Sexual Health Exams

Sexual health exams can feel daunting or uncomfortable for some. For example, individuals who are trans or gender expansive may experience dysphoria related to sensitive exams. For individuals who have experienced power-based violence and/or sexual violence, these exams could be triggering or might cause a patient to disassociate. It can be beneficial to inform the practitioner ahead of time, or to request that a friend accompany you during the exam.

Students who are concerned about and/or may be avoiding a sexual health exam can receive support before, during, and/or after the exam by contacting the Health Promotion office at 502-852-5429 or hlthed@louisville.edu.

You are not alone and the staff at Health Promotion are here to support you in accessing the essential care that you need. 

Testicular Exam

Testicular cancer occurs most often in people with testes aged 15-34. That is why it is important to learn how to look for testicular cancer.

• The best time to examine yourself is in the morning after a shower.
• Your testicles should feel round, smooth, and firm. They may be different sizes.
• You are looking for any lumps (no matter how small) or swelling in your testicles.
• When feeling your testicles, feel them one at a time by rolling your testicle between your thumb and fingers.
• Cup your scrotum and look for any change, redness, swelling, or unusual feeling of heaviness.
• The epididymis is a cord like structure at the top and back of the testicle. Carefully check this area for swelling and painful tenderness.
• If you notice any lumps or swelling, or if you feel pain or tenderness inside the testicle when it is lightly touched, you should see your doctor immediately.

Annual Exam/Pap Smear

Gynecological health care is essential for all people with uteruses and vaginas regardless of age, sexual orientation, marital status, or sexual activity. An annual pelvic exam (including a breast exam and often a Pap smear) is recommended starting at age 21. A Pap smear is a screening test for cancer of the cervix. This test can show early signs of cell changes that can lead to cancer. A sample of cells is taken from the surface of your cervix during a pelvic examination and examined under a microscope at a laboratory. This service is provided by “appointment only.” The Pap smear can be done regardless of menstrual flow. Avoid vaginal medication, lubricants, and vaginal contraceptives for 48 hours before your exam. It is recommended to avoid sexual intercourse for 24 hours prior to the exam, but it is not necessary to reschedule if intercourse has occurred.

New national guidelines now advise waiting until age 21 to begin Pap screening for detection of cervical cancer regardless of when the patient becomes sexually active. However, clinicians who provide sexual and reproductive health care at CHS will continue to offer annual exams to people of all ages. While the clinician may not do a Pap or even a physical exam during these visits, the visits are opportunities to screen for STIs, review available immunizations, discuss contraception and provide other important preventative health care and education. Please call 502-852-6479 if you have further questions.

What to Expect at Your Annual Exam

• Review of personal and family's health history
• Blood pressure and weight check
• Contraceptive discussion/options if needed
• Review of your immunizations
• Discussion and testing for sexually transmitted infections as desired
• Physical exam including breast and pelvic exam for those over age 21 and if desired for those under age 21
• Pap smear screening for cervical cancer for those age 21 and older
• Review of healthy lifestyle/habits

Pelvic Exam

If you feel uncomfortable with the provider, you are entitled to request a different provider, or to have a medical assistant, or friend with you during the exam.

You will be asked to place your feet in the footrests at the end of the table. Slide your hips down to the edge of the table. Let your knees spread wide apart, and relax as much as possible. The more you are relaxed, the more comfortable the exam will be. You can cover your lower abdomen and thighs with the drape sheet to feel less exposed.

The exam lasts just a few minutes. First there will be an external genital exam. The clinician visually examines the folds of the vulva and the opening of the vagina to check for signs of irritation, discharge, cysts, genital warts, or other conditions. Next, the clinician inserts a metal or plastic speculum into the vagina. When opened, it separates the walls of the vagina, which normally are closed and touch each other, so that the cervix can be seen. You may feel some degree of pressure or mild discomfort when the speculum is inserted and opened. Once the speculum is in place, the Pap smear is collected by rotating a soft brush on the cervix. The clinician also checks for any irritation, growth, or abnormal discharge from the cervix. Tests for sexually transmitted infections may be taken by collecting cervical mucus on a swab. These tests may not be done unless you have a concern about infections and ask for testing. Lastly, wearing an examination glove, the clinician inserts one or two lubricated fingers into the vagina and places the other hand on top of your lower abdomen, while feeling for any abnormalities that might have occurred since your last pelvic exam. The clinician checks the size, shape, and position of the uterus for changes in your ovaries. 

Remember, talk with your clinician about your concerns or fears. If you feel pain, tell the clinician.