On the first day of the OB/gyn clerkship, we get to spend 1 hr with a standardized patient. And for the first time in our whole entire lives we get to do the entire female gyne exam solo, starting with the breast exam.

There are three parts to the gyne exam - inspection, speculum and bimanual exam. You'll feel the back of my hand against your thigh. Now I'm going to inspect the skin and hair around your vulva and labia. [awkwardly combs through pubic hair] Everything looks good....er...healthy and normal. Now I'm going to do the speculum exam. You'll feel the back of my hand..Now I'm going to spread your labia and insert the speculum. Okay, inserting...now!

You get the picture. There is FAR TOO MUCH talk before touch going on. No one wants to hear all of that! Jeez.

Other terrible memories from that day:

Me: Now I'm going to examine your breast. Can you lower your gown to expose your left breast?
Standardized patient: Expose my left breast eh? How much are you willing to pay me? (muahahHAHA)

Me: [tentatively inserts gloved finger into vagina]
SP: Is that a fingernail I feel?!! I have a very sensitive cervix you know. None of my doctors believe me, but my cervix can feel everything.

Me: [loosens the speculum bills and speculum flies out, half opened, no thanks to her strong vaginal muscles]
SP: OUCH! Lucky for you I'm used to this. You need to take CONTROL of that thing.

I was a bad medical student that day. I could never remember to use the words "examine, inspect, and check" and for goodness sakes, why couldn't I get a patient with a normal unfeeling cervix? Anyway, I stuttered and fumbled my way through that orientation session and left feeling like a totally incompetent medical student.

[1.5 weeks later]

I performed my first pap smear and speculum exam all by myself on a real patient and it went JUST FINE. It was quick and uneventful and not that hard at all. Freaking SP.

How can it possibly not be awkward when the pelvic exam takes 30 minutes, or when the patient is holding your hand in her vagina, or when you have to explain why you're going to comb through her very normal pubic hair slowly and methodically? Ugh. One more time for the OSCE and then never again.