Lecture 43 Flashcards
Preventive Health and NonHormonal Contraception Hebenstreit
cervical cancer screening rec
under 21 yo - no screening (ACS recommends under 25, ACOG recommends 21)
21 to 29 yo - pap smears every 3 years
30 to 65 yo - either pap smear every 3 years, HPV testing every 3 years, or co-testing (Pap + HPV) testing every 5 years
65+ yo - no screening
screening if a person has had a hysterectomy
none regardless of age
SE of HPV Vaccination
injection site reaction (most common)
dizziness, fatigue, and headache (2nd)
syncope, vomiting, and myalgia (uncommon)
HPV vaccination 9-15 yo
2 dose series
dose one, then another 6 to 12 months later
HPV vaccine in 16-45 yo
3 dose series
does one now, then dose two 2 months later, and then final dose 6 months after first dose
risk vs benefits for ages 27 to 45 for HPV vaccine
must do a discussion
benefits - 88 to 95% effective for genital warts, vulvar cancer, vaginal cancer, and cervical cancer in females with efficacy inferred for men
behavioral methods for non hormonal contraception
coitus interruptus
lactation amenorrhea method (LAM)
fertility awareness methods (FAM)
natural family planning (NFP)
Natural Family Planning (NFP)
combined with FAM
methods – basal body temperature, billing ovulation methods, calendar/rhythm method, standard days methods, and two day
failure rate between 1 and 34%
advantages of NFP
no effect on hormones or menstrual cycle
no side effects
inexpensive or free
acceptable in many religions and cultures
disadvantages of NFP
no protection against STI
difficulty predicting ovulation in those with irregular cycles
requires consistent and accurate record keeping
requires extended periods of abstinence or backup contraception
types of barrier method
male/female condom
vaginal sponge
diaphragm
cervical cap
contraceptive gel
spermicide
barrier method
physically prevents sperm from entering the uterus
must be used correctly each time a person has intercourse
fewer side effects but less efficacy compared to hormonal contraceptives
common advantages of barrier methods
no systemic side effects (diaphragm, cervical cap)
low cost (male condom, spermicide)
HIV/STI protect (male/female condom)
common disadvantages of barrier methods
user dependent (condoms, vaginal sponge)
no HIV/STI protection (vaginal sponge, diaphragm, cervical cap, contraceptive gel, spermicide)
need proper fitting (diaphragm, cervical cap)
long term method of nonhormonal contraceptives
copper intrauterine device
Copper IUD advantages
prevents pregnancy for up to 10 years
could be used as emergency contraception
extremely effective (under 0.8% failure)
non-hormonal
copper IUD disadvantages
expensive
no STI prevention
side effects of heavy/painful bleeding and spotting
permanent methods
surgery sterilization (male vasectomy or female tubal ligation)
what should a pt use if they want it to be highly effective but still allow her to have children later?
Number One Choice – Copper IUD (up to 10 years)
Secondary due to effectiveness – Diaphragm, Female Condom, Cervical Cap, Vaginal Sponge, FAM, Spermicide
What should a pt use if they want no painful side effects?
diaphgram
THEN male condom, female condom, cervical cap, or sponge
THEN FAM or spermicide
what should a pt use if they do not want to think about contraceptives?
copper IUD or implant
what should a pt use if they are need HIV/STI prevention?
male/female condom
what should a pt use if they are only worried about STI prevention?
copper IUD
(male and female condom prevent against both HIV/STI)
