Sexual health

Question 1

What is the main guidance around emergency contraception?

Answer 1

Should only be given to the patient using it.
Copper IUD can be fitted 5 days after the event.
After 72 hours - levonelle
After 120 hours - EllaOne
If the patient throws up within 3 hours, come back

Question 2

Discuss the use of EllaOne

Answer 2

Licensed for use within 120 hours
One tablet
Not recommended for patients that have taken CYP3A4 enzyme inudcing medicines (phenobarbitol, phenytoin, st johns worts, rifampicin, gluccocorticoids),
Ok in heavier people,
people with severe asthma not recommended,
do not breast feed for one week after

Question 3

Discuss the use of levonelle

Answer 3

Licensed for use within 72 hours, give 2 tablets for patients on CYP3a4 inducing enzymes, less effective in women over 70kg, breastfeeding can continue straight after

Question 4

Discuss the combined oral contraceptive

Answer 4

21 day pill, with a 7 day break. Increased risk of breast cancer, blood clots, not appropriate in smokrs, high BMI, migraine, family history of breast cancer

Question 5

What are the main interactions with the combined oral contraceptive

Answer 5

cyp450 enzyme inducers, rifampicin, carbamazepine, absorption of lamotrigine may be reduced.

Question 6

What are the main counselling points with the combined oral contraceptive?

Answer 6

If you are sick within 2 hours, take another
Severe diarrhoea for more than 24 hours, take pill as a missed pill
if two or more pills are missed, use a barrier method

Question 7

What are the main counselling points for the POP

Answer 7

• contains progesterone hormone
• one missed pill - take straight away
• less than 3 hours late, take it and then take next at usual time
• 12 hours if desogestrel
• if the patient is sick within 2 hours then take another
• if the patient has diarhoea then take another

Question 8

Common interactions with contraceptives

Answer 8

medications for epilepsy, HI, St Johns wort can reduce the levels of oral contraceptives and reduce effectiveness

Question 9

What are the main risks with the COC

Answer 9

• blood clots
• breast cancer
• migraine
• stroke

Question 10

What are the main risks of pop

Answer 10

ovarian cysts

breast cancer

Question 11

What are the causes of erectile dysfunction?Vascular: hypertension, atherosclerosis, hyperlipidemia, smoking
Neurological: Parkinson’s disease, multiple sclerosis, stroke, spinal cord injury, peripheral neuropathy
Hormonal: hypogonadism, hyperprolactinaemia, thyroid disease, Cushing’s disease
Drug-induced: antihypertensives, beta-blockers, diuretics, antidepressants, antipsychotics, anticonvulsants, recreational drugs
Systemic disease: diabetes mellitus, renal failure
Structural: pelvic trauma, penile trauma, Peyronie’s disease
Psychogenic: depression, anxiety, performance anxiety, schizophrenia

Question 12

What symtpom history should be taken around suspected ED?

Answer 12

Onset of sexual dysfunction (i.e. short, gradual)
Duration of sexual dysfunction (i.e. lifetime or acquired)
Difficulties with arousal
Rigidity of erections
Duration of sexual stimulation
Difficulties with ejaculation
Difficulties with orgasm
Presence/absence of morning erections

Question 13

What other areas of history should be taken around ED?

Answer 13

Past medical history: previous sexual dysfunction, cardiovascular disease and previous pelvic surgery.
Medication history: antihypertensives, beta-blockers, diuretics, antidepressants, antipsychotics, and anticonvulsants.
Psychiatric history: current or previous psychological problems (e.g. depression, anxiety)
Social history: smoking, alcohol consumption, illicit drug use, diet, exercise
Sexual history: current sexual partner(s), relationship status, partner’s reaction to ED

Question 14

How can ED be managed?

Answer 14

Modify the risk factors, psychosexual counselling, Sildenafil

Question 15

How can you modify the risk factors for ED?Where applicable, patients should be encouraged to adopt healthy lifestyle behaviours, including smoking cessation, minimal alcohol intake, and weight loss. Many of these risk factors are linked to cardiovascular disease and diabetes, among others, which are known to predispose to ED. Research shows that in many cases, addressing the lifestyle risk factors that predispose to ED, can significantly mitigate or eliminate the disease.17

If a medication is suspected to be the cause of the ED, consider substitution or withdrawal of this substance for 2 weeks and review the effect.

Question 16

How is sildenafil initiated?

Answer 16

relaxation of penile blood vessels (sildenafil, vardenafil, avanafil).

Try drug at full dose prior to switching therapy. Frequency of use may vary with the severity of the patient’s ED.
take on an empty stomach 30 minutes prior to intercourse, avoid alcohol and fatty meals as it reduces drug absorption.
The drug is intended to last for roughly 4 hours
PDE-5 contraindications include concurrent nitrate use. Caution is required when treating patients with cardiovascular or cerebrovascular disease in the previous 6 months (hypo/hypertension).
side effects include headache, flushing, dizziness, dyspepsia and rhinitis
Arrange follow-up at 6-8 weeks for review of treatment

If a man presents with priapism an erection lasting greater than 4 hours, urgent hospitalisation is required for further investigation and management.