Module 15 - Sexual & Reproductive Health Flashcards
Delayed puberty occurs in approximately what percentage of children?
3%
It is more common in boys
Precocious puberty is defined as the development of secondary sexual characteristics at what age?
<8 years old
How is delayed puberty defined in boys and girls?
Lack of testicular development or testicular volume <4ml in boys >14 yrs
Lack of breast development in girls >13 yrs
How common is expulsion of an IUCD (over 5 years)?
Occurs in 1 in 20 women over 5 years
Most common within the first 3 months of insertion
What is the incidence of premature ovarian failure in women under 40?
1%
Premature ovarian failure affects 1% of women under 40
A 25 year old woman has unprotected SI with her husband D25 post ELCS. She is breatsfeeding sporadically. She opts for Ulliprostal acetate 30mg. She asks about the risks to breastfeeding?
Discard breast milk for 1 week after taking ullipristal acetate
Women who breastfeed should be advised not to breastfeed and to express and discard
milk for a week after they have taken UPA-EC
A 25 year old woman has unprotected SI with her husband D25 post ELCS. She is breatsfeeding sporadically. She opts for Levonorgestrel 1.5mg. She asks about the risks to breastfeeding?
No risks, she can continue
Women who breastfeed should be informed that available limited evidence indicates that
LNG-EC has no adverse effects on breastfeeding or on their infants.
Can women who breastfeed effectively use lactational amenorrhoea method (LAM) as
contraception?
If <6 months postpartum, fully breastfeeding and amenorrhoeic then lactational amenorrhoea method is a highly effective form of contraception
If reducing breastfeeding, starting using supplemental feeds, menstruating or >6 months postpartum it is less effective and other forms of contraception are recommended
What marks the start of puberty for girls?
The ability to sexually reproduce
What is the definition of precocious puberty in girls?
The development of secondary sexual characteristics <8 years old
What is the definition of precocious puberty in boys?
The development of secondary sexual characteristics <9 years of age
What is the definition of delayed puberty in girls?
The absence of breast development by age 13
What is the definition of delayed puberty in boys?
The absence of testicular development, or testicular volume <4ml by age 14
What is the normal range of puberty for girls?
Age 8 - 13
What is the normal range of puberty for boys?
9-14
You are discussing contraception with a 22 year old woman. She is interested in the Nexplanon® contraceptive implant. What would you advise her is the commonest reason for discontinuing with the implant?
Irregular/prolonged vaginal bleeding
20% (1 in 5) women will discontinue nexplanon due to irregular/prolonged vaginal bleeding
What proportion of women will have amenorrhoea after using Nexplanon?
20% (1 in 5)
What is the failure rate with typical use of nexplanon?
0.05%
Failure rate close to zero (0.05%) with typical use i.e. most effective reversible contraceptive
What is the background risk of VTE in non contraceptive users who are not pregnant?
2 per 10,000
What is the risk of VTE in pregnancy?
10 per 10,000
Pregnancy gives a 5x fold increase in VTE risk
What is the VTE risk of women taking CHC containing ethinylestradiol plus levonorgestrel, norgestimate or norethisterone?
5-7 per 10,000
What is the VTE risk of a woman taking CHC containing ethinylestradiol plus gestodene, desogestrel or drospirenone?
9-12 per 10,000
What is the most common cause of genital ulceration worldwide?
Chancroid
What is the recurrence rate of BV?
58%
(50-60%)
What is the most common cause of infective vaginal discharge?
Bacterial vaginosis
What is the second most common cause of infective vaginal discharge?
Vulvo-vaginal candidiasis
What is Amsel’s criteria?
Used to diagnose BV. Require 3/4 of the following:
1) Vaginal pH >4.5
2) Homogenous, white, non-viscous discharge
3) Positive ‘whiff’ test
4) >20% clue cells
OCP is protective for which cancers?
Ovarian cancer
Endometrial cancer
Colorectal cancer
OCP is a risk factor for which cancers?
Breast cancer
Cervical cancer
You are discussing contraception with a 21 year old woman. She is interested in the Nexplanon® contraceptive implant. What would you advise her regarding the failure rate of Nexplanon® with typical use in 1 year?
0.05%
What percentage of women will discontinue Nexplanon due to heavy or irregular bleeding?
20% (1 in 5)
What is the risk of uterine perforation following IUD insertion?
0.2%
What is the risk of ectopic pregnancy if pregnancy occurs with an IUD in-situ?
1 in 20
A 49 year old woman comes to see you in clinic. She is perimenopausal and has been started on cyclical (sequential) hormone replacement therapy. She tells you she is in a new relationship and asks if the HRT will be contraceptive. Cyclical HRT inhibits ovulation in what percentage of patients?
40%
Cyclical HRT only inhibits ovulation in 40% of women so there is still a risk of pregnancy. Contraception should therefore be prescribed in addition to cyclical HRT
What proportion of pregnancies in women >40 years old are unplanned?
20%
What proportion of pregnancies in women >40 years old end in termination?
28%
In women >50 years old using non-hormonal contraception when can you stop contraception?
After 1 year of amenorrhoea
In women <50 years old using non-hormonal contraception when can you stop contraception?
After 2 years of amenorrhoea
If >50 years old and using progestogen-only contracpetion, when can you stop contraception?
1 year after recording 2x FSH levels >30 at least 6 weeks apart
You can use 2x FSH levels 4-6 weeks apart to diagnose menopause in women <50 years old, but cannot use it to stop contraception in women <50 years old
How long do you need to stop the COCP for before testing FSH to diagnose menopause?
2 weeks
How long do you need to stop the depot injection for before testing FSH to diagnose menopause?
12 months
You are discussing postpartum contraception with a 32 year old woman. She has expressed an interest in the copper intrauterine device (IUCD). She is breastfeeding and is concerned about the risk of perforation. What is the risk of perforation in breastfeeding women compared to non-breastfeeding?
6x higher in breastfeeding women
What is the risk of VTE in non-pregnant women not taking hormonal contraception?
1-2 in 10,000
What is the risk of VTE in pregnancy?
8-10 in 10,000
Relative risk of VTE in pregnancy is increased 4 to 6 fold compared to non-pregnancy
What is the absolute risk of VTE in pregnancy?
1-2 in 1,000
What is the risk of VTE in women taking CHC containing ethinylestradiol plus levonorgestrel, norgestimate or norethisterone?
5-7 in 10,000
What is the risk of VTE in women taking CHC containing etonogestrel (ring) or norelgestromin (patch)?
6-12 in 10,000
What is the risk of VTE in women taking CHC containing ethinylestradiol plus gestodene, desogestrel or drospirenone?
9-12 in 10,000
What is the risk of VTE in women taking POP or prostogen-only contraception?
2 in 10,000
There is a suspicion that a serious sexual assault on a 30-year-old bar woman was drug facilitated. Up to when after the assault can a blood sample be taken for forensic tests?
3 days
There is a suspicion that a serious sexual assault on a 30-year-old bar woman was drug facilitated. Up to when after the assault can a vaginal sample be taken for forensic tests?
7 days
There is a suspicion that a serious sexual assault on a 30-year-old bar woman was drug facilitated. Up to when after the assault can a peri-anal sample be taken for forensic tests?
3 days
There is a suspicion that a serious sexual assault on a 30-year-old bar woman was drug facilitated. Up to when after the assault can an oral sample be taken for forensic tests?
2 days
There is a suspicion that a serious sexual assault on a 30-year-old bar woman was drug facilitated. Up to when after the assault can a urine sample be taken for forensic tests?
14 days
What proportion of women diagnosed with tubo-ovarian abscess are nulliparous?
60%
What proportion of cases of TOA/PID are polymicrobial?
30-40%
What proportion of cases of PID will develop a TOA?
15-35%
What are the features of MRKH (Mayer Rokitansky Kuster Hauser) Syndrome?
Incidence: 1 in 1,5000 births
Mullerian agenesis
Absent of uterus and vagina
Short or blind-ended vagina
Normal sexual characteristics
Primary amenorrhoea
40% have renal abnormalities
12% have one kidney
3% have hearing hoss
Treatment: Vaginal dilators and psychological support. 95% success rates with sexual intercourse
Surgery also an option
What are the features of complete androgen insensitivity syndrome?
Previously known as Testicular Feminisation syndrome
Genotype: 46XY (male)
Phenotype: Female
X-linked recessive inheritance. Passed down maternal line
Insensitivity of testosterone receptor
Features:
- Inguinal hernias with testes - lap orchidectomy after puberty complete. Risk of malignancy is 20% by 4th decade of life
- Sparse pubic hair
- Short vagina
- Absent uterus, cervix, tubes and upper 1/3 of vagina
- Abdominal pain
- Normal sexual intercourse
- Normal secondary sexual characteristics (female body habitus, breast development)
- Primary amenorrhoea
What is the most common cause of ambigious genitalia?
Congenital adrenal hyperplasia
A woman with chlamydia delivers her baby by SVD. When does chlamydia conjunctivitis develop in newborns?
5-12 days after delivery
Which cancers does the COCP put you at risk of?
Breast cancer
Cervical cancer
What proportion of transgender people are sexually abused at some point of their lives?
1/2
50%
When do you give PEPSE as prophylaxis after sexual assault?
ASAP, but within 72 hours
Continue for 4 weeks
What proportion of sexual assaults result in genital injuries?
1/4
25%
What are the two most common psychosexual complaints women have?
1) Lack of desire/interest in sex
2) Lack of orgasm
To qualify as sexual dysfunction needs to be present for >75% of the time for >6 months
What is the effectiveness of the coitus interruptus (withdrawal method)?
Perfect use - 96%
Typical use - 78%
What is the effectiveness of the COCP?
Perfect use - 99.7%
Typical use - 91%
What is the treatment of acute candidiasis in pregnancy?
Clotrimazole 500mg p.v. for 7 days
What is the treatment of recurrent candidiasis in pregnancy?
Clotrimazole 500mg p.v. for 10-14 days then weekly
What is the treatment of acute candidiasis in non-pregnant women?
Fluconazole 150mg pv stat
What is the treatment of recurrent candidiasis in non-pregnant women?
Fluconazole 150mg pv every 3 days for 3 doses then weekly for 6 months
What is the definition of recurrent candidiasis?
≥4 episodes in 12 months
What proportion of women experience recurrent thrush?
6%
What proportion of women will experience at least 1 episode of thrush in their lifetime?
75%
What proportion of candidiasis is caused by candida albicans?
80-90%