Gynecology

Women/women at birth should begin scheduling annual gynecological health exams when they turn 21. Prior to age 21 this exam is not called an "Annual Preventative Exam" but patients should be seen for STI (sexually transmitted infections) screening, pregnancy prevention, or menstrual concerns.  

An annual health exam could include consideration of pregnancy prevention and screening for STI. The exam may also include a physical exam, breast exam, and pelvic exam.

Pap smears are performed according to a recommended screening schedule usually beginning at age 21 and repeated every 3 years if normal. Gonorrhea and chlamydia testing are recommended yearly through age 24. Patients 25 years of age and older should receive gonorrhea and chlamydia testing if they have a new partner or additional risk factors.

What should I expect during the exam?

Before the physical exam begins a medical and reproductive history will be recorded as well as your weight, height, blood pressure and pulse. The information requested will vary depending on the reason for your visit but may include questions about family history of illness; your present health status and habit; details of your menstrual cycle; your sexual history; present method of contraception; and past illness, operations, and pregnancy. This information helps your provider determine your health needs.

Before the exam, you will be asked to change into a gown or drape in the exam room. Your physician, nurse practitioner, or physician's assistant may then examine your thyroid gland, heart, lungs, breasts, and abdomen to help identify potential health concerns. Breast self-exam is no longer recommended, but self-breast awareness is recommended, which means if you notice any changes or have concerns about your breasts you should bring it to your providers' attention.

If a pelvic exam is needed, you will be asked to lie down, slide to the end of the examination table, and put your heels in the footrests, called stirrups. Feeling tense, anxious, or even embarrassed is common. Deep breathing and relaxation techniques can be helpful. Your provider will first look at your external genitalia for signs of redness or infection then proceed to examine your internal pelvic organs. To do this, your provider will separate the walls of the vagina with a speculum. The speculum is a slender metal or plastic instrument that looks like a duckbill. It should not pinch and may be warmed or moistened before being gently inserted into your vagina.

Although the pelvic exam may be an awkward experience, it should not be painful. You may feel pressure, which can be uncomfortable but you should not feel pain. Tell your clinician if you feel pain.

At this point, your health care provider can see your cervix. The cervix is the lower portion of your uterus and can be a site of abnormal cell development. The clinician may do a Pap smear. A Pap smear involves collecting cells from your cervix in order to test for precancerous or cancerous changes of the cervix.

Additional tests for vaginal or sexually transmitted infections can be taken at this time as well. Then the speculum will be removed. A small amount of vaginal bleeding or spotting after your exam can be normal. You provider will next place two gloved fingers into your vagina while their other hand gently presses on your lower abdomen. This identifies the size, shape, and position of your uterus, fallopian tubes, and ovaries. Again, you should feel pressure but not pain.

Finally, a rectal exam may be performed. Still wearing a glove, your health clinician will insert a finger into the vagina while another well-lubricated finger is gently inserted into the rectum. This is done to determine if there are any masses in the anal canal and also to feel the uterus, cervix, and ovaries. Again, try to relax. If you want to refuse the rectal exam, please let your clinician know.

That's it! Your pelvic exam is over. If you want to discuss birth control and contraception now is a great time to discuss what option is best for you with your health care provider.

How can I prepare for my appointment?

• Please print and complete the Women's Health History Form if this is your first women's health visit.
• Refrain from intercourse or placing anything (tampons, suppositories, etc.) in your vagina 48 hours prior to your exam to ensure a more accurate pap smear result.
• Please note: If you are experiencing significant gynecological problems such as severe menstrual cramps, severe PMS, infrequent periods, or very irregular periods, you will need to first schedule an appointment to specifically address these problems. An annual exam for routine care can be scheduled at a later date.

Human Papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the U.S. and is most prevalent in the late teens and early twenties.

Vaccines can protect against some of the most common types of HPV. These vaccines are given in three shots. It is important to get all three doses to get the best protection. The vaccines are most effective when given before a person's first sexual contact when the person could be exposed to HPV.

Many people refer to HPV as genital warts, but HPV includes over 100 viruses. One-third of these viruses cause genital problems that affect both sexes, such as genital warts on the penis, vagina, or cervix. In a small number of women/women at birth, cell changes in the cervix may be precancerous. Genital warts can appear as small hard spots or have a fleshy cauliflower appearance, but in other cases, warts are not visible to the naked eye.

Gardasil is given in a series of 3 injections, with dose 2 given 2 months after the first dose, and dose 3 given 6 months after the first dose. Gardasil has been shown to protect against most types of HPV that cause the majority of cervical cancer and genital warts. The most common side effects of the vaccine are pain, swelling, itching, and redness at the injection site, and fever.

Individuals who are allergic to any ingredient in the vaccine or who have an allergic reaction after the first dose should not receive the vaccine. As with all vaccines, the HPV vaccine may not protect everyone who gets it and will not protect against types of HPV that are not contained in the vaccine.

Fees: Students should contact their insurance provider prior to their appointment to determine if they will cover all or part of the cost. Three injections are needed. Students may elect to pay the charges at the time of the visit or have the charges added to their student accounts.

There are many contraceptive options available, most of which are offered through University Health Services. Please talk with your provider to determine which option is best for you.

Getting Started

• Schedule a brief appointment (without an exam) with a clinician to review your health history and discuss various contraceptive options.

            OR

• Schedule a complete annual preventative exam, typically recommended to start at age 21. The various contraceptive options and their risks and benefits may be discussed at that time.

Available Contraceptives

• Intrauterine Devices (IUDs)
• Nexplanon  (Arm Implant)
• Depo Provera (the shot)
• The Pill (combined hormonal and Progesterone)
• The Patch
• The Ring
• Barrier Methods (male and female condoms)

Emergency Contraceptives

The emergency contraceptive pill (Plan B) can be used by women/women at birth who are concerned about a possible pregnancy due to unprotected intercourse, birth control misuse, or sexual assault.

Emergency contraceptive is currently available over-the-counter and does not require a prescription from a health care provider. It is effective up to 72 hours or 3 days after intercourse. Another emergency contraception pill, Ella, requires an office visit and prescription but can be effective up to 5 days after unprotected intercourse. 

The effectiveness of an emergency contraceptive pill decreases the longer you wait, so don't delay if you are interested.

Common gynecological health concerns 

• Menstrual disorders
• Sexually Transmitted Diseases (STIs)
• Pre-Menstrual Syndrom (PMS)
• Urinary tract infections
• Vaginitis (yeast infections)
• Pelvic pain, swelling, or discharge
• Pain or swelling in the breast
• Pelvic abnormalities including ovarian cysts, uterine fibroids, and polyps

Women with urgent problems are typically seen the same day. If you have a medical problem requiring an urgent appointment, please call the appointment line during regular business hours. If you are experiencing a women's health issue after hours, please call the UHS Advice Nurse to discuss your medical concern. The nurse will help you decide what action is needed to address your health problem.

UHS does not provide prenatal care, a referral will be given to a local obstetrician/gynecologist.

Pregnancy Testing

Pregnancy testing is available at University Health Services by appointment with a nurse. Appointments for pregnancy testing are usually available within 1 to 3 days.

Pregnancy Counseling

For patients who are pregnant and unsure of their options, counseling is available through University Health Services and can be scheduled through myUHS or by calling the UHS appointment line during regular business hours.