GP ILA 3: Sex matters Flashcards
Menstrual cycle: days
a) Menses
b) Follicular phase
c) Luteal phase
a) 5-7
b) 0-14 (FSH and oestrogen)
c) 14-28 (LH surge and progesterone)
Menstrual cycle hormones
a) Feedback between oestrogen and FSH/LH
b) Oestrogen curve
c) Progesterone curve
a) Negative, but when oestrogen levels above a critical point it has positive feedback on LH, creating a surge
b) Rises during follicular phase and peak at day 14ish
c) Rises from day 14, peak at day 21ish (which is why day 21 [mid-luteal] progesterone level is used as a marker of ovulation) and fall by 28 if no fertilisation
Vaginal discharge: presentation
a) Cottage cheese, neutral odour. Vaginal pruritis, soreness, superficial dyspareunia, vulval erythema
b) Thin, off-white, fishy. Not commonly associated with other symptoms.
c) Profuse, frothy, greenish-yellow, malodorous discharge (no trickery). Vulval pruritis and soreness, superficial dyspareunia, PCB, strawberry cervix, dysuria, abdo pain
a) Thrush
b) BV
c) Trichomonas (no trickery)
Vaginal discharge: treatment
a) Thrush
b) BV - n.b. only need to treat in…?
c) Trichomonas
a) Fluconazole, clotrimazole
b) Generally only needs treating in pregnant women: 400mg oral metronidazole for 7 days
c) 400mg oral metronidazole for 7 days
Budding yeast cells are typical of…?
Candida
Flagellated bacteria are typical of…?
Trichomonas vaginalis
Clue cells are typical of…? (Mexican sombrero)
BV
What is the most common form of contraception in the UK?
COCP
What is the main mechanism of the COCP?
- Other mechanisms?
Inhibits FSH/LH (hypothalamic-pituitary axis)
- Thickens cervical mucus
- Prevents implantation of a blastocyst
What is in the COCP?
Oestrogen and progestogen (synthetic progesterone)
What other forms of combined contraceptives are there?
Transdermal patch (lower dose, if risk of high dose Vaginal rings (rare)
Absolute contraindications for the COCP
Migraine with aura Smoker of >15/day and >35 years old Current or past VTE History of CVA Ischaemic heart disease BP >160/100 Current breast cancer < 6 weeks postpartum
Norethisterone.
a) Dose to stop periods
b) How it works?
a) 5mg TDS
b) Thickens cervical mucus, stops ovulation, prevents implantation of blastocyst
IUD - copper coil.
a) Mechanism of action
b) Serious risks
a) Endometrial inflammatory reaction preventing implantation; reduced penetration of sperm due to copper effect on cervical mucus
b) If pregnancy occurs when copper coil is in, there is an increased risk of ectopic
Nexplanon.
a) Benefits
b) Contains what?
a) Reversible easily, reduced/no periods in most
b) A progestogen called etonogestrel
Unplanned teenage pregnancy.
a) Medical risks to mother
b) Medical risks to baby
c) Psychological problems
d) Social problems
e) Why might it be a positive thing?
a) Pre-eclampsia, iron-deficiency anaemia
b) LBW, prematurity, stillbirth, NTD (due to unplanned pregnancy and lack of folate at time of conception)
c) Post-partum depression, depression and anxiety, stress
d) Exacerbates deprivation, poor education
e) NICE transition point for health behaviour change
Legal age of consent.
a) Absolute
b) Generally (some mitigating circumstances)
a) < 13 year old: cannot consent to a relationship. If 18 year old has sex with 12 year old = statutory rape
b) < 16 ; if have sex with > 18, this is unlawful but can be consensual. But if in position of power, unlawful to have sex with someone under 18 if you are over 18.
HPV strains
a) Warts. What is a differential for penile warts in men?
b) Cervical cancer
a) 6 and 11; pearly penile papules
b) 16 and 18
Give two bugs that may cause BV
Gardnerella vaginalis, mycoplasma hominis
5 points required by the Fraser guidelines for prescribing contraception under the age of 16?
Capacity to understand, retain and weigh up Health will suffer without treatment Interests of patient Likely to do it anyway Definitely won't tell parents
