My nurse helped the wife up onto the end of the exam table and sit down. The wife was a very nice looking woman. I looked at her chart and it said she was forty one years old.

I asked my nurse to start taking her vitals while I asked some basic questions. If she had any concerns? How were her bowel habits? Any chronic diarrhea or constipation? Black or tarry stools ? She looked at me like she couldn't believe I was asking her these questions. This was really embarrassing her I apologized but explained I needed to know it was important. She answered no to everything but the constipation she explained it wasn't chronic but she did get constipated. I asked her when was her last bowel movement? She looked at me with a red face and said two days ago. I told her not to worry about it we would check it out and I could give her something for it.

By the time I was done with the interview my nurse was finished with the patients vitals. I asked if she was ready to get started? She looked at me and shook her head yes. I explained I would do her physical the same as her husband's starting with her head and working down.

I told hers would take a little longer she had more body parts. This made her laugh. I looked over at her husband he smiled and nodded his head.

I asked my nurse for the ophthamaloscope and began checking her eyes. Then the Otoscope checking her ears. Before I checked her throat I ran my hands through her hair checking her scalp. Then I took a tongue depressor and checked her throat. With this done I checked the lymph nodes in her neck.

I grabbed my stethoscope and told her I needed to listen to her heart and lungs. I asked if it would be ok to reach inside the front of her gown. She nodded her head yes I reached in placing my stethoscope under her right breast towards her breast bone and listened. When I was done listening to her heart I asked my nurse to untie the gown exposing the patients back I placed the stethoscope on her back and told her to take a few deep slow breaths holding them and then releasing them. Her heart and lungs sounded good.

Everything was going good her husband just sat and patiently watched. I told her next I needed to examine her breasts, if she would lower the gown down around her waist. I would examine her breasts then I would have her lay back I would examine her abdomen.

She lowered her gown exposing her breasts. She had medium sized breasts her areolas were dark with small nipples her nipples were ridged but not fully erect but stiff. I began by using both my hands palpating her left breast this caused her to utter a low quiet moan. And her nipples to stiffen even more. Now both my nurse and her husband were watching very intently. I repeated the same process with her right breast this caused more quiet moaning and her nipples to stiffen even further.

When I was done with the breast exam I had her lay down on her back. I explained I was going to palpate her abdomen and if this caused any pain to let me know. I began right under her breasts and worked my way down towards her waist. When I got to the top of her pelvic bone I stopped.

I asked her to sit up and started to explain that next I was going to examine her genitals and her anus. I was also going to do a pap smear and a rectal examination.

I explained I needed to ask some questions. I asked about her periods were they regular? Any bad or smelly discharge? And then I just asked if she had all of her lady parts and were they working properly? This helped ease the embarrassment of these questions. She smiled at me and told yes she still had all of her parts and yes they were working properly.

I told her my nurse would help her lay back and if she wanted she could sit up in a inclined position? That way she could see my nurse and her husband. She said she would like that. My nurse got her positioned and in the stirrups. She got her bottom scooted down and exposed. Now I could hear her husband figeting around in the chair trying to get a better view.

I looked at my patient and asked her if she was ready for this? She looked at me and told me she was as ready as she would ever be. I looked at my nurse and asked her if she was ready? She looked at me and nodded her head.

I sat down on my stool and held out my hand the nurse offered me a pair of gloves. I put them on with a snap. I looked at my patient and made sure to make eye contact I asked if she was ready? I told her I was going to touch the inside of her thigh and then feel her labia.

I touched her iner thigh with my left hand and then gently pinched her labia between my thumb and forefinger using my right hand. Then using my thumb and forefinger spread the lips of her vagina exposing her clitoral hood, and the opening of her urethra, and the opening of her vagina. I visually examined her vagina noticing that it was unusually moist. Then visually examined her perineum noticing it was wet with slick liquid, I spread her buttocks and noticed her anus was damp as well. I couldn't help but think between watching her husband's physical and this happening to her that she had become sexually aroused. With the visual exam completed I was ready to do the pap smear.

I announced this to my nurse who handed me the speculum. I looked at my patient and nodded my head yes and she said go ahead. I gently placed the blades of the speculum against the opening of her vagina and slowly and gently started working the speculum into her. This caused her some discomfort but the natural lubrication was helping with this. I opened the blades of speculum with out causing a lot of discomfort. I noticed my patient was making eye contact with my nurse. The patients husband hadn't made a sound he was watching quietly. I visually examined the opening of her cervix and the walls of her vagina and then quickly finished the pap smear using a brush. Placed the brush in a contaminat free vial. As I withdrew the speculum I noticed there was a rather large wet spot forming on the paper cover under her bottom. I placed the speculum on the cart and quickly had my nurse lubed my fingers for the bimanual exam.

I informed the patient I was going to do the bimanual exam and began sliding my two fingers into her vagina. I watched her face for signs of pain, I saw her eyes roll back in her head and a small moan escape her throat. She eventually focused her eyes on my nurse and watched my nurse intensely. I took my left hand and began palpating her abdomen feeling for her ovaries. My patient layed still breathing heavily. Without saying anything I let my middle finger drop down and I slowly and steadily pushed it into her rectum to complete the rectovaginal exam. When she felt her anus get penetrated her eyes fluttered and she wiggled her bottom as to try to get away from my invading digit. Once this was completed I slowly withdrew my finger from her anus and then her vagina. She looked at me and asked am I done. I looked her directly in the eyes and told her no. Now I'm going to give you a rectal examination.

When she heard me tell her she was not done. She looked at my nurse as if to ask her instead of me. My nurse looked at her and in a soothing voice told her no you are not done yet the doctor needs to examine your rectum. She looked back towards me and asked me do you really need to. I explained yes I really needed to, especially if you haven't moved you're bowels in two days. This is not what she wanted to hear. She started to complain. This is when her husband spoke up, he had been sitting in the chair the whole time and hadn't said anything. I almost had forgotten he was there. He told her to stop complaining and let the doctor do what he needs to do. She looked at her husband and started to tell him. But I don't and then stopped mid sentence. He asked what were you going to say. She was silent for a second, then she said that she didn't want one because she didn't want anyone to see my finger after I pulled it out of her butt. Her husband looked at her and said WHAT! She repeated what she had said and then added. I saw the doctors finger when he pulled it out of your butt and it was GROSS! Her husband looked at his wife and in a calm voice told her to stop complaining and wasting the doctors time.

With this finally figured out I asked if she were ready now. She reluctantly replied yes I'm ready now. I changed my gloves and my nurse lubricated my index finger. I looked at my patient and placed my finger against her anus. My finger was cold and slimy causing her to flinch. My nurse told her to relax, she smiled at my nurse. I told her to bear down like she was trying to have a bowel movement. When she did this, a little gas escaped her anus, causing her some embarrassment. I told her to try it one more time. When I felt her anus push against my finger I pushed in fast.

When my finger pushed through her anus and past her sphincter she stiffened her legs and raised her bottom up off the table, grinding her hips back and forth, she sucked in a deep breath making a long drawn out ohhh! Her anus was very tight. Once my finger was fully inserted in her rectum, I could feel thick, hard stool. I believed her when she said she hadn't had a bowel movement for two days. With my finger buried in her rectum. I glanced up to see her face, looking to see if she was in a lot of discomfort. Her eyes were rolled back in her head and her mouth was open in an O shape. When I looked up I caught a glimpse of her vagina and couldn't help but notice it was very damp with arousal fluid her labia were slightly swollen and open. I could feel her anus start clenching, when I began twisting my finger working it deeper trying to feel the walls of her rectum. I couldn't feel any abnormalities, this was a little difficult with her rectum being so full and impacted with feces. I looked at my nurse who then new to get the occult blood test card ready. She grabbed it and held it out for me to smear my finger on. When I pulled my finger from the patients anus it slowly closed around the the tip of my finger. My finger was covered with dark thick smelly feces. My patient who was sitting up in the incline position saw my finger. She commented by saying that is Gross!!! My nurse who was looking at me just rolled her eyes and wrinkled up her nose. I quietly smeared my dirty gloved finger on the card and removed my gloves.

I looked at my patient and told her she was indeed impacted. She was still in the stirrups at this point. I told her my nurse could take her down the hallway to the restroom and give her a couple of fleet enemas, or my nurse could give her a glycerin suppository. She looked shocked no and said she didn't want either!! I told her she needed to do something? She asked me if I couldn't just give her something to take? I told her I could write her a prescription for a laxative. And if that doesn't work in twenty four hours she was to come back in, and we would help her out with this. She agreed, I told her my nurse would help her clean up and then help her out of the stirrups and she could get dressed and then her husband to walk up to the office.

My nurse and I were waiting in the office when they walked up front. I handed her a written prescription for laxative, and reminded her twenty four hours, and if it's not helping she needs to come back in. She looked at me and told me yes she would. Then she apologized for fussing about the? and then stopped, and said you know the? I said yes I know the rectal exam she said yes that. I told her not to worry about it everyone fusses. She smiled and her and her husband left.

By now it was almost noon I offered to buy my nurse who was now back to being my receptionist lunch.