Which comes first in the physical exam?

Many patients seem to have different ideas of which part of the exam comes first...some prefer the breast exam, then to move on south, so to speak. Depending on the anticipation, some prefer to get the rectal out of the way, while holding off on the pelvic which gives them plenty of time to get absolutly lubricated (Damn near dripping out of them). Some getting so wet that the warm metal speculum just glides in, almost swallowed up by a hungry vagina. Yet , some want to leave the breast exam to last. By the time the pelvic is complete, the mere touch to the nipples almost guarantees an instant orgasm. I'd like to hear the ladies thoughts on this/

I prefer that the Dr. work top down and front to back. If I frirst got a vag/rectal and then a rectal exam leaving the heart lungs til last, I would be so excited they would probably send me to a cardio Dr. - Vicki

Usually for me it is head to toe but skipping genital and rectal until end for what ever reason I dont no.

[quote author=vickisenema link=topic=658.msg3973#msg3973 date=1202675831]

I prefer that the Dr. work top down and front to back. If I frirst got a vag/rectal and then a rectal exam leaving the heart lungs til last, I would be so excited they would probably send me to a cardio Dr. - Vicki

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I agree. In real life thats how all of my doctors have done it...minus the rectal, I haven't had that yet.

I have always had the breast exam first, i'm not really sure why though. i have also never had a gyn give a rectal, they have always said that it wasnt really needed. i have had them in play clinics though, and i kind of wish that the real doctors would do it!

My wifes Doctor usuallly starts at the top then works her way down.She can only remeber one time where the Doc started the exam out with doing the Pelvic as the first part of the exam.

Everyone I've seen has always gone top to bottom too. Although one time she was told to get in the stirrups and then the exam began.

I've always had it top to bottom and would feel strange if it happened in any other order.

I've always had it done from the top down. My heartrate would be too fast if they started with the pelvic.

I've had the opportunity to read through a number of medical texts describing the examination process, and all of them have the patient being examined from head to toe, with the pelvic exam being the last procedure done.

I would imagine it's done this way in order to ease the patient into the pelvic as gently as possible, since this is the procedure that comes with the most apprehension.

I guess, once you've had a doctor see every other part of your body up close, they figure it'll be easier for you to offer up that last bit to him/her.

I think it should be from top to bottom. Why should a doctor touch the genitals and then move to the chest.

My SO's gyn always does top to bottom. The pelvic is last and then they give us some privacy to clean up.

...sorry to be boring, but add me to the 'top down' camp. Both experience and preference 😃

My experience is that it starts with the breast exams and then goes to the vaginal.

My first time I made sure it was breast first, then vaginal and then rectal, because I was 13 and really nervous. Now i just tell him which I want first and we go from there. only had the rectal first once, it really does increase you heart rate!

First doctor should perfom all vital assessment than should go for rectal veginal exam many people found uncomfertable and wet inside so thay realy want this exam could done as sopon as possibe.

For me its absolutely most erotic that the genital exam is done last.

I imagine a somewhat shy 19 year old college girl going to get a pre college exam and ending up at this subtly perverted old doc.. 😜

All the physicians I have been to have started with the breast exam, then the pelvic exam, then the rectal exam. I wouldn't have it any other way. 😉

I think a lot of it comes with the anticipation of what's coming next, so top to toe just builds the experience, and you're rewarded with the prize at the end 😉

Head to Toe leaving the gyno/rectal last. The only time when the waist area would be exposed first would be Prep enemas and rectal temps for taking vitals.

Doing the more intimate parts of the exam last allows the patient to relax and build rapore with the doctor so they won't be as nervous and embarrassed when that time arrives.

Doing the most intimat parts first allows for relaxation of the patient,but also prevents cross contamination from bowel etc upwards, its logical when you think about it, after all, the rectal exam is 'dirty' ....

Whenever I give an "exam", depending on what has been discussed with the "patient" prior to actually meeting, the basic standard is: height & weight, eent, bp, pulse rate, heart & lungs, lymph glands, reflexes (arms, knees, feet/ankles), chest/back/spinal column, abdominal/stomach, extremities including pulses, arteries, etc., checking nasal passages and obtaining throat cultures, neurological, gait & station, rom, urinalysis, breast exam, genital inspection and pelvic exam, and rectal exam.

In real exams, it's a matter of health risk. You want to go from least to most risk of spreading germs/bacteria. So, breast to vagina to rectum is the safest.

For role playing, I think it's whichever order you want as long as you change gloves after the rectal exam. Remember, it's all about having safe fun. 😁

Well, generally speaking head to toe sequence, head, neck, lungs and heart, breast, abdominal exam, gynecological including rectovaginal and sometimes rectal exam.

I may start with vitals an BP, It may include leg examination.

personally I can give the longest version or simply start by BP and a good thorough heart/lungs auscultation before moving to the breast exam

In a play setting I think I would have liked to try breast exam, then external pelvic inspection, then rectal, then vaginal.

Fugitiva-

Maybe it's just me and the way I was trained, but a rectal exam should NEVER follow a vaginal. The rectal exam should always be the very last on the list.

If you do decide to change the order around (and it is certainly your right to do so), your doc should remove his gloves, wash his hands thoroughly and than reglove (double gloving would be good for what I'm about to describe). After regloving, your pelvic area should be cleansed from front to back. Then doc should put on clean gloves, or remove the top pair, and then you should be relatively safe for a vaginal exam. Cross-contamination is always a concern, and precautions against contamination are time well spent for an easy way to avoid an infection.

Just a thought,

LadyDoc

[quote author=ladydocisin link=topic=5143.msg311167#msg311167 date=1283121027]

Maybe it's just me and the way I was trained, but a rectal exam should NEVER follow a vaginal.

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I think you meant a vaginal should never follow a rectal.

User264!

You are so right, my apologies for the confusion. There I go, wixing my mords again!

Sorry,

LadyDoc

I think the reason for the top half of the body is examend 1st is that the doctor knows breast exam and nipple pinching helps to lubricate the vaginal canal thus without saying to the person on the table that they work their way down to the vagina is self explanatory that it is done this way, as with the tests they did back in the 50s to see how couple react with different sexual stimulation.

but i think some docs just start up top to start the lubrication off on us girls . but who knows it could be that they want to leave the vagina 2ND to last because they was trained to check that part over more thoroughly .