What to Expect: A Guide to Exams that Require an Attendant

Before We Get Started

Our Language

We acknowledge that the language we use for certain body parts in this guide might not be the language that you use to describe your own body. For example, you might use “chest” instead of “breasts,” “front hole” instead of “vagina,” or “strapless” instead of “penis.” Those terms are all valid!

During your visit, please let your provider know which terms you use for your own body parts so that we can make your visit as comfortable as possible by using the same terms. You have the right to be treated with dignity and respect.

The Purpose of This Guide

The purpose of this guide is to make sure that you are informed about what might happen during breast, genital and rectal exams performed at a medical provider’s office -- including those at Student Health & Counseling Services (SHCS). You deserve to know what may happen to your body during your visit, and you deserve respectful healthcare.

Check out the Resources section at the end of this guide for information on sexual health resources, making an appointment at SHCS, reaching the Advice Nurse, learning how to provide feedback to us about your experience as a patient and for information on sexual violence prevention and support.

You Make the Rules!

Remember: you’re the boss. Tell your provider if you have any suggestions for improving your comfort. If you want to bring a stuffed animal with you, then please do so. You can also let your provider know if you would like to bring someone you know and trust into the room with you. Likewise, if you feel uncomfortable at any time, then let your provider know and the exam will immediately stop.

If you need to have a provider of a specific gender identity for religious, personal or cultural reasons, SHCS will make every effort to accommodate your preference.

The door will be closed during exams, and the provider will always wash their hands (or use hand sanitizer) and wear gloves when performing exams. If you need to remove your clothing to be examined, you will be given a gown or sheet. Only the parts of your body being examined should be uncovered. If the gown or sheet is too big or too small, let your provider know.

Your body, your health, your rules!

Clinical Attendant Policy

it is our policy to have a clinical attendant in the room during any exam that involves the breasts, genital or rectal areas. You may also request an attendant for any other exam. For your comfort, you are also welcome to bring someone you know and trust to your appointment with you – although, the provider will likely want to discuss your exam with you alone first to ensure having that person in the room is your decision.

What is a Clinical Attendant?

A clinical attendant –also called a chaperone – is a specially trained member of our healthcare team whose job is to enhance your comfort, safety, privacy, security and dignity during exams and procedures.

What Does A Clinical Attendant Do?

During the exam or procedure, the attendant will stand in a location where it is possible to see what is going on and assist as needed. They are trained to know what an exam or procedure usually entails, and are charged with stepping in if they notice something inappropriate.

What Happens If I Decline To Have An Attendant Present?

If you decline to have an attendant present, then the exam or procedure cannot be completed at SHCS and you will be referred to a provider in the community.

Choosing a Medical Provider

It is always important to establish an ongoing relationship with a provider you trust. Feel free to spend some time browsing the bios of all of our medical staff on our website to find one that you think would best meet your needs.

For example, if you are transgender, it is helpful to know that we have the Gender Care Team. These are providers who have specialized training in addressing the needs of trans patients. To access these providers, contact the Appointment Desk at (530) 752-2349 and mention your interest in their services.

Please remember that you are always able to switch providers on your Health-e-Messaging portal if you feel that your needs are not being met.

Privacy and Confidentiality

Student Health & Counseling Services (SHCS) is committed to protecting your medical, mental health and personal information. Please see our website for our Notice of Privacy Practices and Confidentiality and Release of Health Information pages.

If you are covered under another person’s health plan in California and are concerned about confidentiality, then you can check out MyHealthMyInfo.org for assistance with submitting a Confidential Communications Request to your insurance provider.

Reporting Sexual Assault and Domestic Violence

All medical providers in California – including nurses, nurse practitioners and physicians at SHCS – are mandated reporters when physical signs of domestic violence and sexual assault are present. Except for Counseling Services staff, all SHCS staff are considered Responsible Employees and are therefore required to report knowledge of any violations of the University’s Sexual Violence and Sexual Harassment Policy to the Title IX Office. If you wish to keep the sexual assault private,

you may tell the medical assistant, nurse or provider that you need to discuss serious emotional concern that is highly personal and you wish to discuss your concerns more fully with a mental health professional only. You will then be referred to Counseling Services, which is a confidential resource on campus that does not have the same reporting requirements. You may also contact the Center for Advocacy, Resources

and Education (CARE), which is the main confidential resource oncampus dedicated to sexual violence prevention and response. Check out the Resources section at the end of this guide for more information on sexual violence prevention and support at UC Davis.

General Things To Know

Know that your responses are confidential in accordance with the law, and that they allow your provider to make the most appropriate recommendations. However, it is always your right to refuse to answer any questions that you don’t want to answer.

Conversations about Your Medical History

When taking a medical history, your provider might ask you questions about:

  • Your general physical and mental health and well-being
  • Your alcohol, tobacco and other drug use
  • Your sexual and relationship health and well-being
  • Family history of certain medical conditions
  • Present or past trauma

Questions about Your Sexual Activity

You may not be comfortable talking about your sexuality, and might wonder why your provider needs to know so many detailed questions about it.

Here are some reasons why your provider needs to ask specific details about your sexual health in order to give you the best care possible:

  • Each sexually transmitted infection (STI), including HIV, has its own test. You might need to provide a urine sample for one test, for example, while another test might require that you get swabbed or have blood drawn.
  • Infections can be found in the throat and rectum, too, so it is important for your provider to know which body parts have been involved in sexual activity.
  • It takes time for STIs, including HIV, to be detected by a test. So, your sexual practices can influence how often you should get yourself tested.
  • The best birth control (if applicable) for you can depend on several factors, such as how often condoms are used or your relationship style(s)
  • Safer sex is not just about condoms, and you might engage in sexual activity in which condoms cannot be used. So, safer sex recommendations depend on your specific sexual practices.

Types of Exams

Clinical Breast Exam (CBE)

Sometimes performed as part of general screening, especially if you have a significant family history of breast cancer or if you have breast symptoms such as pain, rashes, or lumps.

Pelvic Exam (For People Who Have a Cervix)

Can include visual inspection, speculum exam (to collect cells for a Pap test beginning at age 21

and in some cases to test for STIs), and bimanual exam (to diagnose conditions of the abdomen and pelvis such as pain).

Penile Exam

To diagnose symptoms including pain with urination, rashes, sores and discharge from the penis (may also collect sample for STI screening).

Pubic/Groin Region Exam

To diagnose symptoms such as pain, lumps, rashes, and lesions in this area.

Rectal Exam

To diagnose symptoms of the abdomen, pelvis, and gastrointestinal system such as abdominal pain, blood in the stool, and sores or lesions. Can include visual inspection, a digital exam (finger inserted into the rectum), testing for STIs, and an anoscopy exam (this scope is made of disposable plastic and allows your provider to get a detailed look at the tissue within your anal-rectal areas).

Clinical Breast Exam

A clinical breast exam (CBE) is usually performed if you have a breast issue or concern, such as pain or lumps. Your provider may also offer you a screening CBE, based on your personal and family risk assessment.

Visual Examination

During a clinical breast exam, your health care provider checks your breasts’ appearance. This is often conducted with the patient lying on an exam table, opening the front

of the dressing gown. You may be asked to raise your arms over your head to allow your provider to look for differences in size or shape between your breasts. The skin covering your breasts is checked for any rash, dimpling, or other abnormal signs.

Manual Examination

Using the pads of the fingers, your provider palpates (pressing with the hands) your entire breast, underarm, and collarbone area for any lumps or abnormalities. The manual exam is done on one side and then the other. Your provider will also check the lymph nodes under the armpit to see if they are enlarged. Your nipples may be

checked to see if fluid is expressed when lightly squeezed.

Pelvic Exam (for people who have a cervix)

Most health care providers agree that you should have your first exam when you have symptoms such as discharge or pain, or when you turn 21, whichever comes first.

You may feel slight discomfort or pressure during this exam, but there should be no pain. If you experience any pain, tenderness, or excessive pressure, please tell the provider right away, and ask any questions you may have.

The pelvic exam generally can include:

External Exam

Examination of external labia, clitoris, vaginal opening, perineum, and rectal area. This is conducted with the patient lying down on an exam table with paper/cloth coverings over the stomach and legs, and feet placed in stirrups.

Speculum Exam

Examination of the vaginal canal and cervix, aided by a speculum (a duck bill-shaped instrument that is gently inserted and opened to provide visual access into the vaginal opening).

During this part of the exam, the provider can conduct a Pap test (beginning at age 21), using a thin plastic cervical cell collector brush to gently collect some cells from the cervix. These cells will be tested for early changes to the cervix before they become cancer. Additional fluid

may be collected for STI testing if you are sexually active. Your provider may also collect fluid for diagnosing vaginal discharge. The speculum will be closed gently and removed. The provider may need to move the speculum once it is inserted to fully see the cervix.

Bimanual Exam

If you have pain or other symptoms in the lower abdomen and reproductive organs, the provider may perform a bimanual exam.

The provider will insert one or two gloved fingers into the vagina.

With the other hand, the provider will gently apply pressure to the lower part of your belly, palpating (pressing with the hand) to check the size and placement of the ovaries and uterus. The provider may use their fingers to gently move the cervix from side to side to check for signs of infection.

Penile Exam

If you have pain, sores or other unusual symptoms, the provider may perform a visual and manual examination of the penis, including

the skin, foreskin, glans, and urethra. If you are uncircumcised, the provider may ask you to retract the foreskin back in order to examine all surfaces of the penis for sores and lesions, and may palpate (press with hands) the area for irregularities.

The provider may examine the urethral meatus (opening of the urethra), and may use a swab to collect a lab sample. Sometimes the provider may press along the shaft to express any potential fluid. If you prefer and are comfortable doing so, you may swab the area yourself. On occasion, the provider may need to squeeze the muscle of the penis to check for scarring (Peyronie’s disease).

Note: Some patients may develop an erection during the examination; this is completely normal, as erections can result from anxiety, temperature changes or a reflex to touch, in addition to sexual arousal.

Pubic/Groin Region Exam

This includes a visual examination of the scrotum (if you have one), groin, and hip crease to look for any abnormalities, accompanied by palpation (pressing with the hands) on the groin, inner upper thigh crease, and lower abdomen, especially along the lymph nodes of the hip area, the testicles (if you have them), as well as the spermatic cord connected to the testis inside the scrotum.

Rectal Exam

If you have pain in the lower abdomen and reproductive organ, have blood in your stool, or have other gastrointestinal or rectal symptoms, your provider may perform a rectal exam. It is also performed to collect tests for STIs of the rectum. A rectal examination is done either lying on one’s side or kneeling on the examination table.

There should be no pain associated with the exam, however, if you experience any pain, tenderness, or excessive pressure, please tell the provider right away, and ask any questions you may have.

Note: Some patients may feel sensations similar to an urge to urinate or defecate during the rectal exam. This urge usually passes quickly, but if the urge is strong, you can ask the provider to stop the exam.

The rectal exam generally can include:

External Exam

A visual examination of the anus and area around it to look for sores, rashes and bumps. Your provider may position a light so they can see

better. Your provider may also collect tests for STIs by placing a cotton swab into the rectum. The swab is inserted about 1 inch (2-3 cm), rotated gently and removed after 15-20 seconds

Digital Exam

The provider inserts one gloved and lubricated finger into the anus and palpates to detect any lumps or other abnormalities. The provider may also push firmly on the prostate

gland (if present) to check for pain or tenderness.

Anoscope Exam

Examination of the rectal canal aided by an anoscope (a rigid hollow tube 3 to 5 inches long, and about 2 inches wide) that allows the provider to examine the anus and rectum in detail. The anoscope is gently inserted with lubrication into the rectum then slowly withdrawn as the provider exams the rectal canal. While the anoscope is being inserted, the provider may ask

you to squeeze your internal muscles and relax as you would when having a bowel movement. This eases the placement of the anoscope. The provider may position a light or ask a medical assistant to hold a light during the procedure.

Conclusion of Visit

Ask any questions about follow-up care, make plans for your next appointment, and congratulate yourself—you’ve taken important steps to safeguard your health by participating in this appointment.

SHCS Resources

SHCS Advice Nurse/Appointment Line

SHCS Sexual Health Resources

If you feel that your rights have not been respected, or wish to file a complaint, compliment or suggestion, you can:

  • Complete a Comments Form and deposit in one of the locked comment boxes at the Student Health & Wellness Center
  • Contact the Student Health and Counseling Services Quality Management Office at 530-752-6559

Statement of Nondiscrimination

In accordance with the UC Davis Principles of Community, we affirm the dignity inherent in all of us, and we strive to maintain a climate of equity and justice demonstrated by respect for one another.

SHCS’ Patient Rights and Responsibilities affirm that all patients have a right to the same consideration and respect as anyone else, regardless of race, age, beliefs, sexual orientation, gender identity or lifestyle.

If you need language, hearing and/or visual access assistance, please let us know as you are scheduling your visit on the Health-e-Messaging portal or by calling 530-752-2300.

The University is committed to creating and maintaining a community where all individuals who participate in University programs and activities can work and learn together in an atmosphere free of sexual violence and sexual harassment (External link).

When allegations of sexual violence or sexual harassment are brought to the University’s attention, those allegations are promptly reviewed and addressed under the UC Policy on Sexual Violence and Sexual Harassment (External Print-Only PDF link).

Harassment and Discrimination Resources at UC Davis

Anonymous Call Line

  • (530) 747-3865

Online Reporting Option

Harassment & Discrimination Assistance and Prevention Program Please call this office to make a report of harassment or discrimination, including sexual harassment, sexual violence, hate and bias; to schedule an educational program; or to request materials.

Sexual Harassment Advisors

The advisors are specially-trained staff and faculty who have expertise in sexual harassment laws, the UC Davis policy, and sexual harassment

complaint resolution. The advisors are available to consult with or provide information to any faculty member, staff member or student.

For an updated list of Sexual Harassment Advisors and their contact information, visit the UC Davis Harassment & Discrimination Assistance and Prevention Program.

Title IX and Lead Discrimination Officer

Sexual harassment constitutes a form of gender discrimination under Title IX (federal regulations). Individuals may also report sexual harassment and violence, discrimination, and bias concerns to the Chief Compliance Officer, who also serves as the UC Davis Title IX and Lead Discrimination Officer: Wendi Delmendo (530) 752-9466, [email protected]

Additional information about sexual violence, including resources for options and reporting is located at UC Davis Sexual Violence Prevention and Response.

Additional Campus Resources: Confidential Support

Confidential Counseling

Dealing with a discrimination or harassment problem can be stressful, whether you have a complaint, have been accused, or are otherwise involved. These confidential counseling resources may be helpful.

Academic and Staff Assistance Program (staff/faculty)

  • (530) 752-2727

Counseling Services (students)

  • (530) 752-2349

Additional Confidential Resources

Conversations with staff in these units are not considered official reports. You can speak openly without giving up any control over your situation. These units will not report your concerns to anyone else, and they will not take action toward resolving your concerns without your consent.

Ombuds Office

  • (530) 219-6750

Confidential Resources: Sexual Harassment and Sexual Violence

Center for Advocacy Resources and Education

Women’s Resources and Research Center

Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual Resources Center