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My Reproduction > Sexual health > Flashcards

Sexual health Flashcards

1
Q

What is the main mechanism of LARC contraception?

A

prevent ovulation by suppressing FSH and LH

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2
Q

What is the mechanism of action of emergency contraception?

A

delays ovulation

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3
Q

What are the other less used mechanisms of contraception?

A
  • prevention of fertilisation eg condoms, diaphragm and spermicide
  • prevention of implantation by hormonal methods by creating a hostile endometrium
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4
Q

Why is LARC good?

A

user failure rate is nearly equal to the method failure rate as it doesn’t rely on remembering to take something or do something

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5
Q

What are the features of IUDs and IUSs?

A
  • IUD is an intrauterine device
  • IUS is an intrauterine system which has hormones too
  • long lasting, effective but are invasive to insert
  • prevent fertilisation and also implantation
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6
Q

What are the features of the copper IUD?

A
  • last up to 10y
  • non-hormonal so periods tend to get worse
  • prevents fertilisation primarily but also implantation
  • as emergency contraception it prevents implantation primarily
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7
Q

What are the features of the hormonal IUS?

A

works for heavy periods or pain eg with endometriosis, can cause irregular bleeding to start with to thin lining and then periods will most likely stop

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8
Q

What are the features of the rod/Nexplanon?

A
  • most effective
  • lasts three years
  • causes prolonged bleeding which is extremely unpredictable
  • takes 7 days to work after implantation
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9
Q

What are the main guidelines used for contraception choices?

A

UKMEC is the eligibility for contraception guidelines

  • Always useable
  • Broadly useable
  • Counsel/caution
  • Do not use
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10
Q

What is covered in combined hormonal contraception?

A

pill
patch
ring
these stop ovulation

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11
Q

What is the effectiveness of the pill impaired by?

A
  • impaired GI absorption
  • increased metabolism eg drug interaction or liver enzyme induction
  • forgetting to take pill
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12
Q

What are the risks involved with CHC?

A
  • venous thrombosis (prescribe more effective pill with lowest increased risk and educate on DVT)
  • systemic hypertension (must be under 140/90)
  • arterial disease/MI, migraine with aura (increases risk of stroke so contraindication for pill)
  • age >35y
  • breast cancer (small additional risk which returns to baseline after stopping for 10y)
  • cervical cancer risk
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13
Q

What are the benefits of CHC?

A
  • reduces the risk of ovarian and endometrial cancer so no overall risk of cancer
  • less PMS
  • treatment for PCOS
  • improves skin
  • less bleeding
  • fewer functional ovarian cysts
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14
Q

What are the side-effects of CHC?

A

nausea
bleeding
breast tenderness
spots

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15
Q

What are the features of the POP pill?

A
  • Cerelle (desogestrel) is the most commonly used
  • inhibits ovulation
  • risks = limited and the only contraindication is current breast cancer
  • missed POP guidance is simpler and within 12h missed is okay
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16
Q

What are the features of depo?

A
  • depo provera is the implant given by doctor
  • sayana press is self-administered
  • lowers oestradiol and suppresses FSH and stops menstrual cycle
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17
Q

What are the side-effects of the depo?

A
  • nausea
  • weight gain is common as appetite increases
  • spots
  • bleeding (amenorrhea eventually)
  • headaches
  • !!has an effect on bone mass due to effect on oestradiol so this maybe shouldn’t be used in teenagers!!
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18
Q

What are the less effective types of contraception?

A
  • diaphragm
  • natural family planning
  • female sterilisation
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19
Q

What is the process of male sterilisation?

A
  • needs counselling as there is a lot of regret involved
  • complications with the surgery
  • very effective with semen sample afterwards to verify
20
Q

What is patient notification?

A

contact tracing process for STIs to stop community outbreaks which is cost effective and reduces morbidity and mortality from the early diagnoses

21
Q

What is pre-exposure prophylaxis?

A
  • taken before sex and is highly effective in high risk patients to prevent HIV infection
  • given to MSM who have condomless anal sex often and people who have had a rectal bacterial STIs
22
Q

When is post-exposure prophylaxis given?

A

after sex for either HIV with antiretrovirals or Hepatitis B vaccine

23
Q

What are the two types of clause for abortion?

A
  • 7 clauses for abortion
  • 5 that need to be signed by 2 doctors for a specific indication
  • 2 which are emergency and only need 1 doctor signature
24
Q

What are the two time limits for abortion?

A
  • can be done up to 24 weeks for any reason

- after 24 it is for foetal abnormalities or if there is a severe risk to mother’s life

25
Q

What are the two most common clauses for abortion?

A
  • clause C: gestational limit of 24 weeks stating that continuing the pregnancy would cause injury to women
  • clause E: no gestational limit which is for when the child will be seriously handicapped and is the second most common clause
26
Q

What are the exceptions to CO for abortion?

A
  • doesn’t apply in emergency situations
  • should not delay patient’s access to care
  • doesn’t apply to indirect tasks such as admin or supervision
27
Q

How is medical abortion done?

A
  • oral mifepristone
  • PV/SL misoprostol 24-48hrs later which cause the uterus to contract and the cervix to open
  • <12 weeks can self-administer or >12 weeks it is an inpatient procedure
28
Q

What are the changes to abortion with covid?

A
  • Mifepristone can now be given at home
  • 12 weeks gestational limit for home
  • no US to assess gestation unless really needed
29
Q

What are the requirements for medical abortion at home?

A
  • adult at home
  • live close enough to the hospital
  • be over 16y
30
Q

What are women given when they have an abortion at home as well as drugs?

A
  • analgesia
  • antibiotics
  • antiemetic
  • 6m of POP
  • low sensitivity pregnancy test
31
Q

What is the process of surgical abortion?

A
  • under anaesthesia
  • cervical priming with misoprotol
  • <14w an electrical or manual vacuum aspiration procedure is done
  • > 14w is a dilatation and evacuation (only done in England)
32
Q

What are the complications of abortion?

A

haemorrhage, incomplete abortion and infection but these are rare

33
Q

What antibiotics are given and when for TOP?

A

surgical TOP and those doing medical TOP who are under an increased risk of STI but during covid all women are given antibiotics (doxycycline)

34
Q

What else is given to women of a certain blood type having TOP?

A

Anti-D is given to women who are rhesus negative having surgical abortion or late medical abortion

35
Q

What is given to women with a high risk of clotting for TOP?

A

VTE prophylaxis in the form of LMWH

36
Q

What is Gillick competence?

A

used for underage children and medical advice

37
Q

What are the factors used to assess Gillick competence?

A
  • child’s age
  • issue understanding
  • understanding of risks
  • understanding of alternative options
  • ability to explain reasoning
38
Q

What are the Fraser guidelines used for?

A

to advise, give contraception and sexual health for under 16 year olds

39
Q

When are the Fraser guidelines used?

A
  • if child won’t inform parents
  • understands advice
  • their health will suffer if they aren’t treated
  • best interest to be treated
  • continue having sex wihtout contraception
40
Q

What are some psychosexual disorders?

A
  • erectile dysfunction
  • dyspareunia/vaginismus
  • loss of libido
  • emotional effect of STI
  • post-childbirth
  • post-menopause or infertility
  • after TOP or surgery
  • after sexual abuse
41
Q

What are the side-effects of the morning after pill?

A

-stomach ache
-headache
-nausea/vomiting
(if the patient vomits she needs to get an IUD or take another pill)

42
Q

What are the options for emergency contraception?

A
  • morning after pill: Levonelle (<3d) and EllaOne (<5d)

- copper IUD

43
Q

How do the morning after pills work?

A
  • Levonelle: man-made progesterone to stop or delay the release of an egg
  • EllaOne: contains Ulipristal Acetate to stop progesterone working so stops or delays the release of an egg
44
Q

What is the draw-back of EllaOne?

A

can’t be given if contraception is being taken within 7 days and stops any quick-start contraception started

45
Q

What are the features of the copper IUD for emergency contraception?

A
  • up to 5 days after sex or 5 days within date of ovulation
  • more effective than the pill
  • can then be left in
  • releases copper to stop the egg implanting in the endometrium and is toxic to the egg
46
Q

When is the next time you can ovulate after a third trimester pregnancy?

A

28d so contraception cover needed from 21d

47
Q

What is the transmission of Hepatitis A?

A

fecal-oral so MSM

My Reproduction (8 decks)

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