Sexual Health Flashcards
1
Q
What are the natural/conservative methods of contraception?
A
- Family planning
-Condom use
2
Q
How affective are natural/conservative methods of contraception?
A
75-82%
3
Q
What are the shorter acting methods of contraception?
A
-COCP
-POP
-HRT patch
4
Q
How affective are short acting contraceptions?
A
99% theoretical
91% actual
5
Q
What are the longer acting methods of contraception?
A
- Depot provera
- IUS
- IUD
- Nexplanon implant
6
Q
How affective are long acting contraceptions?
A
99%
depot = 84%
7
Q
What are the sterilisation methods of contraception?
A
- Vasectomy
- Ligation
8
Q
How affective is sterilisation?
A
99.9&
9
Q
When is the COCP acceptable to give postpartum?
A
After 6 weeks
10
Q
When is the IUS/IUD acceptable to give postpartum?
A
< 48hr after then > 4 weeks
11
Q
When will contraception become affective if started on day 1-5 of a cycle?
A
Immediately
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
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
14
Q
What is progesterone’s mode of action in contraceptives?
A
Maintains the endometrium, thickens cervical mucus, decreases cilia flow
15
Q
How long is levonorgestrel 1.5mg affective as emergency contraception?
A
Up to 72hrs
16
Q
How long is EllaOne (ulipristal acetate 30mg) affective as emergency contraception?
A
Up to 120hrs, less affective over time
17
Q
How long is the IUD reliable as a form of emergency contraception?
A
Up to 120 hrs
18
Q
What are the options for emergency contraception?
A
- IUD
-EllaOne
-Levonorgestrel
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
20
Q
What should you do if a patient misses 2 of their COCP in week 1 of their pack?
A
Emergency contraception
21
Q
What should you do if a patient misses 2 of their COCP in week 2 of their pack?
A
Nothing
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
23
Q
What are the pros for COCP?
A
- very effective
-decreased risk of endometrial cancer
-decreased risk of ovarian cancer
-immediate fertility return
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
25
Which hormones are in COCP?
Increased oestrogen and progesterone
26
What is UKMEC 3 for COCP?
-immobile/wheelchair use
-BMI >35
-BRCA 1 or 2
27
What is UKMEC 4 for COCP?
- Migraine with aura
- History of VTE
- >35 yrs + >15 cigs a day
- Liver tumours
- SLE
- Breast cancer
28
Which hormones are in POP?
Increased progesterone
29
What are the pros of POP?
- very effective
- breastfeeding friendly
- may stop periods altogether
- immediate fertility return
- good when COCP is CI
30
What are the cons of POP?
- small window to be taken every day, increased risk of missed pills
- spotting
31
What is the window for a missed pill on levonorgestrel (POP)?
3 hours
32
What is the window for a missed pill on desogestrel (POP)?
12 hours
33
What is UKMEC 4 for POP?
Breast cancer
34
How often is the depot injection had?
12 weeks
35
What are the pros for the depot provera?
- long lasting
- less room for human error
- good when COCP is CI
36
What are the cons for the depot provera?
- weight gain
- mood swings
- delayed fertility return (up to 12 months)
37
How long can the implant be effective for?
3 years
38
What are the pros of nexplanon (implant)?
- long lasting
- effective
- breast feeding friendly
39
What is UKMEC 4 for the depot?
Breast cancer
40
What are the cons of nexplanon (implant)?
- mood swings
- spotting
41
What is UKMEC 4 for nexplanon?
Breast cancer, pregnancy
42
Which medications can reduce COCP efficiency?
Carbamazepine
43
How soon before surgery does the COCP need to be stopped?
4 weeks
44
How long is an IUS affective for?
Mirena - 8 years
Kyleena - 5 years
45
What are the pros of an IUS?
- long acting
- effective
- breastfeeding friendly
- good for pts with menorrhagia
- can stop periods altogether
- can be used as HRT for 4 years
46
What are the cons of an IUS?
- spotting
- can move
- ectopic pregnancy risk
47
What is UKMEC 4 for an IUS?
- PID
- endometrial cancer
- unexplained uterine bleed
- breast cancer
- pregnancy
48
What is UKMEC 4 for an IUD?
- PID
- endometrial cancer
- unexplained uterine bleed
- Wilson's disease
- pregnancy
49
How long can an IUD be effective for?
5-10 years
50
What is the mode of action for an IUD?
Copper is spermicidal - it targets sperm golgi apparatus
51
What are the pros of an IUD?
- long lasting
- very effective
- can be used in an emergency
- can be used in breast cancer
52
What are the cons of an IUD?
- menorrhagia
- can move
- ectopic pregnancy risk
53
Which contraception can be used with breast cancer pts?
IUD
54
At which point is contraception not needed to stop pregnancy?
- 12 months since last period if 50+
- 24 months since last period if > 50
55
What is the definition of infertility?
UPSI 3xs/week for > 12 months with no pregnancy
56
What percentage of couples conceive within a year of unprotected sex?
80%
57
What can cause female infertility?
- decreased reserve
- anovulation
- structural issues
- tubular issues
58
What can cause a decreased reserve of eggs in females?
- menopause
- Sheehan's syndrome
59
What can cause anovulation in females?
- PCOS
- hyperthyroidism
- hyperprolactinaemia
- ED's
- chronic stress
60
What can cause reproductive structural problems in females?
- endometriosis
- fibroids
- turner's syndrome
- asherman's
61
What can cause reproductive tubular problems in females?
PID
62
What can cause poor sperm quality?
- decreased testosterone
- increased prolactin
- cystic fibrosis
- haemochromatosis
- Kallmann's
- testicular cancer
63
What infertility tests are performed on males?
- sperm analysis + semen
- bloods - testosterone, prolactin, FHS, LH
64
Which fertility tests are done on females?
Bloods: oest, prog, LH, FHS, prolactin, serum HBG
- transvaginal ultrasound
- NAAT swab
65
If a pt is young and struggling to conceive what do you recommend?
Try for a further 6 months then come back
66
If a pt is >35 and struggling to conceive what do you recommend?
Earlier referral, start on clomifene
67
What is clomifene's mode of action?
Stimulates ovulation
Oestrogen modulator
68
What is the last line treatment for infertility?
IVF or IUI
69
What are the side effects of clomifene?
- flushing
- blurred vision
- mittelschmerz
70
When is IVF or IUI offered?
If not conceived for >2 years
71
What are the possible complications with IVF?
- twin pregnancy
- ectopic pregnancy
- ovarian hyperstimulation syndrome (OHSS)
72
When is IVF more successful?
In younger patients
73
What is often given with IVF?
B-HCG
74
What are the risk factors for an STI?
- <25 yrs
- UPSI
- sexually active
- IVDU
- immunosuppression
75
How are STIs detected in males?
First catch urine MC+S
76
How are STIs detected in females?
Triple swab - high vag NAAT, endocervical NAAT, endocervical charcoal)
77
What is the most common STI in the UK?
Chlamydia
78
How does chlamydia appear histologically?
negative cocci
79
What are the symptoms of chlamydia?
- dysuria
- purulent discharge
- cervicitis
- proctitis
- fever
80
How is chlamydia diagnosed?
NAAT swab
81
How is chlamydia treated?
10mg PO doxycycline for 7 days BD
82
What are some of the possible complications of gonorrhoea?
- opthalmia neonatorum
- reactive arthritis
- gonoccocal sepsis
- disseminated gonococcal infection
83
How does gonorrhoea appear on histology?
Negative diplococcus
84
What are the symptoms of gonorrhoea?
- dysuria
- green urethral discharge
- cervicitis
- proctitis
- fever
85
How is gonorrhoea diagnosed?
NAAT swab
86
What are the possible complications of chlamydia?
- PID
- lymphogranuloma venereum (ulcers)
- opthalmia neonatorum
- infertility
- reactive arthritis
87
How is gonorrhoea managed?
IM ceftriaxone 1g STAT
88
What is the most common STI worldwide?
Trichomonas vaginalis
89
How does trichomonas vaginalis seen histologically?
pear shaped, flagellated protozoa
90
What are the symptoms of trichomonas vaginalis?
- urethritis
- yellow frothy discharge
- strawberry cervix
- cervicitis
91
How is trichomonas vaginalis diagnosed?
Triple swab (need to do wet mount swab)
May show raised pH like BV
92
How is trichomonas vaginalis treated?
PO 400mg BD metronidazole x7d
93
How does Herpes simplex virus present?
- Genital ulcers
- Herpetic whitlow
- keratitis
94
How is HSV diagnosed?
PCR
95
How is HSV treated?
PO Aciclovir 400mg TDS x5d
96
How does HPV 6+11 present?
Painless genital warts
97
How is HPV prevented
HPV gardasil vaccine
98
How does syphilis present?
1. Painless chancre - ulceration @ genitals
2. chancre resolves then - snail track ulcers, diffuse rash, condylomata, patchy alopecia
99
What are the complications of syphilis?
- increased HIV transmission risk
- seizures
- memory problems, demenita
100
What is bacterial vaginosis?
Loss of normal bacterial flora; lactobacilli replaced with gardnerella vaginalis
101
What are the symptoms of BV?
painless, thing grey "fishy" discharge
102
How is BV diagnosed?
3/4 Amsel criteria:
- pH > 4.5
- positive whiff test
- white/grey discharge
- clue cells on histology
103
How is BV treated?
PO 400mg metronidazole BD for 7 days
104
What are the possible complications of BV?
- increased STI risk
- miscarriage
- preterm premature rupture of membranes
105
Who are more at risk of candida?
- pregnant
- T2DM
- recent abx use
- new sexual partner
106
What are the symptoms of thrush?
- painless cottage cheese discharge
- itching
- satellite lesions
107
How is thrush diagnosed?
clinical, but do need high vag swab of discharge
108
How is thrush treated?
STAT dose 150mg PO fluconazole
preg - 300mg clotrimazole pessary
109
What are the symptoms of PID?
- deep dyspareunia
- discharge
- cervicitis
- chronic pelvic pain
- salpingitis and oopheritis (reduced fertility)
110
How is PID diagnosed?
- triple swab
- adnexal motion tenderness on bimanual
- TV USS with contrast
- HIV serology
111
How is PID treated?
100mg doxycycline BD PO x7d + IM ceftriaxone + PO 400mg metronidazole
112
What are the possible complications with PID?
- infertility
- increased risk of ectopic pregnancy
- Fitz Hugh Curtis syndrome
113
What are the symptoms for lymphogranuloma venereum?
- ulcerating papule
- proctocolitis
- inguinal lymphadenopathy
114
What is lymphogranuloma venereum caused by?
Chlamydia trachomatis, especially serovars L1, L2, and L3
115
What is blanitis?
Inflammation of the glans penis by candida or lichen sclerosis
116
What are the symptoms of balanitis (candida)?
Candida - white itchy lesions, thick white discharge
117
What is the treatment for balanitis (candida)?
topical clotrimazole
118
What are the symptoms of lichen sclerosis?
- white shiny plaques - worse with friction
119
How is lichen sclerosis treated?
high potency steroid
120
What are the symptoms of pubic lice?
- severe itchy pubic region +/- visible movement
- maculae cerulea
121
How is pubic lice treated?
permethrin topical insecticide
122
What are the symptoms of chancroid?
- painful genital ulceration
- discharge
- inguinal lymphadenopathy
123
What is the treatment for chancroid?
STAT PO azithromycin
124
What is hypoactive sexual dysfunction disorder (HSDD)?
>6m of decreased sexual desire, decreased sexual cue response, decreased initiation of sex
125
What are the risk factors for HSDD?
- Having a mood disorder (depression, anxiety)
- Endocrine problems (diabetes)
- Opioid use
- SSRI use
- Abuse + trauma
126
What increases sexual stimulation?
- dopamine agonists
- melanocortin
127
What can inhibit sex drive?
- high doses of serotonin (SSRIs)
- opioids
128
How is HSDD diagnosed?
- Bloods - oest, prog, LH, FSH, SHBG
- history
129
How is HSDD treated?
- Couples therapy
- CBT
- decrease stress
- increase exercise
- flibanserin
130
What is anorgasmia?
Failure to orgasm despite adequate stimulation for >6m
131
What can cause anorgasmia?
- Mood disorders
- DM
- post menopausal
- post hysterectomy
- stress
132
How is anorgasmia diagnosed?
- Bloods - oest, prog, FSH, LH, SHBG
133
How is anorgasmia treated?
- couples sexual therapy
- CBT
- sexual education
- decrease stress
- increase exercise
- clitoral vacuum
- COCP
134
What is vaginismus?
Involuntary contraction of vaginal wall muscle (spasm) - doesn't allow penetration
135
What are the symptoms of vaginitis?
- Problematic sex
- Can't do pap smears
- Can't insert IUS/IUD
136
What is the treatment for vaginitis?
- Sexual education
- Keigel exercises
- vaginal dilation therapy
137
What is vulvodynia?
>3m of vulval pain, can be provoked or unprovoked
138
How is vulvodynia diagnosed?
If painful when touching can do swab test (burning when touched)
139
How is vulvodynia treated?
- Avoiding friction
- keigel exercises
- topical analgesia
140
What is erectile dysfunction?
>6 months of impotence
141
What can cause erectile dysfunction?
- mood disorders
- stress
- Peripheral vascular disease
- DM
- spinal cord compression
- hyperprolactinaemia
- MS
142
How is erectile dysfunction diagnosed?
- Bloods - test, oest, prolactin
- QRisk3
- Ankle Brachial Pressure Index
143
What are the treatments for erectile dysfunction?
- physiotherapy
- keigel exercises
- Sildenafil (Viagra)
- Penile ring
- Penile vacuum
144
What is premature ejaculation?
ejaculating within 1 minute of sex +/- penetration (ejaculation before pt wants it) >6m
145
What are the main causes of premature ejaculation?
- performance anxiety
- watching pornography
- sex abuse
146
How is premature ejaculation diagnosed?
Bloods - test, oest, prolactin, SHBG, TFT
147
How is premature ejaculation treated?
- stop start squeeze
- 54321 breathing technique
- keigel exercises
- dapoxetine (SSRI)
148
What is retrograde ejaculation?
Dry orgasm
149
What can cause retrograde ejactulation?
- TURP
- alpha blockers and beta blockers
- ace inhibitors
150
How is retrograde ejaculation diagnosed?
Post ejaculatory void - increased sperm
151
What is the treatment for retrograde ejaculation?
None
152
What is Peyronie's disease?
Type 3 collagen deposits in the tunica albuginea which can result in deformed contractures of the penis
153
How is Peyronie's disease diagnosed?
Penile ultrasound - hyperechogenetic fibrotic plaques
154
What is the treatment for Peyronie's disease?
- Surgery - plications
- Intropenile injections (collegenase)
155
What can cause anejaculation in a male?
- MH problem
- endo - DM, decreased testosterone
- neuro problem - nerve damage, MS etc.
- SSRI
156
What is the treatment for anejaculation?
- CBT
- couples therapy
- sex stimulation education
