The Human Condition: Slip your panties off, dear, and pop up on the couch...

Cringe-making at best, humiliating at worst, internal examinations are most women's least favourite experience. But they're traumatic for doctors, too. Emma Cook hears toe-curling tales from both ends of the speculum

We've all heard the horror stories. No two pieces of medical equipment are more guaranteed to provoke tales of indignities and embarrassment among the female population - the stirrups and the speculum. Even a syringe seems more hi-tech, and less a fixture of the dark ages, than these two stalwarts of female internal exploration.

From low-key niggles like, "He never warms it up before he puts it in," to the more creepy stuff: "My last GP used to stare straight into my eyes throughout the internal - it freaked me out", those on the receiving end always have more to say on the subject.

All this may change with new guidelines issued this week by the Royal College of Obstetricians and Gynaecologists. In the working report, they specify how doctors should behave during intimate examinations. As well as avoiding over-familiar terms like "love" and "dear", they advise not to raise issues that may be viewed as personal, like weight, until a woman is fully dressed. They also say a chaperone should be offered to all patients - already a standard procedure in many hospitals and GPs' surgeries.

It's hard to know how doctors will respond to the report. As it is, there's a wall of silence that surrounds their feelings when it comes to intimate examinations. For instance, what's going through their minds when they ask you to, "Hop on the couch and draw your knees up and let them fall open?" Are they on automatic pilot or desperately trying to think of England as they peel on their rubber glove and peer between your legs?

"It was horrendous," admits Rob, 32, now a GP working in Surrey. "I was a fourth-year medical student and I was acutely embarrassed. I had to do it in front of a female consultant and a nurse. The patient knew I was nervous. She hadn't even taken her knickers off and was quivering under the bed. There I was with KY jelly all over the glove, not really knowing where to look or what to say next."

He says, "Now I try to perfect a nonchalant, middle-distant gaze." Over the years he has learnt to adapt his spoken behaviour. "I'm always aware to hold back on too much banter like, "Oh, that's a nice tan you've got. Been anywhere nice?"

He's also aware of the class and culture of his patients. "It can be geographically bound, too. Hop or pop up on the bed may be acceptable for some patients but seen as patronising by others. You just have to be astute and judge people individually."

But what's more likely to make a woman's heart sink are some of the in- jokes floating around. One junior doctor admitted, "We used to kid around and say, 'How many 'UBEs' have you notched up?" UBE being 'Unnecessary Breast Examination'."

Which raises the real fear, on both sides, of sexual connotations or inappropriate behaviour - probably the root of most embarrassment and anxiety. Ben, a 34-year-old GP, admits, "I have felt uncomfortable before - there are times when I've felt attracted to the patient. If in the past a flirtation has occurred then it can be a problem. Then it's good to have a third party present - a chaperone."

Hopefully there will be less room for such ambiguities with a new set of guidelines. While part of the medical establishment may question why they are necessary, many patients may wonder why on earth they're not in place already, especially when there seem to be little specific training for doctors in this area. Although medical students are taught and examined on their communication skills during consultation, there's still not much formal instruction in how to behave, or not to behave - especially during sensitive situations.

According to Dr Friedericke Eben, consultant obstetrician and gynaecologist at the Whittington Hospital, students still learn most of their skills through experience. As one fifth-year student says, "I pick up from my consultants and then develop my own style." Eben adds, "I often tell male students if I feel their language is inappropriate. I know male students can feel very embarrassed and find it awkward at first, especially if it's in front of me. They're so young and can find it terribly difficult."

They can also find it just as difficult examining male patients. Dr Ian Banks, medical editor of Men's Health magazine, says,"It really is the worst of both worlds - there's a macho mentality on both sides of the desk, which means there can often be some collusion not to do the kind of examinations that are necessary. We don't like to admit it but we know it's true." Whereas it's more routine to give a woman an internal examination, he says male doctors think far more seriously about carrying out rectal or testicle examinations on other men. "Quite often doctors will say we need a rectal examination but lets do it at the next visit."

These issues clearly affect doctors of all ages - not just the inexperienced medical students. Interestingly, it's the older ones who are probably in need of more guidance than their much younger colleagues. After all, a nervous and shy approach isn't nearly as offensive to women as the sort of condescending attitude one associates with the old- school generation of doctors. Phil Hammond, doctor and columnist for The Independent, says, "The sort of doctors who say, 'Pop your panties down and make your legs like a frog', have probably been getting away with it for 15 years or more and they haven't been told it's wrong. There's a dinosaur end but also a new generation who are much more switched on about good communication."

But in an ideal world, says Hammond, there shouldn't have to be any guidelines because women should speak out if they find someone's attitude inappropriate. One wonders, though, why it should be up to the patient to tell the doctor how to do his job properly. Hammond says, "If women gave direct feedback, the doctors would know there and then." Hammond also hopes the guidelines advise doctors to warm the speculum before use (they do). It's just a shame they couldn't ask for a re-design - something that's warm, plastic and doesn't look like it belongs in the tool department of B&Q.

Some names have been changed

'I think this stamp belongs to you'

Jenny Eclair (right), comedian: After I had my baby, I had this really bad stitching that looked like a six-year-old's knitting. To heal the stitches I had to attend this brand new clinic which was being opened the day I visited. I was sitting with my legs in strirrups. They put this plastic bag of water over my fanny and then applied electronic waves. At this point the dignitaries invited to cut the red tape walked in - Neil Kinnock and the the Lord Mayor - to see me with legs akimbo. They must have stumbled into the wrong cubicle, but I've never seen two men exit a room so fast.

Kathy Lette (far right) author of 'Foetal Attraction' and 'Mad Cows': I once made the mistake of going to a Harley Street gynae. In complete silence, he jacked me up like a car chassis. As he prepared to insert the icy tongue of the speculum, I got sick of his cold indifference. I joshed, "Aren't you even going to say you love me first?" This prompted a severe lecture. "There's only one 100-per-cent-safe oral contraceptive, Ms Lette. The word 'no'." Tell that to Mike Tyson.

Suzi, 33, researcher: Just before an internal examination I asked if I could go to the loo before I saw my doctor. Unfortunately there wasn't any loo roll and I had to use an old tissue I salvaged from the bottom of my handbag. A few minutes into the examination I noticed he was looking baffled and holding something gingerly between his thumb and forfinger. "I think this may belong to you," he said and held up a soggy-looking first class stamp that must have come from my bag.

Joanna, 34, pharmacist: I was worried I might have fibroids and went to see a female gynae. There was a student doctor with her as well. I said I didn't mind and she told me to get up on the bed. As I was trying to explain to her how much I hated any sort of internal, she barked at me, "Speak up I can't hear what you're saying." I was completely rigid, barely able to move at which point she shouted, "Just try and relax - if you don't mind I'd like to keep my finger for the rest of the afternoon.'

Tina, 29, teacher: My worst memory is going to hospital for a vaginal examination. I was in this cubicle on a long corridor with the curtain drawn. I was half-dressed and the doctor arranged my legs in the stirrups and then absent-mindedly walked off, drawing the curtain back and leaving me stuck in this thing for all everyone to see as they walked past. I couldn't believe he had just left me there like that.

Paula, 23, researcher: I was so scared of having my smear test done a month ago. The spectrum looks like an instrument of torture in gleaming metal - it could only be designed by a man. Every time the doctor tried to put it up me I started to freeze - I couldn't bear it. All she could say was, "Think of penis. That's a similar size and can fit inside you." Thinking of a giant penis at that point really wasn't much of a help.

Ben, 28, record shop manager: My girlfriend had thrush and I was worried I may have caught it so I went to see my GP, a woman. I was terrified she would stick a long needle up the end of my penis - somebody told me that's what they do. Of course she didn't, but half way through the examination I began to feel really sick and faint. I knew she thought I was a complete wimp. In the end, she gave me a glass of water and asked me to come back the next day.

Hugo, 32, accountant: A nurse was preparing me for an appendix operation and started to shave off my pubic hair. For some reason I got an erection half way through and the nurse noticed. She said, drily, "You're an excitable young man, aren't you?" Through terror and embarrassment, I think, I've always avoided nurses and female GPs ever since.

David, 23, business studies student: Last year I got genital warts and had to see a nurse. She took a look then got out this small umbrella contraption out. A rectal examination would have been a picnic compared to the thought of an umbrella shoved up my foreskin.

Emily, 31, script writer: The last nurse I went to for my smear was so clueless. After ten minutes of groping around with her rubber glove on, she apologised and admitted she couldn't find my cervix. Then she asked me if I knew where it was - as if I might of mislaid it or left it at home. In the end she gave up and asked the doctor to step in. He politely asked, "Would you mind if I have a go instead?"