Note: This story was dynamically reformatted for online reading convenience. ï>¿Let's Play Doctor by JoandD Wife teaches medical students to do breast and pelvic exams. When we were first married, we were both back in graduate school at the state university. We were poor students again, living on Dave's half-time teaching assistantship and my finding part-time gigs here and there. Married student housing was still a bargain, as were ramen noodles and jug wine. I was working on my Master of Social Work degree and needed to do a summer practicum. This placement was to theoretically gain hands-on experience in the field, which seemed a little superfluous, since I'd already worked in the field for six years. And to make matters worse, we weren't to be paid for our practicum work experience. I had originally hoped to get a summer job in the field and appeal to have it count as my practicum too. This would allow me to earn the fall semester tuition and help with some living expenses. The faculty denied that request implying a career in the field included a vow of poverty, or at least a taste of it. Some younger students found a practicum back home, where they could live with parents and save some housing costs. Dave and I were older and married, so we clearly didn't want to live apart for the summer. I lucked out and got a practicum in the social work department of the University Hospital. Much of this involved helping with discharge planning, but also working with child abuse and sexual abuse cases where I already had direct experience and some recognized expertise. The supervisor of my practicum, Jim was about my age, and he seemed like a nice laid-back kind of guy. He also gave me credit for having my years of experience. I thought this would be an easy tour of duty for me. He also had some responsibilities with the College of Medicine, so wouldn't be around full time to "snoopervise" my workday by day. That sounded good too. After my first week or so, Jim invited me and Dave to dinner and to meet his wife, Sally. She worked in a grant writing job in the sponsored programs office, and had a great sense of humor, and I liked her immediately. It wasn't long before we were getting together with them regularly for dinner, a movie, or to play golf on weekends. As we got to know them better, they learned more about our financial situation, and I told them I had been looking at part-time jobs for the fall. So many of the jobs I'd been looking at just didn't pay enough and were often so far from campus that scheduling between classes would be difficult if not impossible. For that reason, I had been seriously looking at university jobs on campus. I told them some jobs I'd been looking at were things like cleaning classrooms at night, caring for lab rats and only half-jokingly I added that I'd even looked into being a nude model at the art school. After all, it paid over twice what fast-food and retail paid. Everyone seemed to get a yuck out of that. Jim said, now being serious, "Gee, if you'd be comfortable doing nude modeling, you ought to consider applying to be a Gynecological Teaching Associate; that's a "simulated patient" for the medical students to practice doing GYN exams." He explained that the low unemployment rate at the time was part of the problem finding women willing to do this, and with budget cuts the college had fewer younger women on their staff who were interested in "moonlighting" for the extra cash this job provided. Grad students were now their best source for women. He most passionately told us how the need for women to do this was critical to the students' education, as well as how vital the timing was for that part of the curriculum. I think he was kind of getting-off on telling us the details of what the GTAs or simulated patients do, waiting to see Sally's and my reactions. After providing great details about the subtleties of how to learn to give pelvic and breast examinations, he explained that their usual fee for female simulated patients was $25 per hour, while for males it was $15; the more intrusive nature of the female exam being the reason for the wage differential. Jim is usually pretty good at teasing and giving everyone a hard time, so I wasn't too surprised when he turned to me and said, "You ought to consider doing this, it's not bad money and not really very hard work. I bet if they don't find enough women by the end of next week, they'd go as high as $45-50 an hour." Both Sally and I dismissed his bravado as so much talk intended to tease, torment, and titillate us, and soon our discussion moved on to other topics for the rest of our evening. Then, on our way home I was thinking more about Jim's offer. At first blush I hadn't taken his offer all that seriously, and if I had I probably still wouldn't likely have given it a serious second thought. But now, as I thought about it more, the money was intriguing for sure; not many jobs paid $45 an hour and I had plenty of time available. But there was also something that sparked my more daring sexual side. "What would you think about my doing that simulated patient thing?" I asked Dave. He didn't quite know what to say, since my question came as a complete surprise to him. He's never been jealous or possessive, but I wasn't quite sure how he felt about a bunch of young medical students (most probably male) being quite so intimately involved with my body when it didn't directly involve my health and well-being. "Why would you possibly want to do that?" he replied, probably a little more harshly than he intended. "It would be an easy way to make a few hundred dollars a month," I responded, sounding like we might not be able to buy groceries if I didn't moonlight doing this. Dave pointed out that the economics of this didn't seem like a very compelling reason alone. There certainly were many other jobs that didn't challenge one's sense of modesty so much. "It sure wouldn't hurt us to have smaller student loan debt and maybe for something fun and frivolous, like a short vacation," I replied very seriously. I was trying to keep things light and have a little fun with him. I don't think he knew if I was serious, and I wasn't so sure myself. But I think he decided to go along with me and see how far I would go with this. "If you want to do it, just say so and do it, but don't use the money as an excuse. We certainly don't need it bad enough if it isn't something you'd really like to do," he told me. It was like he was trying to smoke out my more base reasons and not let me get by with the more acceptable issue of economic necessity. I was really quite surprised to find myself actually getting turned-on by this conversation, and by the prospect of me exposing myself to a number of other men, even if it were in a clinical situation. It also seemed to excite him to try to push me into admitting it might arouse me on too. "Why are you being so difficult," I retorted, "are you jealous of the idea of my being seen naked by the men students?" "Maybe I am a little bit," he had to admit, "but I don't think you're telling me the whole story why you really want to do this either." "I told you already, it's like getting paid for doing almost nothing, someone needs to do it," I protested, "why do you care so much?" By now I was getting a little upset with his badgering me about my motivation, and I was pretty sure I couldn't be completely honest about being sexually excited by the idea. "Whatever you want to do is fine with me, I'm just a little surprised that this would be something that would excite you," he just had to say, testing or teasing me one last time. I wanted to respond with some protest to his choice of the word "excite," but to continue this discussion was not something either of us wanted to do. So, we went home and went to bed not saying much beyond small talk. Over the next week or so he pretty much forgot about all this discussion, while I couldn't get it out of my mind. Maybe a week later Jim asked me if I had thought any more about the simulated patient job. "I might be interested, but I'd like to know a little more about it if you could give me a rough idea of how it all plays out." "Well, sure," he said wanting to milk this for all the shock value it was worth. "The first thing is you go through a training process. That includes watching some films and doing some reading from an accredited GTA training group. After that, you do kind of a "lab practical" where you have a physical and the doc walks you through what procedures and techniques you will be giving training and feedback on. "How about when I do the actual student exams? How does that go?' "I'm not all that up on the details, but I can get you in touch with the program coordinator and she'll answer all your questions. He gave me his card and wrote her name and phone number on the back. "Just give her a call," he added matter-of-factly. I called that afternoon, for fear I would chicken out if I waited. The woman I talked to was in fact in charge of the Gynecological Teaching Associate program. I could tell from her enthusiasm that she was more than glad to hear my interest and told me the University of Iowa was one of the first to use a GTA approach in teaching. She herself had started as simulated patient. She wanted me to come in the next morning for an interview. I went, not mentioning it to Dave, and she told me much the same things that Jim had told me. She talked much more about the psychological aspects of being comfortable in the situation, not being intimidated, and the need to learn the curriculum to teach the students about the patient's perspective on their bedside manner and their clinical skills. She scheduled me for the first three hour "training session" the next day already. I also received written materials and instructions to read before the training. I wanted to do my reading before Dave got home, since I was still wrestling with how to tell him I was most likely going to do this. The training the next day was a combination of classroom and the "lab practical." The classroom part was mainly going over the information I had read and watching a couple of CDs. The first was really old, and it was probably transferred from 16 mm film on to the disc. It was the basic training on doing breast and pelvic exams. The hair styles of the doctor and patient really dated it. But not much has changed on the basic mechanics. The second was from the college that did GTA training and certifications, and really emphasized the importance of the GTAs in teaching the students to be sensitive to the patient and making the examination experience more patient driven. The program manager continued to stress how the GTA was in charge of the experience and was empowered to critique the students' technical skills, attitudes, and behavior toward the patient. She was very honest in addressing the issue of potential sexual arousal by both students and GTAs, and how to deal with inappropriate behavior by physicians and students. There was something exceedingly mission driven in her and the woman narrating the film, and it made me doubt that I had anywhere near that level of passion or commitment to the cause. This did give me pause to reflect on whether this was something I should do. The "lab practical" was an examination by the resident instructor. I was led to an exam room by the program manager and told to undress and put on a gown and that she and the instructor would be right in. When they returned the doctor/instructor started talking to me about the process and trying to get me to relax. "It isn't every woman who can feel comfortable enough to 'open herself-up' like that, pardon the expression," he said trying to be funny. "The 'baby docs' can really intimidate some of the women." I think he was giving me a chance to change my mind before going any further. Once he decided I was serious about the job, he talked about my role with the students and the feedback I was expected to give them about their examination techniques and their bedside manner. This all reinforced what the program manager had said. Then he went into what the job entailed in each session. He started with, "You'll go into the exam room and undress and put on a gown, just like you'd expect. Then for the first semester I or another resident instructor comes in with four or five med students, and they ask medical history questions. First, the instructor will show them how to conduct the examinations. Then the first student does his exam. This begins with a breast exam where you will be exposed to the group. Your part in this is to tell the guy if he's being too rough or too gentle; too rushed, too slow. It's important that you learn these techniques and how to give constructive criticism, because after the first semester, you'll be doing the training by yourself." His switching to the male pronoun was not lost on me. I assumed it reflected the gender mix of the students at that time. "You'll get more training on this here today, and in regular sessions with other GTAs this semester. Because of the instructional nature of the procedures with multiple examiners, you will be exposed for a lot longer time than in a real physical. This is part of what could make some women more self-conscious." "Then you lay back and they'll position you for the pelvic exam. First, they will take a lot more time on the external examination, so they know exactly what they're looking at and for. Then they do the internal exam, you know, two fingers and a rubber glove. It takes some real effort to gain the skill to find your ovaries. Then they practice inserting a speculum for a pap smear, and after that is the dreaded rectal exam. Again, these take longer since each of the students does the exam, and you'll tell them again if they're too rough or anything else is not quite right." He then said he would need to examine me, to see if there were any problems that would preclude me from being a simulated patient, or any "anomalies" that students should catch on their examination. He also described in some detail the students' role at each phase of the examination and what I was to look for. With that he proceeded with literally the most thorough exam I've ever had. He pointed out what he was looking for at each step and what feedback I would be expected to provide to each student. Again, he reminded me that with multiple examiners and my suggestions, this would all take longer, and I'd be more exposed than in a normal visit. It's hard to explain, but he fact that this was not necessarily an exam for my own health, made things less clinical and potentially more sensuous. I could only expect those feelings to be more intense with the students examining me. Were these thoughts all GTAs struggled with? Or should I be reassessing my motivation for being here? Tough questions for me to answer honestly to myself. While examining my breasts he called attention to their size and density. Mine are 36A and though not saggy, they are not overly firm. He said smaller and less dense breasts are the best for learning examining techniques. The thoroughness of his exam, and all this talk about the size and shape of my tits had my nipples at attention which drew his attention too. He looked at them for quite a long time. "Are your nipples always this sensitive?" he asked. His words and the length of time he stared at them confirmed my growing suspicion that no matter what we're told, even older, more experienced male doctors are not immune to the sight of a naked woman. While I found that thought quite exhilarating, I must have had a skeptical look on my face because he quickly tried to cover his professional demeanor by saying, "We go to great lengths to be very clinical in a situation that can cause arousal in both patients and students. If students sense the GTA is feeling aroused, it can trigger similar emotions in them." I felt too embarrassed to answer completely honestly and admit to being aroused, so I just confessed to having very sensitive nipples that get erect easily when cold, touched or exposed. He seemed to accept this explanation, and I sensed I was still in the program if I chose to be. I left out that I could reach an orgasm from nipple stimulation alone. It didn't seem medically relevant. While doing the pelvic exam, he asked lots of questions about my periods, age at onset, any pregnancies, any pain while having sex or other times. I answered all of them honesty. But when he asked if there were any other conditions he should know about, I couldn't admit to being a "squirter." When I have a real strong orgasm, I squirt a stream of fluid, often called female ejaculation. This just didn't seem relevant, and my embarrassment trumped full disclosure. As I got dressed, I needed to pat dry my vaginal area, and I wasn't sure how much of the moisture was KY and how much may have been from my own excitement. Things were kind of on autopilot at this point with everyone just assuming I was ready to sign on. Without any reasons to say "no," I was scheduled for two clinical teaching sessions the next week. And I still wasn't sure if I wanted to tell Dave. The next Tuesday morning I had an early class, so I didn't find time to say anything about my day's plans before we both left home. My first "appointment" at the med school was right after lunch and I didn't have much of an appetite, so I got there early. I had to do some paperwork on permissions, HIPPA, and liability and then I was led to the exam room where I again undressed and got ready. I was trying to remember all the things I was told from the manager, CDs, books, and from the doctor. I was getting pretty anxious sitting on the end of the table, and I was a little startled when there was a knock at the door, and the male instructor entered with four students: one woman, three men. He explained that I was a new GTA, and we'd all be learning new lessons today. The doctor gave everyone an explanation of what was going to happen, then asked the woman to lead taking my medical history. I hoped he hadn't asked a woman to do this as a more stereotypically clerical role. She did great, asking very good medically based follow-up questions, that impressed the group. On to the fun stuff. After the instructor did each part of the exam, each student followed suit. The general med stuff was pretty easy for everyone. Then came the time for me to lower the gown for my breast exams. I really did feel much more exposed with five sets of eyes all looking at my bare breasts. I don't know if it was the room temperature or the fact that there were four men there that made my nipples quite erect. I could feel them all staring at my tits, and I didn't think with clinical interest alone. The doc quickly told them that some women's nipples are very sensitive, especially when being examined, and they needed to be equally sensitive to her. Then quickly I had five pairs of hands touching them for good measure. The Dr. did the most thorough exam, the woman student the gentlest, and the three men students trying hard to look and touch in a very clinical manner. Only their continual eye contact and their much warmer hands gave away their male interest in my female body. Most of my comments to them had to do with touching too firmly or too lightly on my breasts, and mostly not pinching my nipples hard enough to expel any fluids. Their questions and dialogue were all appropriate. There was something about my role that was both humbling and very empowering at the same time. This surprised me after I had so casually dismissed much of that message in the training film. After a little abdominal examining, it was time to put my feet in the stirrups. After they got me positioned, they really did have to pull the gown up a lot further so everyone could see what was going on. Out came five pairs of rubber gloves and the KY, and in went ten fingers, two at a time. Again, the Dr.'s experience showed, as he described what he was doing and what he was looking for. He commented on my wider pelvis, and how it made for easier childbirth, not to mention for a group examination. When he started, he spread my labia that shot me a major jolt of excitement. And when he touched my clitoris, I really thought I could climax. And as promised, he spent a lot of time giving them a primer in Female Anatomy 101. His lengthy internal exam at the lower end of my vagina was also the most gentle, if not the most sensual exam I've ever had. The students' touch was rougher on the external parts, and too gentle on the internal. The speculum exams seemed to take forever, and I really did feel quite exposed to the world for this part too. Doing it five times gave my vagina a workout, and I could see why the pay was what it was. The students all inserted the instrument too quickly, and while I was awash in KY jelly now, a real patient wouldn't be and might feel some friction. Those were the messages I was getting paid to impart on them. The coupe de gras was the rectal exams, and in addition to being very revealing and invasive, it was the only part that actually did hurt a little after repeated intrusions. I gave them lots of advice on how to do this better. The woman's smaller index finger was a blessing. Since these were 3rd year med students, at the very beginning of their OB/GYN rotation, I could tell this was their first experience with such intimate examinations. After my final critique, they left me to get dressed and leave quite unceremoniously, an anti-climax, pardon the expression. I was scheduled again for Thursday afternoon, and I was surprised that I was actually looking forward to it. I was getting more relaxed at being nude in front of multiple people, the majority being men, and being touched in all my most intimate places. I certainly felt I more than earned my hourly wages, first for selling my modesty, and second for contributing to medical education and sensitivity of male doctors specifically. Thursday was almost a rerun of Tuesday, but with the instructor and four students being men, and one female student. My comfort level was definitely better this time, and I made much more eye contact with the students. That meant I also saw them as people in addition to being student clinicians. So, I did notice that the guys this session were good looking, and I swear were looking at me as a woman, not only as a would-be patient. When they dropped my gown to expose my breasts their eyes gave them away. I knew they liked what they saw, and I couldn't help looking to see if anything was stirring in their crotches. Then things got too busy for me to pay enough attention to that. My nipples were again fully erect, though this instructor didn't discuss the reasons why this time. I as I said, I can reach an orgasm from just fondling my nipples, so this part of the exam was testing my ability to stay purely clinical. I worked hard to keep my thinking about my job. I know my feedback was more detailed and helpful than in the first session, and the time went more quickly. When one of the men was examining my breasts, his eyes flitted back and forth between my nipples. I asked him, "What are you looking for?" His guilt heard me ask, "What are you looking at?" He was too embarrassed to answer right away, so I helped him out with my best clinical critique, saying, "You're looking for any dimpling or asymmetries." The resident instructor was impressed with both my knowledge and my sensitivity to the student's situation. When I got in the stirrups, the external exam was again long and the touches arousing. What I hadn't anticipated was the cumulative effect of all this touching. So, by the time the sixth set of fingers were probing my vagina, I actually feared an involuntary orgasm. And as mentioned earlier, when I'm having a particularly strong orgasm, I can be one of a small percentage of women to "squirt." Not only would that have been horribly embarrassing, but it probably would have gotten me expelled from the program too. While my immediate state of mind was evolving from having my vagina examined to having my pussy played with, I held it together somehow and finished my final critique with the instructor's compliments on my awareness of procedures, and ability to articulate the patient's perspective. At home that night Dave asked how my day was, and again I struggled with telling him. I'd done two clinics now, without saying a word to him. The fact that I was struggling to tell him was solid evidence that I was feeling a little guilty for sexually enjoying the experience. But not telling him had risks too. My practicum boss, Jim, would know and would likely bring it up when the four of us got together next. I needed to 'fess up." "Well, I need to tell you that this afternoon I was a simulated patient at the medical school," I said matter-of-factly. "And you didn't tell me?" he shot back trying not to sound mad. "I wanted to earn the money to do something special for you, so no I didn't want to ruin the surprise." "How much have you made?" he asked. "I'll make close to a thousand dollars this semester," I replied sounding frustrated with having to discuss this at all. "You will make?" he asked. "That sounds like you will be doing this again." "Yeah, at least 10 or 12 more times, if you need to ask.' I still couldn't admit to already doing it twice. After a long pause he asked, "Well, aren't you going to tell me about it?" "What's to tell?" I sighed. "You heard everything when the four of us first talked about it, and probably with lots of Jim's embellishment too." "I just want to know if it turned you on doing it; was there a little bit of an exhibitionist in you, nothing more? Tell me and I won't ask again." "What do you want me to say, that it excited me to get seen and touched by them?" I asked with some frustration. "Yeah, that was part of it, and the money was too. Let it be." "Well, if it helps, thinking about you being examined that way turns me on too, and the only reason I'm asking is to get a little vicarious thrill from hearing you tell me about it in some detail," he said very softly not wanting to make this threatening at all. I was so relieved. I told him pretty much what I shared here, and I could see him getting more aroused as I explained everything. "I just wish I could have been there," he said. "When do you go next?" "Next Tuesday and Thursday, then Tuesdays and Thursdays for the rest of the semester. I didn't tell you before, because I was afraid you wouldn't like it. Now seeing your reaction, I wish I had," I said very sincerely. "That's alright," he said, "your doing it this way makes it more erotic any way. I sure wish I could have been there." "That can't happen, but the next time I go for my regular exam, you can come along," I offered. "Do you think you could bring home a speculum, gloves and a gown, and we could do some role playing?" he asked. "That could be some good foreplay." Geez, it seemed every man I saw these days wanted to "play doctor" with me. I got better at my educator role every week, and by the end of the semester it became very natural and nonthreatening to me, and I developed a comfortable rapport with the students, especially the men. The last session of the semester was again with a male doctor, five male students and only one woman. Typically, the later rotations were students who were most interested in that specialty, so I had a room full of aspiring OB/GYNs who wanted to show off for the instructor. One handsome guy made flirty eye contact with me right away and I feared trouble. When my breasts were exposed, they were as always, very erect and did not go unnoticed. The doc mentioned the reasons and need to be sensitive, while the flirty guy looked like he was just dying to say something snarky. Since they all wanted to demonstrate their exceptional examining skills, my breasts got felt-up but good. So good that I was pretty sure when they got to the lower body stuff, I probably wouldn't need any KY at all. When the instructor did the first insertion, I could hardly feel it. Then each student took their turn being progressively more thorough as they went. As in the second session, I found the cumulative effects of all their touching to be taking me to the edge again. The good-looking flirty guy was the last and I swear he could read that I was in the throes of arousal. His fingers went right for my G-spot. And while his outside fingers on my abdomen appeared to be seeking my ovaries, his inside ones stayed working their magic right where they were. The instructor was asking him something about what he was finding or feeling, but at this point I wasn't paying much attention. Then it happened, I came and squirted at the same time. I could suppress my reaction to the orgasm itself, but my squirt was more like a gush all over Dr. Flirt's hand. No one could have possibly missed that. He pulled his hand out of me looking shocked, first from my body's reaction to his fingers, and second from the look on the instructor's face. The doctor clearly knew what he had done. To spare me any more humiliation, he told the students that sometimes the exam can put pressure on the bladder causing involuntary release of urine. He dismissed the students and told the perpetrator to meet him in his office. Now alone he gently asked me how I was doing. "I knew he was trying to give me an orgasm, but I thought I could just ignore it. I should have blown the whistle right away and called him out for unprofessional behavior. I'm so sorry." I was close to tears. "Yes, you should have. You acted more like too many actual patients might have, instead of as a professional educator. That's a lesson not every GTA is forced to learn this way. And that's fortunate. I hope you'll stay with us second semester. You're very good in articulating your feedback, and now you have experienced a situation we hope most won't ever encounter. Our student in question will be taking some time out from his medical education." When I got home after that session, I decided to share every detail with Dave. We talked about the sexual side and then the professional and ethical side. We both were enjoying expanding our repertoire of sexual playfulness more than either of us would ever have expected. This included my exhibitionist fun, and his so-far, only vicarious voyeurism. We agreed our fun and games would be best done together, though we both recognized, there may be some opportunities, like this experience, where we both couldn't participate. Full disclosure would allow the other to enjoy that vicarious voyeurism Dave had found. Then there's the role money plays as both an incentive to participate as well as possibly serving as an excuse or at least a more acceptable reason to engage in sexual fun. I would never have taken this job without being paid well, and it illustrated the perils of mixing sexual adventures with how we make our livelihoods, even part-time ones. But that doesn't mean money might not be involved in the decision to participate some kinds of erotic bets or games. I did a second semester as a GTA and it turned out to be a great experience for both of us, and never fails to get us worked up when we talk about it. This was a turning point for us to explore pushing our sexual boundaries to include other people in our pursuit of our fantasies.