Personally, I have never brutally said to a patient “spread your legs”
After the interview which begins the consultation I indicate that we are going to move on to the examination and specify that I am starting with the chest.
Most of the time the patients immediately get naked and sit on the couch.
After the palpation and examination of the breasts which is done sitting then lying down, I invite the patient to sit down.
I use stirrups which I prefer to leg rests.
I frequently remind people that it is appropriate for the pelvis to be as close as possible to the edge of the table but for spreading the thighs, this is never necessary.
If necessary, often for a first consultation, I lightly press on the knees while spreading the elbows when I sit down.
I must specify that in France, in private practice, there is never a nurse who assists the gynecologist.
In public hospitals, this is sometimes the case but less and less so.