I split my consultations into four distinct phases - assuming that the patient opts half way through for 'therapy'. If she doesn't - and there are no obligations whatsoever - then it's two phases.
The initial phase is Introductory, when we discuss the medical history form which the patient has completed and brought with her and I will ask some supplementary questions. Beside being an essential step so I can be aware of contra indications to an examination its a good ice breaker before she goes to change into a gown.
If an examination is to happen - and its free choice to walk away - then I will simultaneously change in the consultation room from day clothes into scrubs for the second phase, Examination. The examination is non sexualised and as realistic as possible, including intimate parts if agreed, though it is almost invariably the case that a woman will exhibit signs of arousal from the outset and this may increase as the examination proceeds.
The third phase is Rest, when we will discuss my findings and the patient will be encouraged to ask questions, which often spill over into discussion of therapy.
If therapy, the fourth phase, is requested I will change back into day clothes or something comfortable, usually in the bathroom. When I return I will have assumed my alter ego as a Sex Therapist. The Doctor persona and his scrubs, will be left behind. That means that in a repeat visit, when the examination will happen again, it wil be easier for the patient to separate the Doctor figure from the overt Sexual Therapist. Sounds odd, but it seems to work if comments are anything to go by. The break and the change gives time for anticipation to mount, to advantage. As I say in my blog - A little anticipation strengthens realisation!