On-ED
Thursday, October 12, 2006 - The Michigan Daily - 5A
Checking in with UHS
A student-friendly
gynecology clinic
BY THERESA KENNELLY
Visiting University Health Ser-
vices during Welcome Week real-
ly put in perspective the problem
with having a University-oper-
ated center promoting safe sex:
UHS just can't figure out how to
be approachable for students. The
elderly woman who sat behind the
"safe sex" booth with a basket of
condoms, stickers and posters was
not the best person to encourage
University students to familiar-
ize themselves with responsible
sex practices. How many people
want to talk with a woman who
resembles their grandma about
intercourse - let alone ask her for
condoms?
The best part of my trip to
UHS, however, was not seeing
student after student ignore the
woman and booth stationed liter-
ally at the front entrance; rather,
it was watching them flock to the
unattended basket of condoms as
soon as the woman abandoned her
positionclearly illustrating UHS's
PR problem.
The department most affected
by UHS's lack of approachability
is the gynecology clinic, which is
home to a variety of services for
students, many of which could be
lifesaving. It's not just that the clin-
ic doesn't know how to reach out to
women on campus - it's also the
lack of respect young women often
receive when they come. When
a women comes to UHS seeking
emergency contraception, she first
must endure a series of questions
0 concerning her need for the pill in
the not-so-private cubicles in the
lobby of UHS. After her interro-
gation, the nurses clip a big yellow
slip of paper reading "E.C." atop
her medical history, which she
must carry up to the gynecology
clinic to wait for her appointment.
When a woman comes to the clin-
ic requesting birth control, she is
forced to sit down to a 15-minute
movie at the entrance of the clinic
that outlines her options - which
of course ends on the point that
abstinence is the only guaranteed
way to prevent a pregnancy.
In order for the clinic to make
its services more accessible to the
female student body and effec-
tively promote safe-sex methods
around campus, UHS needs to
be student-friendly. The Safe Sex
Store representatives who stand
on the corner of State and Hoover
Streets before football games sym-
bolize what the clinic, and UHS
as a whole, should work toward
- making contraceptives and
safe sex appealing. While it may
not be necessary to station cute
girls around campus dispersing
packets of lubrication in order to
draw women in, UHS does need to
work toward getting more people
into its offices to talk about sex and
make women less scared to have a
stranger look at their vaginas.
While few women may be dis-
suaded from obtaining birth con-
trol at the clinic just because of a
mandatory movie, the feelings of
embarrassment and discomfort
that accompany certain aspects of
the clinic are lasting and discour-
age patients from returning. Cre-
ating a comfortable atmosphere
as well as not making a huge pro-
duction of sex-related issues at the
clinic will only help it to run a more
successful safe-sex campaign. The
resources are ready and waiting
for students at UHS, but until it
reforms its unnecessarily awkward
systems - and perhaps hires a
more youthful person to work at
the "condom counter" - a major-
ity of students will continue to
ignore it.
Kennelly is an LSA junior and
an associate editorial page editor.
INTERVIEW BY AMANDA BURNS
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 teen-
agers. After high school, college stu-
dents 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 tak-
ing place.
Although University Health Ser-
vices 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, Medi-
cal 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 dur-
ing 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 dur-
ing 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 comfort-
able 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 avail-
able 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, radiol-
ogy, 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 ser-
vices 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 thera-
pist that specializes in pelvic floor
therapy. At the hospital it is very dif-
ficult to get patients in to see a physi-
cal therapist with that kind type of
expertise, and here it is a free service
for students. I always ask my col-
leagues at the hospital that, if they
attend to a student who needs ser-
vices, to send them back over here
because we can do so many things
for students without cost.
RE.: We try to have as many ser-
vices 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 pop-
TREVOR CAMPBELL/Daily
UHS Chief of Gynecology Services Dr. Susan Ernst and Medical Director Dr. Robert Ernst.
TELL A FRIEND, MAKE A DATE,
GET VACCINATED
Step one: Call your insurance provider. Although the
vaccine in now available at UHS, each health-care insur-
ance provider will have specific guidelines regarding reim-
bursement for the vaccine's cost. For example, M-CARE
will cover the vaccine, but only when administered by the
student's primary care physician. Uninsured students can
get the vaccine at UHS for $188 per dose.
If your insurance covers vaccination at UHS, proceed
to step two.
Steptwo: Call the immunization clinic at UHS (734-764-
8304) and set up an appointment to get the first dose.
Step three: Two months after the first dose, go to the
immunization clinic's walk-in hours to receive the second.
Step four: Six months after the second dose, finish the
vaccination cycle during walk-in hours.
KATIE GARLINGHOUSE fkosE. ARREST
ulation. 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 col-
lege 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 col-
lege population, where HPV is so
commonly acquired. It is a great safe-
guard against disease.
Were you surprised by the contro-
versy 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
havechosen that ageto be universally
applicable.
Why do you think that sofew stu-
dents were aware of HPV and its
connection to cervical cancer? Per-
sonally, the "tell someone" TV ads
that aired this summer really caught
my eye.
SE.: 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 diffi-
cult. That TV commercial did a mil-
lion 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 associ-
ated 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
duringsexualintercourse,andHPV is
a disease spread by skin-to-skin con-
tact, 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 manu-
facturer 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 pur-
chase 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 inten-
tionally keep pricing low. Increas-
ingly, itsis 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 Stu-
dent Affairs rather than the Division
of Medical Affairs because the col-
lege 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 impor-
tance 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 deduct-
ible 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 lib-
eration may belong to our parents,
but the age of sexual health can and
should belong to us.
Burns is an LSA senior anda
member of the Daily's editorial board.
UNIVERSITY OF WISCONSIN'S BIRTH CONTROL
NEAR-CRISIS: COULD IT HAPPEN HERE?
During the summer of 2005, when most of the University of Wiscon-
sin's student population had left for the summer, the state Assembly
passed the University of Wisconsin birth control ban. This bill explicitly
prohibited University of Wisconsin health services from prescribing or
dispensing emergency contraception to students, and the state attor-
ney general said it could be interpreted to ban all birth control. The
state representative who introduced the bill believed open access to
EC encouraged promiscuity. The bill ultimately didn't become law, but
it could have left thousands of students who relied on university health
services for contraceptives with few alternatives. The University of
Wisconsin is similar to our university in so many ways that it presents
the question: How secure is students' access to birth control in Ann
Arbor?
Dr. Robert Winfield, the director of University Health Services, pro-
vided the answer. The University is a state institution, meaning state
laws govern it. If the state Legislature in Michigan were to pass a law
similar to the one that nearly passed in Wisconsin, UHS would have
to abide by it - much like the Department of Public Safety has the
responsibility to enforce the state's minor-in-possession law. While
Winfield believe that such legislation is unlikely, the Office of Gov-
ernmental Relations would consult UHS in the lobbying effort against
such a measure. The Wisconsin case is an excellent reason for stu-
dents to always keep an eye on what is transpiring in Lansing.
-Amanda Burns