The Pelvic Exam
Urinary Tract Infections
HPV/HPV Vaccine Gardasil
The more you know about your body, the easier it is to stay healthy. Learning about your body will help you:
- Understand you body's natural pattern -- your body changes during your monthly cycle and as you age. It's important to be aware of what's normal for you, and what isn't.
- Recognize warning signs of illness -- If you know when your body is functioning normally, you'll be better able to detect an illness before it becomes serious
1. Do a Breast Self-exam (BSE) every month
- Do it 2-3 days after your period ends -- it's easy to remember, and your breasts are less likely to be swollen and tender
- Most breast changes aren't cancer, but if you find a change have a health care provider check it out right away
- Be sure to examine the whole breast area, from collarbone to below your breasts, and from breastbone to armpit.
- Look for changes in front of a mirror:
i. with arms at your sides
ii. with hands clasped behind your head and pressed forward
iii. with hands on your hips
- Look for changes from month to month:
i. a whitish crust on or near the nipple
ii. any fluid from the nipple
iii. a sunken or pulled-in nipple, or a change in nipple angle
iv. any puckering dimpling, scaling or redness of the skin
v. any change in the shape or size of your breasts
vi. any lump or thickening that wasn't there before
5 Good Reasons to Check your Breasts
- You learn what your breasts normally feel like
- You can find a change early
- It's quick, easy and free
- You can do it at home in privacy
- Your breasts get checked at least 12 times a year.
2. The Pelvic Exam
- Current recommendations for cervical cancer screening (Pap tests) are to begin screening within 3 years of onset of sexual activity or age 21, whichever comes first. Therefore if you are in this group you should consider having your first pelvic exam.
- The exam should occur when you're not having your period.
- The pelvic exam takes only a few minutes and includes:
- an exam of your external sex organs for growths/rashes
- a bimanual exam to check your internal sex organs with the examiner placing gloved fingers into your vagina to touch your cervix and pressing on your abdomen with the other hand
- a speculum exam to do a Pap smear, by inserting a warm plastic or metal speculum into your vagina allowing visualization of your cervix, and cell tissue sampling with a cotton swab or brush.
3. Vaginal Problems
- YEAST INFECTION: an overgrowth of a fungus normally present in the vagina; this can be caused by taking some brands of birth control pills or antibiotics.
- There are over the counter antifungal medications available to treat yeast infections, however, if you're not sure if this is what you have, if your symptoms don't respond to these medications, or you're having frequent recurrences of similar symptoms, you should be checked by SHS or your health care provider.
- Symptoms are:
1. itching, irritation, and redness around the perineal area
2. thick, white vaginal discharge that looks like cottage cheese and may smell like yeast
3. burning and/or pain with urinating or during sex
- BACTERIAL VAGINOSIS: an overgrowth of one or more types of bacteria in the vagina.
o Must be diagnosed and treated by SHS or your
health care provider
o Often a sexually-related infection, but not necessarily sexually transmitted
o Symptoms are:
1. mild vaginal irritation or burning
2. a watery grayish-white or yellow vaginal discharge
3. a foul, sometimes fishy smell to the discharge especially after intercourse
- GENITAL HERPES: a viral infection caused by the Herpes Simplex virus. Type 1 often affects the oral area, showing up as cold sores, but can affect the genital area, too. Type 2 usually affects the genital area, upper thighs, and area near the anus, as painful blisters, sores, and ulcerations, but can also affect the oral area.
- The virus is spread by direct skin to skin contact from the site of infection to the contact site, but can also be spread during periods where there are no noticeable symptoms/sores.
- Oral sex can spread herpes from the mouth to the genital area and from the genital area to the mouth.
- With outbreaks, especially the first one, there may be flu-like symptoms -- swollen glands, fever, body aches.
- There is no cure for herpes, but medications are available from your health care provider to help minimize the severity of an outbreak
- Lab tests can determine if herpes simplex is causing your outbreak if the tests are done when you have active lesions.
- Stress, fatigue, illnesses, etc. may trigger outbreaks.
- Signs and symptoms may occur as early as 2 to 20 days after contact
- Symptoms are:
1. itching, irritation, and tingling in the genital area 1-2 days before the blisters appear
2. painful blisters/sores (there may be 1 or many) on the genital area, anus, and thighs/buttocks
3. after a few days, the blisters break upon and leave painful, shallow ulcers, which can last from 5 days to 3 weeks
4. Urinary Tract Infections
A urinary tract infection (UTI) occurs when bacteria enter the urinary tract. Females are more susceptible to UTIs because their anuses, vaginas, and urethra are so close together that bacteria can easily spread from a contaminated area to the urethra. Also, a female's urethra is much shorter than a male's, so bacteria can travel up to the bladder and kidneys more easily. Common symptoms of a UTI are:
· pain or burning when urinating
· feeling a sudden, urgent need to urinate
· urinating more often than usual
· urinating only small amounts even though the bladder feels full
· blood in the urine
· cloudy or foul-smelling urine
· pain in the lower abdomen, especially when urinating
· back pain
- Any UTI symptom should be checked by a health care provider. Early recognition is important because an untreated UTI can result in more serious problems.
- Most UTIs are not contagious but occasionally an STD can cause similar symptoms.
- How to avoid UTIs:
· drink plenty of water -- a minimum of 8 glasses/day
· wash the genital area daily with mild soap
· urinate frequently and empty your bladder completely -- don't hold in urine for long periods without voiding
· wipe from front to back after bowel movements
· don't use douches, deodorants, strong soaps, or sprays
· urinate before and after intercourse
· drink a small glass of cranberry juice each day
5. Emergency Contraception
If you've had unprotected sex within the last 3 days, it's not too late. You can do something to prevent pregnancy. Emergency contraception, often called "the morning after pill," works like regular birth control pills to prevent pregnancy in one of two ways. It may stop the egg from being released, so it can't be fertilized, or it may change the lining of the uterus so the egg can't attach and grow.
Emergency contraception can and should be used if you had sexual intercourse and:
- the condom broke or fell off
- you didn't use any protection
- you're on birth control but missed taking pills during this cycle
- your diaphragm wasn't in place
- you were forced to have sex.
Presently, emergency contraception is only available from your health care provider -- SHS has it available. You need to start it within 3 days (72 hours) of when you had intercourse. The sooner it is started, the more effective it is. Emergency contraception does not cause abortion. It will not work if a woman is already pregnant -- it is NOT the same as RU 486 (the abortion pill).
The biggest side effect from emergency contraception is nausea and possibly vomiting. It is recommended to take it with food, to minimize this. It also will alter your menstrual cycle, and may cause bleeding/spotting within a few days of taking it.
For further questions, contact Student Health Services.
Emergency contraception does not protect you from STDs. If you've had unprotected intercourse you should consider being tested for sexually transmitted infections, because you are at risk.
6. Human Papilloma Virus (HPV) and the NEW HPV vaccine
In the US, HPV is considered to be the most common sexually transmitted disease. Because HPV is so common and prevalent, a person does not need to have a lot of sexual partners to come into contact with this virus. HPV is the name of a group of viruses that includes more than 80 different types. Certain types of HPV cause warts on the hands or feet, while others can cause visible genital warts. However, sometimes HPV infection causes no warts, and many people with genital HPV don't know they have it. Some kinds of these invisible HPV infections cause growths that are cancerous.
What are the symptoms of an HPV infection?
Most people who have a genital HPV infection don't know they are infected. The virus lives in the skin or mucous membranes and usually causes no symptoms. Some people get visible genital warts, which appear as growths or bumps on the vulva, in or around the vagina or anus, on the cervix, and on the penis scrotum, groin, or thigh. They may be raised or flat, single or multiple, small or large. Some cluster together forming a cauliflower-like shape. They tend to be flesh colored or whitish in appearance. Sometimes genital warts are so small that they can't be seen with the naked eye. Warts usually do not cause itching or burning.
How are Genital HPV infections spread?
Any person who is sexually active can get HPV. The types of HPV that infect the genital area are spread primarily through genital contact during vaginal, anal, or oral sex. Most HPV infections have no signs or symptoms; therefore most infected persons are unaware they are infected, yet they can transmit the virus to a sex partner. Infection spreads through skin to skin contact, whether or not warts are visible. Warts may appear within several weeks after sexual relations with an infected partner; or they may take months to appear; or they may never appear. This makes it hard to know exactly when or from whom you got the virus.
The surest way to avoid transmission of sexually transmitted diseases, including HPV, is to refrain from genital contact. HPV infection can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. While the effect of condoms in preventing HPV infection is unknown, condom use has been associated with a lower rate of cervical cancer, an HPV-associated disease. The use of condoms should not be a substitute for routine Pap tests. Sexually active women should have a regular Pap test to screen for cervical cancer and other pre-cancerous changes.
To reduce risk of HPV, a person should have sex with only one partner, who only has sex with them. If someone has visible symptoms of genital warts, he or she should not have sexual activity until the warts are removed. Condoms help, but since they don't cover all genital skin, they don't protect 100%.
Is there a cure of Genital HPV infections?
There is no "cure" for HPV infection, however there are several treatment options available for genital warts. The goal of any treatment is to remove visible genital warts, which may help reduce the risk of transmission to a partner. Whether or not warts are present, though, it is believed that in some cases HPV may stay in the body for life. Because the virus can lie dormant in the cells, in some cases warts return months or even years after treatment; in other cases, warts never recur.
What is the connection between HPV, genital warts, and cervical cancer?
Only certain, "high risk" types of HPV are linked with cervical cancer. The types of HPV that cause raised external genital warts are not linked with cancer, "low risk" types. However, genital warts may accompany other genital HPV infections, and an infected person may have -- and pass along -- more than one type of HPV. That's why many clinicians consider all infections to be warnings of potentially cancerous conditions.
In the US, cervical cancer is the fifth most common cancer among women. Pap tests can detect very early precancerous conditions, which are easily treated. The majority of cases of cervical cancer are in women who have either never had a Pap smear, or have not had one in five years or more. Regular Pap testing and careful medical follow-up, with treatment if necessary, can help ensure that pre-cancerous changes in the cervix caused by HPV infection do not develop into life threatening cervical cancer.
Most of the time, men will not have any symptoms or health risks such as cancer with the "high risk" types of HPV. It is the female cervix that needs to be monitored.
The younger a woman becomes sexually active, the higher her risk for HPV infection. A younger woman has maturing cells in her cervix that are more easily infected than those of an older woman. A younger woman has also had less time to develop natural defenses -- antibodies -- against HPV. The risk of infection increases with higher numbers of sexual partners.
GARDASIL -- THE NEW HPV VACCINE
In June 2006 a new vaccine was approved for young girls and women that prevents four strains of HPV -- 16 and 18 (which account for 70% of all cases of cervical cancer) and 6 and 11 (which are responsible for 90% of genital wart cases). The vaccine is administered in 3 shots over a six month period at a cost of about $360 for the entire series.
Specific recommendations for the HPV vaccination are:
- Routine vaccination for girls 11 and 12 years old (generally pre-sexual exposure and likely to produce lots of antibodies to the vaccine)
- Girls as young as 9 years can receive the vaccine
- Girls 13-18 should be caught up if they haven't received the vaccine or complete the series if started earlier and not finished
- Vaccinating those between 19-26 years should be based upon discussion regarding risk of potential previous exposure
- Males are currently not included in the licensure for this vaccine
The Gardasil vaccination is given into the muscle in the upper arm or thigh area. The most common side effects are soreness in the injection site and headaches. It is contraindicated in pregnant women. The schedule of the 3 shot series is:
• Shot #1
• 2 months later Shot #2
• 6 months from #1 Shot #3
The Gardasil vaccine only prevents infection, it does not prevent disease in a person already infected with the virus. This is the reason the vaccine is recommended at a young age, before first sexual exposure, and potential infection. If a woman has been exposed to one type of HPV, though the vaccine will not have effect on that type, it will still offer protection against the other three types.
The Gardasil vaccine only prevents four strains of HPV, therefore there are still 20-30 types of genital tract HPV that can still cause problems. For this reason Pap tests are still needed to detect cervical abnormalities that may be caused by these less common strains of virus. Pap screening should still continue in both vaccinated and unvaccinated women.
For more information the CDC Vaccine Information Sheet for the HPV vaccine is at: