Everyone remembers the sex-ed question box – students wrote their anonymous sex questions on a sheet of paper and the high school gym teacher explained the truth about crabs and orgasms to fascinated teenagers. After high school, college students are either forced to believe what their best friend’s roommate told them about chlamydia or make the much-feared trip to the gynecologist. At a school where women are willing to wear “I (heart) Michigan Vaginas” T-shirts and the Daily gives tips on having sex in the stacks, it is unclear how many productive conversations about sexual health are actually taking place.
Although University Health Services often gets bad reviews from students due to long lines and its lack of a cure for the common cold, it has a vast number of resources to help students manage their sexual health. I sat down with the chief of gynecology services for UHS, Dr. Susan Ernst, and her husband, Medical Director Dr. Robert Ernst, to ask the sexual health questions students should know the answers to.
What impact do you think UHS can have on women’s health?
Dr. Susan Ernst: I think UHS can have a great impact on student health; we see a large number of women for health maintenance exams, and during that time we try to educate them about a variety of things. We educate them on emergency contraception, we do contraceptive consulting and we do a sexual health assessment during those visits.
Dr. Robert Ernst: I think that there is also the sense that coming in for an annual exam may be one of the first opportunities women have to seek health care by themselves, and I think just helping them feel comfortable taking care of their own health-care issues for the first time in their lives is an important aspect of student learning that goes on here.
What services are currently available to students free of charge at UHS?
R.E.: The goal is to limit out-of-pocket expenses and remove barriers to care. Most everything that we do here – visits, education, labs, radiology, nutrition counseling – are the things that are going to be included. It is almost easier to list the few things that are not free.
How does UHS compare to other universities?
S.E.: We look at how we compare to other Big Ten universities and whether we are offering similar services or more services. I would say that as far gynecologic services are concerned, we offer a little bit more than other universities. We have a fair number of patients with pelvic pain or pain with intercourse, and we actually have a physical therapist that specializes in pelvic floor therapy. At the hospital it is very difficult to get patients in to see a physical therapist with that kind type of expertise, and here it is a free service for students. I always ask my colleagues at the hospital that, if they attend to a student who needs services, to send them back over here because we can do so many things for students without cost.
R.E.: We try to have as many services as possible on site because that gives the most flexibility to students. Take radiology services, for example: We offer ultrasound services on site. Also, the fact that we have more than one gynecologist as a consultant is a real luxury amongst college health centers.
Can you explain a little about the new human papillomavirus vaccine?
S.E.: I am passionate about it because I feel it is perfect for our population. HPV is the most common sexually transmitted infection. There are studies that show 60 percent of college-age women will come into contact with HPV during their college career. HPV is the known cause of cervical cancer; 13,000 women a year are diagnosed and 4,000 women per year die, so it is a major health issue. This vaccine protects against strains 6 and 11, which cause about 90 percent of cases of genital warts, and strains 16 and 18, which cause about 70 percent of cases of cervical cancer. It is an amazing advance in medicine, particularly for this college population, where HPV is so commonly acquired. It is a great safeguard against disease.
Were you surprised by the controversy the vaccine has created?
S.E.: It is hard for me to separate myself as a gynecologist and myself as a parent. These are parents that are saying that if we give this vaccine it almost endorses sexual activity at age 12, but I don’t see it that way. They have chosen that age to be universally applicable.
Why do you think that so few students were aware of HPV and its connection to cervical cancer? Personally, the “tell someone” TV ads that aired this summer really caught my eye.
S.E.: We try so hard! We give out pamphlets, we tell patients about it, we ask if they have any questions before we administer Pap smears. So many times when we call them back and say the pap smear was abnormal they say, “What does this mean?” We say it looks like it could be related to HPV, and ask what that is. It is difficult. That TV commercial did a million times more than we could ever do. I don’t know where we are going wrong.
R.E.: The term STD has some very negative connotations associated with it, but at the same time Susan has given data to suggest that by the end of college 55-60 percent of college students will be exposed to it. But it still doesn’t change the fact that people label it as an STD, and I think that is probably part of it.
Why are condoms not effective in preventing the spread of HPV?
R.E.: Condoms are somewhat protective in preventing HPV, but they are not 100-percent effective because they do not cover all of the area of skin that comes into contact during sexual intercourse, and HPV is a disease spread by skin-to-skin contact, like herpes. We definitely have patients who have never had sexual intercourse but who have HPV.
What is UHS’s policy concerning emergency contraception?
S.E.: About four years ago, we made EC available on a walk-in basis. Students could come in and just talk with a nurse and get the prescription through the nurse. Now that it has been approved for over-the-counter use, we will have it available in our pharmacy. The only thing that is holding us up now is that the manufacturer has to change the packaging to comply with FDA requirements. They think it will be available by the end of the year, or in January. At that point students will have to prove their age; they have to be over age 18. UHS will still have the walk-in protocol for students under 18.
It is often less expensive to purchase birth control through UHS than at regular pharmacies. Why is that?
R.E.: Historically, we have had some advantages in purchasing birth control that allowed us to very intentionally keep pricing low. Increasingly, it is becoming difficult to get those kinds of deals. We have had to increase our prices, and we are going to need to increase them again, unfortunately.
Both doctors stressed the point that UHS is part of the Division of Student Affairs rather than the Division of Medical Affairs because the college population has different needs, and a health system catering to these needs should have different priorities. For example, the pharmacy handles birth-control purchasing separately because it understands the importance making it available at a low cost to students. Drs. Susan and Robert Ernst are part of a large team at UHS working to improve sexual health on campus, but I couldn’t help but detect a frustration that students aren’t quite catching on. After college, women will be faced with finding their own health insurance and paying a deductible in order to receive gynecological services. Yet right now these services are free of charge – all it takes is a little initiative. The age of sexual liberation may belong to our parents, but the age of sexual health can and should belong to us.
Burns is an LSA senior and a member of the Daily’s editorial board.