One of the educational tasks of HCPs is the normalization of perceived “abnormalities” in anatomy and/or bodily functions. As has been described in Chap. 8, body image plays an important role in women’s lives. Social comparison is a prerequisite to build up a realistic way of looking at oneself. Because comparing genitals is hardly possible in our culture, this feedback process is hampered. Especially in young girls, this may lead to “perceived pathology.” This is especially the case in an era in which the selection of models and photo altering are even more disturbing to the already fragile normal feedback processes, e.g., the (non)verbal reactions of peers.

In order to meet this educational task, it is important to know what the worries are. After that, an “educational gynecological examination” (EGE) can be very instructive for women of all ages. This EGE is carried out by using a hand mirror for the woman while the health care professional (HCP) can explain to her what he/she sees and what the function of the different vulvar structures are. In addition to giving information, this investigation should also be used for gathering information. Think of the woman’s ideas about the physical aspects of sexual functioning, but also information relating to questions about what is normal, to reduce a possible negative body image and correction of myths. Such an examination is performed only after consent of the patient and should take place in an atmosphere of maximum security. Because partners, especially young male ones, often also lack this kind of knowledge, it is desirable, but not necessary and only if desired by the patient (!), that the partner is present at the investigation. Using the functionality of the examination as a basis, one needs to discuss these kinds of circumstances in advance. In the end, it is the woman who decides with whom and how in nonmedical terms. Of course, the investigation itself is basically painless. However, because this cannot be fully guaranteed, it is important to agree upon a “verbal fuse,” e.g., stop is stop!

There is not always a medical reason to perform the full gynecological examination, especially not when it is the first time. Such an EGE provides a good opportunity to give realistic information about the appearance and function of the genitalia. When a vaginistic reaction is found, this can be addressed and discussed in light of a possible reaction during coitus. This may prevent a future negative spiral of anxiety and pain. Although perhaps the impression has been created that this approach to the patient is only possible after much practice and mastery of technical feats, this is not the case. Of course, “practice makes perfect,” but what really matters is to express a certain attitude, namely, an attitude of genuine interest and empathy for the woman and the willingness to solve the problem together. Empathy is described in Chap. 28 as “the ability to put oneself into the position of the other.” Or to put it in biblical terms, do not do to others what you would not like to be done to you!

As has been described in Chap. 26, it is important for physicians and HCPs to balance between “maximal approach while keeping distance.” In order to be able to do so, as an examiner one needs to maintain a professional attitude and that is exactly what is lacking in inexperienced HCPs. Especially students often have all kinds of emotionally upsetting connotations with a gynecological examination, including sexual ones. Therefore, one of the most challenging aspects of the gynecological examination is to find a way to professionally handle one’s own emotional and sexual feelings and associations. Only then may one serve as a guide to the women who are being examined and who are struggling with a wide variety of “mixed feelings” themselves. Although the latter probably holds for all women, this is especially the case for women with negative sexual experiences in the past.

HCPs have to learn to deal with situations in which they can feel strongly emotionally involved with their patient. This may lead to “overinvolvement” and “countertransference,” endangering the professional distance between the health care professional and the patient. This phenomenon and the way one should deal with it are described in detail in Chap. 26.

When the HCP is capable of neutralizing the situation and thereby “desexualizing” it, both participants obtain complementary positions in the encounter. For the woman it stays a unique situation, possibly loaded with all kinds of (sexual) associations and fear. For the HCP it becomes a procedural examination, which gets rid of a confusing, possibly sexual connotation. When the HCP is not aware of this kind of emotional turmoil, his or her own (sexual) associations could evoke compensatory behavior, such as the tendency to objectify the woman in an exaggerated way as “a vagina with discharge”; asking how is “the vagina” doing; and choosing a distinctive, superior, and arrogant attitude. Such reactions may evoke a feeling of humiliation in the woman.

When the HCP wants to fulfill the role of a neutralizing person, acknowledgement and recognition of a wide variety of emotions and associations including sexual aspects is a prerequisite. If this does not happen, the HCP’s attitude will be insensibly influenced by his or her own experience with sexuality in general and his or her expectations regarding this experience.

The gynecological examination could be perceived as an encounter between two different individuals, each with a different role and a different reaction to what takes place. At the same time, they are mutually dependent on each other in order to reach the final goal: bringing the gynecological examination to a good conclusion. However, this good conclusion encompasses more than just an encounter between two people. The personal background of the HCP and the woman and both their expectations are influencing the way they experience this encounter. Previous experiences, for instance, about sexuality and power(lessness) may influence the signals, answers, and reactions that become apparent in the interaction. Negative sexual experiences in the past, e.g., violation and rape or even sexual abuse during childhood, may hinder collaboration. The inability to trust the other, especially someone who represents authority, may negatively influence the course of a gynecological examination, which is frequently not recognized as such. Although usually in less far-reaching terms, the same may hold for fear of sexually transmitted disease, extramarital affairs, etc. By being aware of the “abnormal” (including sexual) aspects of a gynecological examination, the examiner is capable to avoid obstructions in the collaboration. When there seems to exist an atmosphere of tension and potential conflict of power, HCPs can avoid this by simply pointing out to the woman that she is the one who ultimately can control the situation.

First of all, it is important to define which aspects of the gynecological examination need to be carried out and which do not need to be carried out. These aims determine which procedures and thereby which instruments, etc., will most likely be used. We say “most likely” because sometimes one may encounter unexpected problems. In order to avoid instantaneous logistical problems, plan abundantly. Better to be safe than sorry!