Part II

Students Recall Slut-Shaming, Unprofessionalism at Student Health Center

Going to the gynecologist can be a nerve-wracking process for many. For students, that anxiety may be heightened by being far from home, navigating their healthcare, and taking agency of their bodies for the first time in their lives. It certainly doesn’t help that reproductive healthcare requires the great deal of vulnerability and discomfort that comes with having a stranger between one’s legs.

A negative experience at the gynecologist can have a lasting impact, and for people who are in the early stages of sexual activity, it can put people off from returning for anything from routine Pap tests to medical emergencies.

UC Santa Barbara’s Student Health Services has recently made a concerted effort to reduce the discomfort that comes with the territory of a pelvic exam. Until part way through the 2019-2020 school year, UCSB’s Student Health portal offered just three options under the gynecology umbrella:

“Age 20 and younger, I want birth control. 

Age 21 and older, I want an annual exam and/or birth control. 

Gynecologic and birth control problems.”

Today, the portal today is far more specific and comprehensive, allowing students to choose from a laundry list of options, instead of the one-size-fits-all method of its predecessor. Dr. Ali Javanbakht, interim director of Student Health Services (SHS) at UCSB, says the change was something “long overdue.”

“The old thinking in the medical community was you tie birth control to pap smear for cervical cancer screening,” he explained. “Upon further reflection, the risk of someone not having birth control and having an unintended pregnancy was a lot higher and much more serious than them not getting a pap smear right at 21, and the logic linking the two just didn't really stand the test of time.” 

Dr. Javanbakht explained that the new standard is to treat birth control and pelvic exams as two separate needs. “With the birth control need you address the birth control need, with as few tests, few barriers as possible. You take the opportunity to educate people. So if someone's over 21 and we say ‘Hey, you’re over 21, you should have a pap smear, here's how you get it set up.’ But we don't hold the birth control hostage, so to speak,” he said. 

However, Student Health’s gynecological and testing services still face allegations of inappropriate behavior, often tied up within how students are treated by doctors and nurse practitioners. Many students have found that everything from subliminal messaging to overt condescension takes place within the walls of Student Health, and has ultimately tarnished their views of the service as a whole. All of the names of those interviewed have been changed to protect their privacy.

Grace, a senior at UC Santa Barbara, was a sophomore when she experienced a negative run-in with a medical professional that left her distrustful of the institution as a whole. She and her long-distance boyfriend, who had come to visit her for the weekend, had both blacked out while drinking and, unknowingly, had sex with Grace’s tampon still in.

Exhibiting no symptoms, Grace wasn’t aware that anything had gone awry until she realized she “didn’t smell the best.” While being examined by a nurse practitioner at Student Health, Grace was horrified to hear her exclaim, “Oh my god!”

“If I literally have you in between my legs, I don't want to hear, ‘Oh my god’,” she said. “So she pulls out these prongs and gets it out. And when she pulls it out, she plugged her nose and she was like, ‘Ew!’” 

For Grace, the issue did not stem from the (fairly common) problem itself, but rather the “judginess factor” coming from a medical professional. “Obviously I know that smells, why do you think I came in here? So it was just kind of embarrassing, but I shouldn't have had anything to be embarrassed about because we're all students in college,” she said.

Grace was mortified by the experience, which colored her perception of Student Health — a place she now refers to as a “last resort.” She is not the only one.

Laura, a third-year student, was midway through her second year at UCSB when she went to Student Health for a rash. At the time, Laura only had one sexual partner and was unaware that he had additional partners.

After several fruitless appointments, Laura was finally diagnosed with scabies, an itchy, highly-contagious skin condition caused by mites burrowing under the skin, that can be sexually transmitted (though the rash can appear anywhere on the body). She was already uneasy, as the nurse practitioner who delivered her diagnosis was not her primary care physician.

Laura struggled to pin exactly what about the whole interaction made her so uncomfortable, but felt that the nurse didn’t trust her. “Upon me explaining that I literally have one [sexual partner], I felt like she almost didn't really believe it in a way,” she explained.

“I think in those situations it's so important to be sensitive. So if [a medical professional is] not being very open, even in terms of body language and eye contact and everything, that's what really turns me off. So I just left feeling really shitty.”

Distrust for medical professionals at Student Health left Abigail, a now-senior at UCSB, with a permanent negative perception of the health services as a whole after a negative experience as a freshman left her needing physical therapy. Abigail, who wanted to go on birth control at 18 to help curb her severe acne, felt frustrated with the behavior of her doctor, whom she said, “kept making really awkward jokes,” about why Abigail was “really” getting on birth control. 

“I was really nervous about it making me gain weight and stuff. And she was like, ‘Well, I mean if you sit around all day and eat pizza at your boyfriend's house.’” Abigail felt as though her concerns were not being taken seriously. The distrust that she had for her doctor led to more serious consequences. Abigail’s muscles remained so tense during the pelvic exam that her doctor performed that she required physical therapy afterwards. “I told her I was really sensitive to stuff like that and she was just kind of nonchalant about it,” she said.

Interactions with healthcare professionals have left many students with a bad taste in their mouths, yet they are often unable to articulate why. The line between professional advice and condescension is thin, and many students and medical professionals alike are unsure of how to navigate the grey area. 

Megan, a senior at UCSB, was exhibiting symptoms that she worried could be Herpes Simplex Virus (HSV), and went to Student Health for testing. “I was always a mess. I was sobbing uncontrollably,” she said. “I was in [the laboratory] and the woman taking my blood was like, ‘It's okay. Over half the population has it. This will teach you a lesson.’” Megan was horrified by the comment, but did not feel as though she had the authority to say anything back.

“I was sobbing and I would say I was pretty vulnerable and she's like, ‘You know, I’m right, right?’ And I just kind of sat there in my mind, I was like, ‘No, you're not right, this isn't teaching me a lesson. You can't say that to me,’ but I wasn't really in a place to argue, so I just shook my head yes.”

Megan later told a doctor about her experience getting tested and was able to speak to the head of the department, who assured her that the nurse’s behavior was unacceptable.

Unlike Megan, many students do not speak to any authority figures about their negative experiences at Student Health. One of the reasons that students who have faced judgement or shaming from medical professionals form an innate distrust for Student Health as an entity lies within the ability to report unsavory experiences. Student Health’s current system of placing hard copy feedback forms around the building are ineffective — not only are they not well advertised, but they also force a student who has experienced an uncomfortable, or even traumatic event to remain in the same building, or to return at a later time if they wish to leave feedback. 

UC Berkeley’s Tang Center and UC Los Angeles’ Ashe Center both have highly visible and easy-to-navigate options on their respective homepages for reporting sexual harassment, with clear guidelines for patient reporting. On UCSB’s Student Health homepage, however, the option to give feedback leads students to an automated email template addressed to Student Health’s generic contact email address. The options offer no overt mention of reporting policies, Title IX reporting option, or notices of nondiscrimination. UCSB’s Student Health center inherently discourages reporting by omission of crucial information.

The lack of confidentiality — and not knowing who is on the receiving end of an extremely personal email — is what turns many students off and prevents them from reporting.

“In the moment I was super embarrassed and didn't want anyone else to know about that, so I didn't really ever consider reporting it,” Grace said. “I don't even think I told my friends about it til like a year later.”

The stigma surrounding sexuality shames many victims of slut-shaming — the unwarranted criticism of people, particularly women, for their sexual activity — into silence. For Laura, the already-uncomfortable nature of her appointment is what she believes gave her healthcare provider the license to behave condescendingly towards her, which can leave patients with a skewed perception of how doctor-patient interactions should work.

“That's manipulation, because you already know that that person is really insecure,” she explained. “So if you're going to talk down to them like that, it's like easy for [the patient] to just think, ‘Oh it's me.’”

According to Dr. Javanbakht, there are currently no complaints of slut-shaming on record at Student Health. “Not that I’m aware of,” he said.

The reporting process, he explained, is invoked when a student launches a complaint via email or feedback box, or tells a member of the Student Health staff. From there, the Medical Quality Improvement Committee — composed of Dr. Javanbakht, the associate medical director, an MD, a Nurse Practitioner and the lead psychiatrist — examine the report of the patient, talk to the healthcare professionals involved, determine what was handled inappropriately, and decide what action to take.

Steps are being taken to improve the reporting process at Student Health, which includes intervention from the Title IX office. Director of UCSB’s Title IX office Ariana Alvarez said that several measures to improve the process of reporting were underway, including: adding specific language to our response procedures for staff, updating the websites of the SHS and Title IX departments, conducting training for SHS staff regarding reporting requirements, response procedures and provision of resources and updating Title IX’s handouts to include patient care resources and reporting options. “All of the above noted actions are still underway,” she said. “Moving forward, I expect that SHS will continue to report any incidents of sexual violence and sexual harassment to my office as they have in the past.”

Staff training for Student Health employees is currently no different than other campus departments — an online module that goes over the reporting process and community resources. However, “[t]he new upcoming training for SHS is an in-person session that supplements the online training. It includes additional language, definitions and scenarios that reflect situations in the patient care context,” Alvarez said.  

Yet, some reportable issues at Student Health may not stem from inappropriate commentary by Student Health employees, but rather a clear, black-and-white breach of medical protocol.

In October 2019, Lucy, a fourth-year UCSB student, was in the process of treating a month-long urinary tract infection that devolved into several trips to Student Health. Lucy, who had been treated for several UTIs in the past, was concerned that Student Health only performed a dip test to confirm the presence of bacteria, but did not order a culture — a process that would inform the type of bacteria and the most efficient medication to treat it. Instead, they gave her generic antibiotics that failed to treat the infection.

After three trips to Student Health, Lucy was finally given a culture, but was given a generic antibiotic in the hopes that it would successfully defeat the infection. When the first antibiotic proved unsuccessful, she returned again to follow up about the results of her culture. Instead, she was given a second culture, as well as an STI test, all while “in immense pain.” Five days after her tests, Lucy received a message on her patient portal to call Student Health. “I called them back and they wouldn't talk to me over the Student Health phone line,” she said, instead telling her that her doctor would call her from a private line.

Lucy’s doctor called her and explained that Student Health had accidentally released her entire confidential sexual history to another patient immediately following the completion of her sexual history form, which included her full name, the number and genders of her partners she had, the specific types of sex she was having, and history of STIs. “The way that this was handled over the phone was extremely unprofessional. Like the doctor said, ‘Oh, this is kind of awkward.’” Rather than giving a blank form to fill out, a different patient had been given Lucy’s completed form by mistake.

“They also told me that the student who had seen it told them that they know me,” she said. Due to the Health Insurance Portability and Accountability Act (HIPAA), Student Health could not tell Lucy to whom they released her sexual history.

“So someone out there who knows me knows my entire sexual history, and I don't know who it is,” she said.

All of the students who recounted uncomfortable or negative experiences at Student Health are all upperclassmen now. Many of them noted that these experiences took place in their first or second years of college, a time when navigating healthcare — particularly gynecological health — was still considered uncharted territory.

“I had never seen an OBGYN before,” Abigail said, “so I was like, ‘Oh, is that just how it is?’”

Many students like Grace don’t wish to report because they “felt embarrassed,” and “didn’t really want anybody to know about it,” or like Lucy just wanted to “let it go instead of further pursuing it.” Given the chance to reflect, however, a lot of them hope that their stories can help others. Though Lucy chose not to report, she now looks back on it with a different mindset: “[I]f I had reported it that it could prevent it from happening to someone else in the future.” Laura agrees that she would have felt compelled to report if “I had heard that someone else had an experience with the same doctor.”

Reporting these instances does not happen when students are unaware until much later that what they experienced is inappropriate conduct. 

“I think that a big issue is, like, if it wasn't my first time dealing with all that stuff that I would have been like, ‘Oh this isn't normal,’” Abigail said. “I would have just been able to handle them a lot more. But it was my first time dealing with that. I was not equipped to handle it.”