HealthSensitiveExams patientguideto
2 HEALTH 101 CAREYOU-CENTERED
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Taking care of your sexual health is important because you are important. Regular screenings of reproductive systems may be recommended (such as a pap smear if you have a cervix—only recommended starting at age 21 and older) by your provider. A trained assistant and your medical provider will be attuned to your sense of safety and comfort during all sensitive exams. Why do we care? Because sexuality and sexual curiosity are common, healthy parts of connecting with people or practicing solo self-care. Whether you are having lots of consensual sex, no sex at all, or anything in between, your sexual expressions and activities are perfectly normal. They might even change at different times of your adult life. The information in this booklet describes health care recommendations for female and male anatomy, including reproductive organs and USCsystems.Student Health recognizes that anatomy and gender identity are different aspects of a person’s individual health; either or both may change over Lettime.your health care team know your pronouns and any questions you may have, and our team will make your health care experience as comfortable and helpful as possible. We are here for youto listen to understandyou,your needs, and provide the very best care and outstanding patient experience.
YOUR SEXUAL HEALTH MATTERS
4 GENERAL THINGS TO KNOW An assistant will be with your provider during the exam. You are in charge. Any examination, including a sensitive exam, is your choice. You have the right to decline an examination or stop the exam at any point. Ask questions and say something if you are uncomfortable or need specific clarification on what is going to happen.
• Clinical Breast Exam (CBE) for general screening beginning at age 25; earlier if you have breast symptoms such as pain, rashes, or lumps, or if you have a significant family history of breast cancer
• Penile Exam to diagnose symptoms including pain with urination, rashes, sores and discharge from the penis (may also collect sample for STI screening)
• Rectal Exam to diagnose symptoms of the abdomen, pelvis, and gastrointestinal system such as abdominal pain, blood in the stool, and sores or lesions. Can include visual inspection, a digital exam (finger inserted into the rectum), testing for STIs, and an anoscopy exam (this scope is made of disposable plastic and allows your doctor to get a detailed look at the tissue within your anal-rectal areas)
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TYPES OF EXAMS
• Pelvic Exam can include visual inspection, speculum exam (to collect cells for a pap test beginning at age 21 and in some cases to test for STIs), and bimanual exam (to diagnose conditions of the abdomen and pelvis such as pain)
Current symptoms and concerns 5 Ps of sexual history Partners (Current, Past and PreventionFuture)of Pregnancy (History of Pregnancy) Protection from Sexually Transmitted Infections PastPractices(STIs)History of STIs Physical and mental health history, family history Smoking, alcohol and other drug use Allergies and medications limitedbutincludeshistorymedicalisnotto
• Pubic/Groin Region and Hernia Exam to diagnose symptoms such as pain, lumps, rashes, and lesions in this area and to check for a hernia
6 MEDICAL HISTORY CONVERSATION The provider will explain what the examination consists of, ask questions in order to establish your general health and gather any history that may be contributing risk factors to your good health. Your provider may provide educational information to help you better understand optimizing your reproductive and sexual health.
• Your general physical and mental health, smoking, alcohol and other drug use, allergies and medications you are taking
• If you have been diagnosed with a sexually transmitted infection or if you have had sexual contact with someone who has
• Your menstrual period, such as how old you were when you first got it, how long it lasts, how often it comes, how much you bleed, the first day that your last period started, if you have cramps or other symptoms with your period
Some patients may not be comfortable talking about their sexual history, sex partners, or sexual practices, and wonder why such sensitive, personal, and specific information is Theseneeded.questions are important because there is no single test or panel for screening or testing for sexually transmitted infections. Sexual practices and risk behaviors vary among individuals. Identifying each person’s risks and what parts of the body are used for sex is important for the provider to recommend what individual tests are needed and what parts of the body should be tested.
• If you or your partner is concerned about becoming pregnant and what protection you are using
You have the right to refuse to answer any questions, but this may limit your provider’s ability to adequately evaluate you. The information that you provide is confidential.
historysexualyouraboutquestions
7 Your provider will ask you questions about:
• Any family history of certain conditions such as breast or ovarian cancer or blood clots
recommendations.htm)guidelines/screening-std/treatment-(Source:cdc.gov/
• If you have vaginal itchiness, discomfort, sores, bumps, any unusual discharge (drainage) or unusual odors
• If you have had penile discharge, sores, bumps, or other discomfort
• If you have been sexually abused or assaulted (See section, About Reporting Domestic Violence and Sexual Assault)
• Your past and current sexual activities, including number and gender identity of your sexual partners, detailed questions about types of sexual contact (oral, vaginal, anal, penile), use of barriers such as condoms, and if you have ever exchanged sex for money or drugs, or had sex with someone who has
8 SENSITIVE HEALTH EXAMINATIONS A trained assistant will be present at all times during a sensitive health exam; you may request an assistant of a specific gender. You can also have a friend or family member present in addition to the assistant.
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assaultandviolencedomesticreportingsexual
You can also have a friend or family member present during the exam, in addition to the trained assistant. You are in charge during the examination, and you have the right to stop the exam at any time, as well as the right to seek care elsewhere. You can decline to have a sensitive exam at any point.
All medical providers in California, including nurses, nurse practitioners, physician assistants, and physicians at USC Student Health are required to make a report to local law enforcement when a patient seeks care for conditions related to domestic violence and sexual assault. If you wish to keep information about sexual assault private, you may tell the medical assistant, nurse, or provider that you need to discuss a serious emotional concern that is highly personal and you wish to discuss your concerns more fully with a mental health professional ONLY. You will be referred to Counseling and Mental Health Services OR Relationship and Sexual Violence Prevention and Services in USC Student Health.
Tell your health care provider if something bothers or frightens you. Be clear about your modesty needs. If for religious, personal, or cultural reasons you need to have a provider of a specific gender identity, USC Student Health has male and female providers available and will make every effort to accommodate your Ifpreference.youneedto remove your clothing to be examined, you will be given a gown or sheet. Only the part of your body being examined should be uncovered. If the gown or sheet is too big or too small, let your provider know.
In addition to you, the patient, and the provider who is providing your care, a trained assistant will be present at all times during examination of the genital area, rectum or female breast. You may request an assistant of a specific gender.
10 HEALTH 101 Female ExamsSensitiveAnatomy
Most health care providers agree that you should have your first exam when you have symptoms such as discharge or pain, or when you turn 21, whichever comes first. You may feel slight discomfort or pressure during this exam, but there should be no pain. If you experience any pain, tenderness, or excessive pressure, please tell the provider right away, and ask any questions you may have. The pelvic exam generally can include:
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Speculum Exam Examination of the vaginal canal and cervix, aided by a speculum (a duck bill-shaped instrument that is gently inserted and opened to provide visual access into the vaginal opening). During this part of the exam, the provider can conduct a Pap test (beginning at age 21), using a thin plastic cervical cell collector brush to gently collect some cells from the cervix. These cells will be tested for early changes to the cervix before they become cancer. Additional fluid may be collected for STI testing if you are sexually active. Your provider may also collect fluid for diagnosing vaginal discharge. The speculum will be closed gently and removed. The provider may need to move the speculum once it is inserted to fully see the cervix.
CLINICAL BREAST EXAM
Manual Examination Using the pads of the fingers, your provider palpates (pressing with the hands) your entire breast, underarm, and collarbone area for any lumps or abnormalities. The manual exam is done on one side and then the other. Your provider will also check the lymph nodes under the armpit to see if they are enlarged. Your nipples may be checked to see if fluid is expressed when lightly squeezed.
DIAGNOSING CAUSES OF PAIN OR UNUSUAL SYMPTOMS—BIMANUAL EXAM
External Exam Examination of external labia, clitoris, vaginal opening, perineum, and rectal area. This is conducted with the patient lying down on an exam table with paper/cloth coverings over the stomach and legs, and feet placed in stirrups.
Visual Examination During a clinical breast exam, your health care provider checks your breasts’ appearance. This is usually conducted with the patient lying on an exam table, opening the front of the dressing gown. You may be asked to raise your arms over your head to allow your provider to look for differences in size or shape between your breasts. The skin covering your breasts is checked for any rash, dimpling, or other abnormal signs.
If you have pain or other symptoms in the lower abdomen and reproductive organs, the provider may perform a bimanual exam. The provider will insert one or two gloved fingers into the vagina. With the other hand, the provider will gently apply pressure to the lower part of your belly, palpating (pressing with the hand) to check the size and placement of the ovaries and uterus. The provider may use their fingers to gently move the cervix from side to side to check for signs of infection.
A clinical breast exam (CBE) is usually performed if you have a breast issue or concern, such as pain or lumps. Your provider may also offer you a screening CBE beginning at age 25, based on your personal and family risk assessment.
PELVIC EXAM
12 HEALTH 101 Male ExamsSensitiveAnatomy
A male urogenital exam may be performed to check for hernia, or if the patient is experiencing pain, swelling or discharge, has sores or other unusual symptoms. There should be no pain associated with the exam, however, if you experience any pain, tenderness, or excessive pressure, please tell the provider right away, and ask any questions you may have.
Note: Some patients may develop an erection during the examination; this is completely normal as erections can result from anxiety, temperature changes and a reflex to touch, in addition to sexual arousal.
DIAGNOSING CAUSES OF PAIN OR UNUSUAL SYMPTOMS—PENILE EXAM If you have pain, sores or other unusual symptoms, the provider may perform a visual and manual examination of the penis, including the skin, foreskin, glans, and urethra. If you are uncircumcised, the provider may ask you to retract the foreskin back in order to examine all surfaces of the penis for sores and lesions, and may palpate (press with hands) the area for irregularities. The provider may examine the urethral meatus (opening of the urethra), and may use a swab to collect a lab sample. Sometimes the provider may press along the shaft to express any potential fluid. If you prefer and are comfortable doing so, you may swab the area yourself. On occasion, the provider may need to squeeze the muscle of the penis to check for scarring (Peyronie’s disease).
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The male urogenital exam generally can include: PUBIC/GROIN REGION, HERNIA EXAM Visual examination of the area including the scrotum, groin, and hip crease to look for any abnormalities, accompanied by palpation (pressing with the hands) on the groin, inner upper thigh crease, and lower abdomen, especially along the lymph nodes of the hip area, the testicles, as well as the spermatic cord connected to the testis inside the scrotum. During a hernia exam the provider places fingers through the scrotum while you are standing.
14 HEALTH 101 Rectal Exams
If you have pain in the lower abdomen and reproductive organ, have blood in your stool, or have other gastrointestinal or rectal symptoms, your provider may perform a rectal exam. It is also performed to collect tests for sexually transmitted infections of the rectum. A rectal examination is done either lying on one’s side or kneeling on the examination table. There should be no pain associated with the exam, however, if you experience any pain, tenderness, or excessive pressure, please tell the provider right away, and ask any questions you may have.
The rectal exam generally can include: EXTERNAL EXAM A visual examination of the anus and area around it to look for sores, rashes and bumps. Your provider may position a light so they can see better. Your provider may also collect tests for sexually transmitted infections by placing a cotton swab into the rectum. The swab is inserted about 1 inch (2-3 cm), rotated gently, and removed.
DIGITAL EXAM The provider inserts one gloved and lubricated finger into the anus and palpates to detect any lumps or other abnormalities. The provider may also push firmly on the prostate gland to check for pain or tenderness. ANOSCOPE EXAM Examination of the rectal canal aided by an anoscope (a rigid hollow tube 3 to 5 inches long, and about 2 inches wide) that allows the provider to examine the anus and rectum in detail. The anoscope is gently inserted with lubrication into the rectum then slowly withdrawn as the provider exams the rectal canal. While the anoscope is being inserted, the provider may ask you to intensify your internal muscles and relax as you would when having a bowel movement. This eases the placement of the anoscope. The provider may position a light or ask a medical assistant to hold a light during the procedure.
Note: Some patients may feel sensations similar to an urge to urinate or defecate during the rectal exam. This urge usually passes quickly, but if the urge is strong, you can ask the provider to stop the exam.
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16Test so you know your status. If you test positive, getting treatment early can be an important step. It’s also important to tell any partners, even though this may not be easy. If you are not experiencing symptoms of an active infection but want to get tested for sexual transmitted infections, you can schedule a self-directed STI test through MySHR (usc.edu/myshr) . This will create an order for you at the USC Student Health Center labs on the first floor of Engeman. You can go straight there to complete your sample collection and receive results without a clinical visit. usc.edu/myshr KNOW YOUR STATUS STI SCREENING RECOMMENDATIONS *Testing for gonorrhea and syphilis is recommended if you are pregnant; a man / nonbinary person / transgender woman who has sex with men; have HIV infection; and/or have partner(s) who have tested positive for these infections. A one-time test is recommended if you are anatomically female. • HIV: blood test recommended for all individuals • Genital sex: urine test for chlamydia & gonorrhea • Oral sex: throat swab for gonorrhea • Anal sex: anal swab for chlamydia & gonorrhea • Blood test for syphilis*: by population or practices • Self-pleasuring practices (masturbation): no testing required
• The internal condom (designed to fit inside the vagina) resembles an external condom made of polyurethane. The female condom is pre-lubricated and is ‘one size fits all’.
• Always use a new, lubricated condom every time you have sex. Check the use-by date and open the packet, being careful not to tear the condom with fingernails, jewelry or teeth.
• If you need extra lubricant, use only water-based lubricants. Other lubricants can damage the condom.
INTIMATE TOYS Sanitize (https://nyti.ms/3tINzfN) as a hygiene practice, especially if shared between partners. Condoms offer the best available protection against STIs by acting as a physical barrier to prevent the exchange of semen, vaginal fluids or blood between partners. Safe sex is also called ‘safer sex’ to highlight the fact that condoms and other barrier methods are not 100 per cent effective in preventing STIs. However, condoms do offer the best available protection when used correctly. For vaginal, anal and oral sex, you should use condoms. Points to keep in mind include:
• The external condom (used on a penis) is a fine, strong, latex-rubber sheath available in a variety of sizes and styles. Condoms made from polyurethane are available for people allergic to latex.
• To be effective, condoms must be used from the start of sex to the very end as STIs can be transmitted via pre-ejaculate.
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• You should also use other barrier methods for protection – for example, external condoms on vibrators and other penetrative sex toys, a latex glove for digital penetration of the vagina or anus, and a dental dam (a sheet of latex worn over the female genitals) during oral sex.
• Remember that a diaphragm (a cap worn high in the vagina to cover the cervix) offers good protection against pregnancy, but low protection against STIs.
CONDOMS AND SAFER SEX
18 CONCLUSION OF THE VISIT Ask any questions about follow-up care, make plans for your next appointment, and congratulate yourself— you’ve taken important steps to safeguard your good health by participating in this appointment.
19 studenthealth.usc.edu24/7PhoneLine:213.740.9355(WELL) University Park Campus Location Engemann Student Health Center 1031 West 34th Street Los Angeles, CA 90089 Health Sciences Campus Location Eric Cohen Student Health Center 1510 San Pablo Street Suite 104 Los Angeles, CA 90033 View the digital version of this booklet View the Chinese-language (中文) version of this booklet.bit.ly/USCsensitiveguideCNbit.ly/USCsensitiveguide
