Any time you have a visit with a medical professional at University Health Services, it will start at the beginning—with a discussion! Our care team is passionate about creating a partnership with our patients and using shared decision-making to improve health and well-being.

College is all about education and empowerment. Your visit to University Health Services is part of this experience. For many students, a medical appointment may feel overwhelming. Besides navigating the appointment system, interpreting medical terminology, and figuring out your health insurance, you may be coming to an appointment for the first time on your own or experiencing new health concerns. Your exam might also lead to a concern regarding a private part of your body—making the whole process feel daunting. This guide is to help you feel as comfortable and confident as possible so you know what to expect during a sensitive examination and how to get the support you need.

First things first

• We define a sensitive exam as any physical exam involving body parts typically covered by undergarments, including breasts, genitals, buttocks, groin/pubic region, and rectal area. However, since every patient has a different history and a different experience with their body, you may define other body parts as sensitive. We encourage you to let us know if any exam seems sensitive to you. 
• Your visit is confidential. We follow the same privacy regulations as any hospital or clinic. If you have questions about how we handle your private health information, let us know or refer to our Notice of Privacy Practices. Note: Go to https://health.uoregon.edu/forms for the Notice of Privacy Practices in other languages including Arabic, Chinese, Japanese, and Korean.
• You always have the right to refuse to answer certain questions or to decline a physical examination of any part of your body. You are the one in charge and nothing should happen without your consent. You also have the right to withdraw consent and stop your examination at any point. 
• Any visit to the doctors and nurse practitioners at University Health Services will include a discussion about the use of a clinical chaperone, a trained member of our nursing staff who may be present for a portion of your visit to support you and assist your clinician.
• If you have any concerns about your visit at any point, voice your concerns. 

Do I need an exam or not?

Not every health issue requires a physical examination. We will only do what needs to be done to care for you appropriately. We will always discuss this with you and make sure you understand and consent to the plan prior to proceeding.

Common reasons why you might need only a discussion and not an exam

• A contraception consult, such as a birth control pill prescription or visit to discuss long-acting reversible contraception (IUD/implants/shots)
• A visit to discuss emergency contraception, such as “the morning after pill.” 
• A visit for routine STI screening when you have no symptoms (you can collect your specimens by peeing in a cup or self-collecting a vaginal/rectal swab privately) 
• A visit for treatment when you’ve been exposed to an STI but have no symptoms

Common reasons why you might need a discussion and an exam

• A symptom involving your genitals; this could include a rash or sores, itching, burning, unusual discharge, different odor, lump/bump, or pain
• Pain or discomfort with urination (this may or may not need a genital exam)
• Pain or discomfort with bowel movements, lump/bump/rash on anus, anal itching
• Breast pain or discomfort, nipple discharge, rash or sores on breasts
• Pelvic pain or lower abdominal pain
• A routine well visit, such as a pelvic exam/pap test or testicular exam
• A visit to place an IUD (intrauterine device) for contraception

What to expect from the discussion 

Your clinician will need specific information about your symptoms, your sexual health, and your sexual behaviors in order to care for you appropriately. The type of examination and the type of testing you might need depend on this information, so asking the questions and getting the right answers are crucial. You may feel awkward or uncomfortable providing this information, as it is very personal. If you have questions or concerns about the information being asked or about confidentiality, make sure to speak up and get them addressed.

Typical types of information your clinician may ask about 

• Your general health—especially if you are new to University Health Services
• Follow-up questions about any symptoms you are reporting
• Your menstrual history, if applicable: age at first menstruation, the quality and timing of your periods
• Your sexual history: if you are sexually active, what body parts you and your sex partners use for sex (oral, anal, vaginal, outercourse, etc.), how many sex partners you have had, your use of safer sex supplies
• Your pregnancy and contraception history, if applicable: if you’ve ever been pregnant, what you and your sex partners do to prevent pregnancy
• Any history of past testing for and treatment of sexually transmitted infections such as chlamydia, gonorrhea, syphilis, herpes, human papilloma virus
• Any history of sexual abuse or assault
• Any history of exchanging sex for basic needs (money, food, shelter, safety) or drugs
• Your use of intoxicants, including alcohol, marijuana, other inhaled/oral/intravenous drugs (we do not report this information to anyone unless there is a health/safety emergency)
• Any family history of certain conditions, such as breast/uterine/cervical/ovarian conditions, blood clots, and bleeding problems

What to expect during a sensitive exam

Once your clinician determines what examination needs to take place, they will review this with you. It is your clinician’s responsibility to obtain informed consent from you prior to the examination. This includes telling you what exam they think you need and why, making sure you fully understand, discussing use of a clinical chaperone, and making sure you specifically consent to the plan. This is your time to get your questions answered and to convey any issues or needs you might have with regards to the exam. Since every person has different needs, we rely on you to speak up and let us know your preferences. 

General principles for any sensitive exam

• We will always provide you with privacy to undress and dress. 
• We will provide drapes, gowns, and shorts that allow you adequate cover for your body during an examination. 
• We will only uncover the parts of your body that need to be examined and keep them uncovered for the shortest time necessary to allow for appropriate examination.
• We will communicate with you using anatomical terminology instead of slang words and common lingo. While these words may not always be the words you would use to describe your body and your behaviors, these words best communicate our respect for your body and your experience. 

Types of exams you might need

Breast exam 

Why: Breast exams are recommended if you report a symptom or concern, such as a breast lump, rash, nipple discharge or breast pain. If you have a family history of breast issues or are at an age when breast cancer screening is recommended, your clinician may also recommend a breast exam. Lastly, if you have questions as to how to perform your own breast exam, your clinician may do a breast exam to educate you on how to monitor your breasts.

What: You will asked to remove any undergarments such as a bra, and will either be given a gown or simply asked to lift your shirt out of the way. Your clinician may first inspect your breasts visually—oftentimes when you are sitting and then laying on your back. Your clinician might ask you to raise your arms above your head or bend forward to assess for changes in your breasts as you change position. Then, your clinician will ask you to lay back and put one arm above your head. They will use their fingertips to check your whole breast tissue for abnormalities that aren’t visible, and will also check under your arms for any enlarged lymph nodes. Your clinician will also examine your nipple area and possibly press the nipple to check for any discharge. They will they repeat this exam on the other side.

How long: This exam takes about 3-5 minutes. 

Groin exam (exam of area where pubic hair grows)

Why: This exam is generally recommended when you have a symptom in the area, like a rash, an itch, or discomfort. It is also performed if your clinician needs to check for hernias or needs to check the arteries providing blood flow to your legs (such as for a sports physical) or for swollen lymph nodes. 

What: You may be laying on the exam table or you may be standing up for this exam. Depending on what you are wearing, you may be asked to undress and given a drape or shorts to wear, or you may be simply asked to move your clothes slightly away from the area to be examined. Your clinician will visually inspect the skin (sometimes using a magnifying glass) then palpate the area with the gloved fingers. 

How long: This exam should take 1-2 minutes.

Pelvic exam (examination of vulva and vagina, and can include examination of cervix/ uterus, ovaries and fallopian tubes, and bladder)

Why: A pelvic exam is recommended whenever you have symptoms such as vaginal pain, itching or sores, abnormal vaginal discharge, abnormal vaginal bleeding, or pelvic pain. Sometimes, urinary symptoms also require a pelvic exam to help evaluate their cause. Pelvic exams are also routinely done when you have no symptoms but are due for cervical cancer screening – recommended starting at age 21. 

What: You will be undressed fully from the waist down and will have a drape to cover your abdomen and legs. You will be laying on the exam table with your bottom at the edge of the table and your legs open with the heels of your feet resting in supports called stirrups. For some people, this can feel awkward or vulnerable, so make sure you are checking in with yourself and your clinician. It is crucial that you feel in charge of what happens to your body. Your clinician will be wearing gloves throughout this entire exam and will always tell you what they are going to do before they do it. In general, the first step is to visually inspect the outer vagina (the skin and pubic hair region, then the vulva, including the labia, the clitoris, the vaginal opening), the area between your vagina and your anus (perineum), and your anus. They will then examine the inside of your vaginal canal using a speculum, which is an instrument shaped like a duck’s bill that will be put into the vagina and opened just enough to provide full visualization of the sidewalls of the vagina and the cervix. Sometimes your clinician will need to reposition you or the speculum to ensure full visualization. Your clinician may take samples of the cells of your cervix using a soft plastic brush (a pap test) or samples of the fluid within your vagina using a Qtip-like brush (to test for infections and yeast/bacterial overgrowth). In some circumstances, your clinician might recommend a “bimanual examination.” This is an examination to evaluate your internal pelvic organs (uterus, ovaries, fallopian tubes, etc.). Your clinician will stand at your feet then put one or two gloved fingers into your vagina to stabilize your uterus while using the other hand to push down lightly over your lower abdomen to check for tenderness and to assess the size and position of your pelvic organs. 

How long: This exam takes 5 minutes, sometimes less.

Penile/scrotal exam

Why: This exam is recommended if you report any symptoms such as genital rash, penile discharge, urinary discomfort, testicular pain, swelling or lump. It is also routinely done to check for hernias and as part of a full physical exam. 

What: You may be lying on the exam table or standing, depending on what your symptoms are. You will typically be asked to lower your shorts or pants. Your clinician will be wearing gloves for this exam. They will start by visually inspecting your penis and scrotum. If your penis is uncircumcised, your clinician may ask you to retract your foreskin to allow full visualization of the penis. They may also need to reposition your penis or touch the tip of your penis to check for discharge. Your clinician will then feel the contents of your scrotum, including your testicles. Occasionally, special tests will be performed, such as shining a bright light through the scrotum to look for fluid or lightly touching the inner thigh to observe for a reflexive retraction of the testicle. And if there is any discharge from the urethra, a sample of it may be collected for laboratory analysis. It is not rare to experience an erection with this examination, as erections can be triggered by anxiety or as a simple reflex to touch. If this happens, please know this is very normal.

How long: This exam takes 2-3 minutes.

Buttocks/anal/rectal exam

Why: This exam might be recommended if you are having lower abdominal pains, unusual lower back pains, urinary discomfort, blood in your stool, any symptoms on your buttocks or around your anus such as rashes, sores, lumps, itching, discomfort, or swelling. 

What: Depending on what you are wearing, you may be asked to undress and given a drape, or asked to move your clothes aside for the exam. Depending on your symptoms, you may be asked to lie on the exam table on your side with your knees curled into your chest or you may be asked to stand and bend over the exam table. Using gloved hands, your clinician will examine the skin of your buttocks then gently spread your buttocks and anal tissue to allow a thorough visual inspection. They will then use their finger to manually inspect the outer anal tissue. If more information is needed, your clinician may recommend a “digital rectal exam,” which involves gently introducing a gloved, lubricated finger into the rectum to palpate for abnormalities and (if applicable) prostate tissue. Additionally, your clinician may recommend an “anoscopy,” which involves inserting a small plastic lubricated hollow tube (about an inch wide) into your rectum to allow better visualization of the tissue inside. If necessary, your clinician may use a small swab to collect cells or fluid from inside the anus for laboratory analysis. 

How long: This exam takes about 2-3 minutes.

Our goal is to ensure that you are an active, informed participant in your health care and that your sensitive examination is a safe, respectful, and educational experience. 

If you have any questions or concerns after reading through this information, please let us know. You can speak to your medical team at any time or, if you prefer, you can request to speak with a Patient Care Advocate by calling 541-346-2770.