The patient came to the campus health clinic at approximately 4:00 PM and
requested a physical examination. It was clearly explained to the patient that
no female medical personnel were available to assist in the examination,
however, the patient signed form # W-152 (Waiver for Un-aided Examination). The
patient is a 20-year old unmarried female. On the day of the examination she
appeared to be personally well kept, and was dressed in a sweater, blue jeans,
and tennis shoes --- not uncommon attire for college students at this campus.
The patient was asked to provide a urine sample and to remove her clothes and
cover herself with the typical gown provided. Urinalysis indicated that there
were no abnormal conditions, no drug usage, no pregnancy. I felt, however, that
disrobing appeared to take more time than usual. Upon checking the dressing room
monitor, I observed the patient sitting upon the chair, dressed in only her
panties. Her legs were spread with one hand inside of her panties and one hand
on her breasts. The patient appeared to have been masturbating and was
experiencing orgasm during my observation. Shortly thereafter, she stood, placed
the gown on her body, and exited the dressing room. I met the patient in the
examining room. I conducted a routine history and determined that there were no
contraindications in the family history. The patient explained that she was
sexually active and that it had been almost a year since her last complete
examination. Weight and height of the patient were noted at 115 pounds and 66",
respectively. With the patient sitting on the edge of the examining table, vital
signs were taken and noted as follows (+): Blood Pressure - 135/80 Pulse -78
Temperature -99.5 (*) (*) Temperature was taken ORALLY. The patient indicated
that she had drunk a cup of coffee 15 minutes prior to the examination. (+)
Elevated levels may be a result of patient's achieving sexual orgasm prior to
the examination. I asked the patient to lie on the examination table in the
supine position. Her gown was lowered to just above her waist. Respiration and
palpitation of abdominal organs indicated no abnormalities. The patient was
asked to turn upon her left side for further confirmation of the respiration and
palpitation examination. With the patient returned to the supine position, her
breasts were examined. The texture was firm and there were no abnormal masses.
Symmetry was within tolerance. No discharge was noted at the nipples. It was
noted, however, that respiration increased during the examination of the
patient's breasts. Further, the nipples hardened at the touch and remained
hardened throughout the examination. The patient was informed that a pelvic
examination was part of the complete physical. She indicated that she had been
examined by a gynecologist on a number of occasions. Further, she confirmed that
she waived her right to have female medical personnel present during this
examination. The patient's gown was removed fully and she declined my offer for
covering her upper extremities and/or draping the area below her hips. The
patient was asked to move herself farther down the table, placing her buttocks
at the table's edge. She complied without hesitation, and upon her buttocks
reaching the table's edge, she placed her feet in the examining stirrups.
External examination of the genitalia revealed that pubic hair had been trimmed
to confine it to an area slightly above the vulva. There was no pubic hair
around the labia, perineum, or anus. Left untrimmed, however, pubic hair growth
appeared to be normal. The patient indicated that she trimmed her pubic hair as
a matter of: 1) personal preference, 2) to accommodate her swimwear, and 3) to
heighten sexual activity/response. There were no unusual odors or discharges and
the patient indicated that she had not douched within 48 hours prior to the
examination, although she douches regularly. Internal examination of the
genitalia revealed no abnormalities. However, there were sufficient natural
secretions that lubricating gel was not required (although used as a matter of
procedure) for the digital examination or insertion of the speculum. Bi-manual
examination revealed that all reproductive organs were properly aligned. The
recto-vaginal examination was conclusive. Papanicolaou's Test was performed and
the results were returned "negative" from the laboratory. The patient's vagina
accommodated a # 2 speculum. During the pelvic examination, natural secretions
continued to be emitted from the patient's vagina. Further, upon insertion of my
finger(s) into the patient's vagina I observed that her hips raised toward
insertion and the vaginal walls contracted during palpitation. Respiration
increased. A similar response was received in the patient's rectum during the
recto-vaginal examination. Insertion of two fingers into the patient's rectum
was easily accommodated. The patient indicated that she was sexually active,
enjoying vaginal and rectal stimulation, as well as anal intercourse. Upon
removing my fingers, I noticed that the patients hips continued to gyrate while
respiration decreased. The patient was then asked to assume the dorsal recumbent
position for examination of the rectum. External examination revealed no
abnormalities; preliminary insertion to the first knuckle of one finger revealed
a firm rectal muscle and normal response. Full insertion of the finger into the
anus revealed no abnormalities or hemorrhoids. Minor impaction was noted. The
patient was questioned concerning the regularity of her bowels. She responded
that her bowel movements were regular, however, her eating habits were sporadic.
A cleansing enema was recommended. A rectal dilator was inserted and the
rectal/anal walls were observed to be consistent with the digital examination.
The patient, however, appeared to be stimulated by insertion of items into her
rectum as she pushed her hips toward insertion. Due to increased vital signs
observed at the beginning of this examination, the patient was asked whether she
would object to her temperature being verified rectally. She responded that this
verification was acceptable. With the patient straightening her knees and
lowering her buttocks, a rectal thermometer was lubricated and inserted. During
the thermometer's registering, her pulse and blood pressure were again checked.
The vital signs were: Blood Pressure - 135/80 Pulse -78 Temperature -98.6 (!)
(!) Temperature adjusted downward one degree. Following removal of the
thermometer, the patient was advised that she could get off of the table and get
dressed. She explained that she was feeling a bit "flushed" and requested that
she be permitted to lie on the table for a few moments. I complied and completed
the required paperwork. After several minutes, and with my back to the patient,
I heard several moans coming from her. When I turned to see her, I observed the
patient lying on her back. Her feet were in the stirrups, she had the
thermometer inserted into her rectum, three fingers of her right hand were
inserted into her vagina, and her left hand was vigorously rubbing her clitoris.
As she noticed my approaching the examination table, she exclaimed, "Doctor,
please excuse me. I'm cumming....." With this exclamation, her hips began to
gyrate violently as sexual orgasm increased, overwhelming her for approximately
30 seconds, then subsiding. The patient removed the finger from her vagina. I
took the liberty of removing the thermometer from her rectum. Also, in the
interest of medical science, I again checked her vital signs: Blood Pressure -
120/80 Pulse -60 Temperature -99.5 (!) (!) Temperature adjusted downward one
degree. THE ELEVATED VITAL SIGNS CONFIRM THAT SEXUAL EXCITEMENT AND ORGASM LEAD
TO THIS NOTICEABLE INCREASE. The patient removed herself from the examination
table, got dressed, and returned to my office for post-examination consultation.
She explained to me that she was "overly erotic" and that "any stimulation of
[her] tits, pussy, or ass requires [her] to masturbate or receive another form
of sexual gratification immediately." The patient advised me that she
masturbated almost daily, and had sexual intercourse at least 5 days a week,
sometimes twice or three times daily. The patient indicated that she also
enjoyed sexual relations with other females. Sexual gratification is received
through oral sex and the use of various objects designed for insertion into the
vagina and anus. Physical examination revealed that there was no indication of
any abuse, although the topic was discussed as a matter of precaution with the
patient. My physical examination of the patient revealed no sexual dysfunction,
and my psychological evaluation of the patient does not indicate any emotional
imbalances. We discussed the need for adequate protection against both disease
and pregnancy during sexual activity. The patient takes Lo-Ovral daily and is
aware of the need for regular and consistent use of "the pill". She requires men
to wear a condom before engaging in sexual activity with them. She is also aware
of the need to separate vaginal and anal sexual activities. As noted during the
rectal examination, the patient was reminded to administer a cleansing enema to
herself of approximately two quarts. She indicated that she had an enema nozzle
attachment to her douche bag. Proper positioning and retention was discussed
with the patient. The patient left the facility at approximately 4:45 PM.
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