Sexual Health Flashcards
what is sexual health?
‘Sexual health is a state of physical, emotional, mental, and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction, or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence
why are midwives in best position to give advice?
-Midwives are in the ideal postion to provide information and advice on contraception
May lack the confidence to do so
-Ovulation can recommence between 21 and 25 days postpartum
Importance of providing sound information about contraceptive choices
-Choices of contraception may be limited due to health, breastfeeding, cultural beliefs
Can be a difficult topic to discuss for both midwives and women
Requires sensitivity and signficant communication skill as well as knowledge
The advice provided can be empowering for women through the provision of choice best suited to their individual needs
What is family planning/ contraception?
- Both terms used interchangeably
- Used to define the prevention of pregnancy or control over fertility
- Literal meaning – plan for number and spacing of children within the family.
- Religious or cultural beliefs maymean that contraception is not an option
importance of timing?
-NICE guidelines – within first week postpartum
-Strong association with transfer from hospital to community care and discussion about contraception but also at time of transfer to Health Visitor.
-Often rushed
-Overload of information
–Lack of privacy and confidentiality (within hospital environment)
Individualised women centred approach depending on need andensuring that women are fully informed about sex, contraception andplans for future pregnancy at a time which suits the woman
What are the priorities for family planning advice?
PRIVATE- topic should be raised in private, ensure conversation cannot be overlooked
INDIVIDUALISED- discussion should be women centred, assumptions about religion or culture should not be made, consider issues such as perineal and c/s wound discomfort
CONFIDENTIAL- discussions and decisions are confidential, however women may wish to involve her partner and should be given the option to do so
What are the psychosexual issues?
- Approach topic with sensitivity
- Important to discuss the resumption of sexual intimacy
- Consider pain from perineal and/or vaginal trauma
- Pain from minor grazes/lacerations can be significant and have lasting effects on a woman
- Impact of traumatic birth
- It is safe to resume sexual imtimacy when the woman feels ready but should not feel pressured into it.
What are the cultural issues?
- Cultural Diversity
- Midwives need to have some understanding of the influence of culture and religion on contraceptive choices
- Provide culturally competent care whilst avoiding stereotypical assumptions
- Recognise that all women do not necessarily share the same values and beliefs as their peers
essential info to advice?
Age of woman General health Weight and BMI Medical history Gynaecological history Previous menstrual problems/cycles Obstetric history Chosen infant feeding method
What are the available contraceptives?
Barrier Hormonal Long Acting Reversable Contraception (LARCs) Natural Emergency Contraception Non-Reversible Sterilization
Information Essential to EffectiveContraceptive Advice
Lifestyle
Smoking, health beliefs and cultural beliefs
Family history
Cardiovascular disease or breast cancer
Previous contraceptive use
Including contraceptive failure or significant side effects
Woman’s knowledge of her menstrual cycle
Any issues of importance to the woman or her partner
what are barrier methods?
-Male condom
Used correctly provide 98% effectiveness
Provided free of charge within FPC/Sexual Health Clinics
Must be used every time, at the right time and fitted correctly
-Female Condom
Often referred to as femidom
Also available from FPC/SHC
95% effective is used correctly
Allows the woman to be in control
-Diaphragms/Caps
Fitted within the vagina and cover the cervix
92-96% effective with the use of spermicide
Need to be fitted to ensure correct size is used
Weight gain/loss requires new size to be fitted
Hormonal
-Combined Pill
Combination or oestrogen and progesterone
99% effective if taken consistently
Usually taken daily for 21 days with 7-day pill free break Can be commenced on day 21 postpartum
May impact on lactation
Use with caution for high BMI /smoking/focal migraines
-Progesterone only Pill
Cerezette- 12 hour window (99% effective)
3-hour window - 96%
May result in amenorrrhoea or changes in menstrual cycle
Weight gain common
Can commence 21 days postpartum
Appropriate for B/F mothers
Contraceptive Patch
Combinedoestrogenand progesterone
99% effective
Weekly patch x 3 weeks followed by patch free week
Can commence from day 21 postpartum
Good method if tendency toforgetto take the pill
Caution - as for combined pill
Contraceptive Ring
Combinedoestrogenand progesterone
Inserted into the vagina – left in for 3 weeks
Lower oestrogen dose than combined pill and patch
99% effective
Can be used from day 21 postpartum
Requires good muscle tone to hold in place
Long acting methods
-Implant Progesterone only Small flexible rod inserted under the skin of the inner upper arm 99% effective Licensed effective for 3 years Can be fitted from day 21 postpartum Can only be inserted by trained health professional -Injection Progesterone only 99% effective Given every 12 weeks Can be given at 21 days but recommended waiting until 6 weeks postpartum Can delay return of fertility -Intrauterine Device IUD/Coil 98-99% effective Licensed use 5 – 10 years Can be fitted 4-6 weeks postpartum Can also be used as emergency contraception Can cause dysmenorrhoea and menorrhagia -Intrauterine System Plastic, T shaped device which releases progesterone Licensed use 5 years May cause amenorrhoea Can be fitted 4-6 weeks postpartum
Natural Methods
-Rhythmn method
Recognizing fertile and infertile times of the menstrual cycle
Body temperature
Calendar
Cervical mucous
Can take up to 6 months to learn effectively
-Lactational Amenorrhoea
Considered to be 98% effective prior to return of menstrual cycle
Total breastfeeding
Baby under 6 months
Emergency
Used when a contraceptive method fails Condom splits No contraception used Forgot to take POP Effective if provided within 72 hours of unprotected intercourse Levonelle or EllaOne Copper IUD (can be fitted up to 5 days after UPSI or within 5 days of ovulation) Consider need for STI screening
