Gynecologists practicing in a university setting can play a critical role in the lives of their young patients. College students are often away from home and trying to navigate their own healthcare for the first time. Many don't have a relationship with a primary care provider after graduating beyond a pediatric practice. Some may not have health insurance, making the cost of care a deciding factor.
A university OB/GYN has an important part to play in helping these patients navigate such challenges, both from an education and a treatment standpoint. The role of a gynecologist in a university clinic or campus health center is largely different from that of many private practice physicians.
Gynecology in the University Setting
Although you may encounter some older patients, most current college students are part of Generation Z, the cohort born after 1995. Reaching patients of a younger generation can require all your depth of experience. You may see international students on campus, who require care that recognizes cultural or religious sensitivities. Gen Z is also more gender diverse and accepting of nonbinary identities, notes the Pew Research Center, meaning providers need to possess a deeper knowledge of the needs of LGBTQIA+ patients.
A survey of college-aged patients published in Public Health Nursing found that participants wanted providers who were knowledgeable, but approachable. They expressed an interest in building a trusting relationship with providers, while also relying on their physicians to provide them with pertinent healthcare information. Participants preferred to be spoken to in detail and not spoken down to.
A college student visiting a gynecologist may be facing embarrassment over their situation, such as a potential sexually transmitted infection (STI) or a lack of knowledge about contraceptive options. Many want to see a provider who will not come across as judgmental. Young patients will also need assurance that their patient/provider interactions will be kept confidential.
Practice Issues for the University OB/GYN
Many college students still have a lot to learn, and their knowledge of sexual health may be inadequate. New situations come with exposure to new pressures, stressors and risks.
Education plays a big role in office visits with students. An OB/GYN — potentially the first one they ever meet — can guide them on how to protect and manage their own health. Gynecologists practicing on campus or primarily seeing college students should be up to date on the following issues.
Sexually Transmitted Infections
According to the Centers for Disease Control and Prevention, people ages 15 to 24 acquire half of all new STI cases. When meeting with patients who may be sexually active for the first time, gynecologists need to allow ample time for education about birth control options, negotiating consent and discussing STI risks with a partner or partners. Students need to be explicitly informed about where and how they can access birth control and STI testing.
In addition to compassionate, understanding care, patients may also need counseling if they contract an STI. Encourage early testing and diagnosis, along with sharing information about the risks associated with untreated STIs, such as the development of pelvic inflammatory disease (PID) and fertility issues.
If your university clinic has ultrasound available, it should be utilized as a cost-effective tool for monitoring patients for the development of PID or other issues. Ultrasound provides patients with quick results, and it saves them the cost and stress of being sent to an imaging center run by an outside provider with whom they do not have a rapport.
About 23 percent of female and more than 5 percent of male undergraduate students experience rape or sexual assault through force or incapacitation, according to the Rape, Abuse and Incest National Network (RAINN). Some students who have been assaulted may come to campus health services before reporting the incident to the police. They may need help choosing whether to report the assault, dealing with the physical and mental aftermath and finding support groups or counseling services.
Gynecologists on campus have an opportunity to provide guidance on what constitutes consent, as well as on recognizing the signs of an abusive relationship. Be prepared to offer information on other campus groups or services such as RAINN's provider locator, and to lead a distressed student to the right resources if necessary.
LGBTQIA+ Community Needs
According to international market research group Ipsos Mori, less than 66 percent of Gen Z members are exclusively heterosexual — the lowest level of any living generation. LGBTQIA+ students will need their providers to understand basic concepts such as the difference between gender and sexual orientation, asking for a patient's pronouns and not assuming the gender of any sexual partners.
Compared to their counterparts in private practice, university gynecologists may be more likely to see transgender patients, and can benefit from further training or knowledge on trans-specific health issues. This can include topics such as the effects of hormone therapy, coping with gender dysphoria and the increased risk of HIV within the trans community.
Keep a list of resources for campus clubs, support groups, counseling services, local LGBTQIA+-affirming medical services and other campus or community resources that your patients can refer to, especially if you are still working to master these treatment areas.
Pressure from schoolwork, peers, athletic activities or perceived body image standards can create the "perfect storm" for developing an eating disorder in college, according to the Child Mind Institute. The National Eating Disorders Association reports that eating disorders typically manifest between the ages of 18 and 21, and affect between 10 percent and 20 percent of women and 4 percent to 10 percent of men. These rates are rising, so it is important that a university provider can uncover the signs and provide appropriate referrals.
Conditions such as anorexia and bulimia were once mostly diagnosed in young, affluent white women, but providers now know that eating disorders affect patients of all genders, races and socioeconomic statuses. Patients who diet often, seek perfection or have low self-esteem may be at a higher risk for developing an eating disorder. An OB/GYN may be the first clinician with the opportunity to spot the signs of a problem if a patient seeks them out for amenorrhea or breast atrophy caused by restrictive eating.
An eating disorder can even reveal itself during a pelvic ultrasound. Research published in the American Journal of Roentgenology found that in anorexic women with secondary amenorrhea, the uterus can regress to a prepubertal length of 2 cm to 3 cm. The endometrium will be thin or invisible on ultrasound and the ovaries will also appear reduced in size.
Even undetected eating disorders can have a damaging effect on future fertility. Women who are in eating disorder recovery should receive regular monitoring by a gynecologist.
College students need routine gynecologic care, from Pap smears to treatment for polycystic ovarian syndrome. Young patients expect quick results and need affordable care. Ultrasound is an efficient, cost-effective tool to diagnose and monitor gynecologic conditions right in your office.
The ability to visit a provider on campus helps young patients maintain healthcare continuity and build trust with physicians. Many health issues that a university OB/GYN sees may overlap with mental health counseling and other campus services. In this setting, gynecologists need to be aware of the breadth of resources available to refer their patients to ongoing support, peer groups or specialized care. Coordinating with multiple community and campus groups will ensure you are able to provide patients with the most comprehensive care possible.