For me, the rectal exam would be a continuation of a very thorough vaginal exam. Following the biannual exam, the doctor would lube his gloved fingers and do a recto-vaginal exam, thoroughly feeling inside my vagina and rectum as deeply as he could. He would then remove his hand, take off his gloves, and switch them for a clean pair.
He would say something about needing to check something out that he felt in my rectum, so he needed to prep me for a more in-depth exam. He or a nurse would go prep an enema bag. Bringing it back over to me, still on the exam table in stirrups, he would lube up his fingers and bring one to my anus. He would start by massaging my anus to help loosen up the sphincter, and then insert a finger to lube up the anus. Withdrawing his finger, he then lubed up a retention nozzle. He brought it to my anus and pushed it inside. He inflated the balloons, hooked it to the bag, and administer the enema, going slowly but giving the full bag. I wait the required time, and then I'm helped to the bathroom, nozzle removed, and then allowed to expel in peace.
I'm instructed back onto the table, this time on my hands and knees. He starts with a digital rectal exam with one finger, followed by a second. Removing his fingers, He then lubes up an anoscope, and guides it into my anus. I feel the openness as had removed the obturator, and the warmth of the light as he looks inside. He replaces the obturator and removes the scope. He says he needs to look a little deeper, so needs to use one other scope.
He pulls out a rigid proctoscope, lubes it, and directs me into a knee-chest position. He carefully introduces it into my rectum, inch by inch. After taking a good look, he carefully removed it. He helps me into a sitting position, and let's me know everything looks good.