, 2008 1:47:46 PM

Lovely post and very instructive-it's always nice to see guys preocuppied about the comfort of the opposite sex!Thanks for being so open about this experience and for hihglighting its actual purpose,which is to accustom you to take into consideration the patient's emotional well-being throghout the examination.Reminded me of how uncomfortable I felt while performing my first DRE with people scrutinizing.
And to Elizabeth:"A very elegant approach by your resident!"

Posted by: Cristina | Sep 17, 2008 1:41:22 PM

hahahahahahahahahahaha! i just finished a crazy shift at casualty and you post just made me laugh!

Posted by: Trish | Sep 17, 2008 2:57:17 PM

I just had my first proper VE tutorial yesterday. It's awkward enough for me as a female but when my male collegue did it, i was sweating for him! I dont think he's seen a vigina before (apart from those plastic models)and he was extremely uncomfortable in that situation. But i think it is extremely important for us medical student to have these session before doing it on real patients.

Posted by: cyc | Sep 17, 2008 9:20:48 PM

Loved your post!!! I love the way you really care about the way your patient(s) may feel. I truly congratulate you because I think that's REALLY important about being a doctor.

I'm happy for you because you learned something today, not only about medical practice, but about work ethics and human relationships and I hope this experience can help you throughout your career and your future.

On the other side... Thank God you were among women... If everyone but the patient was to be male I think it would have been funnier since no one (except the Resident or the Attending) would know that much about a female anatomy. My best advice is that, politely as you stated it yourself, you try to learn from your female colleagues.

I'm a 5th year med school female student and since 1st year I've had male buddies asking me politely about this stuff, for the sake of learning, and I haven't felt awkward or anything so don't worry about it ^^

Good luck and keep up the good work! ^^

Posted by: Daloha Rodriguez | Sep 17, 2008 9:27:02 PM

great job.
you did not only took it as a requirement for completion sake but as a considerate doctor who believes in the patients' comfort and privacy.

i salute you for that.

as for the resident who did that to the guys, nice one but i suppose it was not necessary. good though.

keep it up.

Posted by: lhems | Sep 18, 2008 6:27:52 AM

have you ever tried obstretrical exams?

Posted by: naz | Sep 19, 2008 6:09:08 AM

hehehe. funny yet true!

Posted by: kinott | Sep 20, 2008 9:02:57 PM

LOL!!!!! I was also scared the first time i had to do a pelvic exam. In the room with me was my attending, a female classmate and the px. I was scared, but practice makes perfect. Besides, why should we feel so awkward? We're the ones giving the exam not getting it!!! Good luck bro

Posted by: ron | Sep 22, 2008 9:46:47 AM

Doing bimanual examination, so to palpate the adnexa seems easy when reading on books but on practice its not like that.

Posted by: Sva | Sep 23, 2008 1:04:36 AM

interesting to know it scares female students too. i would like to hear a male student testify. we start doing gynes and obs rotations in fourth year of med school and straigtaway start doin DVEs. generally its preferable with women who understand(multiparous)before attempting on others.males may become sexually excited but will never say that loud. consequences may be great. worse still no one addresses that question nor offers any help.

Posted by: Arnold | Sep 24, 2008 7:02:29 AM

Haha! Super-funny post!

This is what we (girls) feel like on Urology

Posted by: Linda | Sep 24, 2008 12:57:05 PM

LOL! This post is hilarious but no offense to the 'patient' Really!!!

Posted by: HRNg | Oct 1, 2008 1:17:35 AM

Calm down, We never know what we face in the future.
Someday u'll need that knowledge.
Just imagine, that lady is your wife/sister!

Posted by: Prihadi | Oct 13, 2008 1:42:37 AM

oh my god! that's too funny.. I'm finishing 2nd year in med school, I'm from maracaibo, venezuela. I loved the post, you know.. here in my city when med students tells experiences like that, always make a kinky twist hahaha.. and end up havin' a blast of it!
Don't worry even female doctors can feel awkward in that situation... no one knows what's in their heads!
xD

Posted by: yelainet rodriguez | Dec 6, 2008 8:35:02 PM

Really funny,Great!

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