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Women's health > Week 5 Sexuality > Flashcards

Week 5 Sexuality Flashcards

1
Q

Which of the following is considered a significant barrier to health care for LGBTQ patients?

A

Clinician knowledge Significant barriers to health care for LGBTQ patients include financial barriers, lack of insurance, historical trauma, lack of clinician knowledge, and restrictive healthcare systems, infrastructure, and policies (Schuiling & Likis).

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2
Q

What should the NP take into consideration regarding health risks for LGBTQ patients when compared to non-LGBTQ patients?

A

Dosage amounts of estrogen in hormone therapy and oral contraceptives vary between the two. The amount and type of estrogen available in hormone therapy and oral contraceptives are not the same. Substance abuse is higher in the LGBTQ population. Further studies are needed to understand the rates of PCOS in transgender men. Puberty significantly alters the hormone options for transgender children (Schuiling & Likis; Module 5.6).

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3
Q

What HPV types cause most genital pre-cancers and cancers?

A

16 & 18

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4
Q

At what age does ACIP recommend routine HPV vaccination for adolescents?

A

Age 11 or 12: two doses scheduled (at 0 and 6–12 months; two doses at least 6 months apart)

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5
Q

What HPV types cause most genital warts?

A

HPV 6 and 11 (low-risk, non-oncogenic) cause 90% of genital warts

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6
Q

How are genital warts diagnosed?

A

Visual inspection usually sufficient to diagnose

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7
Q

What are some risk factors associated with acquiring HPV and cervical cancer? #6

A
  1. Sexual activity at early age,
  2. Multiple sexual partners,
  3. High-risk sexual practices,
  4. Smoking,
  5. Lower socioeconomic status,
  6. Weakened immune system
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8
Q

What options are recommended to screen women age 30 and older for cervical cancer?

A

Cytology (Pap) alone every three years, Cytology (Pap) and HPV test (co-testing) every five years

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9
Q

At what ages should cervical cancer screening begin and end?

A

Routine screening should begin at age 21 and continue through age 65 years to prevent invasive cervical cancer.

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10
Q

How often should women ages 21–29 be screened for cervical cancer?

A

Cytology (Pap) alone every three years recommended for routine screening (HPV testing should not be used to screen as a co-test and used only as a reflex test if cytology (Pap) is ASC-US)

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11
Q

High risk types of HPV

A

16 and 18

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12
Q

What are the low risk strands of HPV

A

6 and 11

associated with genital warts

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13
Q

What type of cancer does HPV 16 cause

A

squamous cell cervical cancer

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14
Q

what type of cancer does HPV 18 cause?

A

Adenocarcinoma

“Glandular cells”

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15
Q

What makes individuals higher risk for HPV infection?

A
  • Immunosuppression (HIV)
  • high parity =3+
  • smoking
  • long term use OCP (normal risk after off 10 years)
  • nutrition (low vit c and folate)
  • sex at early age (immature cells)
  • multiple partners
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16
Q

Diethylstilbestrol (DES)

A

risk factor for non HPV cervical cancer

daughters of women who took DES are 40x more likely to develop clear cell adenocarcinoma of cervix and vagina

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17
Q

What is clear cell adenocarcinoma of cervix?

A

rare neoplasm of all cervical adenocarcinomas

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18
Q

Does IUD increase risk of cervical cancer?

A

No, reduced risk

“may mobilize immune system with chronic low grade inflammation”

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19
Q

What is the biggest risk factor for cervial cancer?

A

persistent HPV infection

leads to cervical dysplasia/precancer

especially over 10 years

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20
Q

When will most people clear HPV

A

after 1 to 2 years

not lifelong

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21
Q

What does the squamous epithelium cover?

A

vagina and outside of cervix

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22
Q

what does the columnar epithelium cover?

A

brighter red in color

covers inner cervix and endometrial canal

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23
Q

____ females and during ______ more columnar epithelium is exposed on surface of cervix and sometimes calls ________ or eversion

A

YOUNGER females and during PREGNANCY more columnar epithelium is exposed on the surface of the cervix and sometimes called CERVICAL ECTOPY or eversion

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24
Q

with advancing age the _____ cells are replaced by _______: this is called ________

A

with advancing age the Columnar Epithelium cells are replaced by Squamous Cells: this is called Metaplasia and the SCJ migrates up towards the cervical OS and into cervical canal

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25
Q

What is the Transformation Zone?

A

Area of actively maturing epithelium

Where metaplasia occurs

Most common place on the cervix for abnormal cells to develop

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26
Q

When to start cervical screening

ACOG =

USPSTF =

ACS =

A

ACOG = 21

USPSTF = 21

ACS = 25

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27
Q

What are general cervical screening recommendations and type of screening

<21 years

21 - 29 years

30+ years

A

<21 years = No screening

21 - 29 = Cervical Cytology Q 3 years

30+ years =

  1. Cervical cytology Q 3 years OR
  2. Co-Testing: Cervical cytology and high=risk HPV Q 5 years OR
  3. HPV alone testing Q 5 years
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28
Q

Cervical cancer screening recommendations for someone over 65 years

A

not recommended

3 consecutive negative pap tests in a row

OR

2 negative HPV co test results in a row in past 10 years with most recent in past 5 years

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29
Q

Cervical cancer screening recommendations for total hysterectomy

A

No pap needed unless…

history of cervical cancer in last 20 years = screen for 20 years after surgery

30
Q

what is a reflex HPV

A

HPV test added on after pap test is abnormal

Used to triage abnormal pap tests such as ASCUS results

31
Q

What is a co-test?

A

HPV test ordered along with pap test (cytology)

Ages >30 years

HPV test performed regardless if pap test is normal or absnormal

32
Q

What is primary HPV testing

A

HPV test alone with NO PAP

33
Q

True or False

  1. HPV testing should be done as part of routine STI screening
  2. People who receive the HPV vaccine do not need pap tests anymore
  3. The time lapse between HPV infection and cervical cancer is about 2 years
A
  1. False
  2. False; doesn’t cover all strands
  3. False; 10 years when it causes cervical cancer cell changes
34
Q

Yes or No?

  1. 31 y/o had a negative pap 2 years ago. Should she have a pap today?
  2. 21 y/o with an abnormal pap wants to get HPV vaccine, is it safe to get the vaccine with this abnormal pap test?
  3. 60 y/o with a negative pap and neg HPV test 3 years ago. Does she need a pap today?
A
  1. No; Q 3 years
  2. Yes;
  3. No; Q5 years
35
Q

yes or no?

  1. 66 y/o who has a history of negative pap tests and has been up to date on her routine cervical cancer screenings. She asks you if she can stop having pap tests now?
  2. 38 y/o with Total hysterectomy for benign reasons and no PMH of abnormal pap tests. Does she still need pap testing?
A
  1. Yes; she can stop
  2. No; no history of cancer and no cervix
36
Q

What are the 3 main categories for reporting cervical cytology

A
  1. Negative for intraepithelial lesion or malignancy
  2. Other: See interpretation result (EX endometrial cells in a women >45 years)
  3. Epithelial cell abnormality: see Interpretation result (specify squamous or glandular)
37
Q

Epithelial Cell abnormalities: Squamous Cell types abnormalities #4

A
  1. Atypical squamous cells: mildly abnormal, unable to determine precancer or cancer ORDER HPV REFLEX
  2. Low-grade squamous intraepithelial lesion (LSIL): 1/3 way through cervix
  3. High-grade squamous intraepithelial lesion (HSIL): severe dysplasia; 2/3 thickness
  4. Squamous cell carcinoma: malignant cells penetrate basement membrane
38
Q

Cervical cytology: Glandular Cell abnormalities

A

ENDOcervix: found higher up in cervix

atypical glandular cells have increased association with high grade disease

39
Q

True or False

  1. Atypical glandular cells are more concerning than atypical squamous cells on pap?
  2. Atypical Squamous cells on pap in 26 y/o patient: can ordering an HPV reflex test aid in triaging results?
  3. Negative pap (cytology) with positive HPV co test for HPV 16 in a 35 y/o means the patient should be referred to GYN for colposcopy and biopsy
  4. 21 y/o with LSIL on 1st pap test should be referred to GYN for colposcopy
A
  1. True; glandular are higher more dangerous
  2. Yes; order HPV reflex
  3. Yes; REFER
  4. No; repeat in year
40
Q

true or false: you need to perform other STI screening when genital warts are present

A

true

41
Q

Molluscum contagiosum

Cause

Transferred by….

A

POX virus

skin to skin contact

42
Q

Condyloma lata

Cause

what does it look like?

A

Secondary syphilis

Flatter & wider than HPV warts

43
Q

How long does it take for warts to respond to treatment?

What do you do if they do not?

A

most respond in 3 months

if not, consider another option or surgery

MAKE SURE TO ALWAYS SCREEN FOR HIV & SYPHILIS

44
Q

What ages are gardasil 9 approved for?

A

Ages 27 to 45

Can be given as early as 9

45
Q

What is the HPV vaccine schedule for <14 years old

A

2 doses given at least 6 months apart

46
Q

What is the HPV vaccine schedule for >15 years

A

3 doses given over 6 months

0, 1-2, & 6 months

47
Q
A
48
Q

PrEP takes ____ days to build protective levels of PrEP in anal and rectal tissues and _____ days to achieve protective levels in vagina and blood

A

PrEP takes 7 days days to build protective levels of PrEP in anal and rectal tissues and 20 days days to achieve protective levels in vagina and blood

49
Q

What are the PrEP medications?

A

Truvada/Atripla - approved for vaginal sex

Descovy

50
Q

What are the recommendations for PrEP? #6

A
  1. Documented negative HIV test result before prescribing & Q 3 months
  2. No s/s of acute HIV infection
  3. STI screening Q 3 to 6 months
  4. GFR Q 6 months
  5. Pregnancy screening & intent Q 3 months
  6. Hep B vaccination/status…Chronic infection = test Q 6 to 12 months (might cause reactivation of Hep B)

*people with acute HIV infection at risk of developing resistance if started on PrEP*

51
Q

When can you take PEP?

How is it taken?

A

up to 72 hours after post HIV exposure

Take 3 ART for 28 days to prevent HIV infection

52
Q

What are the breast cancer screening recommendations for trans women?

A
  • Mammogram Q2 years if 50 & on estrogen for 10 years
53
Q

What labs do you want to monitor if someone is on testosterone therapy?

A
  • Lipids: increases triglycerides
  • CBC: watch polycythemia
  • CMP
  • Total Testosterone: goal 400 to 1000
54
Q

What labs do you want to monitor for someone on estrogen therapy?

A
  • Total testosterone: 40-80
  • Prolactin: look for prolactin tumors
  • CBC: lower H&H
  • CMP: monitor K with diuretc meds
55
Q

What age do you start Transgender children medications

How long until fertility returns for these children?

A

Tanner stage 2 or 3 for 3 years with GnRH analogues

*concern about bone growth*

*Reversible

Fertility return ranges from 3 to 6 months; some may experience permanent loss

56
Q

Your patient’s pap results revealed atypical glandular cells. What is your next step of action? Why?

A

Means there are atypical cells higher up in ervix

could be sign of adenocarcinoma

REFER for colposcopy

57
Q

if someone is 25 y/o has low grade pap test what do you do?

A

refer to colposcopy

58
Q

When would you stop HPV screening?

A
  • Stop screening at 65 years if
    • 3 consecutive negative pap tests or
    • 2 negative HPV tests
    • No history of CIN 2 or higher cervical dysplasia within last 20 years
59
Q

What is first line cervical dysplasia treatment?

A

LEEP/LOOP

Electrical surgical excision

60
Q

If a woman has a normal pap test with high risk HPV cotest…what do you do?

A

Repeat pap in one year

Genotype to see if she has 16 or 18

61
Q

Transmale time frames

0 to 3 months

3 to 6 months

6 months to 5 years

A
  • 0-3 months
    • Libido changes (can cause worsening dysphoria because can’t masturbate/sex with correct genitals)
    • Increased appetite
    • Increased body hair***
  • 3-6 months
    • Genital changes***
    • cessation menses
    • Increase muscle mass/strength (quickly in shoulders, neck & trapezius)
    • Voice changes (full pitch change at 2 years)
  • 6 months – 5 years
    • Development terminal facial hair*** (depends on genetics
    • Hair loss based on genetics*** (usually at 5 year mark)
    • body fat redistribution into abdomen
62
Q

What is a matoidplasty

Phalloplasty

A
  • Metoidioplasty:
    • create small phallus (only 6 surgeons in world) oral, buccal mucosa used to increase girth; reroute urethra….
    • testicular implants
    • Orgasm preserved
  • Phalloplasty
    • Creates realistic phallus using forearm and lower leg skin
    • Sensation but not erectile function
63
Q

What labs do you monitor on Transmale

A
  • Monitor
    • CBC: polcythemia risk
    • CMP: elevated cholesterol and triglycerides
    • Total Testosterone: 300-1200
    • Monitor prolactin, CBC (polycythemia risk); lipids (higher risk for hypercholesterolemia); higher sex drive, body changes
64
Q

What are the changes for transfem

0 to 3

4 to 10

10 months to 4 years

A
  • 0-3 months
    • lower libido
    • Softening skin
    • Breast budding **permanent
    • Emotional changes
  • 4-10 months
    • genitalia changes; genitalia atrophy
    • Facial hair will be softer but will not stop growing
    • softening hair
    • decreased muscle mass
    • Cessation of spermatogenesisi **permanent
  • 10mo -4years
    • Breast maturation
    • Body fat redistribution
65
Q

What is the MOA for Imiquimod?

A

active immune enhancer;

stimulates production of interferon and other cytokines

66
Q

Podofilox

MOA

Contra indication

A

MOA: antimiotic that causes wart necrosis

Contraindication: Pregnancy,

**total area needs to be <10cm or toxic

67
Q

What are provider administered therapies?

A

Trichloroacetic acid or biochloroacetic acid

cryotherapy

surgical removal

68
Q

Trichloroacetic acid or bichloroacetic acid

MOA

Side Effect

Response time

A

MOA: destroys warts by chemical coagulation of protiens

*white frost on tissue*

Side Effect

  • pigmentation
  • moderate pain

Response time: 3 months

69
Q

Gardasil 9

ages recommended

contraindication

A

Age 9 to 26 years

Contraindication : yeast allergy

70
Q

Bivalent HPV

What does it protect against

who is it for?

contraindication

A

HPV 16 and 18 only

9 to 25 years….FEMALES ONLY

Contraindication: latex allergy

Women's health (10 decks)

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