Sexual Health Flashcards
IUD
contains copper
reduces sperm motility and reduces survival
inhibits fertilisation, implantation and sperm penetration of cervical mucous
lasts 5-10 years
instantly effective 98-99% (can be used as emergency contraception)
CI - if current pelvic infection or STI or TB, if allergic to copper, if has Wilson’s disease, if pregnant and caution if on anticoagulation
IUS
e.g. Mirena
prevents endometrial proliferation and thickens cervical mucous
contains progesterone only - causes reverible endometrium atrophy which reduces likelihood of implantation and makes periods lighter and less painful
last 5 years
>90% effective, effective after 7 days (if not inserted on the first day of the cycle)
emergency contraception
- emergency IUD: up to 120hrs after sec, toxic to sperm and ovum, if sex >5 days ago can be inserted up to 5 days after likely ovulation
- ulipristal acetate: within 120 hrs, thought to delay or inhibit ovulation, avoid breastfeeding for 36hrs after
- levonorgestrel: within 72 hrs (best if within 12 hrs), suitable for those with focal migraines and Hx of VTE, believed to inhibit ovulation
COCP
inhibits ovulation
taken for 21 days with a 7 day break
effective after seven days (if not started on first day of cycle)
increases risk of cervical and breast cancer
lowers risk of ovarian and endometrial cancer
contraceptive patch
transdermal patch applied on day 1 of the cycle, changed on day 8 and day 15, removed on day 22 for a 7 day break
contraceptive vaginal ring
inserted on day 1 for 3 week , 7 day ring free interval
reasons to avoid combined hormonal contraceptives
history of venous disease or has risk factors (smoker, BMI >30, thrombophilia)
arterial disease - IHD, TIA, stroke, migraine with aura
liver disease - doesn’t work with rifampicin/rifabutin
cancer - history of breast cancer
previous pregnancy complications or is <6 weeks post-partum and breast feeding
POP
have a 3hr or 12hr (if desogestrel) in which to take
thickens cervical mucus and prevents sperm penetration
start on day 1-5 of cycle or needs 2 days of condom cover
depot progesterone
medroxyprogesterone acetate (12-weekly, deep IM) norethisterone enantate (8-weekly, gluteus maximus)
effective after 7 days if not started on first day of cycle
causes weight gain, not used if risk of OP
there may be a delay in the return of ovulation after stopping (can be >2years)
implant
e.g. Nexplanon - subdermal upper medial arm
inhibits ovulation and thickens cervical mucus
provides up to three years of protection
implant on day 1-5 or needs 7 day condom cover
vasectomy
under LA
vas deferens is ligated and excised or lumen is cauterized
needs two negative sperm ejaculates 8 weeks post-op and 1 month after that
reversal is most successful if within 10 years of initial operation
female sterilization
laparoscopic surgery under GA
no more effective than Mirena coil, trickier and risker than vasectomy
Pelvic Inflammatory Disease (PID)
infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries and the surrounding peritoneum
commonly caused by chlamydia
features: lower abdo pain, deep dyspareunia dysuria, fever, menstrual abnormalities, vaginal/cervical discharge and cervical excitation
Rx: oral ofloxacin and oral metronidazole OR IM ceftriaxone and oral doxycycline and oral metronidazole
complications:
infertility (10-20% risk after one episode), chronic pelvic pain, ectopic pregnancy, Fitz-Hugh-Curtis syndrome
endometriosis
growth of ectopic endometrial tissue outside of the uterine cavity
chronic pelvic pain, dysmenorrhoea, deep dyspareunia, subfertility, urinary symptoms, dyschezia (painful bowel movements)
laparoscopy is the gold standard investigation
Rx: depends on symptoms
NSAIDs and paracetamol
COCP/progestogens
GnRH analogues
surgery - laparoscopic excision and laser treatment of endometriotic ovarian cysts may improve fertility
ectopic pregnancy
-97% are tubal, 3% ovary/cervix/peritoneum
Rx: methotrexate, laparoscopy, salpingotomy or salpingectomy
menopause
average peak in the UK is 52 years old
said to be 12 months after LMP
problems are related to falling oestrogen levels: menstrual irregularity, vasomotor disturbance (sweats/palpitations/flushing) and atropy of genitalia, breast and skin (vaginal dryness - UTIs, dyspareunia, stress incontinence), osteoporosis - menopause accelerates bone loss
Rx: diet, exercise, Mirena coil, oestrogen cream and HRT
HRT
if they have a uterus – COMBINED HRT
if they don’t have a uterus – OESTROGEN ONLY
is not a contraception (women are considered potentially fertile until 2yrs after LMP if <50y/o or for 1 year if >50y/o)
benefits: reduction in vasomotor symptoms due to oestrogen, reduced risk of OP #, reduced risk of colorectal cancer
risks: increased risk of breast and endometrial cancer, risk of VTE, risk of gallbladder disease
alternatives to HRT
SSRIs - treat vasomotor symptoms
bisphosphonates and calcium and vitamin D - reduce risk of OP
vaginal oestrogen/ lubricants - treats vaginal dryness
types and risk of hysterectomy
- total
- subtotal (leaves cervix behind, still needs smears)
- removal of tubes and ovaries may be done at the same time
- Wertheim’s (includes LN and cuff of vagina) used for malignancy
risks: bleeding, infection, bladder/bowel/vessel/ureter injury, scarring, VTE, early menopause if ovaries retained
chlamydia trachomatis
often asymptomatic and detected on screening
can cause dysuria and discharge for both sexes
in females can cause deep dyspareunia and post-coital or intra-menstrual bleeding
diagnosis is by NAAT of vulvovaginal swab or first pass urine (M)
Rx: azithromycin (single dose) or doxycycline (7 days) kr erythromycin in children
women need to deliver via C-section
Neisseria gonorrhoea
asymptomatic or urethral/vaginal discharge and dysuria
NAAT and culture for sensitivity
Rx: ceftriaxone (and azithromycin to treat for chlamydia) if a complicated disease then add doxycycline and metronidazole
HPV
genial/anal warts topical podophyllin/cryotherapy vaccine Gardasil protects against 6,11,16 and 18. cervirax protects against 16 and 18. HPV 6&11 cause genital warts HPV 16,18&33 cause cancers
trichomonas vaginalis
thin, offensive vaginal discharge that causes an itch
only 30% of males will experience a whitish discharge and inflamed foreskin
Rx: metronidazole
can be complicated in pregnancy (risk of preterm, low birth weight)
bacterial vaginosis
thin, white, fishy discharge, no itch or soreness
pH >4.5, KOH whiff test
Rx: PO or PV metronidazole
or PV clindamycin
