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~Subject: Dr.’s Examination Notes-College (F)
~Date: Sun, 03 Mar 96 23:30:36 EST
UNIVERSITY OF MARYLAND
- College Park Campus -
*** M-E-D-I-C-A-L E-X-A-M-I-N-A-T-I-O-N N-O-T-E-S ***
Patient’s Name:Candy WestDate: 11/28/90
Attending Physician:Dr. Stephens
Primary Complaint:Routine Examination
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
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
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
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
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
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
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
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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