Womens Sexual Health

Question 1

Endometriosis symptoms

Answer 1

Painful periods - starts a few days before periods and lasts throughout
Pain during sexual intercourse - may last a few hours after
Pain in lower abdomen, back and pelvic area
Dull, aching in nature
Worsens just before and during menstruation
Bleeding in between periods
Heavier periods

MUST REFER TO GP

Question 2

Fibroids symptoms

Answer 2

Heavy or more painful periods
Bloating or swelling in lower abdomen
Lower back pain
Urinary frequency
Constipation
Pain during sexual intercourse
May cause problems during pregnancy, miscarriage or infertility

MUST REFER TO GP

Question 3

Pelvic inflammatory disease

Answer 3

It is infection of the uterus and fallopian tube
Mild to severe pain in the lower abdomen
Abnormal vaginal bleeding - heavier periods, bleeding between periods, bleeding after sexual intercourse
Pain during sexual intercourse
Abnormal vaginal discharge
Fever
Low back pain

MUST REFER TO GP

Question 4

Pre menstrual syndrome symptoms

Answer 4

Symptoms occur each month before a period
Psychological symptoms - tension, irritability, fatigue, feelings of aggression or anger, low mood, loss of confidence, anxiety, feeling emotional, changes in sleep pattern, sexual feelings, appetite

Physical symptoms - Breast swelling and tenderness, Abdominal bloating, Swelling of the feet or hands, weight gain, headache

Question 5

Treatment of PMS

Answer 5

Calcium 1000-1200mg a day
Magnesium 200-400mg a day for two weeks before period

Primrose oil helps with breast tenderness

Question 6

Primary dysmenorrhoea symptoms

Answer 6

Cramping lower abdominal pain, starts at or upto a day before starting periods and eases as bleeding progresses.
Lasts 12-24 hours
Headache, fatigue, back ache, diarrhoea, constipation, breast tenderness, nausea, GI discomfort, bloating, feeling faint, dizziness, tearfulness

Question 7

Dysmenorrhoea treatments

Answer 7

NSAIDs are first line to reduce prostaglandin activity and reduces bleeding
Ibuprofen
Diclofenac
Naproxen
Take after food
Other treatments include - paracetamol with or without codeine, aspirin, hyoscine, caffiene

Question 8

Causes of vaginal thrush

Answer 8

Antibiotics predispose due to effect on normal flora
- Alkaline vaginal environment
- Lack of oestrogen (older women)

Question 9

Vaginal thrush symptoms

Answer 9

Vaginal discharge (cream coloured, thick and curdy - cottage cheese), sometimes watery, odorless
Intense pruritis
Burning itch
Vulval redness, discomfort or pain
Pain/discomfort on urination
Discomfort/pain during sexual intercourse

Question 10

Treatments for vaginal thrush

Answer 10

• Topical azoles
• Oral fluconazole 150mg single dose preferred when vulval area is sore, potential for interaction with warfarin.
• Treat partner only if symptomatic

Avoid tight fitting clothes
Cotton underwear
Avoid perfumed products
Avoid vaginal douches
Avoid feminine itching products
Wipe from front to back after defecation

Question 11

Red flag symptoms for vaginal thrush

Answer 11

Under 16 years or over 60 years
First occurence
Pregnancy or suspected pregnancy
More than 2 attacks in the previous 6 months
Previous history of STD/Exposure to partner with STD
Abnormal/irregular vaginal bleeding
Blood stained discharge
Vulval sores, blisters or ulcers
Lower abdominal pain or dysuria
Known hypersensitivity to antifungals
Redness, irritation, swelling due to treatment
No improvement within 7 days of treatment
Diabetics
Immunocompromised patients

Question 12

Bacterial vaginosis symptoms

Answer 12

Due to overgrowth of various bacteria in vagina
Vaginal discharge (white-greyish in colour, thin, fishy smelling, smell most noticeable during sex, heaviest during period)
No itch or soreness around the vulval
MUST REFER

Question 13

Trichomoniasis symptoms

Answer 13

Vaginal discharge (green-yellow in colour, malodorous - sometimes fishy)
Vagina may be itchy and uncomfortable
Painful sexual intercourse
Painful urination
MUST REFER

Question 14

Cystisis symptoms

Answer 14

Usually starts suddenly
Dysuria (pain, burning)
Urinary frequency
Only passing small amounts of urine
Urgency
Feeling of incomplete emptying of bladder
Cloudy, strong foul smelling urine
Lower abdominal pain/tenderness
Lower back pain

Systemic symptoms - Fever, nausea, vomiting (indicative of upper UTI)

Question 15

Cystitis referral

Answer 15

Children and men
Elderly
Pregnancy
Symptoms suggestive of diabetes
Recurrent cystisis
Systemic symptoms suggestive of upper UTI
Haematuria
Vaginal discharge

Question 16

Cystisis treatment

Answer 16

May resolve without treatment
- Paracetamol or ibuprofen
- Potassium/sodium citrate/ sodium bicarbonate
2 days max (refer if no improvement)

Avoid potassium citrate if on potassium sparing diuretics, aldosterone antagonists, ACE inhibitors, kidney disease

Avoid sodium citrate/bicarbonate if hypertension, heart disease, pregnancy

Question 17

Advice about cystisis

Answer 17

Drink lots of fluid
Urination immediately after sexual intercourse
Wiping from front to back after defecation
Complete emptying of the bladder - wait 20s after voiding then strain to empty last drops, lean backwards
Cranberry juice (no evidence)

Question 18

Chlamydia

Answer 18

Bacterial infection
In women, it affects the cervix and uterus
In men, it affects the urethra in the penis
Can sometimes cause infections in the lungs, eyes and throat.
Passed from sexual contact via:
- Unprotected sex
- Sharing sex toys
- From mother to baby during birth

Question 19

Chlamydia screening

Answer 19

Done for free for 16-24 year olds. Tests done via urine analysis in men and through swabs in women
Women and men under 25 years are required to do chlamydia screening every year or when you change sexual partner.
If anal or oral sex, then rectum or throat swab is done

Question 20

Chlamydia treatment

Answer 20

1st line: Azithromycin oral capsules 250mg x 4 (1g) orally as a single dose (P licensed)
2nd line: Doxycycline oral capsules 100mg BD for 7 days

No sex for a week after completing treatment and partners must be treated too

Question 21

What is emergency contraception

Answer 21

Contraceptive measure taken after sexual intercourse to prevent pregnancy

Question 22

Levonorgestrol (Levonelle)

Answer 22

72 hours - 1.5mg
Over 16 years
Prevents or delays ovulation
Does not disrupt implanted embryo
Does not cause abortion
Effective until LH surge
Number of times in a cycle
If patient vomits within 3 hours, then another dose is to be taken

Question 23

Ulipristal acetate (EllaOne)

Answer 23

120 hours - 30mg
Under 16 years is not contraindicated
Prevents or delays ovulation
Effective in LH surge
Not recommended if possibility of implanted pregnancy
Only once in cycle
If vomits within 3 hours, another dose needs to be taken

Question 24

Copper intrauterine device

Answer 24

5 days
Copper ions have direct effect on sperm
Impedes implantation
May stop implantation
Fitted within 5 days of unprotected sex or within 5 days of ovulation

Question 25

Emergency hormonal contraception questions

Answer 25

Are you pregnant?
Last menstrual period?
Other episodes of unprotected sex since last menstrual period or in the last three weeks?
Periods normal and on time?
Currently on contraception and taking normally?

Question 26

COC failure

Answer 26

One missed pill between 24-48 hours
- Take asap
- Continue taking at the normal time
- Does not require emergency hormonal contraception

2 or more missed pills:
- Take asap
- Continue taking at the normal time
- Action required depending on pill taking week

Week 1:
- If unprotected sex was in pill free interval or week one then take EHC for days 1-7 with the use of condoms until 7 consecutive days complete

Week 2:
No indication of all pills prior taken correctly and following 7 days taken correctly

Week 3:
No indication, however do not have a pill free week and start new pack next day

Question 27

Tranexamic acid

Answer 27

OTC tranexamic acid 500mg for reduction of heavy menstrual bleeding
- Taken when heavy bleeding starts
- Two 500mg tablets three times a day
- Not to be taken for more than 4 consecutive days

Question 28

Tamsulosin

Answer 28

OTC tamsulosin 400mcg
Treatment of benign prostatic hyperplasia symptoms in men ages 45-75 years
Symptoms:
- Difficulty when starting urinating
- Urinating more frequently or for longer

Single 400mcg to be taken everday after the same meal
Provide 2 weeks supply and if there is improvement another 4 weeks OTC supply but patient should be advised to see their doctor within 6 weeks.
If doctor confirms the continuation of use then can be supplied further.
Patient should see their doctor every 12 months for a review

Question 29

Lifestyle advice for benign prostatic hyperplasia

Answer 29

Avoid drinking fluids 1-2 hours before bed
Reduce alcohol and caffeine consumption
Regular exercise
Increase fruit and fibre in diet (to avoid constipation)
Avoiding unnecessary use of cold and allergy medication