Clinical/Comm Skills - Week 2 - C - Sexual History Taking and Emergency Contraception Consultation Flashcards
Sexual history taking will usually be performed as part of a wider history. This allows you to build rapport with the patient before asking more intimate details. It can be helpful to advise patients here that you will take a medical history then a sexual history & ask permission Usually ask, PC, HPC, PMHx
Sex of the partner and whether regular and how long for how long have they been with this partner Where is the partner from Type of sex if it is a MSM Anal sex - insertive (giving) or receptive (receiving) Oral sex - Insertive or receptive again Was the sex with a condom (protected) or not
After asking about the last sexual intercourse The next thing to ask about the sexual partners in the last years What months are important to ask about?
Ask about the sexual partners in the last 3 months Then ask about the sexual partners in the last 12 months Same information for all partners
Components of sexual history Last sexual intercourse (LSI) Sexual partners in last year Next is the lifetime sexual partners What is asked here?
Lifetime sexual partners Any previous male partners for men, any previous MSM partners for females Paid sex Overseases partners and if so from where Non-consensual sex - delicate question to ask
Components of sexual history * Last sexual intercourse * Sexual partners in last year * Lifetime sexual partners Now a blood borne virus risk assessment What would be asked here?
Ask if ever PWID or PWID partner Sexual partners with HIV/BBV Non-professional tattoo
What is important to ask in sexual history especially in someone with a male partner? Female is the biggest risk factor for this
Important to ask about gender based violence (ask about this in all sexual related histories)
Name some other risk factors for gender based violence?
Gender-based violence’ and ‘violence against women’ are terms that are often used interchangeably as most gender-based violence is inflicted by men on women and girls. However, it is important to retain the ‘gender-based’ aspect of the concept as this highlights the fact that violence against women is an expression of power inequalities between women and men. Being female sex, disability, pregnancy, social isolation, HIV infection
It is important to ask a quick contraceptive and reproductive health history when taking a sexual history What is asked here?
Current contraception and compliance LMP and menstrual pattern Previous pregnancies Previous pregnancies including outcomes and complications When the last cervical cytology was taken
When asking about sexual partners What is the contact tracing for sexual partners if you are found to have chlamydia or gonorrhea (urethral or other symptoms)? or syphilis (primary or secondary symptoms)?
Urethral chlamydia symptoms - 4 weeks Any other - 6 months Gonorrheal - urethral - 2 weeks Any other is 3 months Syphilis - primary stage - 90 days, secondary stage - 2years
EC consultation
No question for this flashcard
When taking a history for an emergency contraception consultation It is important to know when the last unprotected sexual intercourse took place and if there were any previous episodes this cycle What can be given for EC and for how long?
Levnogestrel (Levonelle) (LNG) - up to 3 days post UPSI - given as a single 1.5mg tablet UPA - Ulipristal acetate (EllaOne) - up to 5 days post UPSI Copper IUD can only be given up to 5 days post UPSI or up to 5 days after earliest expected date of ovulation
What is important to know about the menstrual cycle?
the date of LMP, regular cycle and length of cycle
Take a PMH and drug history to see any contraindications to use of the emergency contraception What are some contraindications to UPA?
If the patient is wishing to quick start contraception If the patient has used hormonal contraception within the last 7 days If the patient has severe uncontrolled asthma by oral steroids Or if the patient is breast feeding or on any liver enzyme inducers
Discuss contraception advice and any STI screening If the patient had unprotected sexual intercourse with a PWID whom may be at risk of HIV, what happens?
Patient is started on post exposure prophylaxis (PEP) if within 72 hours
