My name is Andy, I'm 50, male and live in San Francisco. I do thorough, gentle pelvic and rectal exams, specializing in some particularly creative "special procedures".

I prefer to get to know my patients and their proclivities and preferences before an exam. Following is a narrative of an examination that I performed on a woman named Jill (not her real name), a 42 year old attorney from Los Angeles recently in the Burbank Hilton Hotel. I use it to describe me and my bedside manner.

I explained to Jill that her new firm had ordered a very thorough physical examination that would include a complete pelvic and rectal exam. While she seemed to feel slightly apprehensive she readily gave her consent.

I asked Jill to completely disrobe and put on an cotton exam gown for me with the opening in the front. I then left the room while she disrobed.

Upon returning, I asked Jill to sit on the edge of the examining table while I took a brief history and got a few vitals: blood pressure (a bit high), pulse (a bit fast) and respirations (normal).

I had Jill open her gown for the breast examination as she sit on the table. I carefully but firmly palpitated each quadrant of each of her breasts, starting with her arms at her side. Using one hand to cradle her breast and the other to do the examination, I worked my way around the circumference of each of her breasts. I then repeated the same examination with each of her arms placed behind her head in turn. After a through exam of her breasts, I asked her to lay back on the table, relax and place her hands behind her head.

As she complied, I opened her gown, exposing her entire body to view. I saw a light blush flash across her face; but, of course, said nothing.

The examination of her breasts continued including a very careful check of her nipples, starting with me carefully, but firmly, pressing with the tip of my index finger on her areola, first at the 12 o'clock position, then at 1 o'clock position and so forth until the entire circumference of each nipple had been gently expressed and thoroughly examined.

Next, her nipples were gently, but briskly, rolled between my finger and thumb. The room was cool but comfortable and I immediately felt her nipples becoming erect as they were gently pummeled; again, I made no comment even though Jill began to squirm slightly on the table. Noting her reaction I lingered over this portion of the examination until Jill's nipples had become rock hard and noticeably erect. When I had finished, I told Jill that I was ready to perform the pelvic exam.

I asked Jill to place her feet in the stirrups, to slide her bottom down to the very edge of the exam table, to try to relax, to let her knees fall apart and to just breath normally. Jill was completely exposed before my gaze. I quietly noted a slight blush in Jill's cheeks; but, of course, proceeded without comment.

Next, I explained that, for the sake of a thorough examination, I was going to prep her by shaving her pubic and peri-anal areas completely. As I told her this, I placed a warm, moist towel over her genitalia to soften the hair and gently began a light massage of the area. I could tell that Jill was to relax and enjoy this; so, I took my time.

After the application of several, progressively warmer and warmer towels and more light massage of the area, I pulled my stool into position between her open legs, turned on the exam light, removed the warm towel and......

with a small battery powered shaver began to systematically remove most of her pubic hair. As I finished, I noticed that her naked vulva were becoming engorged. Apparently, the vibration from the shaver had an arousing effect on her; so, I tarried on this part of the prep as well. However, this time, I not only took note; but, also mentioned it to Jill. I assured her that women often become aroused during this procedure; but, assured her that it was nothing to be embarrassed about. Jill seemed to relax visibly and her demeanor became more open and expressive. As I mulled this over, I turned to the instrument tray......

and retrieved a safety razor, a pan of warm, scented water and some shaving cream that I had warning in a basin of hot water. I began to gingerly apply the warm shaving cream to her mons. Jill's hips began to move. The pace was deliberate but leisurely.

Once I had Jill thoroughly lathered, I began to carefully and completely shave her entire crotch including her peri-anal area. She obviously found the procedure exciting; the signs of self lubrication were evident; so I took the time necessary to make certain that every last trace of her pubic had been removed.

When finished, I patted her dry with a clean, warm, towel and gently applied a soothing sparingly to the area around the openings of her vagina and anus in a languid, sensuous manner. The view was delicious and Jill was now very wet. Her crotch was as smooth as a peach and about the same tawny, blush color with a very slight sheen from the cream that I had applied. Jill later told me that the sensation during the depilation was "wonderful".

Next, I re-gloved, as I warned Jill that I was about to begin the examination of her external genitalia. I promised to be gentle and to explain everything that was about to happen before I actually started. As I explained the external exam, her labia were very gently spread apart and very thoroughly inspected both visually and manually by my probing, gloved fingers. Again, her state of arousal was apparent. I lingered over this part of the examination, too. After a few minutes of this, I gently spread the opening of Jill's urethra with my gloved thumb and index finger and performed a thorough visual examination of the wide open orifice. I then informed Jill that I'd like to check her responses to some light stimulation of her clitoris. This seems to have surprised her; but, she made no protest, so I proceeded.

With that, I retrieved a small stainless steel instrument from the instrument tray that looked something like a small spoon with a hole in its middle. I explained what I was about to do and then, with my gloved left hand, I carefully surrounded Jill's clit with the instrument and depressed the area around it. This gently stripped back and held the hood of her clitoris. The bud of her clitoris stood proud, turgid, erect and naked. With my right hand, I selected one of several long handled artist's sable brushes. It's bristles where extremely soft, thin and long. These bristles had been resting in a small droplet of KY lubricant on the instrument tray. With this brush I began to slowly and with exquisite care, circle the base of Jill's clit using just the tip of the long soft bristles. I had to caution Jill to lay still several times over the next few minutes as I worked from the base of her clit to it's tip. Her breathing came in short little gasps. As she acclimated to this stimulation, I began to slowly, thoroughly, steadily massage her clitoris in a circular motion with the tip of my gloved and very well lubricated index finger. My manner was easy and unhurried.

Jill gasped. Her breathing became heavier. I glanced past her heaving and engorged nipples, looked into her face and just then, she had a convulsive orgasm after which I proceeded to palpitate Jill's Bartholin's glands at the 4 o'clock and 8 o'clock positions of her vaginal opening with my gloved and lubricated thumb and index finger as Jill regained her composure. This must have felt good; but, nothing like what had just happened.

When I finished with this part of the exam, I turned to my instrument tray and produced a metal speculum which had been warming in a pan of warm water. I tested it's temperature by clasping it between my hands for a moment. Once certain that it was almost exactly body temperature, I gently inserted the warm speculum into Jill's wet vagina in one smooth motion. It slid right in with no additional lubrication because of her highly aroused state. I immediately inserted a gloved and well lubricated index finger through the speculum before turning the handle into the traditional 6 o'clock position for the internal exam and began to firmly massage the ventral (top) surface of her vaginal canal about two thirds of the way in with a strong, slow, back and forth motion of the tip of my slightly crooked finger. I explained that this was another check of her response to stimulation as I looked up at her. I asked her how it felt but she just stared at me with half closed eyes and said "good, don't stop". No sooner have the words left her mouth than I stopped and turned to my instrument tray again.

From it, I produced a long, slender plastic device with a tip that looked like a bullet. She must have immediately realized that the device was a vibrator. Without saying a word, I also retrieved a thick, un-lubricated condom from the instrument tray, rolled it down over the shaft of the vibrator, applied KY jelly to the tip, inserted it through the speculum and began to work over the same area as before with slow, firm circular motions; but this time the powerful vibrator brought her an almost immediate and roaring climax.

As she climaxed our eyes meet and, despite my attempts to maintain a professional demeanor, I think that Jill could discern signs of my enjoyment.

After she again regained her composure and as her breathing and heart rate returned to normal, the speculum was rotated to the correct position (six o'clock) for the internal exam and a pap smear was taken with a long sterile swab. As the tip of the swab just penetrated the os of her cervix, it was rotated. Jill later told me, she was a bit surprised by just how good the procedure felt. This was due to the intense orgasm that she'd just experienced. Her cervix was deep pink, completely relaxed and her os was slightly dilated. When I finished with the pap smear, the speculum was gently removed. I re-gloved. Jill probably wondered what could be coming next........

As I slid a well lubricated rectal thermometer into her quivering bottom, I informed Jill that I was about to perform a digital rectal exam. I asked if she'd ever had one before as I held the thermometer in position. I was surprised to hear her say no; but she may have said so just to hear the explanation of the procedure. I removed and read the thermometer as I explained that I would start by inserting a gloved and lubricated finger in her rectum. No sooner has I said this, than I had the tip of my gloved and well lubed index finger poised at her sphincter. I carefully spread the cool lubricant around here anal opening in a circular motion and paused for a few seconds as her anticipation built. I then asked her to take three deep breaths, hold the last one and bear down hard for me.

As she bore down, My finger began its slow but relentless invasion or her rectum. I asked her to relax and to exhale slowly. As she did so, I steadily, inexorably advanced my finger, deeper and deeper, as I twisted it back and forth slowly to aid its entry. After a few seconds, my finger was buried all the way to the knuckle.

A leisurely, examination of the internal surfaces of Jill's rectum followed with special attention being paid to the ventral aspect, an area which allowed my finger tip to touch and massage Jill's "G" spot right through the wall of her rectum. Jill's legs became ridged and her hips began to move again. I could feel her sphincter opening and closing involuntarily. Jill mentioned later that this part of the examination felt like an intensely arousing internal massage.

After a few minutes of this, I finally had her press down as if to expel my finger and, as she did so, I very slowly withdrew my finger. When this is done, the sensation is bizarre, somewhat like having a bowl movement; but, it is not at all unpleasant. Without a pause, I re-gloved and lubricated both my index and ring fingers liberally and without a word began to work my index finger into her vagina while simultaneously working my ring finger into her rectum for the recto - vaginal examination. Jill's hips started to move again, so I spent a fair amount of time palpitating her abdomen and moving my fingers around inside of her. She certainly seemed to have no problem with the leisurely pace of this part of the examination. Her arousal was becoming quite evident again.

After Jill's gynecological work up (which I noted that she seemed to enjoy thoroughly), I informed her that I thought that it would be prudent to do a complete rectal examination, as well.

Although I could tell from the expression on her face that no coaxing or explanation would be necessary, I began to explain that the examination would be preceded by a large volume retention enema, administered with a nozzle that had an inflatable cuff on it's end to preclude accidental expulsion. I then proceeded to show Jill the nozzle and demonstrate how the cuff inflated to hold the nozzle in place. I told Jill that I would administer the enema very slowly, while she lay on her left side with her right knee drawn up against her chest to expose her rectum for treatment and examination. The enema would consist of 2500 cc of warm (slightly above body temperature) saline solution. I assured Jill that I would pause anytime she began to feel uncomfortable as the enema was administered. After I had administered the enema, I had Jill retreat to the bathroom to expel.

After she had been in the bathroom for a few minutes I knocked and then entered explaining that I was going to do a quick digital rectal exam to see if a second enema would be necessary. I had Jill bend over for me as I donned a pair of exam gloves and lubricated the tip of my index finger. Jill was squeaky clean; so, I left Jill to afford her some privacy as she cleaned up and awaited here return for the resumption of her examination.

When she returned, I explained to tell Jill that she would be placed in a nylon web sling, that passed over her shoulders to her ankles to help to immobilize her for the procedure to which she was about to submit and to prevent her from having to strain to keep her knees back and apart during the examination. I showed her the sling and then helped her into it. Jill seemed interested to learn that the exam would start with a very deep and protracted Digital Rectal Examination (DRE) during which I would stimulate her "G" spot with my well lubricated and gloved index finger directly through the recto - vagina wall while using the other hand to gently palpitate her exposed clitoris. She seemed relieved when I assured her that, it was quite common for patients to become aroused by this procedure and, therefore, there was really no cause to be embarrassed by it.

I then showed Jill the Proctoscope, a stainless steel instrument about 6 inches long and about an inch in diameter. The instrument looked like a long tube with a pointed end and a pistol grip handle. I demonstrated how, once lubricated and fully inserted in her rectum, the bullet shaped tip could be withdrawn through the barrel of the instrument allowing the full length of her rectal lumen to be carefully examined as the instrument was slowly withdrawn from, moved about and maneuvered within her.

I assured Jill that the insertion would be careful, slow and gentle and would, at worst, be only slightly uncomfortable, and even then only momentarily. I also let her know that the entire examination would take only 10 to 15 minutes and that she should let me know if she needed a rest or if she was uncomfortable. As I uttered this admonition, Jill feel the cool touch of my gloved finger at her anal opening and the examination proceeded.

After the proctoscopic examination, which Jill tolerated without visible signs of discomfort and perhaps even some relish, I prepared for the last procedure. To illustrate this procedure, I showed Jill the three billed Cook Rectal retractor that I would use to finish her rectal exam. I explained that the three bills would be closed, lubricated and then very gently inserted into her anus. Once inserted, the bills would be very slowly separated to expand her anal sphincter to a diameter of perhaps two - three inches to allow me complete access to finish the survey of her lower rectal lumen and anal sphincter muscle. I also explained that this procedure wouldn't be rushed and, like the proctoscopic examination that had just been performed, we would pause if Jill became uncomfortable or unsettled. I advised Jill that it would help if she could stay calm and relaxed as I performed this portion of the examination and offered to help her do so by gently massaging her clitoris while the exam was proceeding. She seemed to like this idea and accepted readily.

With that, as I pulled on a latex exam glove, I asked Jill to roll over onto her left side for me, pull her right knee up against her breast and take a deep breath. As she did so, I applied a glob of KY to the tip of my index finger and placed it at her sphincter and entered just an inch of so. I then asked her to exhale slowly for me and she did so, my finger began lubricating her rectum for the procedure that I subsequently performed. Jill didn't suffer any discomfort during the procedure and, in fact, had an orgasm during it.

As Jill rested, warmed up and relaxed after her rectal, I carefully washed my hands with Betadine soap and explained that a clean catch urine specimen would be necessary. When I had finished washing my hands, I placed her back in the stirrups again. I then opened the disposable cath tray set and laid out it's contents on the sterile drape contained in the set, being very careful not to contaminate its contents. As I did so, Jill's eyes followed my every motion and I explained what was about to happen as I opened the packet of Providone Iodine swabs that it contained and put on sterile gloves.

Next, I told Jill to relax and let her knees fall apart, I gently spread her labia with my gloved left hand, picked up one of the Iodine swabs with my gloved right hand and located Jill's urethral opening. After warning Jill that she was about to feel the touch of the swab, I very carefully inserted the tip of the swab about a quarter of an inch into her urethra. Jill flinched slightly as I rotated the swab about half a turn. I paused and told Jill to relax for me knowing that this part of the procedure produced a strange but not painful sensation. She immediately regained her composure and I proceeded to very gently apply the Iodine from just inside her urethral opening out to the area immediately surrounding it.

When I was finished, I explained to Jill that I was about to thread a thin, sterile catheter into her urethra until it reached her bladder, a distance of not more than two or three inches. As I picked up the catheter and showed it to Jill, I lubricated its tip with the sterile lubricant contained in the cath tray kit. I explained that the insertion would be only slightly uncomfortable, just a very slight burning sensation at worst, and that, even then, the sensation would last for only a few seconds. I also assured her that, after the insertion, the catheter would be completely painless and that she would only experience a vague feeling of fullness as the catheter dwelled in one of the most private and sensitive parts of her body.

As I finished telling her this, she felt the tip of the 18 fr. silicone, Foley catheter touch her urethral opening and pause there. I went on to explain that when the catheter was fully inserted, she would experience an intense urge to urinate; but, that she would not be unable to do so. As I finished my explanation, I asked Jill to take a deep breath, hold it, relax and then slowly exhale. As she did so, I began threading the catheter into her bladder. Before Jill had completely exhaled, the catheter had glided into place and urine had begun to flow into the collection bag. I immediately retrieved a pair of forceps from the instrument tray and clamped off the hose to stop the flow of urine. Next, I retrieved a pre-filled, 30cc syringe from the cath tray kit, inserted it into the balloon valve on the catheter and filled the tiny balloon that was now just inside of Jill's bladder with sterile water to prevent expulsion of the catheter. This also markedly increased the feeling of fullness that Jill was experiencing.

Once Jill was comfortable with the foreign object and the strange new sensations that it was eliciting, I began to use my gloved and well lubricated left hand to gently message her clitoris as the well lubricated ring finger of my right hand plunged deep into her vagina and started to, again, work over her "G" spot. I could feel the catheter through her vaginal wall. Jill was immediately responsive. This stimulation continued gently, thoroughly, relentlessly. She drew her breath in short little gasps and her hips began to move in a way that was indicative of intense pleasure.

After just a minute or so of this stimulation, she achieved an intense orgasm. Jill mentioned later that she had never before felt a sensation like the one that she had experienced as she climaxed with the catheter inserted.

After Jill regained her self-possession, I released the clamp on the catheter's tube and allowed the entire contents of Jill's bladder to escape into the sterile collection bag.

Next, I explained that there may, again, be a few seconds of mild discomfort as the catheter was removed; but, that Jill would then be left with a pleasant tingling sensation that would be nearly completely gone by the time that she left the office.

With that, I used the syringe to evacuate the sterile water that had inflated the balloon on the catheter. I then had Jill take a breath, hold it, relax and exhale as I gently but quickly withdrew the catheter from her urethra.

As Jill relaxed, I excused myself briefly to wash my hands. Upon returning, without saying a word, I turned to the instrument tray, re - gloved with new, sterile gloves and retrieved a sterile, 18 fr. stainless steel sound, one of a set of six sounds on the instrument tray ranging from 18 fr. to 28fr. I began to apply Polysporin antibiotic ointment to the instrument as a lubricant and then turned to Jill.

She looked at the gleaming instrument in my hand, glanced at the sound set on the instrument tray and then into my eyes for a moment. Her eyes closed slowly and I began the insertion of the first of the three sounds (18fr., 22fr. and 26fr.), each larger than the one before it. Jill had never experiences such a feeling of fullness, stimulation and focus on her previously neglected and unexpectedly erogenous urethra.

When Jill's examination was completed, I had her roll over on her tummy for me. I and gave her a complete massage from head to toe using a good skin lotion for those areas of her now very familiar body below the neck. Her examination had lasted nearly four hours. She was tired. Jill fell asleep. I tenderly covered her up and tucked her in for a half hour cat nap as I washed, sterilized, dried and put away my instruments.