I’ve been a Naturopathic Doctor (ND) for five years, and have practiced in Berlin for the past year as a Heilpraktikerin (the German version of an ND). But in Canada, where I’m from, Naturopathic Doctors (ND) are primary healthcare providers, and as such, we are trained and regulated to perform complete physical exams, including pelvic exams, rectal exams, male genitalia exams, and all kinds of other assessments. In naturopathic medical school, we learned how to perform most of our physical and clinical diagnostic skills on each other: taking heart rates, performing abdominal exams, inspecting the ear canal, and even doing gynecological exams.
We were given the option to volunteer as gynecological models for the third and fourth year students. When I heard about this opportunity in my first year, I thought: “Who the hell would volunteer to do that?” But by my second year I couldn’t wait to get involved. I want to be clear — my modeling experience was not mandatory, but voluntary. We were paid for these shifts, but nobody was modeling for the money.
Because of the make-up of our student body, which seemed like it was 90 percent women, male genitalia and rectal/prostate exam modeling wasn’t offered to our male counterparts. So for the male exams, we practiced with paid actors who simulated patients.
By the time I volunteered, I was really interested in women’s health. I wanted to learn more, and I wanted to be the best. I could do this through being a model — I could learn how to do a gynecological exam a year earlier than everyone else, and also learn from the older students as they troubleshot through the learning process. Volunteering to be a gynecological model was a big chance for me help make an impact. I’d be helping myself, other future NDs, and all of our collective future patients.
But getting the confidence to get naked in front of my peers? That was more of a project.
From personal trainer to ND
For four years before I came to naturopathic medical school, I was a personal trainer. When you are a trainer, clients and potential clients tend to judge you on your physical appearance. You are essentially selling yourself: “hire me, do what I say and do, and you can look like this.” The pressure to maintain my physical appearance always had a impact on me. I felt like I was never strong enough or lean enough, or that I wasn’t lifting heavy enough, no matter how hard I trained. This constant pressure just perpetuated more self-judgement and scrutiny.
You’d think that constant body awareness would make me retreat from any opportunity for my body to be on display, but I think the opposite happened. Unlike much of the rest of my body, my vulva, vagina, cervix, uterus couldn’t be trained to be made better, visibly stronger, leaner, or prettier. This was 100 percent me.
After a year of performing in-depth and personal physical exams on my classmates, I learned firsthand how all bodies are different. My classmates weren’t judging my belly fat — they were trying to feel my abdominal aorta pulse. I wanted to change the narrative about my own body. I wanted help people (and myself) feel more confident. I tried to emit confidence so that other people would feel confident too. I still try to do this.
My first exams as a model
But as confident as I was, it was still a bit nerve-wracking. People who I knew — friends, even that cute boy a year older than me — were going to have their faces really close to my vulva and they would be touching me, inspecting me. It was pretty terrifying at first.
My first modeling experience was with another model in my year. Before we let the third and fourth years practice on us, we had to be trained to perform a pelvic exam. We needed to know how the exam was properly done in order to correct or give feedback to the other students.
Although there was always a trained professional ND overseeing the students, only the patient can really give feedback if something feels uncomfortable or incorrect. You also have to be trained to act like a real patient would: keeping your knees together, sitting incorrectly, asking questions if the student doesn’t explain the procedure correctly.
During my shifts as a gynecological model, it was just me, the supervising ND, and the student. Thank goodness it wasn’t a whole classroom! Usually, I would only volunteer for an hour at a time, each time with two or three exams performed. The exam rooms were regular small rooms with a sink, cabinet, gynecological table with footrests (we never say stirrups!), a large light, and a small trolley for holding all the supplies. The blinds would be drawn — it would usually get pretty hot in those rooms. The student was nervous, I was nervous. Especially if it was the student’s first gynecological exam, they could often be shaky and sweaty — which I think is normal and understandable.
What I learned from teaching the students
People were often afraid to apply any pressure when performing the physical exam of the external genitalia. I would almost always have to give feedback that they should apply more pressure. Irregularities can sometimes be more easily felt than observed, or can elicit a response when pressure is applied.
Other errors that often occurred were improper insertion of the speculum, which can be tricky. The physician needs to insert the speculum at an angle and then rotate it into place during the insertion. Also, students often inserted the speculum too anteriorly and could not find the cervix. The vagina is an amazing part of the human body, but because of its folds and flexibility it can be hard to find the cervix, especially as a beginner.
Also, shaky fingers. Being nervous is normal — performing a pelvic exam is a big deal — and it’s scary to think that you might hurt or cause someone to feel uncomfortable. But those people with shaky hands made exams extra awkward. But, even though some assessments may have felt uncomfortable, nobody ever caused me any pain or injury.
One time, near the end of the year, I did a double shift to help the fourth year students achieve their required number of pelvic exams for graduation. I must have had at least 6 exams done.
While a gynecological exam should be painless, it was still a long time to sit there with my legs spread apart. On that particular occasion, I had gotten all my pubic hair waxed off the day before, and the esthetician had actually given me a minor burn on my labia. This was embarrassing, because I had to watch every student react and ask me if I had any sexually transmitted infections (STIs), and then I had to explain my shameful burn. In retrospect, I’m sure this was a great learning experience for all of those students, actually getting to see and find an abnormal result, but it was pretty awkward for me.
During my time as a gynecological model, I must have had about 40 pelvic exams. Every country has different recommendations for how often people should have gynecological exams, but most recommend an annual pelvic exam, even if you’re not experiencing anything abnormal. The American Congress of Obstetricians and Gynecologists (ACOG), recommends having annual gynecological visits and pelvic exams starting at age 21 (1).
I learned a lot from my gynecological modeling experiences that I used in my practice: about how much pressure to apply, how to angle the speculum, and how to position myself to perform an exam that is both comfortable for my patient, and also allows me to gather all the information I need.
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- The American Congress of Obstetricians and Gynecologists. Well-Women visit: number 534. ACOG Committee opinion.The American Congress of Obstetricians and Gynecologists. August 2012 (reaffirmed 2016) [cited 03 Jan 2018]. Available from: https://www.acog.org/-/media/Committee-Opinions/Committee-on-Gynecologic-Practice/co534.pdf