Notes from the vagina

As I've written in the not so distant past, my pelvic exam experience was not as traumatizing as I had predicted it would be...irreparably scared for life, yes, but I have gained a lot of respect for the vagina and female pelvic exam models. I'll also say that I cannot conjure a more awkward than three guys sitting around a woman in the lithotomy position in a small exam room while another woman explains the finer points of her...ahem...anatomy. Completely in role play.

Here's some of the more interesting feedback points that I received from my lovely teacher Fay (who liked to be called Faymous...and had a pretty sweet tat across the left side of her abdomen) and my silent mental responses:

-Please put your thumb down-
"Sorry! Apparently when I'm nervously prodding around a woman's privates for the first time with 4 people observing me I lose track of where my digits are..."

-You don't have to press quite that hard-
"Sorry! I'll be more gentle...I don't know that you were so sensitive down there, I barely moved my finger. I guess the wince of pain was my first clue"

-Push harder-
"But didn't you just say softer? I'm so confused"

-Pull down from your shoulder, not your arm-
"I don't know what that means!!! This is my first time using this medieval torture implement"

-Stop being so polite, look down there not up here-
"Sorry, you're the one that keeps talking to me. My mother taught me to look at people when they're talking, not to stare at their vagina!"

-You had good technique with that walking motion, you might need use that on a woman with a larger clitoris-
"I just had a vagina instructor compliment me on technique...I am the most awesome clitoral inspector ever! I have reached a new low in my life, I shall tell no one"

-You'll notice that there's some cervical mucous and some red pigmentation, that's normal since I'm pretty much mid-cycle-
"Don't gag, poker face, poker face...it kind of looks like someone sneezed on your cervix...don't gag, don't laugh...poker face. "

-What would you say to a woman who is sitting something like this? (knees close together)-
"How do I say spread your legs without saying spread your legs? Uh, uh...I have to ask."

-Make your sweeps bigger-
"size does matter...poker face"

-Faster!-
"hehe...not the first time I've heard that...PROFESSIONALISM!!!"

-You were very gentle and it wasn't entirely an uncomfortable experience once you made your movements smaller-
"Thank you??? My confidence has increased at least 0.5% because of your backhanded near-compliment."

-You did a good job of making words into plain English, not too dumbed down, not too complex-
"Sweet, that's what I go for...can I leave now instead of watching the other guys violate your womanhood? No? Ok...I'll just watch sweaty guy and overly confident guy who did this last year, but failed pathology violate you. I feel dirty being here. Maybe if I stare at the poster on the wall behind her it will look like I'm paying attention. Stop calling my attention to your vagina...No I was just all up in there, I don't need to see your cervix again I don't think it has changed in the past 7 minutes...fine I'll feign interest"

GYN/Breast and GU/Rectal exams

So I've got one of the aspects of medical school that I have dreaded to this point coming up in a few days: The GYN exam. I've seen a few pelvic exams and even with the most experienced hands, it's an unpleasant prospect for the patient as well as the examiner. Appropriate to nothing, our chapter of AMWA just put on their performance of the Vagina monologues, which only adds to the comedic fodder/anxiety that I'm going to experience.

It's not so much the vagina that creeps me out, it's the fact that I have to insert portions of my body into portions of someone else's body that have until this point in my life only been broached from an extracurricular/recreational angle. Not only that, but I'm probably going to have to have my face far too close for comfort fairly close to a complete stranger's vagina, inflicting the torture that is the duck-billed speculum and cervical swab. And then this poor lady has to endure the entire line of medical students serially going through the same horrible exam. I feel really bad for the patient having to go through the discomfort of us clumsy students clumsily poking about in her nether regions. At the same time, I find the cervix is one of the most repulsive and horrifying places that I have ever visited in the human anatomy (although that opinion is heavily influenced by ED patients and you can only imagine the state of hygine of someone who presents to the ED with "purulent discharge" for 3+ days).

To be fair, I'm equally put off about having to poke around some dude's wedding tackle and then place my finger into his rectum. The poop chute is meant as an exit physiologically, and anyone that's willing to get paid a couple hundred dollars to have a bunch of strangers insert their gloved fingers into his chocolate starfish is suspect in my book. I think the most painful aspect will come from the referred pain of having to check for inguinal hernias by following the path of spermatic cord up through the inguinal canal with my finger, a maneuver the requires inverting the patient's scrotum up to the level the inguinal canal and having him cough...ouchie I'm getting shivers just thinking about it.

All kidding aside, I have to thank these people for their willingness to volunteer their bodies and the opportunity to learn from them because they save us from having to train on each other. I personally don't want any of my classmates going near my anus with their knobby little fingers. So thank you, and to show my appreciation, everyone gets two packets of surgilube on whatever is being inserted into their bodily orifices!

Open Wide...

We've had a few lectures in our Physical Diagnosis class in the past week. The first year Oral Surgery residents (dentists) are required to attend these classes since they have no real experiences in physical diagnosis outside of staring into the mouths of patients. I can see some of the material being useful for the general assessment of a patient, especially the head and neck portions of the exam!

What I don't see is how the GU, breast and rectal exams have ANYTHING to do with oral surgery...it gives "Open wide" a whole new meaning