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