It really comes down to the players. Of course, a play exam is not comparable to a real exam for obvious reasons, so forget about the time frame of your (or her) last real exam. Play exams are performed for sexual gratification in one way or the other, period, whether or not actual sex takes place. Most of the exams I've done run anywhere from two to four hours, but even that varies. Since medical fetish is basically psychologically based stimulation, the key lies in the atmosphere, the props, and the imagination. My approach is very clinical (no pun intended), unless the patient wants something different. Health questionnaires and exam forms can be printed from the internet, and add both realism and anticipation, if time allows. I never rush things, but instead allow ample time for both parties to get into their respective roles. There's usually about an hour of preliminaries (forms, interview, pertinent questions, and the basic preliminary before the exam itself begins. A urine specimen is generally requested, then the patient is asked to disrobe, either in her bra and panties or in an exam gown, we always discuss this beforehand). Since these are most often "full body" or "extended" exams, the anticipation builds as the patient is required to sit or lie still as her body is carefully examined and checked, using a very realistic (though somewhat embellished) protocol. That takes another good hour, and if she's in a gown, it gets shifted a lot as she is positioned in various ways. Depending on her desires, this portion can be fairly comfortable, with only brief points of complimentary discomfort (such as the reflex hammers' point being scraped across her bare soles, a deep throat culture, use of a pinwheel in obtaining her reflexes, etc.), or if she wants a certain amount of more intense discomfort (say she's also a sub and wishes to incorporate this into the medical play) it's an easy thing to bump things up to her liking. Once it's time for the breast and gyno exam, there are many options for extending that as well, beginning with a very careful exam of the breasts in various positions, then moving to the gyno portion which may include "tests" to observe and record her climactic responses, and so forth. Bimanual and rectal exams are basic as well, if she's indicated that she wants that included. Again, it really comes down to the players and how long they want the exam and procedures to last. Anything from enemas to electrical stimulation can be added. There are no rules outside common sense safety, mutual respect, and the parameters the doctor and patient agree upon.