It's fairly easy to incorporate restraint into a realistic play exam, as it hasn't been that long ago since restraint was used much more freely in clinical settings. Unless otherwise requested, I begin with a very basic/real world approach, including some initial paper work (medical profile update, consent forms, etc.). While the patient is still dressed, I do the preliminary (blood test if that is to be included, temp, urine analysis, blood pressure, weight), and (again, if the patient has indicated she wants injections included), a mild sedative. She is then asked to undress (either wearing an exam gown or her bra and panties-- again it's something we work out prior to the exam date), and the usual exam is done... height and weight without clothing, eent, bp after sedative, and a complete physical (extremities, reflexes, abdominal, spinal, pulses, rom/gait and station, and finally breast and gyno/rectal). More detailed procedures which may cause discomfort or sudden movement such as deep throat culture, intubation, etc. may require the patient be restrained with wristlets and leg straps, to help her stay still. If the patient is ticklish, restraint is used as a precaution while carefully examining the ribs and armpit areas, except with the arms secured above the head. If it is deemed necessary to check the patients' ability to properly reach orgasm, or if climactic function needs to be monitored, restraints are again used as a precaution, to help the patient remain reasonably (and safely) steady and situated on the table during such procedures which will likely evoke a strong physical reaction. For this, the patients' wrists are secured at the sides of the table and her ankles/feet secured in the stirrups, or the calves strapped into knee crutches. If a more detailed rectal exam (or procedure) is indicated, the patient may be asked to turn over onto her stomach and then have her ankles secured at the corners of the exam table, with a strap across her back to keep her lower body fairly immobile during the procedure, and if necessary, her wrists may also be restrained, or her arms restrained at her sides with the same strap which is run across her back. In any case, you get my point-- there are all sorts of options which can be made workable.