In such a country, such control over the population might have more… nefarious intent, which I might expand on later. Suffice to say that there would be a significant amount of infrastructure required to manage these examinations. I’m envisioning lots of small local centres - one in city at least, and a more… specialised… tertiary centre in the capital city.

Going for one’s examination is an Event, not talked about much by those who have gone through it except in the vaguest, broadest terms. The government speaks of it as one of their great achievements in maintaining public health, and the people largely agree. Most 18-year-olds thus go willingly, or only under mild duress from their parents or teachers or siblings or peers.

Some don’t go willingly and are made to, by the authorities. This medical examination is not negotiable, and force will be used to ensure attendance. Abduction from the street might be an urban myth, but then again might not be.

The centres are pleasant environments, in the main. Separate to hospitals, but usually close by in case more specialised advice is needed. They’re modern, glass and concrete, broadly identical throughout the country. Attendees for the examination arrive at pre-appointed times and wait a few minutes in the lobby, drinking the litre of water that they’re given on booking in. They’re uniformly apprehensive, but every one working in the place is polite and pleasant and smiling and their nerves always dissipate a little before they’re ushered in behind a locked door to the medical suites.

They sit down with a nurse in a comfortable grey office to confirm the medical and dental records that have already been sent ahead by their primary care physician. There are more detailed questions as well, near the end when the patient is more relaxed and open and realising that this whole endeavour is in their best interests anyway.

Do you smoke? How much?

Do you drink? How much? Every day or just in binges?

Do drugs? What ones?

Are you sexually active? When did you become sexually active? With which genders? Vaginal? Oral? Anal? What are your masturbatory habits? Do you use toys? Use pornography? What about any fetishes you have?

The patient by this point is usually feeling too secure and relaxed to worry much about answering these questions truthfully, even if they blush. And the nurse is so nice.

The nurse finishes their questioning with a smile, always, and leads the patient into a small examination room, quite bare aside from an examination couch, a stool, a computer and a small covered trolley. They’re asked to undress, and but on the hospital gown that the nurse gives them, but are allowed to do so in private when the nurse leaves the room.

They’re inevitable sitting on the examination couch when the nurse returns with the doctor, who is always professional and jovial and makes a stupid joke that the patient always smiles politely at. The doctor goes through the procedure quickly, and the patient rarely listens, a bit distracted by the nurse taking their blood pressure and oxygen saturations and pulse and blood sugar with a little nip of a needle in the thumb.

Without the patient even really realising, the doctor’s hands are in motion, picking up the patient’s hands to examine them closely, running up their arms to the neck to press for lymph nodes, pulling down eyelids. A torch is shone in ears, in the throat, in the eyes.

The doctor listens to the patients back, making the patient takes enough deep breaths in and out that lightheadedness sets in. The dizziness doesn’t really abate as the nurse eases the patients shoulder down onto the couch so they’re resting at a 45 degree angle as their town is tugged down to reveal their chest. Girls sometimes instinctively act to cover themselves, but the nurse holds their wrists down by their sides if they try, gently and with a smile.

The doctor listens to their heart with them lying down, then on their side, listens sometimes for minutes. But they’re always eased back onto their back, the couch laid flat, the gown pulled even lower.

The doctor presses and presses all over the abdomen, firmer and deeper until it’s almost painful. Presses over the bladder until the patient is sure that they can’t hold their urine in any more- they can feel every drop of the water they were made to drink.

The nurse holds everyone’s wrists during this, gently and with a smile.

When the doctor is done pushing on the abdomen, they examine the breasts of the girls, palpating thoroughly, pushing and squeezing. And when the patient thinks that it’s done, the nurse lifts her hands above her head and the doctor does the same again.

Without the patient even realising it, the nurse affixes the patients wrists to the top of the bed, so they can help the doctor with the genital examination.

Sometimes patients get recalcitrant here, scream and struggle. No one pays any attention.

The gown is removed - it had been the only thing covering the patient and now they were completely naked. Legs are lifted - sometimes with difficulty in a more aggressive patient - into stirrups, and restrained.

The genitals of the patient are examined in great detail, internally and externally, with sounds and speculums. The anus and rectum are examined, and a endoscopic examination of the rectum performed.

The patients are invariably meek and exhausted, even if they had fought earlier on.

But the doctor remains jovial, and as the nurse unbinds the patient, they’re reassured that everything is a-ok and that they passed the examination with flying colours.

And they’re sent on their way. A little stunned, a little sore, and with the memory of it all fading quickly no matter how hard they try to hold onto it.

Except sometimes they’re not sent on their way.

For all it looks like the medical centres are just people doing their jobs, they’re actually watching the patients very very closely. They’re looking for… traits desirable to the State. From the very moment that the medical records are forwarded to the assessors in the examination centres, from when the patient arrives in the centre, they’re being watched closely.

For attitudes against the State, yes. Those people might find life puts up barriers in the future.

But also for intelligence, beauty, athletic ability. Signs of arousal with pain, with domination, with bondage… those too.

Those people won’t be sent on their way when their examination is done.

Those people will be taken, bound on the bed, into another room. One full of monitors and surgical lights, and people in scrubs who transfer the patient, always terrified, always kicking, onto a surgical trolley.

Wrists are restrained, ankles are restrained, a velcro band across the forehead to keep their head still. There’s a nip of a needle on the back of the patient’s hand, monitors attached, a mask forced over their nose and mouth.. It happens dissociatively fast, too fast for the patient to pay any attention to one thing, All they can hear is the thump of their own heartbeat, the corresponding beep on some monitor somewhere.

Then something burning and cool in the arm, and it all dr i f t s a w a y

Those people are taken for further investigation.