Communication style during gyn exam

In med school we are taught to "over communicate" during the exam so as not to startle the patient to make her uncomfortable or surprise her. For example- "I'm going to touch your thigh, you'll feel my fingers now, I'm going to put 2 fingers in now, this will feel cold, lots of pressure now, etc etc "

Is this actually helpful to you, women? I've noticed some patients prefer I am more quiet perhaps because they want to dissociate just a bit for them awkwardness.

I've noticed over the years that it IS possible to do an exam quietly...a light touch on the knee with just a hint of outward pressure usually is enough of a signal that the patient knows to open her legs. A touch on the inner thigh usually works to have the patient spread further, and so forth, a touch on the cheek will prompt the patient to turn her head this way or that, etc.

It is a ladies' gynecological topic so I moved it.

It can be useful when it's the patient's first visit, or even the first few times. After that, in my opinion, it's no longer necessary. After that, we know what the visit consists of.

Do most women need it, probably not. Is it hugely helpful to past sexual assault victims, a large part of the population, who may or may not have confided that history to you: YEP. I know for me verbal narration and graded contact (like touching the thigh first and then sliding the hand to the vulva in a slow, predictable motion) makes a huge difference in whether I'm having an uneventful exam vs flinching or having a flashback to being assaulted, which for most people involves uninvited, unexpected touch in intimate areas.

I think it's a wise default tactic, and of course you can then change your technique if asked for quiet or where your rapport with the patient suggests it.