As an experienced and mature playdoc my attitude is as follows:-
The examination is sacrosanct as far as stimulation goes. No part of the examination is calculated to arouse, any more than it would at the patients regular doctor/gyno appointment.
If there is arousal then it is ignored, not built upon nor commented on. Of course the woman's partial reason for being examined by a playdoc is because she wants it to be stimulating and arousing, just as many women report arousal at the regular gyno.
There is also the anticipatory aspect because she will have been supplied with a checklist designed especially for her and which indicates that after the examination and during a resting phase there will be an opportunity to ask about possible treatments and even more advanced tests (which are designed to be sexually stimulating).
All that being said it is made clear that nothing need follow the examination, except a report from me, if the patient does not want anything to follow. In fact of course the doctor may him/herself not wish to continue the meeting further, maybe because he/she does not consider it wise or appropriate. Regardless of the circumstances though the examination and anything (or nothing) which might follow are totally separate.
In regard to the range of treatments which might follow this, it can be something as simple as masturbation to orgasm, to repeated orgasms, to mutual masturbation etc., but stops shor of full sexual intercourse. The latter is, I assure you, extremely rare and the circumstances, conditions and the persons involved have to be absolutely right.
Nothing the patient may say during prior extensive chat is ever insisted upon and indeed a patient is discouraged from making such 'promises' which may turn out to be rash.