Title: The Gynecologic Examination Keywords: MF, tort, gyno, medical, humil Author: SubSophie Summary: A chapter from the textbook of twisted gynecology for the evil gynecologist describing how to perform a gynecologic examination to cause the most distress, discomfort, humiliation and pain. THE GYNECOLOGIC EXAMINATION In this chapter we shall cover the conduct of the gynecologic examination from the introductory words to the patient through to its conclusion. This is a very important part of the gynecologist's work and it is vital that it is conducted according to the correct protocol. Patient preparation The examination of the female external genitalia is never a pleasant process for any woman and most approach it with some degree of trepidation. The reasons are not too difficult to understand given the very private and intimate nature of the part of the body being examined and the fact that the examiner is almost always male. A woman is only really comfortable with her lover seeing her vulva, and even then usually only when her inhibitions have been reduced by sexual arousal. It is important for the gynecologist to capitalize on this anxiety and embarrassment and make the examination as unpleasant and humiliating as possible. This can be started with the doctor's opening remarks. From the moment the patient enters the consulting room it is important to instil a sense of apprehension and anxiety in the patient. If it is her first visit to the gynecologist, she will be especially nervous and tense. Tell her right away that there will be no chaperon present and that a comprehensive and invasive investigation will have to be made. It is important to maintain a stern a threatening expression at all times and to avoid smiling or offering any encouraging or supporting words. You should also explain that what you have to do will be uncomfortable and painful for her. Once the scene has been set, the patient must be asked to undress. Rather than merely removing her undergarments (which allows her to maintain some dignity and modesty) she must be instructed to undress completely. Do not provide her with a screen for this purpose, she should be allowed no other option than to undress in front of you. As she does so, you should comment adversely on her appearance by mocking her fashion sense, make up etc. Once she is completely naked, you should look her up and down in a derisory fashion and make insulting and offensive comments about her body. Women are acutely sensitive to this sort of treatment and it is therefore a highly effective way of upsetting her. It is especially important to comment on her breasts (too small, too flaccid) and her pubic area (ugly, too hairy etc). It is also a good idea to laugh at her as you do so. She should then be told to mount the examining table and position herself with her legs in the stirrups exposing her genital area. She should be securely fastened to the table at her ankles, legs, wrists and waist. If she protests, you should explain that it is a hospital regulation that patients be restrained during examination to prevent them falling off the table. Once she is in position on the table, it is worth opening the door to the examining room and leaving it open. This has the effect of reducing her sense of security and privacy even further and sends a clear message that her modesty and rights are of no importance. This is especially effective if your consulting room is in a busy hospital or university medical centre as there will be a constant flow of people passing the doorway. Ideally, the examining table should be oriented with its foot towards the doorway to allow any passer by a clear view of the patient's vulva without even needing to enter the room. At this point, you should inform her that you are going to make a phone call or a cup of coffee and leave the room. She must be told to remain in position until you return. This is most upsetting for the patient as she is now completely naked and in a very exposed and vulnerable position with the door open and no one else in the room. She will be extremely anxious in case anyone should enter the room during your absence. If possible, it is well worth informing the non-medical male staff in the hospital (porters, electricians, chefs, cleaners etc) that your office is open to them at any time should they wish to drop in and see any of your patients. Such an invitation is usually accepted enthusiastically. Instrumentation It is important to lay out every instruments you have on a trolley in full view of the patient. Even if you only intend to use a small number of them. A clinical trolley stacked with a large number of gleaming, surgical instruments is a fearsome and intimidating sight for a young, naked woman whose sexual organs are vulnerable and exposed. The choice of speculum size is important. This should always be one or two sizes larger than would normally be considered appropriate in order to be as uncomfortable as possible when inserted. In addition, a four blade retractor should always be available as this is able to produce much more dilation of the vagina than a normal speculum. A range of probes, seekers, needles and scalpels should also form part of the instrument set, as should alligator clip electrodes and a high voltage stimulator capable of delivering a variety of waveforms. A diathermy or electrocautery system should also be available for precise burning procedures. Alternatively, a soldering iron will suffice for this purpose. Procedure You should start the examination by close inspection of the external genitalia. Part the labia and inspect the vestibule and vaginal introitus. As you do so, be sure to comment on the offensive smell emanating from the patient's vulva, even if (as is usually the case) there is none. You should criticise her poor personal hygiene and tell her how unpleasant she has made the examination for you. This is extremely humiliating for the patient, all the more so because virtually every woman will have scrupulously washed her entire vulval area prior to the examination precisely to avoid such comments. Her sense of injustice and indignation will greatly add to her overall discomfort. You should also take numerous photographs of every part of her body with a macro medical camera. Do not ask her permission before you do so. If she questions the necessity for the photographs, assure her that there is no medical justification whatsoever, but that you have a personal collection of them at home for use as masturbatory aids and to share with your drinking buddies. You might also intimate to her that they will be posted online clearly identified by her name, address and place of work. At this point you might also like to shout out to the corridor to summon anyone who might care to look at the patient or take their own photographs on their mobile phones. Insert a speculum into the patient's vagina without prior warning or explanation. Ensure that it is as cold as possible (immersing it in a bowl of iced water beforehand is recommended) and make sure it is much too large for her (as above). You will have difficulty inserting it, partly because of its size and partly as a result of the involuntary contraction of her vaginal sphincter caused by the cold metal. In order to overcome this difficulty simply push harder until the resistance of her vagina gives way. As you should do so you should express your exasperation and impatience. Open the speculum as fully as possible ignoring any cries of discomfort from the patient. If you have one available, a four bladed retractor is to be preferred as it can produce extreme dilation well beyond what is comfortable or natural for the patient. As you inspect the interior of her vagina, you should express grave concerns to her about the condition of her internal organs suggesting that severe problems exist which will need major surgical correction. It is worth inserting a very large sized sound into her cervix and pushing it well into her uterus as this is acutely uncomfortable and distressing. Similarly, her urethra should be thoroughly probed and stretched with over-sized instruments. It is now time to concentrate on the most important area of the patient's genitals; the clitoris. The exquisite sensitivity of this tiny organ makes it an ideal candidate for harsh treatment. It should be explained to the patient that you have found some clinical signs of disease which indicate immediate treatment which will be extremely painful for her. If she requests pain relief or anesthesia, explain that you have no anesthetist on duty, so she will just have to be brave. Start by retracting the prepuce to expose the glans. You should then scrape the surface of the glans with a seeker or blunt needle. This is sure to produce a protest from the patient, but you should persist in jabbing and scratching the tender tissue. The glans should then be firmly gripped with a pair of artery forceps which are then tightened to the furthest notch. This will produce extreme compression of the clitoris which will become quite white and bloodless as a result. Releasing the forceps after a minute or so will produce even more pain as the blood supply is restored. You should then attach an alligator clip to the clitoris (connected to the positive terminal of the stimulator) and another to her labium majora (connected to the negative terminal). Power up the unit and deliver a spupramaximal stimulus to the clitoris using a variety of different waveforms to vary the effect. Generally a sawtooth wave is the most painful and voltages of several hundred volts should be applied. After electrocuting her clitoris for several minutes after which she will be in very considerable pain, you should proceed to insert needles into her clitoris. These can also be attached to the electrical supply for a much better flow of current which reaches all the nerve endings inside the organ itself. Finally, the electrocautery probe (or soldering iron) should be applied to the clitoris to produce second or third degree burns and eventually painful blistering. This should ensure that the patient suffers considerable discomfort for several days afterwards. Clearly the individual practitioner will be able to devise his own set of favourite procedures, but the above serve as a good introduction to the subject and a reliable basic set of techniques to ensure that your patient will have an extremely painful, humiliating and distressing experience.