CARNAL NATION

There are twelve people in a small room, dressed in matching uniforms of white coats, stethoscopes, Danko clogs and very serious expressions, all pursed lips and furrowed brows. Then there is me. I am smiling. And other than a big grin on my face, I'm only wearing a sheet around my pelvis and an annoying paper robe that will not stay put on my shoulders.

I'm the comfortable one.

This is a familiar scene in my work as a Gynecological Teaching Associate. Simply put, a Gynecological Teaching Associate (GTA) is a person who is paid to teach medical students how to perform pelvic exams so that the experience won't be traumatic for future patients or intimidating for the practitioners. For hours, a GTA essentially rents out her vulva, vagina, rectum and brain, guiding medical students through the entire process of a thorough pelvic exam: how to perform a visual exam (checking for any lumps or bumps), a speculum exam (confidently guiding in the duckbill), a bi-manual (hello, ovaries!) and a rectal exam (every pelvic exam is supposed to include a rectal screening, but this is shyly skipped in most visits to the gynecologist).

One student declared after the exam that "Everything looks as good as Disneyland!" Rather than suggesting that my vulva was a teacup ride away from an unforgettable family vacation, I advised the student to use a more reassuring, poised phrase along the lines of "Everything looks healthy."Sometimes hospitals will refer to a GTA as a Pelvic Model or a Sensitive Exam Model. I choose to identify as a GTA because frankly, I'm not modeling. My vulva is not working the runway. The GTA title is more to the point: the focus of this work is on teaching. I lead the process. I even give out grades.

Critically, I help the students not to freak out about the procedure. I am usually the first live gynecological patient the medical students see, providing them not only with an actual vulva to examine, but the opportunity to do so publically, surrounded by their peers. They are terrified. I remind them that this is practice, and that I will teach them all the things not to do. By the end of the lesson the students are more assured in the process.

The first place nerves show up is usually within eye contact. I experienced a medical student who was so self-conscious about the experience that he kept his gaze glued to my eyes and wouldn't so much as glance at my vulva—and this was during the visual inspection. I gently reminded him that acknowledging the vulva displayed before him as direct and obvious as the midday sun was not inappropriate. In fact, it was medically necessary.

Often, I also have to suggest which phrases are permissible and which ones are not. One student declared after the exam that "Everything looks as good as Disneyland!" Rather than suggesting that my vulva was a teacup ride away from an unforgettable family vacation, I advised the student to use a more reassuring, poised phrase along the lines of "Everything looks healthy."

It's the little things that can make the difference between a straightforward experience and a nightmare that will cause women to "accidentally" lapse on their annual exams. For example, I teach that a clitoris is not a thumb rest, a mistake made more often than I'd care for it to. Likewise, students are often taught that the easiest way to insert a speculum is to do so slowly, but if one puts the speculum in too slowly, the sensation can feel, ahem, sexual. A doctor's visit is not the right moment to create a mood. End of discussion.

So who are the women who put up with the uncomfortable mechanics that are required of GTA work, and why do they do it? As this is not a common job (I don't recall it being highlighted on Career Day in the eighth grade), there are many misconceptions the people who do this.

My fellow GTAs and I have been asked if we are prostitutes, addicts, disturbed rape victims, or if we're just desperate for money. A magazine contacted me regarding a story on easy ways to make extra bucks in the recession. Naturally, the editors thought that GTA work fell snugly into this category, like picking up retail shifts during the holiday season. I explained very firmly that I would not recommend this job for someone who was just strapped for cash. A person must be healthy—both mentally and physically—to handle this work. It can be draining and sometimes extremely difficult to endure.

Yet there are compelling reasons why people get involved. Some view it as a form of public service. Others want to work within the medical field, or enjoy the teaching aspect. There are also those who regard GTA work as a form of activism, promoting sex-positive health care.

Unfortunately, few medical providers actually work with GTAs during their training, and schools that arrange for this type of teaching module are in the minority. But how else do medical providers prepare for real gynecological services to the public?

Since some schools worry that students will find doing the actual procedure on a real woman too terrifying or embarrassing, dummies are used. Others allow students to perform on actual patients without disclosing that it is the student's first time with the speculum. More unsettling are the instances when exams are performed on anesthetized patients. Often one of the forms signed prior to "going under" provides consent to allow students to partake in the medical care. This can include rounds of pelvic exams with nary a mention upon awakening.

Being a GTA is not always comfortable, but it is purposeful work. It's powerful to witness the serious expressions melt into amazement as students experience what a uterus feels like for the first time, or see the complex structures composed in a vulva. The students stride out of the room in their Dankos, more confident that they can give future patients safe, appropriate care, and I feel proud that I opened up my legs up for the benefit of those who will come after me. It makes me smile every time.