Physical Diagnosis 101

The course caught Lisa’s eye as she was registering for her Spring semester courses. It was a one-credit lab course open only to junior year pre-med majors. The course description was brief: Students learn to examine each body system by practicing on a partner under the professor’s instruction.

The student feedback on the course was that it was “really very interesting” and “extremely worthwhile” and that it required much less time than other one credit lab courses. It met for only 5 sessions. There was no test or term paper. The only requirement was 100% attendance.

The first lab session was Head, Eyes, Ears, Nose, Throat. The 12 men and 2 women gathered in the men’s lab. Lisa knew many of the students from almost 3 years of going to classes together. It was a small liberal arts college, and there were only a few dozen pre-meds in each year.

Lisa knew the biology professor, Dr. Walton, because he was their pre-med advisor. He explained how to use the ophthalmoscope and otoscope. He distributed a handout with the instructions on the instruments and the main findings to expect. They didn’t need the 3 exam tables at this session, and the men and women could stay together since everyone stayed fully clothed.

Lisa’s partner was Marian, whom she knew well from classes they had taken together. She peered through the ophthalmoscope at Marian’s retinal blood vessels, and she found the optic nerve. She put the otoscope in Marian’s ear canal and saw her tympanic membrane.

At the end of the lab session Dr. Walton distributed the handout for the next lab, which was Respiratory System. The students were expected to read and understand the material before the session. They were going to listen to breath sounds with the stethoscope and percuss the chest to listen for dull areas which could be fluid accumulation. Then they would use the spirometer to measure how quickly the subject could exhale.

For this and all subsequent sessions, Lisa and Marian were in the women’s lab, which also had 3 exam tables. The instructions for chest examination required removing top and bra. The women were very surprised when Dr. Walton came in to demonstrate percussion and the use of the stethoscope and spirometer. He seemed to ignore their bare breasts. The handout for the next session was Cardiovascular System. They were going to learn to take blood pressure and listen to heart sounds.

They did blood pressure first, keeping their tops on while they took each other’s BP in case Dr. Walton came in. They both succeeded in hearing the Korotkoff sounds and noting the BP reading when the sounds became audible and when they faded. They had to take off top and bra for auscultation of the heart. That was when Dr. Walton came in to show them the right places to hold the stethoscope to hear any mitral or aortic valve murmurs. He just worked around their breasts without seeming to notice them.

The fourth lab was abdominal examination. They felt the liver edge and the splenic edge. They percussed the height of the liver and listened to bowel sounds tinkling. At the end of the session Dr. Walton gave them the handout for the last lab. That was when the bombshell dropped.

The last lab was Reproductive System. The first instruction in the handout was “Each gender will provide a volunteer subject to be examined by the other gender”. They were shocked!

The girls went straight to the instructions for Female Reproductive System. It began with Standing Breast Exam to check for symmetry and retraction. Then Breast Exam Supine to look for masses.

For Female Genital Examination the subject moved to the bottom edge of the table and put her heels in stirrups. The stainless steel speculum was placed in the vagina, and each student looked at the cervix with the bright light.

Then the speculum was removed, and each student sat on the low examining stool and used the bright light to check for lesions of labia majora, labia minora, clitoris, urethra, and vaginal introitus. Each student finished by performing digital vaginal examination with 2 fingers.

There were 12 men in the course, and Dr. Walton would surely demonstrate the method personally. 13 men would be putting fingers in that volunteer vagina.

Lisa and Marian were in total shock. The first thing Lisa did was to look again at the student feedback on the course. Every one of the commenters was male. Now the girls understood the meaning of “really very interesting” and “extremely worthwhile”. If there were any women in the course, they were silenced by Dr. Walton’s position as their pre-med advisor. They needed his recommendation for their med school applications. They could not blow the whistle on him.

Lisa and Marian quickly decided who would be the “volunteer”. Marian’s virginity was a disqualification. Lisa was it. She notified Dr. Walton. He replied that the male subject who had volunteered to be examined by the women would be Tim.

Dr. Walton was very pleased. Lisa was the prettiest of all the junior year pre-meds – tall and slender with a wonderful figure. Marian was short and chubby.

What really tormented Lisa was that she knew most of the guys in Physical Diagnosis really well from being in classes with them for 2 and a half years. She had seen all of them at the first lab session, so she knew who was in this course.

Ryan had been her lab partner in freshman inorganic chemistry. Her lab partner for analytical chemistry wasn’t in this class, but Andrew and Brandon had been her lab partners for the two semesters of organic chemistry. Her biology lab partner wasn’t in this course, but Nick had been her zoology lab partner. She had spent many hours one-on-one with those 4 guys, and she also knew most of the other men fairly well from being in class together.

The one bright spot was that Tim was a transfer student, and neither of the women knew him well. They could examine him with much less embarrassment on either side.

The whole week Lisa was obsessed with thoughts of her 4 male friends examining her genitals as a laboratory exercise. She was burning with humiliation, and there was nothing she could do to stop it.

The day for that Reproductive System lab session came. Lisa and Marian arrived at the women’s lab to find that the extra 2 tables had been removed so there would be lots of room for the large group. There was now just one exam table, and it now had stirrups, placed wide apart. There was a floor exam light near the foot of the table.

At the appointed time Tim arrived. He was very tall and athletic, and very handsome. They each introduced themselves. Tim got undressed. He had read the handout for Male Genital Exam, so he knew what to expect.

The first instruction was about how to retract the foreskin. He was circumscized, so that wasn’t necessary with him.

Next was to measure the length of the flaccid penis. That was difficult, because Tim’s penis was already lengthening rapidly . Marian and Lisa moved on to measuring the fully erect penis. They got 23 cm, which is a little more than 9 inches!

Lisa examined his penis first. She checked the urethral meatus for any lesions, and she closely examined the whole length of his penile shaft. There were no sores of any kind. Just hard thick manhood.

She moved her hand to his scrotum to examine each of his testicles. She was surprised how large they were.

Then Marian did exactly the same examination of urethral meatus, penile shaft, and testicles.

The next instruction was for the subject to kneel on the exam table for prostate exam. Marian went first. She ordered him to spread his knees wide apart. She lubricated his anal opening generously with KY Jelly, and then she lubricated inside his anus. The instructions said to examine the prostate and check if there is any discharge from the penis.

Marian slid her finger into Tim’s rectum and felt along the anterior (front) side until she came to the firm walnut-size prostate. While she was examining his prostate she held the end of his penis with her other hand to check for discharge.

Lisa took Marian’s place and slid her finger into Tim and examined his prostate. His penis became gloriously huge as she cupped her hand over the penile head. There was no discharge.

When Tim was all dressed, Lisa asked him to stay for another few minutes. She wanted Tim to be the first one to see her genitals. She had seen his genitals. In her mind, that made it easier to bear having the others see her genitals.

She wanted Tim to watch her undress. She looked at his eyes as she took off her bra and panties.

Lisa needed Marian to lubricate her vagina before the exam so that all those fingers wouldn’t hurt her so much. She asked Tim to observe.

Marian moved the lever that folded down the foot end of the table. Lisa lay with her feet in the stirrups as Marian adjusted the stirrups to make sure she was well positioned. Marian spread Lisa’s labia and filled her vagina with lots of KY Jelly. She checked to be sure Lisa was all slippery inside. Marian turned a knob that raised the head of the exam table so Lisa could see Tim standing between her thighs. Lisa needed to be able to see who was examining her.

Then Lisa got off the table and put on the pink cloth examination gown. Marian restored the foot end of the table to flat position.

Tim left the room to rejoin his lab team. They had been doing the male exams on each other.

Before the men started from the men’s lab to the women’s lab, Dr. Walton warned them that there was to be no conversation of any kind in the women’s lab. Anyone who talked would have to leave immediately.

Lisa watched the doorway as the men entered the women’s lab, led by Dr. Walton. Nick, Brandon, Andrew, and Ryan were all there along with the 8 other male students. They arranged themselves in a semi-circle so that each had a front-row view.

Dr. Walton followed the instructions in the handout. He told Lisa to put her gown on the chair. Then she had to stand with her hands on her head for the Standing Breast Exam.

He instructed the students to check Lisa’s breasts for symmetry and look for any irregularity of contour. They also needed to be sure that both nipples were everted normally.

Dr. Walton allowed a long time for this. Lisa looked at the eyes of the 13 men who were staring at her breasts and at the rest of her naked body. This was going to be the most humiliating hour of her life.

Lisa was even prettier than he had expected. He was pleased at how well she had shaved off her pubic hair. That was going to make displaying anatomy in the genital exam much easier.

Next Dr. Walton had Lisa lie on the exam table with her hands near her ears. Marian took up her position near the head of the table to give Lisa emotional support.

Dr. Walton invited Team 1 to be first to examine her breasts. He demonstrated the method of pressing the breast tissue against the chest wall with two fingers to feel for any mass lesions. The breast exam was completed by squeezing each nipple to check for discharge.

Each of the four guys had his turn to examine her breasts. Lisa watched the face of each one. They seemed to look serious as they were examining her breasts. Nick was in this group.

Andrew was in Team 2, and Ryan and Brandon were in Team 3. Her breasts were feeling tender after being examined 13 times.

Dr. Walton announced, “Now we will proceed to perform the genital examination”. Marian was intending to spare her the indignity of having Dr. Walton spreading her legs, but Dr. Walton took over before she could do anything.

He instructed Lisa to “scoot down to me”. Lisa slid down the table so her bottom was at the edge of the exam table, and Dr. Walton helped Lisa get her feet into position in the stirrups. “Scoot a few inches more”. Dr. Walton moved the lever that let the foot end of the table fold down. Lisa’s vagina was perfectly positioned a few inches past the edge of the exam table. He placed the big bright exam light to illuminate every detail of her genitals.

The dozen men crowded in as close as possible to the foot of the table to see everything between Lisa’s spread thighs. Lisa looked at all the eyes staring at her most intimate parts.

The men had all memorized every detail of the instructions in Female Genital Examination handout. They didn’t need to use it for reference. They were all eager to do it themselves.

Dr. Walton was standing out of the way, next to the head end of the table. Lisa saw that he was holding a stainless steel speculum bigger than the one her (female) gyn used. He was going to lecture the students before they examined her.

“This diagnostic instrument is a ‘vaginal speculum’. The walls of the vagina are normally together. The speculum holds them apart for examination. The examiner inserts the speculum in the closed position because the narrowest part of the vagina is the entrance, called the ‘introitus’. After the speculum is inserted to the full depth of the vagina, the examiner opens the speculum inside her. It spreads the walls apart for examination”. He demonstrated the open position of the speculum.

“Lisa is in a special position for examination. It is called ‘lithotomy position’. Most men know nothing about it. Most women are very familiar with this position even though they don’t know its medical name. It is the position women are in every time a doctor examines their genitals.

“The lithotomy position rotates the vagina from pointing downward up to horizontal. That allows use of the speculum with the examiner sitting on the low stool and looking straight ahead into the vagina. The raised angle also improves visualization of the external genitalia.

“I will insert the speculum just once, and you will all take turns sitting on the examining stool and looking at the cervix at the far end of the vagina. You will also examine the walls of the vagina as displayed between the blades of the speculum. Don’t move the speculum – it must be closed before it is moved.”

Dr. Walton lubricated the speculum and moved the low examining stool between her thighs. The men watched closely as he spread her labia to expose her vaginal introitus. Slowly he inserted the speculum all the way into her vagina.

Lisa felt the stretching at her opening, and then more stretching inside as he opened the speculum. There was a click when he locked it open.

He used an examining flashlight to adjust the speculum to visualize her cervix, and he had the students line up to do the same. Each of them took a turn looking into her vagina using the flashlight to see her cervix and the ridges on the pink vaginal sidewalls. Do you see any redness or elevations?

Now came the last and the longest part of the Female Genital Examination. Each student was to do his individual exam of her external genitalia and then a digital internal examination with two fingers. The instructions said to be sure to feel the cervix.

Team 1 was first, and the first student in line was Nick, Lisa’s lab partner in zoology. Her worst nightmare was coming true.

Dr. Walton demonstrated to Nick how to spread her labia and where to find her vagina opening near the bottom, the clitoris near the top, and the urethra in between. Then Nick went to work examining each part in detail.

Lisa knew how meticulous Nick had been when they were dissecting the guinea pig together. Now Lisa herself was the guinea pig, and Nick was studying her anatomy as much as he wanted.

After an eternity Nick finished with removing his 2 fingers from her vagina, and the next student took his place. Again Dr. Walton demonstrated how to spread the labia and where to find the organs.

The process was repeated until all 12 students had had their opportunity. Andrew was in Team 2. Brandon and Ryan were in Team 3. Lisa was totally humiliated that her male classmates had examined her genitals so intimately.

Dr. Walton thanked the male students for their patience and declared the lab session completed.