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Phase 3a > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

What are the natural/conservative methods of contraception?

A
  • Family planning
    -Condom use
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2
Q

How affective are natural/conservative methods of contraception?

A

75-82%

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3
Q

What are the shorter acting methods of contraception?

A

-COCP
-POP
-HRT patch

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4
Q

How affective are short acting contraceptions?

A

99% theoretical
91% actual

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5
Q

What are the longer acting methods of contraception?

A
  • Depot provera
  • IUS
  • IUD
  • Nexplanon implant
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6
Q

How affective are long acting contraceptions?

A

99%
depot = 84%

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7
Q

What are the sterilisation methods of contraception?

A
  • Vasectomy
  • Ligation
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8
Q

How affective is sterilisation?

A

99.9&

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9
Q

When is the COCP acceptable to give postpartum?

A

After 6 weeks

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10
Q

When is the IUS/IUD acceptable to give postpartum?

A

< 48hr after then > 4 weeks

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11
Q

When will contraception become affective if started on day 1-5 of a cycle?

A

Immediately

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12
Q

When will contraception become affected if started > day 5 of a cycle?

A

IUD - immediately
POP - 2 days
COCP, depot, IUS, implant - 7 days

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13
Q

What is oestrogens mode of action in contraceptives?

A

Works with progestin to suppress HPG axis, therefore no LH surge and no follicular development

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14
Q

What is progesterone’s mode of action in contraceptives?

A

Maintains the endometrium, thickens cervical mucus, decreases cilia flow

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15
Q

How long is levonorgestrel 1.5mg affective as emergency contraception?

A

Up to 72hrs

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16
Q

How long is EllaOne (ulipristal acetate 30mg) affective as emergency contraception?

A

Up to 120hrs, less affective over time

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17
Q

How long is the IUD reliable as a form of emergency contraception?

A

Up to 120 hrs

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18
Q

What are the options for emergency contraception?

A
  • IUD
    -EllaOne
    -Levonorgestrel
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19
Q

What should you do if a patient misses a pill (COCP) in their pack?

A

Take 2 that day, the missed one as soon as possible

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20
Q

What should you do if a patient misses 2 of their COCP in week 1 of their pack?

A

Emergency contraception

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21
Q

What should you do if a patient misses 2 of their COCP in week 2 of their pack?

A

Nothing

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22
Q

What should you do if a patient misses 2 of their COCP in week 3 of their pack?

A

Omit pill free period and use condoms for 7 days

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23
Q

What are the pros for COCP?

A
  • very effective
    -decreased risk of endometrial cancer
    -decreased risk of ovarian cancer
    -immediate fertility return
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24
Q

What are the cons of the COCP?

A

-risk of human error
-increased risk of breast cancer
-increased risk of cervical cancer
-increased VTE risk

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25
Q

Which hormones are in COCP?

A

Increased oestrogen and progesterone

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26
Q

What is UKMEC 3 for COCP?

A

-immobile/wheelchair use
-BMI >35
-BRCA 1 or 2

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27
Q

What is UKMEC 4 for COCP?

A
  • Migraine with aura
  • History of VTE
  • > 35 yrs + >15 cigs a day
  • Liver tumours
  • SLE
  • Breast cancer
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28
Q

Which hormones are in POP?

A

Increased progesterone

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29
Q

What are the pros of POP?

A
  • very effective
  • breastfeeding friendly
  • may stop periods altogether
  • immediate fertility return
  • good when COCP is CI
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30
Q

What are the cons of POP?

A
  • small window to be taken every day, increased risk of missed pills
  • spotting
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31
Q

What is the window for a missed pill on levonorgestrel (POP)?

A

3 hours

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32
Q

What is the window for a missed pill on desogestrel (POP)?

A

12 hours

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33
Q

What is UKMEC 4 for POP?

A

Breast cancer

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34
Q

How often is the depot injection had?

A

12 weeks

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35
Q

What are the pros for the depot provera?

A
  • long lasting
  • less room for human error
  • good when COCP is CI
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36
Q

What are the cons for the depot provera?

A
  • weight gain
  • mood swings
  • delayed fertility return (up to 12 months)
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37
Q

How long can the implant be effective for?

A

3 years

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38
Q

What are the pros of nexplanon (implant)?

A
  • long lasting
  • effective
  • breast feeding friendly
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39
Q

What is UKMEC 4 for the depot?

A

Breast cancer

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40
Q

What are the cons of nexplanon (implant)?

A
  • mood swings
  • spotting
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41
Q

What is UKMEC 4 for nexplanon?

A

Breast cancer, pregnancy

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42
Q

Which medications can reduce COCP efficiency?

A

Carbamazepine

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43
Q

How soon before surgery does the COCP need to be stopped?

A

4 weeks

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44
Q

How long is an IUS affective for?

A

Mirena - 8 years
Kyleena - 5 years

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45
Q

What are the pros of an IUS?

A
  • long acting
  • effective
  • breastfeeding friendly
  • good for pts with menorrhagia
  • can stop periods altogether
  • can be used as HRT for 4 years
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46
Q

What are the cons of an IUS?

A
  • spotting
  • can move
  • ectopic pregnancy risk
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47
Q

What is UKMEC 4 for an IUS?

A
  • PID
  • endometrial cancer
  • unexplained uterine bleed
  • breast cancer
  • pregnancy
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48
Q

What is UKMEC 4 for an IUD?

A
  • PID
  • endometrial cancer
  • unexplained uterine bleed
  • Wilson’s disease
  • pregnancy
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49
Q

How long can an IUD be effective for?

A

5-10 years

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50
Q

What is the mode of action for an IUD?

A

Copper is spermicidal - it targets sperm golgi apparatus

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51
Q

What are the pros of an IUD?

A
  • long lasting
  • very effective
  • can be used in an emergency
  • can be used in breast cancer
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52
Q

What are the cons of an IUD?

A
  • menorrhagia
  • can move
  • ectopic pregnancy risk
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53
Q

Which contraception can be used with breast cancer pts?

A

IUD

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54
Q

At which point is contraception not needed to stop pregnancy?

A
  • 12 months since last period if 50+
  • 24 months since last period if > 50
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55
Q

What is the definition of infertility?

A

UPSI 3xs/week for > 12 months with no pregnancy

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56
Q

What percentage of couples conceive within a year of unprotected sex?

A

80%

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57
Q

What can cause female infertility?

A
  • decreased reserve
  • anovulation
  • structural issues
  • tubular issues
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58
Q

What can cause a decreased reserve of eggs in females?

A
  • menopause
  • Sheehan’s syndrome
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59
Q

What can cause anovulation in females?

A
  • PCOS
  • hyperthyroidism
  • hyperprolactinaemia
  • ED’s
  • chronic stress
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60
Q

What can cause reproductive structural problems in females?

A
  • endometriosis
  • fibroids
  • turner’s syndrome
  • asherman’s
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61
Q

What can cause reproductive tubular problems in females?

A

PID

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62
Q

What can cause poor sperm quality?

A
  • decreased testosterone
  • increased prolactin
  • cystic fibrosis
  • haemochromatosis
  • Kallmann’s
  • testicular cancer
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63
Q

What infertility tests are performed on males?

A
  • sperm analysis + semen
  • bloods - testosterone, prolactin, FHS, LH
64
Q

Which fertility tests are done on females?

A

Bloods: oest, prog, LH, FHS, prolactin, serum HBG
- transvaginal ultrasound
- NAAT swab

65
Q

If a pt is young and struggling to conceive what do you recommend?

A

Try for a further 6 months then come back

66
Q

If a pt is >35 and struggling to conceive what do you recommend?

A

Earlier referral, start on clomifene

67
Q

What is clomifene’s mode of action?

A

Stimulates ovulation
Oestrogen modulator

68
Q

What is the last line treatment for infertility?

A

IVF or IUI

69
Q

What are the side effects of clomifene?

A
  • flushing
  • blurred vision
  • mittelschmerz
70
Q

When is IVF or IUI offered?

A

If not conceived for >2 years

71
Q

What are the possible complications with IVF?

A
  • twin pregnancy
  • ectopic pregnancy
  • ovarian hyperstimulation syndrome (OHSS)
72
Q

When is IVF more successful?

A

In younger patients

73
Q

What is often given with IVF?

A

B-HCG

74
Q

What are the risk factors for an STI?

A
  • <25 yrs
  • UPSI
  • sexually active
  • IVDU
  • immunosuppression
75
Q

How are STIs detected in males?

A

First catch urine MC+S

76
Q

How are STIs detected in females?

A

Triple swab - high vag NAAT, endocervical NAAT, endocervical charcoal)

77
Q

What is the most common STI in the UK?

A

Chlamydia

78
Q

How does chlamydia appear histologically?

A

negative cocci

79
Q

What are the symptoms of chlamydia?

A
  • dysuria
  • purulent discharge
  • cervicitis
  • proctitis
  • fever
80
Q

How is chlamydia diagnosed?

A

NAAT swab

81
Q

How is chlamydia treated?

A

10mg PO doxycycline for 7 days BD

82
Q

What are some of the possible complications of gonorrhoea?

A
  • opthalmia neonatorum
  • reactive arthritis
  • gonoccocal sepsis
  • disseminated gonococcal infection
83
Q

How does gonorrhoea appear on histology?

A

Negative diplococcus

84
Q

What are the symptoms of gonorrhoea?

A
  • dysuria
  • green urethral discharge
  • cervicitis
  • proctitis
  • fever
85
Q

How is gonorrhoea diagnosed?

A

NAAT swab

86
Q

What are the possible complications of chlamydia?

A
  • PID
  • lymphogranuloma venereum (ulcers)
  • opthalmia neonatorum
  • infertility
  • reactive arthritis
87
Q

How is gonorrhoea managed?

A

IM ceftriaxone 1g STAT

88
Q

What is the most common STI worldwide?

A

Trichomonas vaginalis

89
Q

How does trichomonas vaginalis seen histologically?

A

pear shaped, flagellated protozoa

90
Q

What are the symptoms of trichomonas vaginalis?

A
  • urethritis
  • yellow frothy discharge
  • strawberry cervix
  • cervicitis
91
Q

How is trichomonas vaginalis diagnosed?

A

Triple swab (need to do wet mount swab)
May show raised pH like BV

92
Q

How is trichomonas vaginalis treated?

A

PO 400mg BD metronidazole x7d

93
Q

How does Herpes simplex virus present?

A
  • Genital ulcers
  • Herpetic whitlow
  • keratitis
94
Q

How is HSV diagnosed?

A

PCR

95
Q

How is HSV treated?

A

PO Aciclovir 400mg TDS x5d

96
Q

How does HPV 6+11 present?

A

Painless genital warts

97
Q

How is HPV prevented

A

HPV gardasil vaccine

98
Q

How does syphilis present?

A
  1. Painless chancre - ulceration @ genitals
  2. chancre resolves then - snail track ulcers, diffuse rash, condylomata, patchy alopecia
99
Q

What are the complications of syphilis?

A
  • increased HIV transmission risk
  • seizures
  • memory problems, demenita
100
Q

What is bacterial vaginosis?

A

Loss of normal bacterial flora; lactobacilli replaced with gardnerella vaginalis

101
Q

What are the symptoms of BV?

A

painless, thing grey “fishy” discharge

102
Q

How is BV diagnosed?

A

3/4 Amsel criteria:
- pH > 4.5
- positive whiff test
- white/grey discharge
- clue cells on histology

103
Q

How is BV treated?

A

PO 400mg metronidazole BD for 7 days

104
Q

What are the possible complications of BV?

A
  • increased STI risk
  • miscarriage
  • preterm premature rupture of membranes
105
Q

Who are more at risk of candida?

A
  • pregnant
  • T2DM
  • recent abx use
  • new sexual partner
106
Q

What are the symptoms of thrush?

A
  • painless cottage cheese discharge
  • itching
  • satellite lesions
107
Q

How is thrush diagnosed?

A

clinical, but do need high vag swab of discharge

108
Q

How is thrush treated?

A

STAT dose 150mg PO fluconazole
preg - 300mg clotrimazole pessary

109
Q

What are the symptoms of PID?

A
  • deep dyspareunia
  • discharge
  • cervicitis
  • chronic pelvic pain
  • salpingitis and oopheritis (reduced fertility)
110
Q

How is PID diagnosed?

A
  • triple swab
  • adnexal motion tenderness on bimanual
  • TV USS with contrast
  • HIV serology
111
Q

How is PID treated?

A

100mg doxycycline BD PO x7d + IM ceftriaxone + PO 400mg metronidazole

112
Q

What are the possible complications with PID?

A
  • infertility
  • increased risk of ectopic pregnancy
  • Fitz Hugh Curtis syndrome
113
Q

What are the symptoms for lymphogranuloma venereum?

A
  • ulcerating papule
  • proctocolitis
  • inguinal lymphadenopathy
114
Q

What is lymphogranuloma venereum caused by?

A

Chlamydia trachomatis, especially serovars L1, L2, and L3

115
Q

What is blanitis?

A

Inflammation of the glans penis by candida or lichen sclerosis

116
Q

What are the symptoms of balanitis (candida)?

A

Candida - white itchy lesions, thick white discharge

117
Q

What is the treatment for balanitis (candida)?

A

topical clotrimazole

118
Q

What are the symptoms of lichen sclerosis?

A
  • white shiny plaques - worse with friction
119
Q

How is lichen sclerosis treated?

A

high potency steroid

120
Q

What are the symptoms of pubic lice?

A
  • severe itchy pubic region +/- visible movement
  • maculae cerulea
121
Q

How is pubic lice treated?

A

permethrin topical insecticide

122
Q

What are the symptoms of chancroid?

A
  • painful genital ulceration
  • discharge
  • inguinal lymphadenopathy
123
Q

What is the treatment for chancroid?

A

STAT PO azithromycin

124
Q

What is hypoactive sexual dysfunction disorder (HSDD)?

A

> 6m of decreased sexual desire, decreased sexual cue response, decreased initiation of sex

125
Q

What are the risk factors for HSDD?

A
  • Having a mood disorder (depression, anxiety)
  • Endocrine problems (diabetes)
  • Opioid use
  • SSRI use
  • Abuse + trauma
126
Q

What increases sexual stimulation?

A
  • dopamine agonists
  • melanocortin
127
Q

What can inhibit sex drive?

A
  • high doses of serotonin (SSRIs)
  • opioids
128
Q

How is HSDD diagnosed?

A
  • Bloods - oest, prog, LH, FSH, SHBG
  • history
129
Q

How is HSDD treated?

A
  • Couples therapy
  • CBT
  • decrease stress
  • increase exercise
  • flibanserin
130
Q

What is anorgasmia?

A

Failure to orgasm despite adequate stimulation for >6m

131
Q

What can cause anorgasmia?

A
  • Mood disorders
  • DM
  • post menopausal
  • post hysterectomy
  • stress
132
Q

How is anorgasmia diagnosed?

A
  • Bloods - oest, prog, FSH, LH, SHBG
133
Q

How is anorgasmia treated?

A
  • couples sexual therapy
  • CBT
  • sexual education
  • decrease stress
  • increase exercise
  • clitoral vacuum
  • COCP
134
Q

What is vaginismus?

A

Involuntary contraction of vaginal wall muscle (spasm) - doesn’t allow penetration

135
Q

What are the symptoms of vaginitis?

A
  • Problematic sex
  • Can’t do pap smears
  • Can’t insert IUS/IUD
136
Q

What is the treatment for vaginitis?

A
  • Sexual education
  • Keigel exercises
  • vaginal dilation therapy
137
Q

What is vulvodynia?

A

> 3m of vulval pain, can be provoked or unprovoked

138
Q

How is vulvodynia diagnosed?

A

If painful when touching can do swab test (burning when touched)

139
Q

How is vulvodynia treated?

A
  • Avoiding friction
  • keigel exercises
  • topical analgesia
140
Q

What is erectile dysfunction?

A

> 6 months of impotence

141
Q

What can cause erectile dysfunction?

A
  • mood disorders
  • stress
  • Peripheral vascular disease
  • DM
  • spinal cord compression
  • hyperprolactinaemia
  • MS
142
Q

How is erectile dysfunction diagnosed?

A
  • Bloods - test, oest, prolactin
  • QRisk3
  • Ankle Brachial Pressure Index
143
Q

What are the treatments for erectile dysfunction?

A
  • physiotherapy
  • keigel exercises
  • Sildenafil (Viagra)
  • Penile ring
  • Penile vacuum
144
Q

What is premature ejaculation?

A

ejaculating within 1 minute of sex +/- penetration (ejaculation before pt wants it) >6m

145
Q

What are the main causes of premature ejaculation?

A
  • performance anxiety
  • watching pornography
  • sex abuse
146
Q

How is premature ejaculation diagnosed?

A

Bloods - test, oest, prolactin, SHBG, TFT

147
Q

How is premature ejaculation treated?

A
  • stop start squeeze
  • 54321 breathing technique
  • keigel exercises
  • dapoxetine (SSRI)
148
Q

What is retrograde ejaculation?

A

Dry orgasm

149
Q

What can cause retrograde ejactulation?

A
  • TURP
  • alpha blockers and beta blockers
  • ace inhibitors
150
Q

How is retrograde ejaculation diagnosed?

A

Post ejaculatory void - increased sperm

151
Q

What is the treatment for retrograde ejaculation?

A

None

152
Q

What is Peyronie’s disease?

A

Type 3 collagen deposits in the tunica albuginea which can result in deformed contractures of the penis

153
Q

How is Peyronie’s disease diagnosed?

A

Penile ultrasound - hyperechogenetic fibrotic plaques

154
Q

What is the treatment for Peyronie’s disease?

A
  • Surgery - plications
  • Intropenile injections (collegenase)
155
Q

What can cause anejaculation in a male?

A
  • MH problem
  • endo - DM, decreased testosterone
  • neuro problem - nerve damage, MS etc.
  • SSRI
156
Q

What is the treatment for anejaculation?

A
  • CBT
  • couples therapy
  • sex stimulation education

Phase 3a (6 decks)

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