Well, I had my urology exam a few days ago. I have to say it was much more intimate (if that is the right word) than any GYN exam.
When I first got there, I had to drink about a liter of water, since I needed a full bladder for the first part of my exam. Then I was brought into the exam room by the nurse. I was told to take off all my clothes and put on the paper gown, opening to the front. The paper gown was actually only waist length. I was given a paper sheet to place over my legs as I sat on the exam table waiting for my bladder to feel full, as instructed by the nurse and for the doctor.
I had to urinate, once I felt my bladder full, into a portable commode in the exam room. The nurse told me she had to observe the flow of my urine. So as I sat on the commode, she told me to spread my legs so she could observe the flow. Then she asked me to stop the flow for the count of 10 seconds and then resume urinating until I had emptied my bladder.
In the middle of this commode process, the urologist came into the exam room. I had to walk from the commode to the exam table wearing only the waist-length paper gown. So I had to get onto the exam table and mount the knee supports while I was completely nude from the waist down. The exam table was electronic and the doctor adjusted the knee supports up and out until my legs were up high with my knees being drawn up towards my chest and spread wide apart. Then the doctor sat sat between my spread wide legs and examined my genitals manually.
While he manually spread and held my inner labia wide open, he told me to cough so he could observe for any urine leakage from my urethra. Then he stood up between my legs and inserted his gloved fingers deep into my vagina, palpating in all directions. He also had me cough while he had his fingers still in my vagina, while he felt for my bladder and also to again observe for leakage of urine. So while he had his fingers up in my vagina with one hand, he used his other hand to hold my inner labia wide so he could visualize my urethra when he asked me to cough.
Then while I was still mounted in the knee supports, he inserted a catheter into my urethra to measure the amount of leftover urine in my bladder. He took that catheter out and inserted another one, this time inserting water with blue dye into my bladder. He told me to tell him when I started to feel my bladder full but not to wait until very full. So when I said I felt my bladder start to feel as though it was full, he stopped the flow of water into my bladder and removed the catheter. Then he performed another cough test while he held my inner labia apart to observe the entrance of my urethra for leakage of the blue-dye water. He also performed the same manual vaginal exam as he had done when my bladder had been emptied, but this time with my bladder somewhat full.
This time he also performed a rectal exam on me, inserting his fingers into my rectum to see if sphincter muscle activity of my anus would cause my urethra muscles to relax and cause leakage of urine.
Then, just when I thought the exam was over, since he lowered my legs, he told me to stand on the lift-out step at the foot of the exam table. So there I stood wearing only the waist-length gown. But I guess I should have been over with feeling embarrassed, since I had just spent a good 20 minutes with my legs high in the air and spread so wide that I knew every part of me had been seen and examined. Anyway, it still was embarrassing to be standing on that step so naked.
Then, while the doctor was sitting on a stool right in front of me, he told me to place each of my feet to the outer sides of the step. So I would estimate that I stood with my legs spread further than shoulder width, probably about 28" to 30" wide. He told me to bend my knees slightly while standing with my legs spread wide and to keep my hips aligned under my shoulders. He told me not to bend forward putting my hips behind my shoulders.
Standing that way, while holding onto the exam table knee supports for balance, he first examined my genitals in what he called a neutral position. He spread my outer and inner labia and while I was standing with my legs spread wide apart and my knees bent, he performed a vaginal exam and a vaginal-rectal exam as he sat in front of me and had me cough while he had his fingers in my vagina and again while he had his fingers in my vagina and rectum at the same time. He was looking for both pelvic floor muscle tone and looking for any droppage of my uterus or bladder while standing and/or when coughing.
He also asked the most intimate questions. He asked if I have had urethral leakage when my husband enters me vaginally. He asked if I felt the urge to urinate during intercourse. And when I said sometimes, he asked if I felt the urge when I was below my husband or above him. I have never been asked so many embarrassing questions by a doctor before. But, then again, I had never been so spread wide open and exposed in stirrups as I was in the knee supports. What makes the knee supports different from stirrups is that the knee supports also made me feel as though my genital area was also being thrust upward and forward, towards the doctor; especially since I was also completely nude and uncovered below the waist.
The doctor told me that he feels I have a degree of prolapsed bladder. He wants to do further testing where he will insert a fiberoptic camera (about the size of the catheter he inserted to drain my bladder) up into my bladder thru my urethra and also do a vaginal ultrasound while I am lying on the exam table with my legs up in the knee supports and also from the opposite direction. He will be evaluating the degree of prolapse from various directions via the vaginal ultrasound.
When he left the room, the nurse was still there. I asked her what the doctor meant when he said he would also be doing the vaginal ultrasound from the opposite direction. She said there is another exam room that has a different exam table that will give the doctor access to insert the vaginal ultrasound probe into my vagina while I am in the opposite position from when I have it done while lying on my back. She didn't refer to this other exam table as being a chest and knees positioning table. But I have feeling that is probably what it is.
By the time I left the urologist's office, I felt like I was bow-legged and my genitals felt sore and swollen after so much spreading and palpating and inserting fingers and instruments into every orifice multiple times.