Sexual Health and Contraception

Question 1

Fraser guidelines-

Answer 1

Regarding sexual health for under 16s.

1) Best interest to not inform parents.
2) Will have sex regardless
3) Benefit to their health.
4) Not be convinced to tell their parents.
5) Understand the advice.

Question 2

Contraindications of contraceptions-

Answer 2

COCP- Protective against endometiral and ovarian cancer, increase risk with breast and cervical.
Post-partum- Avoid COCP for 6wks, 6 months if breast feeding, IUD/IUS for 4 wks. Can use POP anytime.
Obese- Avoid COCP, patch and vaginal ring- increase VTE risk.

Question 3

Combined Hormonal Contraception-

Answer 3

Prevents ovulation, increases endometrial proliferation.
Contraindicated in- obesity, migraine with aura, diabetes, Hx/FHx of VTE, smoking, HTN.
Should take for 21 days, with 7 day pill free period. But can reduced the number of PFP or not have one at all.

Question 4

COCP-
Take it…
Advantages
Disadvantages

Answer 4

Take within the first five days of menstrual cycle. If taken as emergency contraception (i.e. not in first week) then need to abstain from sex of use barrier.
Protects against endometrial/ovarian cancers, reduce acne, reduce menorrhagia and menorrhoea, acne. But can increase breast/cervical cancer, increase VTE, IHD and stroke.

N.B Once stopped fertility is restored.

Question 5

COCP-
Side effects
Follow up

Answer 5

Abdo pain, N+V, headache, breast tenderness, HTN, mood changes.
If woman vomits within 3hrs of ingestion then needs to take another pill.
Follow up 3 months after first prescription, then yearly. Check BP, BMI, new RF, knowledge on missed pills etc.

Question 6

COCP- missed pill rules

Answer 6

21 days on with 7 days off.
If missed 1 pill then take once remembered even if take 2 on one day.
If missed >1 then take 1 once remembered even if take 2 on one day.
If missed in week 1 then use emergency contraception.
If missed in week 2 then continue and use contraception for 7 days.
If missed in week 3 then finish the pills in the pack for that day (i.e. missing out the PFP) and start the new pack the next day.

Question 7

Combined transdermal patch-

Answer 7

Very effective, one patch will secrete oestrogen and progesterone over 24hrs for 7 days. Replace weekly, and use for 21 days with 7 days off.
Start at beginning of menstrual cycle, otherwise abstain/use barrier contraceptive for 7 days.
Same SE as COCP, don’t use with rifampicin, anti-epileptics, St Johns wart or anti-retroviral
Look up guidelines for detached patch.
Place on dry, lotion free, non red area of skin, same day every week.

Question 8

POP-

Answer 8

Progesterone will thicken cervical mucus, produce hostile environment for implantation, reduce ovulation, .
Should take 1 every day, take at exact same time each day +/- 3hrs. No PFP.
Start day 1-5 no need for barrier, otherwise use barrier.
Side effects- libido, weight changes, headaches, ectopic, mood changes etc.
Missed pill- take as soon as remembered, use contraception for next 48hrs.
If vomit within 2hrs take another pill.

Question 9

Progesterone implant-

Answer 9

Implanted into arm by healthcare professional, lasting up to 3 years. V.effective, not many SE, can cause irregular bleeding, acne, pain on insertion (since minor surgery). Can take up to 55yrs/menopause.
Inhibit ovulation and thicken cervical mucus.

Question 10

Progesterone injectables-

Answer 10

IM, lasting 8-13wks.
Effective, contraindicated in current breast cancer. SE- mood swings, headaches, weight gain. Take a year to regain fertility.

Question 11

IUS- Mirena coil

Answer 11

Change every 3-5yrs. Safe and effective; prevents ovulation and thickens cervical mucosa. Inserted after day 1-5 of menstrual cycle then need 7 days abstain/barrier.
But can cause mood changes, may fall out, infection, pain on insertion, PID, perforation of uterus wall, weight gain, acne, reduced libido.
Safety net if feeling any (abdo) pain or unwell, or if cant feel the string for the coil.

Question 12

IUD- Copper coil

Answer 12

Copper is spermatotoxic, the coil lasts for 5-10yrs. If cant feel threads, abstain from sex, HCP to look for it, otherwise abdo-pelvis XR to see if embedded elsewhere.
Pain on insertion, PID, ectopic, perforated uterus wall.

Question 13

Barrier contracpetions-

Answer 13

Male/female diaphragms, cervical caps, spermicide (use in conjunction with diaphragms and caps).

Question 14

Emergency contraception-

Types

Answer 14

Progesterone pill- take within 3 days.
Ulipristal acetate- take within 5 days.
Copper IUD- take within 5 days.

Question 15

Emergency contraception-

Indications

Answer 15

Failed barrier, terminate pregnancy, use of withdrawal method, no contraception used.

Question 16

Gillick Competence-

Answer 16

Assessing if children aged 13-16 are competent.