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1 Instructions: Click on the buttons at the bottom of the page to move ahead or back in the online instruction.

2 MAKING APPOINTMENTS After you have finished this online instruction, you can call to schedule your appointment. Let the appointment secretary know that you have completed this requirement.

3 PRIOR TO YOUR APPOINTMENT! Do not urinate for at least 60 minutes prior to your appointment.! In case you need a pelvic exam, avoid douching or using vaginal creams, sprays, or deodorants 3-5 days prior to your appointment.! Do not have sexual intercourse 24 hours before your appointment.

4 YOUR APPOINTMENT DAY! If you are on your period or it starts the day of your appointment, you will need to call and reschedule.! Bring your ECU 1Card and check in at the self check in kiosk, or with a front desk staff member.! Plan on being at the ECU Student Health Service for approximately 45 minutes to one hour.

5 The Annual Gynecologic (GYN) Exam Explained! Women ages 20 and under*: the annual GYN exam will consist of a physical exam from the waist up (checking your breasts, heart, lungs, abdomen) and testing for gonorrhea, chlamydia, HIV and syphilis. If you are having any vaginal symptoms or gynecological problems, you may also need a pelvic exam. The pelvic exam allows the provider to examine your vagina, cervix, and ovaries. *if there is no past history of abnormal Pap testing

6 The Annual Gynecologic (GYN) Exam Explained! Women ages 21 and over: the annual GYN exam will consist of a physical exam from the waist up (checking your breasts, heart, lungs, abdomen) and testing for gonorrhea, chlamydia, HIV and syphilis. If you are having any vaginal symptoms or gynecological problems, you may also need a pelvic exam. The pelvic exam allows the provider to examine your vagina, cervix, uterus, and ovaries. In addition, every 3 years, a Pap test will also be performed.

7 THE MEDICAL WORK-UP Your appointment begins with a nursing staff member, who will check your blood pressure, height and weight and talk with you about your medical history. You will also be given a urine cup to collect a urine sample.

8 THE EXAM Another nurse will call you from the lobby when the provider is ready to see you. You will be asked to undress according to what type of exam you are having. The provider will come in to the room, talk with you, then perform your exam.

9 Sexually Transmitted Infection (STI) Tests! The urine sample collected when you arrive is for chlamydia and gonorrhea testing.! After your provider talks with you and performs your exam, you will go to the lab for blood tests for HIV and syphilis.! Other tests may be also performed if indicated. Your provider will talk with you about what tests he/she recommends.

10 Why do we test for STIs?! Many women have been exposed to STIs but have no symptoms. These STIs can cause long term health problems, and women who are unaware they are affected will continue to pass STIs to other partners. Regular screening is important to overall health and wellness.

11 Testing for other STIs Genital herpes A lab test can be done only if symptoms are presents to confirm the presence of the herpes virus. Genital warts (Human Papilloma Virus) There are no lab tests for warts. It is diagnosed by visualization by the provider. HPV on the cervix may be detected through a Pap test. Hepatitis B or C Requires a blood test. If there are other STIs that you have concerns about, please feel free to talk with the provider about them during your visit.

12 Human Papilloma Virus! What Is HPV? HPV is a sexually transmitted infection (STI) that is caused by human papillomavirus (HPV). Human papillomavirus is the name of a group of viruses that includes more than 100 different strains or types. More than 30 of these viruses are sexually transmitted, and they can infect the genital area of men and women including the skin of the penis, vulva (area outside the vagina), or anus, and the linings of the vagina, cervix, or rectum. Most people who become infected with HPV will not have any symptoms and will clear the infection on their own. Some of these viruses are called "high-risk" types, and may cause abnormal Pap tests. They may also lead to cancer of the cervix, vulva, vagina, anus, or penis. Others are called "low-risk" types, and they may cause mild Pap test abnormalities or genital warts.! How Is HPV Diagnosed? Most women are diagnosed with HPV on the basis of an abnormal Pap tests. A Pap test is the primary cancer-screening tool for cervical cancer or pre-cancerous changes in the cervix, many of which are related to HPV. An HPV DNA test will be done from your Pap test to detect the high-risk types of HPV, if the Pap results have a specific abnormality.

13 Have you heard of Gardasil, the HPV vaccine?! Who should get the vaccine? The HPV vaccine is recommended for year-old girls and boys, and can be given to girls/boys as young as 9. The vaccine is also recommended for year-old girls/women & boys/men who have not yet received or completed the vaccine series who may or may not be sexually active.! Is the same vaccine given to both females and males? Yes, males will receive the same vaccine that females do. GARDASIL is given as 3 injections over 6 months. GARDASIL helps protect males and females ages 9 to 26 from 90% of genital warts cases. GARDASIL also helps protect females ages 9 to 26 from about 75% of cervical, 70% of vaginal, and up to 50% of vulvar cancer cases. Anyone who is allergic to the ingredients of GARDASIL, including those severely allergic to yeast, should not receive the vaccine. GARDASIL is not for women who are pregnant.

14 Gardasil -HPV Vaccine! How long does the vaccine protection last? Will a booster shot be needed? The length of vaccine protection (immunity) is usually not known when a vaccine is first introduced. So far, studies have followed women for five years and found that women are still protected. More research is being done to find out how long protection will last, and if a booster vaccine is needed years later.! What does the vaccine not protect against? GARDASIL will not protect against diseases due to non-vaccine HPV types. There are more than 100 HPV types; GARDASIL helps protect against 4 types (6, 11, 16, and 18). These 4 types have been selected for GARDASIL because they cause approximately 70% of cervical cancers and 90% of genital warts. With the vaccine not covering all types, it is important for women to continue getting screened for cervical cancer (regular Pap tests). The vaccine will not prevent other sexually transmitted infections (STIs). So it will still be important for sexually active adults to reduce exposure to HPV and other STIs.

15 The Breast Exam! Breast cancer affects a growing number of women in the United States. If breast cancer runs in your family, you are at higher risk.! Early detection is crucial.! The health care provider will perform a breast exam as part of your appointment.

16 Breast Self Examination In addition to the breast exam by the health care provider, you should do a breast self examination once a month. Learning how to do the breast self-exam can be life-saving.

17 What is a pelvic exam? The pelvic exam, where the health care provider checks the organs in the reproductive system, may be needed depending on your age, or if you are having any gyn problems.. A speculum is used to open the vagina and lab specimens may be collected. A bimanual exam (the provider uses their fingers to assess internal organs) may also be performed.

18 Pap smears! The Pap smear is a screening procedure to aid in the detection and diagnosis of abnormal changes in the tissue of the cervix. Women over 21 who have normal Pap smears may only need the test once every 3 years. Female Reproductive System

19 ap smear procedure! The speculum is inserted into the vagina.! Two samples of the cervix cells are taken by rubbing the surface of the cervix.! The collected cells are preserved and sent to a lab for analysis.

20 Other screenings Depending on your personal health needs, the health care provider may perform other screenings, such as a urine sample, blood testing, or a rectal exam.

21 Preparing for a pelvic exam A pelvic exam does not take long and should not be painful. If you experience any pain, let the health care provider know. The more relaxed you are, the more comfortable the exam will be. Taking deep breaths, talking to the health care provider, and telling yourself to consciously relax are all ways to prepare for your pelvic exam.

22 After the Exam! The provider will leave the room and allow you to get dressed.! If you have a Pap test, some of the very thin tissue on the cervix can be broken, causing some mild spotting/bleeding.! Talk to the provider about any questions that you may have.

23 How do I get my testing results?! Some lab work is performed here and results will be given to you before you leave. Other tests have to be sent to an outside lab. You will be sent a confidential notification via our secure messaging system. An will come to your ECU letting you know your results have returned and how to log on to your Online Student Health account. If any of your tests are abnormal, you will be advised to schedule an appointment with a provider to discuss the results.

24 COST AND INSURANCE! Cost will depend on what type of exam and tests you have performed. STI screening (chlamydia/gonorrhea, HIV and syphilis) costs approximately $40. A Pap test, if you have one performed, is ~$42. An additional charge of approximately $72 will occur if the HPV DNA test is performed.! If you have the Student Health Insurance Plan, ECU Student Health Service will file your claim. If you have any other type of third party insurance, you will need to request a walk out statement to self file your charges. You should always check your insurance coverage and specific policy limitations prior to having your annual exam.

25 Choosing a contraceptive method How do you know what s right for you? Choosing a method of birth control is a highly personal decision, based on individual preferences, medical history, lifestyle, and other factors. When you choose a method, be sure and find one that fits your individual needs. Pick a method that you are likely to use correctly to guarantee the most effectiveness.

26 THE PILL (Oral Contraceptives)! Method: Pills taken orally; hormones are absorbed through the digestive system.! How it works: Prevents pregnancy by suppressing ovulation, causing changes in the lining of the uterus, and increasing the natural mucus around the cervix.! Correct use: Take them everyday around the same time of day.! Effectiveness for preventing pregnancy: 99% WHEN TAKEN CORRECTLY.! Cost: Call the pharmacy at for exact pricing.

27 THE PILL (Oral Contraceptives)! Common side effects: May include nausea, headaches, fatigue, minimal weight gain, depression, breast tenderness, decreased sexual drive, and changes in the menstrual cycle.! When to use a backup/alternative contraceptive: 1) For the entire first month of use. 2) If you miss a pill, use a backup method until you start your next new pack of pills. 3) With certain medications. Always consult with your health care provider or pharmacists about possible interactions/reduced effectiveness before you take new medications.! No protection from sexually transmitted infections.

28 THE PATCH (ORTHO-EVRA)! Method: Hormones are absorbed transdermally (through the skin).! How it works: Prevents pregnancy by suppressing ovulation, causing changes in the lining of the uterus, and increasing the natural mucus around the cervix.! Correct use: Wear a patch in the abdomen, buttock, or upper back area for 7 days. Replace the patch once a week for 3 weeks. The fourth week--do not wear a patch. Repeat the following month. Alternate patch site to avoid skin irritation.! Effectiveness for preventing pregnancy: 99% WHEN USED CORRECTLY.! Cost: Call the pharmacy at for exact pricing.

29 THE PATCH (ORTHO-EVRA)! Common side effects: May include skin irritation, nausea, headaches, fatigue, minimal weight gain, depression, breast tenderness, decreased sexual drive, and changes in the menstrual cycle.! When to use a backup/alternative contraceptive: 1) For the entire first month of use. 2) If the patch comes off or if you do not change it as directed. 3) With certain medications. Always consult with your health care provider or pharmacists about possible interactions/reduced effectiveness before you take new medications.! No protection from sexually transmitted infections.

30 NUVARING (Vaginal Hormonal Ring)! Method: Hormones are absorbed through the vaginal lining.! How it works: Prevents pregnancy by suppressing ovulation, causing changes in the lining of the uterus, and increasing the natural mucus around the cervix.! Correct use: With fingers, squeeze flexible ring together and insert into the vagina. Guide device with one finger to the upper portion of the vagina. Wear for 3 consecutive weeks and then remove. The fourth week, no ring is worn. Repeat the following month.! Effectiveness for preventing pregnancy: 99% WHEN USED CORRECTLY.! Cost: Call the pharmacy at for exact pricing.

31 NUVARING (Vaginal Hormonal Ring)! Common side effects: May include nausea, headaches, fatigue, minimal weight gain, depression, breast tenderness, decreased sexual drive, and changes in the menstrual cycle.! When to use a backup/alternative contraceptive: 1) For the entire first month of use. 2) If the ring is outside of the vagina for more than 1 hour. 3) With certain medications. Always consult with your health care provider or pharmacists about possible interactions/reduced effectiveness before you take new medications.! No protection from sexually transmitted infections.

32 DEPO-PROVERA (3-month injection)! Method: Hormones are injected intramuscularly.! How it works: Prevents pregnancy by suppressing ovulation, causing changes in the lining of the uterus, and increasing the natural mucus around the cervix.! Correct use: Keep your appointments! A health care provider will administer the injection once every 12 weeks (4 times a year). The initial injection must be given during the first 5 days of the menstrual period.! Effectiveness for preventing pregnancy: 99% WHEN USED CORRECTLY.! Cost: Call the pharmacy at for exact pricing.

33 DEPO-PROVERA (3-month Injection)! Common side effects: May include nausea, headaches, fatigue, weight gain, depression, breast tenderness, decreased sexual drive, and changes in the menstrual cycle.! Calcium Intake: Use of Depo-Provera may deplete the amount of calcium absorbed. Talk to your health care provider about increasing calcium in your diet to avoid risk of osteoporosis.! When to use a backup/alternative contraceptive: 1) For the first 48 hours after the initial injection. 2) If you are late for a scheduled injection.! No protection from sexually transmitted infections. 80% of users stop having menstrual periods after 6-12 months of use.

34 MALE CONDOMS! Method: Disposable latex or polyurethane sheath sold over-the-counter without a prescription.! How it works: Fits snugly over the penis; prevents ejaculatory fluid from coming into contact with a sexual partner.! Effectiveness for preventing pregnancy: 86-98%, depending on correct and consistent use.! Cost: Call the pharmacy at for exact pricing.! Possible side effects: Allergies to latex or spermicide found on condoms may cause irritation. If this occurs, try polyurethane condoms or a condom without spermicide.! Male condoms provide increased protection from sexually transmitted infections. Condoms can be used in conjunction with hormonal methods to increase protection from pregnancy and sexually transmitted infections.

35 MALE CONDOMS! Correct use: 1) Store condoms at room temperature. Keep away from heat! 2) Use caution when opening the condom package, particularly with fingernails. Scissors and teeth should not be used to gain entry to the package. 3) Make sure that the condom is properly lubricated before and during intercourse. If it becomes too dry, it may break. Use a water-based lubricant (like KY Jelly or Astroglide) for additional lubrication. Never use massage oil, Vaseline, or anything oil-based to lubricate a condom. 4) Pinch a ½ inch tip at the end, allowing room for ejaculatory fluid. Place the condom on the erect penis. Roll the condom all the way down. 5) After intercourse, remove the condom before the erection is lost. Hold the condom at the base when withdrawing to prevent the condom from slipping off inside.! If the condom breaks: Immediately stop intercourse and insert an over-thecounter spermicide. Contact a health care provider about emergency contraceptive options.

36 FEMALE CONDOMS! Method: Disposable polyurethane sheath containing two flexible rings sold over-the-counter without a prescription.! How it works: Fits inside of the vagina; Prevents ejaculatory fluid from coming into contact with a sexual partner.! Effectiveness for preventing pregnancy: 79-97%, depending on correct and consistent use.! Cost: Female condoms are not available at the SHS pharmacy but you can contact an outside pharmacy to see if they carry them.! Possible side effects: Rare reaction to polyurethane. Trapped air can create a noise effect during intercourse. If this occurs, add lubrication.! Female condoms provide increased protection from sexually transmitted infections. Condoms can be used in conjunction with hormonal methods to increase protection from pregnancy and sexually transmitted infections.

37 FEMALE CONDOMS! Correct use: 1) Use caution when opening the condom package, particularly with fingernails. Scissors and teeth should not be used to gain entry to the package. 2) The condom should be lubricated when taken out of the package. A small bottle of extra lubrication which may be applied before or during intercourse. 3) The female condom contains two rings. Pinch the ring on the inside of the pouch together and guide the condom into the vagina, placing it as far back into the vagina as it will go. This inner ring serves as an internal anchor to help the condom keep its placement in the vagina. The outer ring of the female condom serves as the opening. Read additional instructions for insertion on the package. 4) Never use a male and female condom at the same time.! If the condom breaks: Immediately stop intercourse and insert an over-the-counter spermicide. Contact a health care provider about emergency contraceptive options.

38 SPERMICIDES! Method: May be in the form of foams, jellies/gels, suppositories, sponge, or dissolving film.! How it works: Chemically kills sperm to prevents ejaculatory fluid from reaching the upper reproductive system.! Effectiveness for preventing pregnancy: 74-94%, depending on correct and consistent use. Spermicides are most effective when used in conjunction with barrier methods.! Cost: Price varies, depending on method of spermicide. The SHS Pharmacy does not keep this in stock, but the Pharmacist can special order it upon request.! Possible side effects: Skin irritation from reaction to chemical spermicidal product.! No protection from sexually transmitted infections. A recent study suggested that spermicides may irritate sensitive genital lining, creating an opening for viruses and bacteria to enter the body and increasing possible risk of transmission.

39 SPERMICIDES! Correct Use: Varies, depending on the method of spermicide used. Follow instructions on the package exactly. Each type of spermicide varies in terms of how it is applied to the vagina, and when contraceptive protection begins. 1) Be sure to use the correct amount of spermicide. A common error is to use too little spermicide. 2) With some methods, there is a brief waiting period that users should observe after inserting before engaging in intercourse. 3) Some methods may need to be re-applied after a certain amount of time has passed, whether intercourse is finished or not. 4) An additional application of spermicide is needed each time intercourse is repeated.

40 THE DIAPHRAGM! Method: A dome-shaped latex cup with a flexible rim around the edge that is inserted inside of the vagina during intercourse. A spermicidal jelly should ALWAYS be used with the diaphragm.! How it works: Serves as a barrier method, preventing sperm from entering the upper reproductive system while spermicide kills sperm.! Effectiveness for preventing pregnancy: 80-94%, depending on correct and consistent use.! Cost: Call the pharmacy at for exact pricing.! Possible side effects: Allergies to the latex material or skin irritation from reaction to chemical spermicidal product.! No protection from sexually transmitted infections. A recent study suggested that spermicides (which are used with the diaphragm) may irritate sensitive genital lining, creating an opening for viruses and bacteria to enter the body and increasing possible risk of transmission.

41 THE DIAPHRAGM (Insertion)! Correct Use: One of the most important things to know about the diaphragm is that it is NOT effective without a spermicide. 1) Wash hands. Check the diaphragm before insertion to make sure there are no holes or tears. 2) Hold the diaphragm with the dome down like a cup. Apply about 1 teaspoon of spermicide (jelly or cream) into the dome and spread some around the rim with your finger. Do not use oil-based lubricants such as baby oil, mineral oil, or vaginal medications for infections. 3) Using the fingers to squeeze the flexible ring together, insert the diaphragm into the vagina. The spermicide that is inside the dome should be facing your cervix. Once the diaphragm is correctly in place, women should not be able to feel it.

42 THE DIAPHRAGM (After Intercourse)! Check the position of the diaphragm, using your finger to be sure the diaphragm is still in place. If it has been dislodged, you may want to contact your health care provider.! Leave the diaphragm in place for at least 6 hours after the last act of intercourse. Diaphragms should not be left in place for longer than 24 hours, however; leaving the diaphragm for a longer period of time increases risk for toxic shock syndrome.! Remove by inserting your finger into the vagina, feeling for the rim of the diaphragm, and pulling the device out.! The diaphragm should not interfere with normal activities.! Using plain soap, wash the spermicide applicator and the diaphragm. Place the diaphragm in its convenient case and store in a cool dry place. Douching is not recommended.

43 CONTRACEPTIVE IMPLANTS! Method: A flexible rod (about the size of a matchstick) is inserted under the skin in the upper arm that provides pregnancy prevention for 3 years. The implants available now are Implanon and Nexplanon.! How it works: It releases a steady low dose of hormones to thicken cervical mucus and thin the lining of the uterus. It also typically suppresses ovulation.! Effectiveness for preventing pregnancy: Less than 0.5% failure rate.! Cost: Call the pharmacy at for exact pricing.! Possible side effects: changes in bleeding patterns, nausea, headaches, decreased libido, mood swings! No protection from sexually transmitted infections.

44 CONTRACEPTIVE IMPLANTS! Once inserted, there is no daily maintence or need interupt sex to have pregnancy prevention! Can be easily removed anytime by a health care provider! Quick return of fertility if a patient desires to remove the implant and become pregnant! You will need to have a consult appointment with a provider prior to having Implanon/Nexplanon inserted; this appointment allows the provider to discuss the method with you, assess any contraindications, and then order your Implanon/Nexplanon.! You will then return once the implant has been received by SHS. You will need to have it inserted while on your period and a pregnancy test will be required prior to insertion of the implant.! Procedure to insert takes about 15 minutes and uses local anesthetic; a bandage is placed over the site and patients can expect healing of the insertion site in 3-5 days.

45 OTHER METHODS OF CONTRACEPTION! Intrauterine Devices (IUD s)! Natural Family Planning/Fertility Awareness! Sterility (Vasectomy and Tubal Ligation) For more information about these methods, contact the ECU Student Health Service at or submit any questions to

46 EMERGENCY CONTRACEPTION! Method: Pills taken orally; hormones are absorbed through the digestive system.! How it works: Also known as the morning after pill, it prevents a fertilized egg from implanting into the uterus lining. Emergency contraception is used after unprotected sexual intercourse, but before a woman becomes pregnant. This is a follow-up method used when contraception has failed or has not been used and because it has a lower effectiveness rate than many contraceptive methods, it should not be used as a long-term birth control method. Emergency contraceptive pills keep a pregnancy from occurring by inhibiting ovulation (release of an egg), inhibiting a fertilized egg from implanting into the uterus, and/or interfering with the process of the fertilized egg passing through the fallopian tubes.

47 EMERGENCY CONTRACEPTION! Time Limit: Emergency contraceptive is not effective once an egg has implanted. For this reason, it must be taken soon after intercourse. It is recommended that emergency contraception be used within 72 hours after intercourse. (It can be used up to 120 hours, but the sooner it is used, the more effective it is for preventing pregnancy.)! Correct use: Take as directed by the health care provider.! Effectiveness for preventing pregnancy: 75-89% WHEN USED CORRECTLY.! Possible Side Effects: Nausea, vomiting, headaches, breast tenderness, dizziness, fluid retention. If vomiting occurs within two hours after taking a dose, contact your health care provider.! Cost: Call the pharmacy at for exact pricing.

48 Pregnancy testing The ECU Student Health Service can provide pregnancy testing. You can request a pregnancy test or the provider may feel you need one based upon symptoms or the date of your last menstrual period.

49 Please answer the following questions.

50 True or False. You should do a breast self-exam once a month. True False

51 THIS IS TRUE. Every woman should perform a breast self exam at least once a month. The best time to do the breast exam is the week following the menstrual cycle. If you find any changes, particularly hardening of the tissue or lumps, see a health care provider as soon as possible.

52 True or False The Pap smear is a screening test which checks for abnormalities of the cervical cells. True False

53 THIS IS TRUE. The Pap smear procedure takes a sample of the cervix cells which can be examined for abnormalities. Because these screenings can even detect pre-cancerous cells and signal the need for treatment, the number of cervical cancers has drastically decreased in the U.S.

54 True or False You will be tested for sexually transmitted infections during your annual GYN exam. True False

55 THIS IS TRUE.! There are reportedly more than 25 STI s; therefore, will not be tested for all STI s at your appointment. However, ECU Student Health Service routinely tests students for chlamydia, gonorrhea, syphilis, and HIV. If the provider feels any other tests are indicated based on your symptoms or risk factors, you may be advised to have more STI testing.

56 True or False You should choose a method of contraception based on your personal needs and lifestyle. True False

57 THIS IS TRUE. Use a contraceptive method that you will be comfortable with, and that you will use correctly and consistently. If you are forgetful about taking medications, the pill may not be the best option for you. Consider all of your options before making a decision on which contraceptive is best for you.

58 True or False GARDASIL helps protect against all types/ strains of HPV. True False

59 THIS IS FALSE. The GARDASIL vaccine will help protect against 4 types (6, 11, 16, and 18) of HPV only. These 4 types have been selected for GARDASIL because they cause approximately 70% of cervical cancers and 90% of genital warts. With the vaccine not covering all types, it is important for women to continue getting screened for cervical cancer (regular Pap tests).

60 True or False Emergency contraception must be used within 48 hours after intercourse for it to be effective. True False

61 THIS IS FALSE. Emergency contraception must be taken as soon as possible after intercourse. It is recommended that emergency contraception be used within a 72 hour span after intercourse. It can be used up to 120 hours, but the sooner it is used, the more effective it is for preventing pregnancy.

62 YOU RE ALMOST DONE! Please enter your full name and ECU ID and then click Submit on this online form to alert the ECU Student Health Service that you have completed this requirement. After you submit this information, you may then call to schedule your appointment. Let the person you speak with know that you have completed the online class. If you have questions about the exam, contraceptive methods, or other sexuality/reproductive health concerns, you can your questions anonymously to:

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