Physical Health | Student Health Services | SIU

All people have some amount of naturally occurring breast tissue. But the risk of developing breast cancer is lowest in cisgender men and higher in people who were assigned female at birth (AFAB). The risk of breast cancer may also be higher in transgender women who use medications to increase female hormones and lower male hormones. Cisgender women, trans women, trans men, and gender non-conforming folks should be familiar with their breast tissue and use self-examination to detect changes in their breasts or breast tissue over time. Eating a balanced diet, getting exercise, and limiting alcohol can all help maintain your breast health.

To perform a breast exam at home, follow these simple steps. Remember, these techniques apply to breast tissue that have been enhanced or reduced.

1. Lie down on your back and place your right arm behind your head. This allows the tissue to spread evenly, making it easier to feel.
   
   
2. Use the pads of your three middle fingers on your left hand to feel for lumps in your right breast.
3. Use small, overlapping, circular motions to feel your breast tissue.  
   
   
   
4. Use three different levels of pressure, light, medium, and firm to feel all of your breast tissue.
   
   
   
5. Move around the breast in an up and down pattern starting at the underarm and moving across the breast to the chest bone.
   
   
   
6. Repeat the exam on your left breast putting your left arm behind your head and using your right hand to do the exam.
   
   
   
7. Stand or sit with your arms slightly raised to look for dimpling, discoloration, redness, or scaliness.

It’s important to become familiar with what’s normal for your body. At home breast exams are a good way to start! If you do not know how hard to press, or have questions, talk with your healthcare provider.

Breast health after top surgery

The risk of breast cancer in trans men who have had top surgery to remove their breasts is not known but is thought to be much lower. If you are a trans man who has had breast removal, you should talk to your doctor about your best options for breast tissue screening.

Trans men who have not had their breasts removed, or who have had them reduced but not removed need breast health screenings similar to those of cis women. Breast cancer screening recommendations vary based on a variety of factors including your age, personal health history, family history, and genetic makeup. Talk to your doctor to find out what’s best for your situation.

The LGBT community experiences some cancers more often. Lesbian women may have a higher chance of getting breast cancer and some gynecological cancers. MSM have anal cancer more often, more so if HIV-infected. Tests can be done to check for cancer. Talk with a healthcare provider about how and when to check for cancer.

Heart health is important for everyone, but you should take care of your heart especially if you smoke or take certain hormones. To keep your heart healthy and reduce risks associated with heart disease aim for 30 minutes of exercise a day, eat a well-balanced diet and quit smoking.

Did you know that until you have had your ovaries/uterus or testes removed you are considered fertile, and could become pregnant or get someone pregnant especially if you are a sperm producer? HRT may reduce your fertility but is not guaranteed to cause sterility. Practicing safer sex (the use of barrier methods like condoms and dental dams during sex), is a good way to help prevent pregnancy, protect you from sexually transmitted infections, and increase your sexual health. More information on barrier different types of barrier methods can be found here.

                                             

                              External Condom                   Internal Condom                           Dental Dam

Sexually Transmitted Infections (STIs)

Sexually transmitted infections (STIs) affect everyone, regardless of sexual orientation and gender identity. Many LGBTQ+ people are at a higher risk of STIs compared to their heterosexual and cisgender peers. Although some of this risk is explained by differences in sexual behaviors, structural inequities, such as discrimination and stigma widen the gap in sexual healthcare. In order to best protect from STIs, the Center for Disease Control recommends the following testing schedules:

• All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.
• All sexually active women younger than 25 years should be tested for gonorrhea and chlamydia every year. Women 25 years and older with risk factors such as new or multiple sex partners or a sex partner who has an STD should also be tested for gonorrhea and chlamydia every year.
• All pregnant women should be tested for syphilis, HIV, and hepatitis B starting early in pregnancy. At-risk pregnant women should also be tested for chlamydia and gonorrhea starting early in pregnancy. Testing should be repeated as needed to protect the health of mothers and their infants.
• All sexually active gay and bisexual men should be tested at least once a year for syphilis, chlamydia, and gonorrhea. Those who have multiple or anonymous partners should be tested more frequently for STDs (i.e., at 3- to 6-month intervals).
• Sexually active gay and bisexual men may benefit from more frequent HIV testing (e.g., every 3 to 6 months).
• Anyone who has unsafe sex or shares injection drug equipment should get tested for HIV at least once a year.
• Hepatitis C - all adults should be tested at least once. Adults at higher risk, including adults that have been incarcerated or with history of IV drug use should be tested more often. 
• Chlamydia and gonorrhea of the vagina and/or rectum - if you’ve had receptive vaginal or anal sex or been a “bottom” in the past year;
• Chlamydia and gonorrhea of the penis (urethra) - if you have had insertive anal sex (been the “top”) or received oral sex in the past year; and
• Gonorrhea of the throat - if you’ve given oral sex (your mouth on your partner’s penis, vagina, or anus) in the past year.

You can prevent STIs by doing the following:

• Talking honestly with sexual partners about STIs and getting tested—before having sex, preferably earlier than immediately before having sex
• Using barrier methods such as condoms and dental dams
• Reducing sexual activity while using drugs or alcohol as these may inhibit safer sexual practices
• Limiting number of sexual partners
• Take PrEP to prevent HIV
• Being honest with your health care provider about all of your sexual activities, so they can help you know what kinds of screening may be most appropriate for you. If possible offer this information even if they do not ask specifically

Rates of cigarette smoking and tobacco use are higher among the LGBTQ+ community than the general population. This may be related to higher rates of stressors and stigma in the LBGTQ+ community, pressure from peers, or aggressive targeting by the tobacco industry. Although quitting smoking is difficult, it can have immediate benefits to your health. Cutting down or reducing the amount you smoke can also benefit your health.

HRT complications and surgery

Avoiding tobacco use becomes even more important for people considering hormone therapy or surgery of any type, including gender affirmation procedures. Use of masculinizing hormones can raise risk of heart disease, and that effect is compounded by tobacco use, especially smoking tobacco. Use of feminizing hormones can increase risk of excess blood clotting, which is also worsened by use of tobacco, especially smoking. Smoking slows healing from injury or surgery and increases risks of anesthesia complications and risk of blood clotting, a risk already higher after many surgical procedures.

Support for SIU students is available for those who are interested in reducing or stopping tobacco use in Wellness & Health Promotion Services. Wellness & Health Promotion Services can help you develop a plan to quit or reduce your use, and connect you with helpful tools, tips, and resources.

5 tips for Quitting:


                                                                                        
                  1. Be patient with yourself        2. Quitting is a process       3. Don’t lose hope if you start again    

                                                                                                                    

                      4. Remember that every smoker can quit               5. Get support from family and friends

                                                                                                                             

                    1. Select a quit date                     2. Calculate your savings              3. Make a resons to quit list

 

                                                                                                                        

                  4. Know your triggers                     5. Plan for cravings                  6. Get support and create a plan!

Vaccinations are another important part of your overall healthcare routine and should be discussed with your doctor. Which vaccinations you need depend on our age and other risk factors.

Seasonal flu vaccine - Recommended for all adults every year to protect you from getting the flu. The flu vaccine is especially important if you have chronic health conditions or are pregnant.

HPV vaccine - A series of three shots recommended for all adults 19-26 years old. The HPV vaccine protects against the types of human papillomaviruses (HPV) that cause most cervical, anal, and other cancers, as well as many types causing genital warts.

Hepatitis A and B - Gay, bisexual, and other men who have sex with men (MSM) have a higher chance of getting viral hepatitis A, B, and C, which are diseases that affect the liver. The major sexual risk factors for getting hepatitis A are “sexual tourism” to an underdeveloped country and/or contact with another person’s anus (back hole), especially but not only oral contact without a barrier. Hepatitis B and C are usually spread by birth to an infected/untreated mom, blood contact or rarely sexual contact. A vaccine is available for hepatitis A and B. There is no vaccine for hepatitis C, but there are new treatments available.

Immunizations including influenza, HPV (Gardasil 9), Tdap, hepatitis A and B, MMR, varicella, and meningococcal and pneumococcal vaccines, and many travel vaccines (though not yellow fever) are available at reduced cost, and some are covered by student health insurance.

Regardless of your gender identity or sexual orientation anyone with a vagina (front hole), uterus, ovaries, and cervix should discuss with their healthcare provider when they will need a pelvic exam and pap smear. Pelvic exams are routine exams done to examine your vagina (front hole), external genitalia and pelvic organs. Pap smears are medical screenings performed to detect changes in your cervix before cancer develops. Pap smears are one of the most reliable cancer screenings and are an important part of your overall health routine.

Before the exam:

You can talk to your provider about ways to make these exams more comfortble. For example, some may find that short-term topical estrogen to the cervix for one to two weeks before the exam makes this process more comfortable.

Talk with your healthcare provider before the exam to discuss any concerns you may have and how the exam can be done more comfortably. If you are concerned about discomfort, discuss this with your medical provider ahead of time. It is recommended to avoid inserting anything into your vagina/ front hole for 1-2 days before the appointment. This includes fingers, sex toys, and douches.

How the exam might go:

• You will be asked to remove your clothes from the waist down and put on a gown or sheet. If you are having a full physical that includes a breast exam, you will also be asked to remove your top including a bra or binder. To help with dysphoria and getting cold, ask if you can wear a zip up sweatshirt. You can keep your socks on.
• Your provider will ask you to lie on your back and scoot your bottom to the end of the exam table. They will then place your feet in stirrups and ask that you allow your knees to fall to the side.
• The provider will then insert an instrument, called a speculum, into your vagina or front hole. (You can ask that they use the smallest speculum possible, put lube on it and warm it up to make it more comfortable.)
• Your provider will then collect a sample of your cervix and put it in a container
• They may also insert a finger and feel the cervix while their other hand feels your abdomen. This is to feel for cysts in the ovaries.
• A rectal exam may be offered and can be declined if you prefer.

Scheduling a pelvic exam with your healthcare provider is a good time to discuss any vaginal or front hole concerns you may have such as vaginal discomfort, dryness, pelvic pain, or bothersome monthly bleeding. Trans men using testosterone can also experience these problems because of natural changes to the vaginal tissue when using testosterone.  Treatments are available. Talk to your healthcare provider if any of these things are concerning to you.