Student Health Services - Sexual Education 2012-11-08


Uploaded by pcclancer on 29.11.2012

Transcript:
[ Music ]
>> Jo Buczko and I'm the coordinator
for Student Health Services and that is a services here
on campus available to you.
And we're-- does anyone know
where we're located 'cause you happen to pass by there?
Yes? No? Okay, we're in D105 which is the building straight
over there, next to L Building [phonetic],
and on the first floor and just past the writing lab
or the computer lab where you check in to do some work.
And so, we're essentially located on campus and--
where a great place to come
if you want some confidential care and medical care.
I just want to make a point
that we don't really care whether you have insurance
or not like Kaiser or Anthem Blue Cross United
or if you have no insurance at all.
We are there for you.
You pay a 13-dollar health fee
which gives you access to our services.
And we run like a professionally run clinic on the outside.
We are above and beyond what you might have seen in high school
where there is a nurse there who is available to ask--
answer questions and maybe allow you to lie
down on a couch, okay?
So as we go through the presentation,
I'll make some comments about what we do there, but I cannot
at all be comprehensive about all the services
that we offer you because there just isn't enough time today
to do that.
What I'm going to be talking today with you
about are students health--
sexually transmitted infections and birth control.
And I would tell you that this is a quick overview.
It is not intended to be comprehensive.
I'm not going to go into detail about statistics
and all that sort of stuff.
It's really just to give you an opportunity to know what's
out there and available to you, in general, in the public,
in clinical medicine, but also here on campus
in Student Health Services, okay.
So I am very relaxed in a sense that if you want
to ask a question during the presentation,
please do that because it helps us all to learn.
And a lot of times, everyday, students teach me something.
And so, it's important that you ask questions
if you feel compelled to.
Now sometimes, there might be a question here today
that you're uncomfortable asking.
And if that's the case, then I would just ask you to e-mail me.
And you can find me on the website.
You'll see my name in a moment.
And just e-mail me a question
and that's confidential between you and me.
I don't repeat it to anybody.
There's no need to do that.
But if there's something you have a burning desire to ask
and you want to ask,
you certainly can e-mail me and do that.
Okay, so I would like to direct you to how you get
to Student Health Services.
And-- so I'm not going to go through the whole page
but I just want to show you how to get there.
And that is you go up to student services and you'll see us
under health services.
You have to scan-- go down here and open up and you'll see here
that it's our main page, our webpage for our health center.
Our hours are there.
Our mission statement's there and what we're doing.
And we-- collectively, you will hear a lot
about student learning objectives.
We have them at the health center as well where we want
to help students identify their at risk health behaviors
and then ask them or show them how they can employ strategies
to reduce their risk behaviors.
So that's what we're about partially.
We are here to help you learn about what you can do
to reduce your risks and learn about healthcare in general.
As far as news and events, we have things that we are--
do outreach with, some things like these
but we're also out in the quad.
Next week, in particular, I didn't bring the flier for it
but I want your group to know that on Tuesday, in this room,
between 12:00 and 1:00,
we're going to have a registered dietician
and dietetic intern discussing healthy foods
on a college budget.
So if you'd like to come in and learn about that,
we're going to be talking about the area establishments
like Jack in the Box and McDonald's and places like that,
how you can eat there in a healthy way and other items
that we'll be offering and there will are also be free food
and resources available.
So you might want to mark that down at--
you can have lunch on us, okay?
And that's actually sponsored
by the Cross Cultural Center here in this building.
Secondly, the other thing I want to just to highlight for you.
There are community resources here.
So in case you can't see us on campus and you need
to get off campus to find somewhere out like
on the weekend or during the evening, there are two
or four pages of area agencies that you could go
to that you could be aware of.
So that's under community resources,
there's health related web sites.
And then down here, one thing I want to kind of point
out to you that's in-- that we've--
that we can show you is the Student Health 101
interactive magazine.
And this has been purchased with your health fee.
It is for you and you can have your own subscription to it.
So the way you subscribe is when you come
up to get your Student Health 101, you just go there
and they will e-mail you directly either on a mobile app
or through your desktop at home.
Your subscription, it's ten months out of the year.
So it runs September through June or July.
And every month, they come
up with something new and different.
You can win a thousand dollars as you can see up there.
And if you're looking for articles, maybe,
for some classes that you kind of want to substitute some
of your references that you can look here in health resources.
So in this month's Student Health 101,
you have "How sleep affects learning."
That might be advantageous for your group and on your honor
and staying more active, that sort of thing.
So when you are-- if you like the magazine and you want
to kind of peruse what's in the background,
you go up to the top there where I just went and you look
for archived articles that go back about three years.
A particular interest might be the one about--
certainly in relationship to this presentation today
about keeping your relationships healthy and I think that's
in February of this year.
Yes, it's over here, "Keeping a relationship healthy,"
I think it's a particularly helpful article.
And "Tattoo and You," when we talk about tattoos, you know,
people are really in to the body art part of it but I'm
into the bloodborne pathogens part of it that I worry
about students who are out there getting tattoos
in unsanitary conditions.
And so, that would be a good article for you
to be aware of as well.
So there's lots of things that you can be perusing here
for fun, there's lots of good things.
And there's one-- I will be very honest
in saying there's one article in one of the months where it says
"To check your safer sex IQ."
I took the test myself and I missed one.
So [laughs]-- and I usually think I'm pretty much
up to speed with this stuff but I actually missed one.
So I would encourage you to take it too because you might be able
to be more informed about how to protect yourself as far
as your reproductive health.
Okay, so we're going to go down and get
to what we're talking about today.
Now, let's see.
Okay, so that's my name.
It looks different than I pronounce it,
but it's Buczko, like B-U-T-C-H-K-O.
And so, if you look-- if you just Google that name
for the website you'll find my name.
So again, if you have any questions about something
that you don't want to ask publicly here,
you certainly can e-mail me.
So just to close off about Student Health Services,
I just want to assure you that it is a confidential site.
When you go there, whatever goes on there stays there.
It is your heap of guidelines,
the privacy of your medical record is held
in strictest of confidence.
There are one or two reasons in public health reasons
like if you had an STI, a sexually transmitted infection,
we have to report it to the public health
but that's something that's between public health and us.
Usually when we're reporting it, we've already treated you
and they're not going to contact you.
So under legal conditions, there are some conditions
in which we would have to release information for you,
but for 99 percent of the reasons you're coming
in to see us, we don't.
So if you're a teacher, like Dr. Martin were to come and say,
"Hey Jo, you know, cross me on the client," say,
"I understand my list was in the clinic the other day,
can you tell me about what was going on?"
Absolutely not.
So no administrator is going to ask about you.
It stays quiet there.
It's between us, okay?
We have counseling service.
I just want you to know that every person,
absolutely without exception, every person that works
in the health center loves working with college students,
loves working in healthcare.
So we are open there to ask-- to answer your questions.
If you're interested in coming in and just chatting,
you don't have to do anything as far as physical examination.
I think that's perfectly okay with us.
We're there to help educate you and answer your questions.
On the other hand, we also have--
so we have doctors and we have nurse practitioners and nurses
and we have a registered dietician
and we have an HIV counselor who comes in from public health
to do HIV testing which is free
and it's provided to you on Tuesdays.
If you can't make it Tuesday time,
we'll give you other related resources in the community
where you could get it for free.
So that's available too.
As far as our clinical services,
we see just about anything there,
anyone who's going to come to the door.
Whether we can continue to see you determine--
is determined by what's going on.
If you're having an acute asthma attack,
absolutely we're going to see you.
If you want to get tested for STIs or you want
to do a pregnancy test or you want to get on birth control,
you know, you have-- you just-- or you just twisted your ankle
or you get hurt on the campus, we're going to see you
for all those kinds of things.
What we cannot continue to see you for is something
like diabetes or high blood pressure or chronic management
of your high blood pressure.
Or if you have a seizure disorder, we're not going
to treat you for your seizure disorder.
We're just going to help you manage what's going
on in campus.
So it's like a short-term clinic, but it's certainly a lot
of care that's relevant to your age group and things
that you need to be aware of and things
that you need to be testing for.
Okay, so we do, do blood tests.
If you want to know what your cholesterol is, we can do that.
If you want to know if you have a urinary tract infection,
we can do that.
So your visits to us are free.
And sometimes you have to pay for medications,
then it's a low cost medications like five to ten dollars along
that range, okay, or less.
So we do offer free STD testing.
I will hit that again later in this semester.
But it's like-- I mean-- this semester-- this session.
It does not require an exam.
You just come in and do the test.
It's urinating in a cup and we send it off to the lab
and get the results back.
If you're positive, we will treat you for free.
And if your partner happens to be a PCC student,
we'll treat your partner for free as well.
Additional testing that would be warranted would also be free.
So you have a tremendous resource here on campus
that you just walk in the door and we're ready to help, okay?
Okay, so we're going to talk about the 411s on STIs,
that's sexually transmitted infections.
Sometimes you're going to hear STDs.
STD is a sort of the older nomenclature,
the older verbiage, but either one is fine.
But if you want to be more current, then you say STI, okay?
And we're going to talk some about birth control.
So now what you have, most of you have clickers, right?
And so, how many of you have used these clickers
in another setting already?
Okay, so not many.
So this is what we call a classroom anonymous system.
And what you're able to do is give us feedback
and give us answers without us knowing who you are,
and it tells us real time data.
So when you put your answer in, the next screen is going to pop
up the answer of the whole class collectively.
So it gives is an idea what the level of knowledge is
for the class right now.
In the end, you're going to see some of these questions again.
And I'm going to ask you to answer the questions
and possibly and hopefully there will be a shift
in the right direction of the knowledge base if there's anyone
who has incorrect information, okay?
And then I'm going to ask you some additional questions just
for our own data for Student Health Services.
So let's start with today's first question
which I'm hoping that's it's very easy for you
and it's "what is your age today?"
So if tomorrow, on Saturday or Sunday, you're going to be 18,
really you're 17 today.
I really don't want to know what you are today 'cause it helps us
with our grouping, okay?
So what is your age today?
And if you could please point your clicker up here.
Hang on a second.
Let's see.
I'm going to have to hold this up 'cause I just want
to make sure that the signal can get to you.
We have 58 clickers out there.
And so, we should get 58 responses back.
So if you're less than 17, press 1 please.
If you're 17 today, press 2 and so on and so forth.
If you press a number and you think "Oh my gosh,
I meant to press another number," you can change it.
It's whatever you entered last, okay?
So if you made a mistake, it's okay.
You can change it.
So there is a possibility we're not going to capture everybody.
We're going to go with 55 at this point.
So I'm just going to ask you to point and click one more time
to make sure we've captured everybody.
See, there we got, somebody.
56, okay. We're going to go with 56.
So, 68 percent of the students in this class today are 18.
We have someone less than 17 and just a few less--
a little bit more 20 or more.
What gender do you identify with?
Are you male, female or gender non-conforming?
[ Pause ]
Okay, one more time 'cause there's someone hanging
out there with-- thank you.
Hey, girl power.
[Laughs] All right, so now we're going
to do another question of a different type.
It's 80 percent of women and 50 percent
of men do not have symptoms when infected with Chlamydia.
So 80 percent of women and 50 percent
of men do not have symptoms when infected with Chlamydia.
So 50 percent think true and 43 percent think false.
Human Papillomavirusses, 16 and 18 cause cervical cancer
in women and in men cause oral and throat cancers,
penile and anal cancers.
Both 1 and 2, neither 1 or 2?
Just point and click one more time.
We'll capture everybody please.
54 and counting.
54. One more time.
Okay, 55. I'm going to go on here.
Okay. So hopefully by the end, with some of these answers,
we're going to see some shifts.
So, what is a back up method
if the current birth control method may fail?
Condoms, plan B, next choice, withdrawal, or praying hard?
[Laughter] Okay, just click one more time
and I'm just going to press four.
We don't capture everybody.
Okay. Okay.
So hopefully, there'll be some shifts here.
All right, so let's talk about birth control.
You can put your clickers away 'til we get towards the end.
All right, so I am going to give you a forewarning now
that I am a nurse.
And-- so when I speak publicly about this, and I'm talking
about STIs, to me, it's a very serious situation.
And so, I really want to drive the point home today
about how you need to protect yourself.
And so, what I do is I bring real clinical photos with me.
So this is a benign picture.
But you're going to see things
that are more graphic than this today.
They're real pictures and there's going
to be frontal nudity, but I think it's important for you
to see it so that you know what you're dealing with as far
as your sexual health and your sexual risk taking.
So, just-- hopefully, this looks familiar to all of you.
This is the woman's reproductive system,
and this is the vagina right here.
When you-- at the top of the vagina, at the very end of it,
you're going to have a cervix which is the opening
into the uterus, and that's called the external os.
And os is Latin for mouth or opening.
And then there's an internal os.
And then-- this is all musculature.
You can see this is the uterus.
It's pretty thick with muscle type tissue.
And that's meant to be that way so that it can expand and grow
for a pregnancy to accommodate a fetus, okay,
a newborn baby coming through there.
So this is all musculature.
But the other thing I want you to be aware of,
this is the lining of this musculature,
it's called endometrium.
And that is, everyday, is being stimulated by hormones
in the reproductive system for the female.
And depending on where she is in her menstrual cycle,
and we consider day one to be the first day of her period,
and then 28 days later, the 29th day like day two--
I mean, day one again starts all over.
Now, that's the textbook case, and women's periods can run
from 26-66, or something like that.
But in a textbook case, we're talking about a 28-day cycle.
So during the month,
she's getting different hormonal stimulations
in this musculature area or in the endometrial lining.
So basically, when she releases an egg and the egg gets here,
if the egg is not fertilized, then that lining is shed
and she has her period.
So that's what's happening.
So I'll come back to that in just a minute.
But if you can see, this is a musculature.
It's going to grow and expand
to accommodate an unborn child, okay.
Then you have your fallopian tubes
and then you have your ovary.
So the ovary releases one egg a month, generally.
Now, we do have situations where you release more,
but I'm just going to talk about textbook at the moment.
So you release it once a month, and the egg floats out here,
and then this little fimbria come and they capture the egg,
and they bring it up into here,
and the egg gradually makes its way down the tube,
goes down here and lands right here.
If it's not fertilized, then it's shed
with the menstrual cycle.
If it is fertilized, it's going to be embedded in here
and it's going to grow.
So that's basically it in a nutshell,
just really concretely.
And generally, when the sperm come up here,
the sperm are going to be right here and they're going
to pass through, and they're going to swim their way up here,
and they're going to join that egg, fertilizing it,
it becomes an embryo at that point or a conceptus, conceptus
and then it's going to travel on down here,
like here, and land here.
So it generally occurs in the outer third of the tube.
Then you have the guys here who--
this is their scrotum or their ball--
their balls and they have two.
You're only going to see one here, but this is a testis
and this is where the sperm begins their maturation,
their development.
And as they grow and they get to a different stage
of their development, they land up here in the epididymis
which is where they're stored for a while.
And then when you ejaculate or cum, then they go up this tube.
They go around the back.
And they come out the uretra, and the uretra--
through the uretra, right here, to this opening here.
So that is the major differences with men and women.
But all these structures here, all these structures are at risk
when we're talking about sexually transmitted infections.
Again, this is just another diagram of what this looks like
and you can see that it's small.
This is the cervix.
So if I were to take this person and put them on a table and look
up in there as if I'm doing a pelvic examination,
this is what I'm going to see.
It's a donut-shaped area, tissue,
and it's the opening into the uterus.
And you can see that it's an opening here,
and this is like a donut.
And I say to people, if you want to feel what it looks--
or feel what it's like, you put your finger nose and you kind
of get an idea of what it feels like, okay.
I also will extend myself and say if you really want
to know what it feels like, put your finger up there
and feel it, [laughter] okay, in your vagina.
So that's-- it's going to be soft.
It's going to be soft.
So this is what it looks like in real life.
So this is just the speculum, the instrument
in which we use to look up in there.
And you could see that it's pink and there-- this is light color,
that's just the reflection of the light that we're showing.
And you can see where it's a nice opening here.
And I can't absolutely say what this looks
like if this person had a baby or not.
It's a little bit marginal.
But usually, you're going to have a more of a horizontal look
to it when you pass the baby through there.
And when you have the baby--
you know, it's a very small opening to begin with.
But when the woman has child birth,
it opens up to ten centimeters up to this area to able to pass
through the head of the baby.
So the other thing to be aware of--
we'll come back to that, okay.
Okay, so we're going to talk about birth control methods now.
I'm going to take the most effective method
to the least effective method in that order.
So the most effective method is sterilization.
What is sterilization?
Anybody can speak up.
[Inaudible Remark] Yeah, through what measure?
[Inaudible Remark] Cutting the tubes.
So when we're talking about the fallopian tubes or we're talking
about the guy's vas deferens, the tube that goes
from the epididymis, those are ligated or cut
so that the sperm can't pass through
or the egg can't pass through.
That's pretty permanent.
It's like 99 percentile permanency.
There are situa-- generally, we don't talk about it
in this age group because people aren't ready
to be sterilized yet.
But sometimes when people had three or four kids
and they think they want to be done with that,
they will do the tubal ligation.
There other situations in which they may want to do that.
But sometimes, people will do that in their 30's
and then they meet someone they want to have a child with
and they try to go back and reverse it.
We coach people and counsel people to say
that this is really a permanent solution
because we can't guarantee we're going to go back and be able
to put those tubes back together
and you have a successful pregnancy from that.
Okay, so then we have implants.
And implants are actually little devices
that you can put underneath your skin.
They are-- they have hormones.
They have a hormone in them and I will just show--
normally, I show this around.
I just pass it around the class.
It might be a little bit more awkward today.
But you can see as up on the screen here,
it's like a little matchstick and it's got hormones in it.
And the way it works is, is that it stops ovulation
so that you don't ovulate, you don't produce an egg.
So you're synthetically we--
you know, we all have normal hormones, they're natural.
We all produce hormones and they are naturally produced
in the body to make things work as far as ovulation
and that sort of thing, preparing the uterus and all.
We have multiple hormones.
And just around reproductive health, there are a number--
two or three of them that are really particularly helpful.
So, what we want to do is suppress ovulation
when we're talking about birth control.
So this has a hormone in it that does that.
And the way this works is that they slip it
in underneath the layer of your skin and it stays there
for a few years, three to five years.
I don't remember exactly 'cause there-- this is Implanon.
It's an older unit, older type and now we're on to Nexplanon.
And so, I've-- off the top of my head, I don't remember
if it's three or five years
that you get the ability to have this.
So it does slip underneath the skin.
You don't have to worry about any other type of measure as far
as birth control, okay?
Then you have intrauterine devices.
Intrauterine devices, there are two on the market.
And again, if you can see here, this is a uterus.
And inside of it is a T-shaped plastic device.
This one is called the ParaGard
and it's got some copper wiring wrapped around it.
And the way that that works is
that it emits the copper inside the uterus
and it creates a hostile environment
where the sperm don't survive.
They don't do well on a hostile environment.
It also has some strings attached to it,
so we know that it can stay in place and that it is in place
and the women can check it.
So they need to be-- women--
you know, when we talk about birth control, a lot of times,
it's really what the woman is comfortable doing.
And, you know, if your friends are taking the birth control
pill, often times, women come in and say, "Well,
I'm here for birth control."
I say, "Okay, what do you want?"
"The pill."
They don't know that there are other options
out there for them.
So this is what's so great about having an opportunity to talk
to you like this today, it's
to let you know what the other options are.
Sometimes, and I'm one of them, people aren't good pill takers
and you have to take the pill everyday at the same time.
If you got a busy schedule, you're working, you're going
to school, you got classes and you got homework,
it's hard to remember those pills.
So the pills aren't necessarily a good option for you,
but an IUD might be, so it might be a good option.
So it goes in, it stays in.
And this particular IUD has a 12-year-- it's a 12-year option.
So it goes in and it's there for 12 years.
So if you're here today thinking, "Oh gosh,
I'd like to get a PhD," this might be a great option
because it's going to take about 12 years to get
that PhD, [laughs], okay?
So again, remember there are strings attached and you have
to feel them to make sure they're in place.
So this is a nice option and you get it and you forget it.
The other one is called the Mirena IUD
and that one does have hormones in it much
like the Implanon or the Nexplanon did.
And that's good for five years.
And again, it has multiple ways that it works
but basically it's not an environment where it's going
to enhance a pregnancy.
But Mirena can make the cervical mucus a lot thicker
and the hormone there is going to help as well.
Okay, so-- then there's the Depo-Provera shot.
Again, that's a hormone.
It's a single hormone that you take a shot everyday--
every three months, rather.
So you have to be able to be at the clinic every 12 weeks,
anywhere between 11 and 13 weeks,
you have to take the shot.
So sometimes that's workable.
And sometimes, we have to use something
like the Depo-Provera shot or the Mirena
because in birth control pills, we have different hormones.
We have estrogen and progesterone type hormones.
Some women can't take estrogen for some medical reason.
They can't take it when they're breastfeeding, for one reason.
And so, they might do well with the Depo-Provera shot
or the progesterone-only birth control pill.
So again, every woman comes in, she maybe gunning for that pill,
but that may not be the best answer for her based
on her medical con-- her medical history and what she's willing
to do as far as taking pills, okay.
So we also have pills.
So we talk about hormonal methods and we--
then we have to talk about delivery of hormonal methods.
So we have the pills and we have the patch and we have the ring.
They all are the same thing.
It's just how they're delivered to your body is different.
So the pill, you're going to take the pill everyday
for three weeks and then you--
actually, you take it for four weeks,
but it's extremely important that you take them
on time everyday for the first three weeks
because those are the active pills,
the last week are the inactive pills.
The last week is when you're going to have a period.
So what's nice about the pill, it's pretty predictable.
I mean you can look ahead and say, "Well, you know,
I don't want to have my period that week," or,
"I know I'm going to have my period that week."
And I can tell the way that this got marketed,
the pill was marketed in the '70s,
is that women were going away for the weekend,
they didn't want to have their period on the weekend,
so the company got wise to that and they said, "Okay,
start your pill on Sunday
and then you'll have your three weeks of pills.
And then when you start your period,
it won't be during the weekend.
It'll be during the week."
So the pill became very popular back then
with that one marketing strategy.
So again, with the pill or the patch or the ring,
it's predictable when you're going to have your period.
So the patch is a very thin one and a half inch square.
It's been misplaced in one of my presentations.
I don't know where it is.
Hopefully, someone's not going to try
to use it [laughs] 'cause those have hormones in it,
but it's embedded with hormones as well but you put it
on once a week and you change the patch once a week
for three weeks and then you have a week off
and then you have your period.
Again, this is all to delay ovulation,
so you don't get pregnant.
And then the ring is also available to you.
The ring is round and it's impregnated
with hormones as well.
And this, you squeeze like a taco and you put it
up inside the vagina and you forget about it
and you leave it there for three weeks.
And then when it's time to remove it,
you just put your finger in your vagina
and you pull out the ring.
And you have your period
and then next week you put the next one in.
So this is good.
It's a great method as well.
The partners don't feel it.
You don't feel it.
You can forget about it.
And I will be honest with you, more than once,
a number of times, I've had women come in and say,
"I don't want my parents to find my birth control pills."
And I say, "Well, there's this option 'cause your parents
aren't going to be finding this [laughter]," okay.
[Laughs]
Okay. So again, this is a nice method.
The only thing with it is it can come out during intercourse.
It can come out when you're using the bathroom.
So it's just something you have to check periodically
and make sure it's in place.
I do have a story to tell you that one of the colleagues
that I know at another college was using it
as a birth control method and she came home one day
and found it on the dresser.
And she said to her husband,
"What is my ring doing on the dresser?"
And he said, "Oh," he said, "When I came home today,
the dog was carrying it around in her mouth."
So it got misplaced somehow.
And-- so he thought it was her hair tie
and that's why he put it on the dresser.
So basically, that is a true story
and they did have baby number three.
[ Inaudible Remarks ]
Okay, we also have another hormonal contraception called
the "morning after pill" or emergency contraception.
This is meant to be for emergency purposes.
It is not meant to be a maintenance form
of birth control because it's a high dose of one hormone.
And it's meant to delay ovulation again.
It's a number-- as a way you can use it.
And the reason you would use it is
because you had unprotected intercourse
when you didn't plan it.
Maybe it was nonconsensual type of intercourse.
And possibly the condom breaks, that's another reason to use it.
So if you're using a birth control method
or if you're just using the condom and it breaks
and you're worried about getting pregnant,
then this is a method you can use.
If you are 17 years of age and you go into the pharmacy
like Rite Aid or Savon, it's not an over-the-counter medicine.
It's what we call behind-the-counter medicine.
That means you have to ask the pharmacist for it.
So you go up and say, "Hey, I need the birth"--
you know, "the emergency contraception."
And you can ask the pharmacist for it,
they'll just check your ID to make sure you're 17
and you can sign out for it and get it.
If you go to Rite Aid or Savon or places like that,
some of them do it and some of them don't.
So you have to kind of call ahead to see if they offer it
or check their website.
But if you go there, I think it's about 50
or 60 dollars to get the pill.
So, your other option is Planned Parenthood
where if you can go there and make an appointment there or get
in there, they will give it to you for free if you're eligible.
At the Student Health Center, you can get it for ten dollars.
So just know that's available for you.
And I also coach students that if you think you might need it,
we will give it to you in advanced.
It's called an advanced prescription.
So if you think about Thanksgiving Day weekend coming
up or winter break coming up and you would want to have access
to something like that, you need
to come see us at the health center.
Okay, and so, the two that we currently deal
with are Plan B and Next Choice.
We actually carry Next Choice in the health center.
If you take it within 24 hours
of having the unprotected intercourse or the reason
as you would be taking it,
then it is 89 percent effective, okay.
Now, one question I get asked from time to time is what
if you're already pregnant and you take this?
It does not harm the baby, okay.
It does not.
It doesn't do anything to the pregnancy.
We have no research to show that.
And partially, I can explain that by saying that it's made
of the hormone that your body naturally produces in order
to support a pregnancy, okay.
You're just getting a higher dose of it.
Okay, so less effective methods.
We have male and female condoms, the diaphragm, the sponge.
Okay, so let's go with a female hormone-- a female condom.
And that's-- this is what it looks like.
It's a condom.
Again, you see how women kind of are in circles here.
So again, you squeeze it like a taco and you put it up inside.
And then this is what's on the outside
of the vulvar area or the vaginal area.
This is the guy's target, right here [laughter], okay.
You don't want their penis to be
on either side or-- I don't know around.
It's got to be in here guys.
That's your target, okay.
So-- and basically, that's going to prevent pregnancy
because you're going to kind
of contain the ejaculation, the ejaculate.
And-- but the one caveat to this is that basically, you know,
if there's any content-- contact of skin to skin
and there's some other sexually transmitted infection there,
then you're not going to have protection.
This only protects the area that's covered.
The same with a male condom, it's only going
to protect the area that's covered, okay.
So that's what that looks like.
It's a one time use only.
You can buy this over-the-counter yourself, okay.
And then we have, what's next, the diaphragm.
This is something that requires a prescription.
You actually have to go into the clinic and get it fitted
because it's size-- it requires sizing.
And so, you can see that these have holes in them.
Would I want a hole in the diaphragm?
This goes in the vagina.
Again, squeeze like a taco, put it up inside.
You're never going to think of a taco the same, trust me.
[Laughter] So it covers the cervix, okay.
And so, the idea is to create a barrier so the sperm don't get
into the cervix, okay.
But there's a hole here.
Do I want a hole here?
No. So the reason we put a hole there so that we don't get it.
It doesn't go missing, okay.
So-- but we do size it in the clinic.
If your weight changes, ten or 15 pounds, then we do have
to change the size of the diaphragm possibly.
You may have to go back for a fitting.
And-- but, you know, again, this is a time
when maybe someone's having intercourse every couple
of months and it's just once or twice or whatever,
and they just-- they don't want to go on hormones
or can't use a hormone, this is a method that they can use
with a condom that will give them pretty full protection
for pregnancy.
Okay, so then we have the sponge as well.
And that is-- again, you can see,
it's going to-- it coves the cervix.
It's got some spermicidal jelly or gel in there.
And when it's activated, it will work and it goes in
and it covers again the cervix.
It stays in for a little while after intercourse,
about six hours or so.
And then when you want to pull it out, you just pull the string
and pull it out, and it's a one time use only, okay.
And then spermicides, I don't bring those in.
There's something you can go and take a field trip to Savon
or Rite Aid or wherever and just peruse what's out there
and see what you can find.
But there are suppositories or like little--
glycerin suppositories like little bullets that they absorb
and they know they dissolve inside the vagina.
There's a film that does the same thing.
We have withdrawal and we have family planning.
Can anyone tell me what withdrawal is?
>> That's when you pull out before you ejaculate.
>> Correct.
Is it a safe method?
>> Not really.
>> Why not?
>> 'Cause you may never know when somebody ejaculated.
>> Right. Part of the-- in the sexual response, you're going
to have some fluid that comes out of the urethra
of the male that's called precum.
I mean that's not the medical term but we can call it precum.
It will have sperm in it.
So the guy may well pull out before he ejaculates,
but you have exposure to sperm in the precum.
So it's not a real reliable method to use.
And then there's family planning.
I don't talk about that in depth here.
It is a matter of taking your temperature every morning,
day after day, month after month
to get an idea of when you ovulate.
And basically, when you ovulate,
the temperature is going along around--
it's a basal thermometer, so it's a special thermometer.
It's not your regular thermometer.
It measures in tenths.
And so, your temperature might run 97, 97, 97, and it spikes
to 98 first thing in the morning.
When that goes-- it drops, it might go 97
and it might go 96.8 and then spike to 98.
That down and spike up is when you ovulate.
We mostly see-- and so, that's when you don't want
to be having intercourse is when you're ovulating.
But when we see this more often used,
not so much in preventing pregnancy, but when women want
to get pregnancy, it's often the first step that doctors
and nurses will take in getting people
to understand their bodies when they're ovulating.
And so, people will find
out is the pattern of when they ovulate.
And then they and their partner are having sex
in order to get pregnant.
So you're going to see a family-- that's family planning,
but basically they want to get pregnant.
That's when they use this calendar method.
And then there's also the cervical mucus.
It goes through different varying stages
of being thin and thick.
It's very, very thin when you're ovulating
because the sperm want to get through it.
And if you were to look at it under a microscope,
it has what we call a fern pattern to it.
It looks like fern leaves.
Those are tracks that make it easier for the sperm to travel.
Okay, I want to talk about lubricant use.
That can be safe-- make safer sex more fun.
The reason we encourage you to use it even if you're young
and healthy and you have lubrication on your own is
because we want to decrease the friction of the mucus membrane
because you can have micro-tears in your mucus membrane.
And we're talking about the lining of the vagina,
the lining of the urethra, and those areas, they are vulnerable
to organisms if they are irritated,
if there's little micro-tears in them.
So you have a greater risk
of getting a sexually transmitted infection
if you have that friction or those tears.
So here are some lubricants.
We have Vaseline, Wesson oil, baby lotion,
butter, whipped cream.
So what about these?
Are these good options?
Anybody, are they good options?
Why not? Who says they're not good options and why?
[Inaudible Remark] [Laughter] What is that?
The brand of butter does not make a difference.
[Laughter] Okay, the reason we don't want you
to be using them is because they can cause problems with the pH
in the vagina, in the urethra-- or in the vagina actually.
And so, it can cause women to get yeast infections, one thing.
But also, more importantly, they are oil based.
And they are oil are based-- when they're oil based,
they can break down the latex condom.
And so the condoms can break more easily.
So you always want to use the water-based lubricant, always.
They clean up easier than petroleum jelly, for one thing.
But basically, they'll cause the breakage of the condom.
So I crossed off the ones I encourage you not to use.
That's Vaseline, Wesson oil, baby lotion, whipped cream.
Whipped cream, they can be fun for other things,
just don't use it as a lubricant [laughter], okay.
And then there's butter.
We don't want to use that.
So I did bring with me today.
At the end of the presentation, I would love for you to come up
and help yourself to these items that I brought.
One book in particular is called Sexual Health Etiquette,
Sexual Etiquette-- Sexual Etiquette 101.
And it goes through a lot of things.
It goes through birth control and it goes
to sexual responsibility and relationships.
And it deals with the issue of domestic violence.
So those kinds of things I would encourage you to be aware of.
So that book is free to you.
I also brought lubricant-- one lubricant called Astroglide.
It's a very nice lubricant.
We house it at the health center.
You are welcome to use that.
I mean try that.
And-- so I have other pamphlets.
I'm going to offer you free condoms and I just want
to let you know that at the health center,
we do offer free condoms both flavored and non-flavored.
So we'll get into that in a minute.
We offer the-- we can give you a sample
of the Reality condoms for women.
And we also have dental dams.
And dental dams are actually plastic vinyl-type pieces
to cover the genital area if you're having oral sex
with someone because you can get oral sexually-- oral sexual--
oral contact sexually transmitted infections.
So I just want you to know that those items are up here free
for you for taking as well.
Okay, so let's do a condom break.
This is always fun.
When we talk about condoms, I just briefly mentioned to you
that we have two condoms, one's latex and one's flavored.
It maybe latex but it's flavored or it's scented.
What-- who can tell me the difference
of when you would use which one when?
>> One's for oral sex.
>> One's for oral sex, which one?
>> The flavored one.
>> The flavored one, right.
Because when you have a latex condom,
sometimes they have a bitter taste to them particularly
if it has a spermicidal gel in it.
It's going to be not so fun.
So you know that-- you just need to know
that those flavored one's are out there.
They're more fun.
And-- so we do carry them at the health center.
We have a little chalkboard that tells us the month's flavors.
And so, we have banana and vanilla and chocolate
and strawberry and mint.
So you can come in.
After these presentations, we always see a little flurry
of activity coming to the health center, that's fine.
We love to have you come in and try these out if you need to
or just have some fun with them.
Okay, so then we have the latex condom.
And the point I want to make about latex condom beyond
that point that it's an oil-based,
if you have an oil-based lubricant,
it's going to destroy it or cause it to break.
The other thing that can happen with either partner is
that you can have a latex allergy
and you can create an irritation
in the genital area because of the latex.
If you find that to be true for yourself, then you need
to switch over to a non-latex condom.
The one that I'm aware of is called Avanti.
There is also another one that's a durex type as well.
But they are made more of a vinyl-type material
so you won't have that irritation.
Please remember, you don't want to have irritation in that area
because it makes you more vulnerable
to a sexually transmitted infection-- exposure, okay.
So again, you have the scented type for oral sex
and then you have the latex.
So what do we-- I just want to talk about condoms in general
about its application, how you put it on.
So-- but do we want-- well, how do we know
that this condom doesn't have a break in it already
or if there's not a hole in it already?
[Inaudible Remark] Okay.
So it should be puffy.
It should not be flat.
It should have a little air pocket in there.
What else you're going to look for before you even open it up?
>> Expiration date.
>> Expiration date.
So we're good with this one.
This was 11/13, okay.
So when you're opening it, you want to be careful
when you open it that you don't tear it when you open it.
You know, you don't want to tear into the condom,
put a hole in the condom.
So with the way that-- so you don't want to open it
with your teeth, not a good idea.
And particularly, watch your nails that you're not going
to open it with your nail.
So one way to protect against that is to push the condom
to the side, just kind of, you know, move it down.
And then you have the space here then
in which you have a little more space in which to open it.
So you're going to open it.
And we encourage you at the health center to use one
that has a reservoir tip in it.
You can see a little tip on the top.
And that's the reason so that we can give you some more space
for the ejaculate because if it's got a round dome to it,
it's more likely to break.
So you want to put some-- to have some space there.
If you don't use a lubricant, then you're going
to squeeze the air out and put it on the hard penis.
As soon as the penis is hard,
that's when you want to put it on.
You don't want to have--
play for a little while and then put it on.
And the reason is because sometimes you throw caution
to the wind, so to speak, and you think, "Oh, screw it.
I don't need the condom, you know.
Forget it."
You want to do it as soon as the--
as soon as the penis is hard so that you don't forget to put it
on or think less of putting it on, okay.
So the other thing.
So if you don't put lubricant in here, you're going
to squeeze out the air.
Now, sometimes guys complain
about that it's not sensitive enough for them.
That it decreases the level of sensitivity.
So I have an answer for that.
You take the water-based lubricant that you're going
to buy or get it at the health center for free.
And it's going to be K-Y or it can be a Surgilube.
It can be Astroglide, Probe, any of those.
You're going to put it inside here.
And then you put the lubricant on the penis as well.
And then once this is on and you roll this
down to cover the penis, you're going to put the lubricant
on the outside of the penis.
And that all those layers of lubricant
and condom will increase the sensitivity, okay?
All right.
So now, I want to show you how to put it on, but I need a guy
to help me to do that.
[ Laughter & Inaudible Remark ]
Come on up.
Who's going to help me?
Who's going to risk?
Don't be shy.
[ Inaudible Remarks ]
Okay. What's your name?
>> Bryant.
>> Bryant?
>> Bryant.
>> This is Bryant, everybody.
>> Hi, Bryant.
[Laughter]
>> Okay, so anyone can help me out with this question.
Why don't guys like to wear condoms?
>> What?
>> Why what?
>> Why don't guys like to wear condoms?
It doesn't feel the same but I just dealt with that, right?
>> Yeah.
>> With the lubricant.
What else do guys say?
It takes too long.
Well, you're just kind of slow him down.
[Laughter] What other-- what other--
what else would you hear from guys?
[Inaudible Remark] Cost.
Well, we've nailed that.
We give them away for free at the health center.
[Inaudible Remark] What else do you hear from guys?
Why don't they like to use condoms?
[Inaudible Remark] Okay,
we're going to take care of that today.
[Laughter] Okay, we always hear, it's not big enough, right?
All right.
Put your thumb inside here.
Close your hand for me and just hold your hand real still
for me.
[ Inaudible Remarks & Laughter ]
Hold your hand still for me.
[ Laughter ]
Just hold still.
[ Inaudible Remarks ]
>> Oh, my God.
>> Okay. So my point is it's going
to be big enough, all right?
The other point I want to make while I have Bryant
up here dying--
>> Oh my God.
[Laughter]
>> -- is that once the guy ejaculates,
he's going to pull out.
[ Laughter ]
You can see that I'm having trouble keeping it
up on his forearm as it is right now.
And that is because there's a rim here
and it can slide easily.
So when the guy ejaculates and he's ready to pull out,
you want to put the fingers on either side of the shaft
of the base of the penis and have him pull out.
So either partner can do it, okay?
But the main thing is because as you see it's already rolling
up on his hand.
But that thing of it is if you're pulling it
out off a partner is
that sometimes it can pull off the partner and be--
end up inside the partner.
So you don't want that to happen 'cause it defeats the whole
purpose of decreasing the risk
of a sexually transmitted infection
and of course pregnancy.
Thank you so much.
[Applause] Okay Bryant, I have some gel for you
and some Kleenex if you need it.
[Inaudible Remark] All right.
That was a non-lubricated condom I think,
but it still doesn't feel quite as great.
All right, so let me have some too please.
Thank you.
All right, and usually when I show women this--
the women in the group this fist within this condom,
I usually say, "If you have something this big coming
at you, get out of town."
[ Laughter & Inaudible Remarks ]
All right, so any questions 'cause we're going to move
on now from birth control.
We're going to hit a little bit about condoms again with STIs.
Was there anything about birth control that's kind
of like a question that you feel comfortable asking
at this point?
[ Pause ]
Okay, so just to give an overview
about sexually transmitted infections,
we know that there's about 20 of them.
I can only talk about a few here.
And so, I'm going to talk about those that I'm most concerned
about in your age group.
There are many more but-- so if you have any questions
about something that's going
on in your sexual reproductive health area,
come see us because I may not have been able
to address it here, it might be something that you have.
So it's always something that you can ask us about.
We know that if people are sexually active, those people
that are sexually active,
that one in two sexually active persons will get an STI
by the age 25, one in two.
So if we go this person and then this person, so look to the left
or look to the right, those are your odds.
That's how significant it is
to have a sexually transmitted infection.
Women are more vulnerable than men.
Why is that?
Why would women be more vulnerable
to getting a sexually transmitted infection
than a man?
[ Pause ]
I'll give you a hint.
It's an anatomic reason.
[ Inaudible Remark ]
More parts that can be infected.
That's partially correct.
Anatomically.
Anybody else want to take a guess at it?
It's safe to risk here.
The reason is 'cause she's internal.
She's a receptacle.
She has more mucus membrane that's exposed
than a guy's urethra at the end
when we talk about mucus membrane.
So she has more area to be exposed, okay.
And so, when the guy ejaculates or it goes in
and if he has a sexually transmitted infection
or his ejaculation, when he goes in there and pulls out,
she's left to absorb whatever he has.
So we know that sperm can live up to about 100 hours and--
so it's in there a lot longer, so she has a greater risk.
If she's got the microorganisms in there, then she's going
to have that risk as well, okay.
So you want to-- one of the things I'm going to point
out to you is that if you're sexually active, then you need
to get in and get tested.
Do not assume.
Please do not ever assume that the provider that you're seeing,
the doctor or the nurse or whatever is testing for an STI.
Even if you're having a pap smear or a pelvic exam,
you have to actually ask them.
And I've had students come in and they say, "Oh no, my doctor,
I just saw him last month, he tested me for everything."
I said, "I can guarantee you he didn't."
"No, no. He told me he's testing for everything."
Not to say that the doctor is lying,
but what people think is everything is not everything,
okay.
So we do definitely want you to get tested for Chlamydia
at least every six months to a year and possibly gonorrhea
and some other things that we can test for
but do not assume that they will.
I've seen students in the clinic
where they've had a typical test--
a typical presentation of herpes,
which is one thing I'm going to talk about, and yet,
they were convinced that they were tested
for it the month before.
So the risk factors for an STI are sex in an early age.
What's the average age that people start having sex?
[Inaudible Remark] Okay, average age.
15, that's exactly right.
There are 12 year olds, but then there are some people
who are not starting 'til later, but the average age is 15, okay.
And having multiple partners puts you at risk as well.
So if you're having one partner every month,
that's a multiple partner.
If you're having one partner every two or three months,
that's still multiple partners.
If you're having one partner-- two partners a week,
that's more than enough multiple partners, okay.
More partners, the more risk you have.
If you're having unprotected sex, that's a risk
for getting a sexually transmitted infection.
And then having sex with those who've had sex with others.
So I use the example here of May and Kent and Chris and Alex.
If May is having sex with Kent and then Kent goes
on to have sex with Chris, Chris is actually having sex with Kent
and May on a cellular level, on a microscopic level.
And then when Alex comes along, when Alex has sex with Chris,
then Alex is actually having sex with Chris and Kent
and May, on a cellular level.
And remember too, I picked non-gendered names
or gender neutral names of Chris and Alex.
You could have multiple partners and then you can have sex
with someone who's bisexual.
And so, that increases your risk as well.
So this is a normal cervix, you've seen it once before.
I'm going to show ones that are not
so normal or different looking.
And so, you can see here that we have a normal cervix up there.
Do with my-- there we go.
So this is a-- this is normal tissue right here.
It's-- there's no lesions.
There's no discharge and there is--
this is where we go to capture a pap smear.
A pap smear is actually a test.
A lot of women say, "I'm going in for my pap test," or,
"I'm going in for my pap," it's a test, it's not the exam.
So we do a little brushing here and we capture some cells here
to see if there's any abnormal changes
when we're doing pap smears.
This is a healthy cervix.
This is a healthy cervix as well but this is an immature cervix.
This is a developing person.
And so, you can see that these cells are just growing in.
So when young people are just developing, you don't have
to be a clinician to see that this is a more vulnerable tissue
for a sexually transmitted infection.
So if these were to be a 12 or 13 or 14 or 15 year old, or--
I mean, you can see something like this
in someone who's in their 20's.
I'm not saying that you can't.
But if you think of this, this is immature--
this looks immature and it's more fragile.
It's more vulnerable to a sexually transmitted infection.
So that's something to be aware of when you're talking
about sex in early age.
And then you have a cervix that's been infected
and I can't tell you for sure but it certainly looks pus
so it could be gonorrhea or Chlamydia.
So Chlamydia is the most common bacterial infection worldwide.
We have 600,000 new cases every year in the United States.
We can't seem to get ahead of it.
It's number one.
It's number one in college students.
The age 15 to 25 is the most common age group.
When you have Chlamydia, 80 percent of the women don't know
that they have infection and 50 percent of the men don't know
that they the infection.
The symptoms can include an abnormal vaginal discharge,
bleeding after intercourse, painful urination
and painful discharge.
There can be bleeding in between periods as well.
When we talk about gonorrhea, I'm going to tell you
as of this week, this is a new slide for me.
I never spent too much time with gonorrhea.
I would say they're very similar.
They tend to run together.
And I didn't really separated out too much.
This week, your group, I have to separate it out.
We have had an increase in gonorrhea on our campus
and an increase in gonorrhea in the LA County area.
I've talked to someone who's worked at other campuses,
they're having-- they're seeing an increase
in gonorrhea on their campus.
I talked to the people who worked at the lab and saying,
"Are you seeing an increase in gonorrhea and Chlamydia?"
"Absolutely."
So I don't know if we're seeing an increase
because I'm doing more presentations.
I don't know if it's really out there but it's a problem.
But I am telling you that students are coming
in to see us now and they are testing positive.
So I just want you to know
that we have seen more gonorrhea this semester than we've seen
in the last two or three years put together.
So 50 percent of the women do not have symptoms.
And I want to alert you that a lot
of people having oral sex now because they think
that that's safer and that is not the case if it's unprotected
because 90 percent of the people who have pharyngeal
or throat cancer-- or throat gonorrhea don't have
symptoms either.
So if you are sexually active and you are having oral sex
and you are having it without a condom, I can tell you
that 90 percent of you are not going to have symptoms.
Sometimes, you can have a mild sore throat,
it just doesn't go away then that's something
that we would be tipped off.
And so, if you were to come see us,
we're going to be asking you more questions which is
to your favor about your sexual activity.
And if you're-- if you have a persistent sore throat,
if there's a problem there, then we're going to test it, okay.
So adolescents in LA County have seven-fold increase
in pharyngeal to genital infection.
So that just says to us there's more sexual activity
with oral sex.
And I want to tell you that we have a problem with gonorrhea
that is approaching a superbug status.
Can anyone tell me what a superbug status is?
If it's becoming a superbug, what is it?
It's becoming resistant to the medications that we have.
So we're down basically to one or two medicines
that we're able to use.
Our first choice medicine, we're seeing cases
in the last few years where it-- not here at the health center
but worldwide, that there is a resistance
to the medicine of choice.
That is problematic for all of us because if we get
into an organism that we don't have a drug for,
we're going to have a problem.
So this is just to underscore it's important
to be protecting yourself.
It's important to be testing yourself.
So as far as gonorrhea symptoms are concerned, you're going
to have painful swelling and burning sensation in urethra
and the urinary tract.
It can often have pus like you saw on the previous slide.
You can have urethral scaring and painful epididymitis,
that's this little tube that sits on top--
little area that sits on top of the testicle.
And as a result of that, you can be sterile.
And in women, it migrates up to the cervix
and the uterus and into the tubes.
It causes pelvic inflammatory disease
and it can cause infertility which is the inability
to get pregnant as well.
Systemically, if it goes unchecked and untreated,
it can get in to the bloodstream.
It can affect your joints, your skin,
your heart valves, and even the brain.
So you have an increased susceptibility
to HIV infection as well.
And if there's a situation where the woman has given birth
to a baby and she's not been treated for the gonorrhea
that the baby can get it during the passage
through the birth canal and the baby can be blind
as a result of that.
Now, I'm going to tell you in practice, in real life,
that they automatically treat all babies born
with a gel to prevent that.
But it is possible that it can happen.
Okay, so when we talk about Chlamydia,
and this is where we get into more graphic photos just
to forewarn you, that we have Chlamydia infection.
This is the vulva, the outside of a woman's vulvar area,
pelvic area, and this is a little abscess
in the Bartholin gland that's there to protect your body.
And then on a darker pigment,
this group of person that's here as well.
It's not as inflamed as this one but it's a similar infection.
We also have Chlamydial cervicitis which is inflammation
of the cervix and you can see that this is redder.
It looks, what I say, more angry.
And it has a discharge here.
And I always keep this slide here because this is the time
where I remind men that if you're going in there
without a condom, you're putting the end of your penis right
into this pool of discharge, okay.
And then there's other--
other infections here and here is the cervix.
So you can see it's red and has a discharge.
This is a guy's penis.
Hopefully, you all know that.
But as you can see, the pussy discharge here.
And again, I would say that they're a suspect
for gonorrhea but not necessarily.
It could be gonorrhea and Chlamydia together.
So what we worry about with gonorrhea and Chlamydia is
if they go unchecked and untreated that they can go
on to pelvic inflammatory disease
and that's a chronic inflammation
of the pelvic structures, and that's very uncomfortable.
It's very painful.
It's hard to sit.
It's hard to have intercourse.
And it can become a chronic problem
if we don't get it treated correctly and in time.
So we worry about that.
We also worry about ectopic pregnancy and infertility
which again is the inability to get pregnant.
So when we talk about ectopic pregnancies,
what are we talking about?
Does anyone know what ectopic pregnancy is?
[ Inaudible Remark ]
Right. It's when you have a pregnancy--
when the sperm has met the egg and it's developing in an area
that is not a normal place.
So a pregnancy could happen out here.
It could start growing out here.
The sperm may have made it out here and they joined.
It could be that it ends up here
and it's growing here or down here.
And a lot of cases, you lose it.
When it's ectopic, you're like--
you're going to probably lose it 'cause it's outside
of what's normal.
What worry about in particular with STI,
sexually transmitted infections, is the scarring that can happen.
And so, scarring can happen in the tubes here.
And so, as this little conceptus is moving down,
you know from biology in previous years that cells divide
and they double and they grow and they grow and they grow.
So as it's traveling down here during those two week path to go
from here to here, it can get caught
in the scarring of a tube.
And if it gets caught and it's lodged somewhere
or stuck somewhere, it's going to continue expanding.
You can see that this material here is more muscular,
this is not.
So if this is not muscular, what's going to happen here
if this fertilized egg continues to grow?
What happens?
[Inaudible Remark] Yup.
Tear, rupture.
We call it rupturing.
You're going to rupture the tube.
And so, that's a surgical emergency for the woman.
She's going to be in the OR very shortly because they have
to clean that area out, stop the bleeding,
and try to repair the tube.
But that is-- that could be fatal to the woman, okay.
They've got to refine it.
So we worry about an increase risk of an ectopic pregnancy
with sexually transmitted infection.
So an ectopic pregnancy, just for your own information,
if you're running a fever or you have unusual pain
that you don't normally have with a period
or you have unusual bleeding that you don't normally have,
we have to consider an ectopic pregnancy.
Back to pelvic inflammatory disease.
So this is what this looks like.
The left side is a normal structure.
The right side is swollen, inflamed, very painful.
Just to quickly hit herpes.
We have two types of herpes that we talk
about in this particular presentation, herpes 1 and 2.
There is no cure.
When we're talking about viral infections,
there's no cure for viruses.
You have-- usually, the oral type is up here in the mouth.
You have fever blisters.
If you have fever blisters,
please don't go down on somebody.
Or if your partner has fever blisters, don't have them go
down on you because they can give you
that fever blister herpes infection in your genital area.
You want to make sure it's well healed
because that particular virus stores itself in the skin
and it comes out with shedding of skin.
You may not have a lesion but it's still present.
Now, there's a lot less risk of getting a viral infection
or herpes infection when it's all healed.
But just to know that when the skin is shedding,
the virus is shedding as well.
We also have herpes 2 which is considered more
of the genital contact herpes.
And you don't-- you just have to have intimate contact to get it.
This is what it looks like on the penis.
It has a red base.
It has blisters.
They progress.
They become erosions or ulcers and they go
on and look like this.
This is in the woman's vestibular area,
the vulva in the-- in her vulva area.
And you can see, it's erosions and there's blisters.
That's very painful.
She probably wouldn't be in class today.
You have Human Papillomavirus and it's HPV.
How many of you have already heard about HPV generally?
Okay. This is the number one sexually transmitted infection
that has a viral-base worldwide, worldwide.
And it used to be that we're picking it
up in 17, 18, and 19 year olds.
It's very common and it can get there.
We used to be aggressive in treating it.
We don't treat it anymore.
We just let it run its course over two years
and the body amazingly can heal itself.
And on that note, we don't advise women
to start having their first paps until age 21 now.
It used to be that once you started sexual activity would
have-- you have a pap.
Or once you-- once you've been sexually active
for three years, you'd have a pap.
We're getting away from that.
The first pap, regardless
of your sexual background, age 21, okay.
Just to note that.
Now, it doesn't mean you can't go in for a pelvic exam
for other reasons but the pap test,
the test we actually do the scraping of the cells is age 21.
So when we talk about Human Papillomavirus,
I want you to know that there are over a hundred of them,
but 40 of them are readily identified
as being sexually transmitted.
And then we've narrowed it down to a few more that we want you
to be particularly interested in and knowing about.
So you can have skin to skin contact.
You don't have to do it to get it.
You can have the infection, not know it.
It's asymptomatic.
And just remember that condoms only cover the area
where the skin is protected.
So if a guy has got some-- and they're called warts,
and he's got some warts on his scrotum and--
the scrotum is coming in contact with your skin,
you can get it through that way.
So we talk about the low risk HPV, the six and 11.
There are four of them.
We're going to talk about, 6, 11, 16, and 18.
You can have no symptoms.
Most of the people who have it don't-- are not aware of it.
And they can present in a way of pink or gray warts.
They can be raised.
They can be flat.
They can be multiple.
They could be cauliflower like appearance
and it can cause itchiness and irritation.
This is what it looks like on the outside
of a woman's female genitalia.
And you can see here that this looks
like a little cauliflower and this does too.
Remember when I said to you, you just have
to have skin to skin contact?
Well, when her legs come together for her to walk,
you can see she's autoinoculating herself
right here.
This is linear and this is linear.
It's probably where she's touched herself, okay.
So these all have to be treated because they'll just grow.
And then there's the isolated lesions
that are here on the scrotum.
So you can see a little one here and here,
and down here, there's a few.
So they were-- they look very different.
Then you have the high risk HPV and those are no symptoms.
Again, they are picked up in an abnormal pap smear.
We can have bleeding in between periods.
The thing I want you to hear about this,
these are Human papillomaviruses 16 and 18.
They are responsible most often times for--
I mean they're definitely responsible
for the cervical cancer.
They are increasingly more the cause of oral throat cancers
and anal cancers and penile cancers.
So those are ones that we have to be concerned
about when we're talking about sexually transmitted infections.
So just to show you, again,
this is a cervical-- this is the cervix.
It's got HPV on it.
These are warts right here.
And if I were to take like a tongue blade or, you know,
wooden spatula and scrape over there,
I couldn't scrape that off.
That is a cervical wart.
It's probably 11-- 6 or 11.
The ones that are more serious, the 16, 18, you don't--
you can't necessarily see, okay.
This is a more graphic case.
This is pretty extreme.
But I just want you to know
that they can become very proliferative and become--
this is something that would have to--
they would have to do some kind of surgery on this.
This is really extreme.
And then there's some warts up in this area as well, HPV.
This is what a guy looks like when it's an extreme case.
These are extreme cases.
It doesn't have to be this bad.
But I want to-- the reason I bring this up,
because I want you to know it can get out of hand
if you choose to ignore it.
So this is from the penis area
and this is perianal warts here as well.
So the other thing I like to do is bring up the point here
and I keep this little icon here to remind me
to please keep the lights on.
You know, check out your partner for flus.
Make sure that there's not some little fleshy lesions
that are there.
You have to watch for discharges 'cause they may not be aware
of themselves.
The good news about this is
that we do have a vaccine available on the market.
It's called the Gardasil vaccine.
There are two, one is Gardasil and one is Cervarix.
Cervarix is mainly for women to prevent cervical cancer.
The Gardasil is available to men and women
because it prevents genital warts in men and women
and cancers in men and women.
So again, it prevents or reduces the risk of genital warts,
6 and 11, and then the cancers
that are associated with 16 and 18.
It is recommended for your age group, from age nine to 26.
We prefer to get this vaccine
into young people before their age 12,
before they become sexually active,
so that we can reduce their risk
of getting a sexually transmitted infection from HPV.
But, sometimes people aren't aware.
Sometimes their parents don't want them to get it.
So for various reasons, people come to our health center
and they don't have it, they want to get it.
I want you to know that we can offer it
to you at the health center.
If you have Blue Cross, Blue Shield, Kaiser, you need to go
to your agency for that, okay.
If you don't have insurance, you can get it through us
at the health center at for--
at no cost 'cause we've arranged a deal through the public--
the Patient Assistance Program
to the company that manufactures it.
So if you could just listen carefully for a moment.
If you are aged 17 and you want this vaccine, you have to go
to the doctor or the Public Health Department
to get it with your parent.
If you are aged 18, you can get it for free
at the Public Health Department.
Aged 18 to 19, you can get it for free without your parent.
It does require three injections.
If you are 19, when you turn 19 and you want the vaccine
and you don't have insurance, you can come
to the health center and we can arrange
to give it to you for free.
I would tell you that if you go out and pay
out of pocket expenses for this, it's about 400 dollars.
So it's a free service
to you that's available here at the health center.
So mainly, I would encourage you
to reduce your risk through abstinence.
I think the less you're sexually active,
the much less risk you're going to have.
If you can hold off on being sexually active
where it puts you at risk for pregnancy
or sexually transmitted infections,
that's less worry to worry about.
Getting the vaccine protection is important as well.
I didn't even talk about another sexually transmitted infection
called the hepatitis B. That is something,
and hepatitis C. We do have a vaccine for B. You can come
and talk to us about that.
So please remember to use condoms with oral sex
and genital sex as well.
Are there any questions?
Yes, so the question is if you have two people
who are clean now and she's protected with birth control,
he's not using a condom and they're having sex,
is there a risk of a sexually transmitted disease?
That sex-- that is-- would be unusual or--
I want to say rare but unusual.
The problem is what are their previous histories?
So a guy may-- the guy may had been having sex
with someone else or the girl and she's--
she has HPV, she doesn't know she has HPV,
so she can give it to this partner now.
That's why it's important for this guy
to wear a condom now, okay.
So we don't know about previous histories.
So if you have two people who started out virgins together
and they don't have-- and they're clean,
they don't have any sexual, you know,
sexually transmitted infections, highly,
unlikely they're going to have anything.
Rare, I mean, you wouldn't.
But again, we don't know about people's histories, okay.
Any other questions?
Okay, so I just want to round off here with a reminder
that we have lots of free opportunities
up here at the table for you.
I'm going to ask you some questions
with your clickers now.
We may have lost some people.
At the end, I'm going to ask you to bring your clickers
to the front table here so this young woman
who is helping me put them together will help.
So-- but before I go to the final questions,
I want to ask you too.
Based on the information presented today,
what risk did Henrietta Lacks have as related to STIs?
Think about Henrietta's history.
You've all read the book, right?
Okay, that was a week, yes.
>> Yeah.
>> Okay, so in her history, in the first few slides,
I talked about what are the risk factors for STIs.
What ones did Henrietta have?
Sex at an early age when she about age 14.
And I'm going to say to you in that period--
we don't have it documented.
We don't know about her for sure.
We don't know all the information about her.
But-- because she was living in various places
and with various people,
there could have been abuse earlier, okay.
So she could have had more partners than we're aware of.
Okay, so she had sex at an early age.
What else did she have?
Her husband kept cheating on her.
So she is in the category where you're having sex
with someone who's had sex with someone else, okay.
And so, she's had sex with all his partners
on a cellular level.
What else?
What other factor did she have?
Was her sex protected with day [phonetic]?
No, so unprotected sex.
And in fact, she had multiple partners which are brought
in with the possibility of abuse earlier on.
Also, the other question was how have her cells helped us today?
Henrietta Lacks immortal cells, how have they helped us
as related to this class, this presentation today?
[Inaudible Remark] Right.
Her cells were actually used to the development
of the Gardasil vaccine.
[ Pause ]
Okay, so let's do the posttest.
Hopefully, we'll get some shift in the answers here
because we weren't quite strong enough in the previous ones.
Let's see.
Let's see here.
I may-- there we go.
So 80 percent of women and 50 percent
of men do not have symptoms when infected with Chlamydia.
Is that true or false?
Is anyone aware of any clickers that are at the table
that aren't being used?
[ Pause ]
Okay, okay.
So the answer is true.
[Laughter] Human Papillomavirus of 16
and 18 cause cervical cancer in women and in men, cause oral
and throat cancers, penile and anal cancers.
Both one and two, neither one or two.
[ Pause ]
If you could point and click one more time
so we can capture the last five people.
[ Pause ]
Okay, we're not capturing somebody here.
Okay. Great, it's one and two, both one and two.
What is the backup method
if the current birth control method may fail?
Right answer please?
Condoms, Plan B, Next Choice, Withdrawal or praying hard?
Remember, I'm testing your post-knowledge.
Plan B, Next choice.
Now, this is a more personal question of yours
and how many sexual partners have you had in the last year?
None for number one, one for number two, two or three,
or three or four-- four or more.
And this is not something to make up.
I just want you to be truthful please.
[Laughter] Okay, so what we have here is an interesting finding.
We have 43 percent have none.
I did a class that was a college one the other day,
there was actually like 75 percent
of the class had no partners in the last year.
Generally, the PCC student profile is about 30
to 35 percent have had no partners in the last year
and about 30 percent have had one.
So this class is sort of in there with the one.
And then we have nine percent, a two or three or four or more.
So I'm going to speak to those certainly in this category--
in numbers three and four.
I hope you come to the health center and get checked, okay.
And certainly, the people answering one partner,
it wouldn't be unwise to come and check.
If you're sexually active, please come in and get tested.
I just saw another note about campus safety.
Our campus police are our first responders.
So if there's an accident on campus
or there's an emergency situation on campus,
if you want an escort to your car at night
because you have a late night class, I encourage you
to call campus police.
Ladies and gentlemen, please do not use your cellphones
to call 911.
You will not get the help that you need within a few minutes.
You call 911, it's going to go out to Glendora [phonetic]
or somewhere and then they're going
to hit it back to Pasadena Police.
So when you're on a campus, if you--
this is the time to dial in this number
on your cellphone if you want.
So it's 626-585-7484.
It is a number you need to have in your cellphone.
If you witness something or there's something going
on in campus you think needs to be reported,
then call campus police even if it's a 911 emergency.
They will be there within minutes.
They have bikes and vehicles and cars and all nine yards.
So the take home message today then please is
to remember that to be informed.
You've had a lot of information thrown at you today.
But if you have questions about what's been presented,
look it at up, check it out for yourself.
Get yourself tested and get vaccinated.
I need just a couple of more questions to be answered
through your clickers and that's just abut this presentation
today and I appreciate you giving me the feedback
if you would, please.
Did the presenter help you identify specific health risk
or behavior that you could change which would protect
or promote your health?
You just point up here or click so I can capture as many
as we possibly can 'cause we are losing a few people, under 55.
Okay, if everybody could point
and click one more time 'cause you may think it's not you
and it is, okay.
Thank you.
So 85 percent of the class feels
that you found something of change here.
In which category did the health risk or behavior belong?
The availability of a lab test at the health center,
the risk reduction behaviors,
health and nutritional counseling,
or birth control education?
[ Pause ]
And if you learned in all three categories or four categories,
that's fine, just pick the one you think is probably most
relevant to you today.
Okay, again, if you could just point and click one more time
up here so I can capture 55.
Okay. So majority went to risk reduction
and birth control information.
On a scale of one, not interested, to five,
very interested, how committed are you
to changing your health risk or behavior in protecting
or promoting your health?
Not interested would be number one, somewhat interested three,
very interested five,
and certainly you can press two or four if you wish.
Okay, one more time we've got 50 out of 55,
I hope to capture more people.
Okay, so about half the class are--
20, 40, about 3/4 of the class is somewhat to very interested.
Did you find the use of clickers effective?
This is the last question.
Did you find the use of the clickers effective
in your educational process today?
Somehow, it seemed to be an easier question to answer.
Great. Thank you so much.
[Applause] I guess-- I want to thank Bryant again for coming up
and helping me with the condom demonstration.
He earned himself a Starbucks certificate.
[ Inaudible Remarks ]
[ Silence ]