Womens Sexual Health Flashcards
Endometriosis symptoms
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
Fibroids symptoms
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
Pelvic inflammatory disease
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
Pre menstrual syndrome symptoms
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
Treatment of PMS
Calcium 1000-1200mg a day
Magnesium 200-400mg a day for two weeks before period
Primrose oil helps with breast tenderness
Primary dysmenorrhoea symptoms
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
Dysmenorrhoea treatments
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
Causes of vaginal thrush
Antibiotics predispose due to effect on normal flora
- Alkaline vaginal environment
- Lack of oestrogen (older women)
Vaginal thrush symptoms
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
Treatments for vaginal thrush
- 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
Red flag symptoms for vaginal thrush
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
Bacterial vaginosis symptoms
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
Trichomoniasis symptoms
Vaginal discharge (green-yellow in colour, malodorous - sometimes fishy)
Vagina may be itchy and uncomfortable
Painful sexual intercourse
Painful urination
MUST REFER
Cystisis symptoms
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)
Cystitis referral
Children and men
Elderly
Pregnancy
Symptoms suggestive of diabetes
Recurrent cystisis
Systemic symptoms suggestive of upper UTI
Haematuria
Vaginal discharge
Cystisis treatment
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
Advice about cystisis
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)
Chlamydia
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
Chlamydia screening
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
Chlamydia treatment
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
What is emergency contraception
Contraceptive measure taken after sexual intercourse to prevent pregnancy
Levonorgestrol (Levonelle)
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
Ulipristal acetate (EllaOne)
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
Copper intrauterine device
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
Emergency hormonal contraception questions
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?
COC failure
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
Tranexamic acid
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
Tamsulosin
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
Lifestyle advice for benign prostatic hyperplasia
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
