A doctor charged with sexually assaulting a patient at Dapto Medical Centre has told a court he took the unusual step of stimulating the woman on his clinic couch after she clamped down on his finger with her private parts, aggravating an injury to his shoulder.
Giving evidence in Wollongong District Court on Friday, Das Vithal Balgi said he had surgery two months later to repair the shoulder.
The woman has accused Balgi, 71, of an assault lasting up to 10 minutes during an appointment on March 12, 2012.
On day five of his trial, Balgi told the court the woman had "given any excuse" to avoid internal examinations in the past. But during the March 12 appointment she became insistent he find out if she had become "too big there" as a result of childbirth, as she feared this could be the cause of her husband's apparent disinterest in sex.
Balgi said he told the woman he believed her unlikely to have the problem because she was young and physically fit, but he agreed to the examination in order to give her "peace of mind", telling her: "I don't mind doing an examination but remember, your problem is not between your legs it's between your ears."
Balgi told the court a proper medical examination would have required him to use at least two fingers, but this proved impossible.
"I told her ... you need to relax, I can hardly put one finger inside. You're squeezing the hell out of my finger, not to mention a lot of pain in my right shoulder. Please relax."
He told the court he asked the woman to hold his free hand and squeeze it, in the hope it would "divert her attention" and cause her to relax internally.
When that failed, "I had to think of something that would relax her ... I thought I'd stimulate her clitoris to get access to the inside to do that proper examination, hoping that she'd relax."
Balgi told the court the act lasted "two seconds - five to six at the most". He said he had experienced the spasming syndrome in a patient once before, but it was only after discussing the woman's case with another doctor that he came to a diagnosis of vaginismus.
Asked during cross-examination why he had never shared his diagnosis with the woman, Balgi said she was "a patient who was worrying about every small thing".
"She's already got dozens of medical problems ... I really didn't think it was worth my while."
Balgi was arrested on October 15, 2012, after the woman met him wearing a recording device monitored by police.
In the recorded conversation, he admitted he had an erection the day of the consultation.
But on Friday, Balgi told the court he had lied about this.
He said the woman, his patient for 10 years, had shared her concerns about her marriage and, in this context, told him she knew she was attractive to men because she had caused them to get an erection.
He claimed he saw the woman glance at his groin and later told her he had an erection both out of pride and to "boost her confidence", drawing incredulity from Crown prosecutor Kate Ratcliffe.
"You thought you would boost her confidence by lying to her and telling her you - an elderly medical practitioner - had an erection during a medical consultation? Is that what you're asking this jury to believe?"
In his response, Balgi said: "She probably knew I didn't have it because she's an expert."
He broke down when he told the court he regretted the conduct.
"I repent it. It's embarrassing."
Ms Ratcliffe accused Balgi of concocting a story about needing to relax his patient.
The trial continues before Judge Paul Conlon next week.