The first time I did a pelvic exam on a real patient, that patient was also my instructor. In the exam room, a bathroom and hospital gown draped the upright exam chair; and staring straight at me hung a laminated photo of the external female anatomy. The paper towel, speculum and two bottles of lubricant had been arranged perfectly on the counter. Another medical student and I had three hours to spend with our educator, someone who was not an M.D. or a med school professor, but rather a professional who has been trained in how to teach about her own body.
“Hi, my name is Liz and I am your educator today. I’m going to walk you through how to do a pelvic exam, which you will do on my body. I’ll guide you through the entire process.” At this point, I felt nervous in my chest. I had read the curriculum pre-notes before the session but had no idea what I was supposed to do once my hand was in the vagina.
After Liz gave us a quick overview, we entered into the portion of physically conducting the exam. “First, you’re going to inspect my external genitalia. Tell me what you see.” She instructs me to cinch the center of the white cloth draped over the lower half of her body and hand her the bunched-up cloth. Here I am, eye-level with her vagina, the educator slightly elevated on the examination table such that she can follow my actions.
Awkwardly, I began to describe the anatomical features, the distribution of hair, any signs of a rash or redness. I felt self-conscious that my patient could hear my observations of her own anatomy described in highly medical terms. She seemed unfazed, though, and expanded on my words.
“In fact, if you look here, this patient had a Brazilian wax and what might be mistaken for an ingrown hair or a cyst. If you see this, palpate the area and ask the patient about any recent changes to their body.”
Liz described herself as “this patient,” which at first made me feel confused. Why didn’t she just use first person pronouns? As the encounter continued, I began to see why. The language allowed herself to separate the two roles of educator and patient. She, the educator, could tell me from a professional standpoint how to accurately and effectively examine the anatomy. She, the patient, could also give me real-time feedback on how to make her more comfortable and what hurt and didn’t hurt.
“Now you’ll go ahead and palpate, making concentric circles to feel for any masses. Then you’ll trace down the labia majora and the labia minora until you reach the introitus, making a piano key–like motion.”
As I placed my hands on the educator for the first time, I realized how this was the first time I had encountered female anatomy from a purely educational standpoint. The interaction was clearly not sexual. It was not personal. I only felt extreme gratitude she would allow medical students to learn from her body.
“Should I take my hand out while you’re answering my questions?” I asked. I felt strangely uncomfortable talking to her with my hand inside.
“No,” she stated, “it’s totally fine.” My fingers sat in her vaginal canal while she gave extensive answers and feedback, often for five to 10 minutes at a time.
As we moved on the speculum portion of the exam, my fear of causing her any discomfort was quelled by her calming tone. She knew her anatomy. She knew how to guide students to find different anatomical landmarks. The death trap of a speculum somehow made it to its place, but I still couldn’t locate the cervix. I tilted the speculum 10 degrees to the right, still trying to visualize the cervix, when Liz declared, “One thing to note is not to move around in there like the speculum is a telescope.”
“Ah, I’m sorry if that hurt.” Liz shook her head denoting that it was okay. “On the flip side, I did find your cervix!”
She immediately broke character. “WHAT? No way. Wait, let me see!” She pulled up a mirror to look at her own cervix. “Students often have a really hard time seeing my cervix, so I never get to see it. Good job, you go girl!” She quickly remembered how she had to be in professional character, and gently switched back to a confident, but beaming, tone. We both smiled.
And that was the moment.
Up to that point, medical school had been: Physician dumps information on students. Physician brings in a patient. Patient gets stereotyped as “the one with this certain disease.” Rinse-Lather-Repeat. The patient and the teacher were roles held by different people. Yet this was the first time I had seen how merging the roles of patient and teacher into one could equalize the playing field, opening the door for a more meaningful doctor-patient relationship. It requires a trust for the patient, trusting that patients know their body best—something not always acknowledged in the practice of medicine today. The opportunity to build that trust happens every time a patient walks into an exam room and the doctor is willing to listen. And from what I’ve learned administering my first pelvic exam with Liz, that can make all the difference.