ILA3 - sexual health Flashcards
History questions for vaginal discharge
Colour, consistency, volume, smell, duration of symptoms
Other questions for a gynae history
Urinary symptoms, systemically unwell, skin changes (swelling, rash), itch, PV bleeding, pain.
Sexual history questions
gender of partner/s, contraception used, contact type, high-risk encounter - alcohol & drug use, foreign travel.
Menstrual history
last period, regularity, length, dysmenorrhea, post-coital bleed, inter-menstrual bleed. previous terminations/pregnancies.
Smear
for abnormal cells indicative of cervical cancer and HPV presence. Over 25yrs, every 3 years.
Swabs
High vaginal for bacterial vaginosis and thrush - Microscopy and culture.
Endo-cervical for chlamydia and gonorrhoea - PCR.
Normal discharge
clear/white, non-offensive smell. High progesterone at end of cycle = sticky and clear. Low progesterone at beginning = thick and white.
Trichomoniasis
pH greater than 4.5, yellow, frothy.
Speculum = Strawberry cervix.
Ix = High vaginal swab.
Rx = metronidazole.
Bacteria vaginosis
pH greater than 4.5, thin, grey/white, fishy smell.
Often from excessive cleaning.
Rx = metronidazole. must treat if pregnant as causes premature membrane rupture.
Thrush
white, cottage cheese. itchy. painful sex. red inflamed skin. Rx=pessary tablet with clotrimazole or fluconazole tablet.
Chlamydia
80% asymptomatic! painful, discharge, frequency and pain on seeing. endo-cervical swab Dx. Rx = azithromycin
Gonorrhoea
commonly asymptomatic. muco-prulent discharge. Bleed on contact with cervix, endocervical swab. Rx = ceftriaxome and azithromycin. TEST OF CURE SWAB
COCP
Oestrogen and progesterone. Prevent ovulation, thicken cervical mucous so less penetrable to sperm and thin endometrium to reduce implantation. Pros: regular period at end of 3 weeks of pack, reduces ovarian and endometrium cancer, can miss 2 pills and not be pregnant. Cons: increase risk of MI&Stroke, increase breast cancer risk (continues 10yrs after stopping), mood swings, breast tenderness, headache. CI: obesity, migraine + aura, severe liver disease. Efficacy: 92%
Progesterone only pill
Thicken cervical mucous so less penetrable to sperm and thin endometrium to reduce implantation. Pros: only 2 days wait until contraception effective, less VTE risk, no breaks in pill taking. Cons: can only miss 1 pill, irregular periods/bleeding. Efficacy: 92%.
Depo Injection
Progesterone only. Thicken cervical mucous so less penetrable to sperm and thin endometrium to reduce implantation. Every 12 weeks IM. Pros: effective, easy to remember, no oestrogen so less VTE risk. Cons: delayed return to fertility, put on weight, decreases bone mineral density at faster rate, over 18yrs only. Efficacy: 97%
Implant
Progesterone only. Thicken cervical mucous so less penetrable to sperm and thin endometrium to reduce implantation. Pros: good adherence as last for 3 years, no oestrogen so less VTE risk, very effective. Cons: infection risk on insertion and removal, irregular bleeding esp for first year. CI in active breast cancer. Efficacy = 99.5%
IUD
Copper coil. Copper makes inhospitable environment for sperm so prevents fertilisation and acts as barrier for implantation also thicken cervical mucous so less penetrable to sperm. Pros: immediate return to fertility, instant contraception, used as emergency contraceptive, effective. Cons: if do get pregnant increase risk of ectopic, no hormones no VTE risk, pain on insertion, heavy bleeds, can be displaced/expelled. Efficacy = 99.2%
IUS
Mirena coil with Levonorgestrel. Endometrial atrophy to prevent implantation and thicken cervical mucous so less penetrable to sperm. Pros: no compliance issue, lasts for 3 years, no oestrogen so less VTE risk, effective. Cons: irregular periods, breast tenderness, risk of expulsion/displacement, if get pregnant increase risk fo ectopic. CI in active PID and pelvic TB. Efficacy = 99.9%
Condoms
Prevent sperm entering cervix. Pros: stop STI transmission. Cons: latex allergy, not effective as preventing pregnancy, able to tear and split. Efficacy = 85%.
Termination of pregnancy GP guides
Before 24weeks gestation and having a child will be detrimental to mum’s psychological health.
Risks with teenage pregnancy
premature delivery, low birthweight, higher post-natal depression, higher noenatal mortality, anaemia.
Gillick competence
Not just for contraception!!
Capacity to consent to treatment in patient less than 16yrs. Must assess for each new decision.
Fraser competence
Only for contraception. Patient must:
1) understand advice.
2) not be persuaded to inform parents/
3) Physical and mental health will suffer if denied contraception.
4) Will begin/continue to engage in sexual activity with or without contraception.
5) patient’s best interests will require Dr to give contraception advise/treatment.
Legal aspects of under age sexual activity.
Person under age of 13 is unable to give consent to any sexual activity. Person between 13 and 16 is able to give consent to sexual activity with a person of a similar age and not in a position of power over the child with no evidence of exploitation or abuse.
