Sexual Health Flashcards
Mechanisms of contraception action
-Avoid sex during fertile part of cycle
-Prevent implantation
-Prevent sperm entering uterus
-Destroy sperm
-Inhibition of ovulation
-Prevent sperm entering vagina
Acceptability in contraceptive methods
-Personal characteristics e.g. age
-Fertility intentions
-Perceptions of effectiveness/safety/ side effects
-Familiarity/ experience of others
-Ease of use and of access
-Need to see a health professional
-Intrusiveness
-Non-contraceptive benefits
Different categories of contraception
Examples of long-acting reversible contraception
-Implant
-Levonorgestrel Intrauterine Devices
-Intrauterine devices
-Injection
Describe the implant
-Small flexible rod placed under the skin, usually in the arm. It gradually releases progestogen over three years
-Failure rate: 0.05% (perfect use and typical use)
-Prevents ovulation
-Bleeding pattern – unpredictable: amenorrhoea, irregular or regular
-UKMEC 4: Current breast cancer
-Last 3 years
-Contains Etonogestrel 68mg
Describe the Levonorgestrel Intrauterine Devices
-Thin layer of the hormone progestogen. This is slowly secreted locally in the uterus, to thin the lining
-Failure rate: 0.2% (perfect use and typical use) – also used to treat heavy periods & as part of HRT
-Thickens cervical mucus, thins endometrium and(sometimes) inhibits ovulation
-Bleeding pattern – high rates of amenorrhoea
-UKMEC 4: Post-pregnancy sepsis, cervical/endometrial cancer, symptomatic STI, pelvic TB, current breast cancer
-Last 3-6 years
-Contains Levonogestrel 52mg/19.5mg/13.5mg
-Risk of perforation 1:1000, risk of expulsion 1:20, infection, ectopic
Describe Intrauterine Devices
-Small plastic and copper device, sometimes T-shaped, with one or two soft threads on the end
-Failure rate: 0.6% (perfect use) 0.8% (typical use)
-Destroys sperm, prevents implantation
-Bleeding pattern – regular but heavier/longer
-UKMEC 4: Post-pregnancy sepsis, cervical/endometrial cancer, symptomatic STI, pelvic TB
-Last 5-10 years
-Contains copper 380mm2
-Risk of perforation 1:1000, risk of expulsion 1:20,infection, ectopic
Describe the injection
-Progestogen hormone is injected into the buttock and gradually released into the body (Depo-provera)
-Failure rate: 0.2% (perfect use) 6% (typical use)
-Inhibits ovulation
-Bleeding pattern – amenorrhoea common
-UKMEC 4: Current breast cancer
-Lasts 12 - 13 weeks
-Contains depot medroxyprogesterone acetate
-Intramuscular (150mg) or subcutaneous (104mg,can be self administered)
Examples of short acting and user-initiated contraception
-Combined hormonal contraception
-Progestogen only pill
-Diaphragm
-Condoms
-Fertility awareness methods
Describe combined hormonal contraception
-Pills, Patches and Rings
-Failure rate: 0.3% (perfect use) 9% (typical use)
-Inhibits ovulation
-Bleeding pattern – regular
-UKMEC 4: Postpartum, Age > 35 and smoking>15/day, Hypertension (BP >160/100), Deep Vein Thrombosis, MyocardiaI Infarction, Cerebrovascular accident, and more.
-Pill taking regimes:
=21 days of use, 4-7 days off
=63 days of use, 4-7 days off
=Continuous use
Positives of combined hormonal contraception
-Reduced risk of colorectal, ovarian and endometrial cancer
-Menstrual regulation
-Treatment of endometriosis
-Reduces acne
Negatives of combined hormonal contraceptives
-Increased risk of VTE, greatest in first year of use
-Increased risk of breast cancer
-Small increase in risk of stroke and heart attack (increased further by smoking, hypertension)
-Weight gain, mood changes, change in libido, headache
Describe the progestogen only pill
-Failure rate: 0.3% (perfect use) 9% (typical use)
-Desogestrel inhibits ovulation
=Levonorgestrel. norethisterone
-Other types thicken cervical mucus
-Bleeding pattern – regular, irregular or none
-UKMEC 4: Current breast cancer
-May worsen acne
Describe the Diaphragm
-Thin rubber dome with a springy and flexible rim. It is inserted into the vagina, fits over the cervix and is held in place by vaginal muscles
-Failure rate: 6% (perfect use) 12% (typical use)
-Diaphragm acts as a reservoir for spermicide
-Can be inserted in advance of sex, keep there for 6 hours afterwards
-May affect discharge and increase risk of UTI
Describe condoms
-Failure rate: 2% (perfect use) 18% (typical use)
-Very user dependent (male partner)
-Prevents STI transmission
-Can be used in conjunction with other methods
Describe fertility awareness methods
-Failure rate: 5% (perfect use) 24% (typical use)
-Avoid sex or use another method for part of the cycle
-Requires meticulous tracking of menstrual cycle
-Improved efficacy by also checking basal body temperature, cervical mucus and position, urinary LH levels
-Complicated
