Module 15 - Sexual & Reproductive Health

Question 1

Delayed puberty occurs in approximately what percentage of children?

Answer 1

3%

It is more common in boys

Question 2

Precocious puberty is defined as the development of secondary sexual characteristics at what age?

Answer 2

<8 years old

Question 3

How is delayed puberty defined in boys and girls?

Answer 3

Lack of testicular development or testicular volume <4ml in boys >14 yrs

Lack of breast development in girls >13 yrs

Question 4

How common is expulsion of an IUCD (over 5 years)?

Answer 4

Occurs in 1 in 20 women over 5 years

Most common within the first 3 months of insertion

Question 5

What is the incidence of premature ovarian failure in women under 40?

Answer 5

1%

Premature ovarian failure affects 1% of women under 40

Question 6

A 25 year old woman has unprotected SI with her husband D25 post ELCS. She is breatsfeeding sporadically. She opts for Ulliprostal acetate 30mg. She asks about the risks to breastfeeding?

Answer 6

Discard breast milk for 1 week after taking ullipristal acetate

Women who breastfeed should be advised not to breastfeed and to express and discard
milk for a week after they have taken UPA-EC

Question 7

A 25 year old woman has unprotected SI with her husband D25 post ELCS. She is breatsfeeding sporadically. She opts for Levonorgestrel 1.5mg. She asks about the risks to breastfeeding?

Answer 7

No risks, she can continue

Women who breastfeed should be informed that available limited evidence indicates that
LNG-EC has no adverse effects on breastfeeding or on their infants.

Question 8

Can women who breastfeed effectively use lactational amenorrhoea method (LAM) as
contraception?

Answer 8

If <6 months postpartum, fully breastfeeding and amenorrhoeic then lactational amenorrhoea method is a highly effective form of contraception

If reducing breastfeeding, starting using supplemental feeds, menstruating or >6 months postpartum it is less effective and other forms of contraception are recommended

Question 9

What marks the start of puberty for girls?

Answer 9

The ability to sexually reproduce

Question 10

What is the definition of precocious puberty in girls?

Answer 10

The development of secondary sexual characteristics <8 years old

Question 11

What is the definition of precocious puberty in boys?

Answer 11

The development of secondary sexual characteristics <9 years of age

Question 12

What is the definition of delayed puberty in girls?

Answer 12

The absence of breast development by age 13

Question 13

What is the definition of delayed puberty in boys?

Answer 13

The absence of testicular development, or testicular volume <4ml by age 14

Question 14

What is the normal range of puberty for girls?

Answer 14

Age 8 - 13

Question 15

What is the normal range of puberty for boys?

Answer 15

9-14

Question 16

You are discussing contraception with a 22 year old woman. She is interested in the Nexplanon® contraceptive implant. What would you advise her is the commonest reason for discontinuing with the implant?

Answer 16

Irregular/prolonged vaginal bleeding

20% (1 in 5) women will discontinue nexplanon due to irregular/prolonged vaginal bleeding

Question 17

What proportion of women will have amenorrhoea after using Nexplanon?

Answer 17

20% (1 in 5)

Question 18

What is the failure rate with typical use of nexplanon?

Answer 18

0.05%

Failure rate close to zero (0.05%) with typical use i.e. most effective reversible contraceptive

Question 19

What is the background risk of VTE in non contraceptive users who are not pregnant?

Answer 19

2 per 10,000

Question 20

What is the risk of VTE in pregnancy?

Answer 20

10 per 10,000

Pregnancy gives a 5x fold increase in VTE risk

Question 21

What is the VTE risk of women taking CHC containing ethinylestradiol plus levonorgestrel, norgestimate or norethisterone?

Answer 21

5-7 per 10,000

Question 22

What is the VTE risk of a woman taking CHC containing ethinylestradiol plus gestodene, desogestrel or drospirenone?

Answer 22

9-12 per 10,000

Question 23

What is the most common cause of genital ulceration worldwide?

Answer 23

Chancroid

Question 24

What is the recurrence rate of BV?

Answer 24

58%
(50-60%)

Question 25

What is the most common cause of infective vaginal discharge?

Answer 25

Bacterial vaginosis

Question 26

What is the second most common cause of infective vaginal discharge?

Answer 26

Vulvo-vaginal candidiasis

Question 27

What is Amsel's criteria?

Answer 27

Used to diagnose BV. Require 3/4 of the following: 1) Vaginal pH >4.5 2) Homogenous, white, non-viscous discharge 3) Positive 'whiff' test 4) >20% clue cells

Question 28

OCP is protective for which cancers?

Answer 28

Ovarian cancer Endometrial cancer Colorectal cancer

Question 29

OCP is a risk factor for which cancers?

Answer 29

Breast cancer Cervical cancer

Question 30

You are discussing contraception with a 21 year old woman. She is interested in the Nexplanon® contraceptive implant. What would you advise her regarding the failure rate of Nexplanon® with typical use in 1 year?

Answer 30

0.05%

Question 31

What percentage of women will discontinue Nexplanon due to heavy or irregular bleeding?

Answer 31

20% (1 in 5)

Question 32

What is the risk of uterine perforation following IUD insertion?

Answer 32

0.2%

Question 33

What is the risk of ectopic pregnancy if pregnancy occurs with an IUD in-situ?

Answer 33

1 in 20

Question 34

A 49 year old woman comes to see you in clinic. She is perimenopausal and has been started on cyclical (sequential) hormone replacement therapy. She tells you she is in a new relationship and asks if the HRT will be contraceptive. Cyclical HRT inhibits ovulation in what percentage of patients?

Answer 34

40% Cyclical HRT only inhibits ovulation in 40% of women so there is still a risk of pregnancy. Contraception should therefore be prescribed in addition to cyclical HRT

Question 35

What proportion of pregnancies in women >40 years old are unplanned?

Answer 35

20%

Question 36

What proportion of pregnancies in women >40 years old end in termination?

Answer 36

28%

Question 37

In women >50 years old using non-hormonal contraception when can you stop contraception?

Answer 37

After 1 year of amenorrhoea

Question 38

In women <50 years old using non-hormonal contraception when can you stop contraception?

Answer 38

After 2 years of amenorrhoea

Question 39

If >50 years old and using progestogen-only contracpetion, when can you stop contraception?

Answer 39

1 year after recording 2x FSH levels >30 at least 6 weeks apart **You can use 2x FSH levels 4-6 weeks apart to diagnose menopause in women <50 years old, but cannot use it to stop contraception in women <50 years old**

Question 40

How long do you need to stop the COCP for before testing FSH to diagnose menopause?

Answer 40

2 weeks

Question 41

How long do you need to stop the depot injection for before testing FSH to diagnose menopause?

Answer 41

12 months

Question 42

You are discussing postpartum contraception with a 32 year old woman. She has expressed an interest in the copper intrauterine device (IUCD). She is breastfeeding and is concerned about the risk of perforation. What is the risk of perforation in breastfeeding women compared to non-breastfeeding?

Answer 42

6x higher in breastfeeding women

Question 43

What is the risk of VTE in non-pregnant women not taking hormonal contraception?

Answer 43

1-2 in 10,000

Question 44

What is the risk of VTE in pregnancy?

Answer 44

8-10 in 10,000 Relative risk of VTE in pregnancy is increased 4 to 6 fold compared to non-pregnancy

Question 45

What is the absolute risk of VTE in pregnancy?

Answer 45

1-2 in 1,000

Question 46

What is the risk of VTE in women taking CHC containing ethinylestradiol plus levonorgestrel, norgestimate or norethisterone?

Answer 46

5-7 in 10,000

Question 47

What is the risk of VTE in women taking CHC containing etonogestrel (ring) or norelgestromin (patch)?

Answer 47

6-12 in 10,000

Question 48

What is the risk of VTE in women taking CHC containing ethinylestradiol plus gestodene, desogestrel or drospirenone?

Answer 48

9-12 in 10,000

Question 49

What is the risk of VTE in women taking POP or prostogen-only contraception?

Answer 49

2 in 10,000

Question 50

There is a suspicion that a serious sexual assault on a 30-year-old bar woman was drug facilitated. Up to when after the assault can a blood sample be taken for forensic tests?

Answer 50

3 days

Question 51

There is a suspicion that a serious sexual assault on a 30-year-old bar woman was drug facilitated. Up to when after the assault can a vaginal sample be taken for forensic tests?

Answer 51

7 days

Question 52

There is a suspicion that a serious sexual assault on a 30-year-old bar woman was drug facilitated. Up to when after the assault can a peri-anal sample be taken for forensic tests?

Answer 52

3 days

Question 53

There is a suspicion that a serious sexual assault on a 30-year-old bar woman was drug facilitated. Up to when after the assault can an oral sample be taken for forensic tests?

Answer 53

2 days

Question 54

There is a suspicion that a serious sexual assault on a 30-year-old bar woman was drug facilitated. Up to when after the assault can a urine sample be taken for forensic tests?

Answer 54

14 days

Question 55

What proportion of women diagnosed with tubo-ovarian abscess are nulliparous?

Answer 55

60%

Question 56

What proportion of cases of TOA/PID are polymicrobial?

Answer 56

30-40%

Question 57

What proportion of cases of PID will develop a TOA?

Answer 57

15-35%

Question 58

What are the features of MRKH (Mayer Rokitansky Kuster Hauser) Syndrome?

Answer 58

Incidence: 1 in 1,5000 births Mullerian agenesis Absent of uterus and vagina Short or blind-ended vagina Normal sexual characteristics Primary amenorrhoea 40% have renal abnormalities 12% have one kidney 3% have hearing hoss Treatment: Vaginal dilators and psychological support. 95% success rates with sexual intercourse Surgery also an option

Question 59

What are the features of complete androgen insensitivity syndrome?

Answer 59

Previously known as Testicular Feminisation syndrome Genotype: 46XY (male) Phenotype: Female X-linked recessive inheritance. Passed down maternal line Insensitivity of testosterone receptor Features: - Inguinal hernias with testes - lap orchidectomy after puberty complete. Risk of malignancy is 20% by 4th decade of life - Sparse pubic hair - Short vagina - Absent uterus, cervix, tubes and upper 1/3 of vagina - Abdominal pain - Normal sexual intercourse - Normal secondary sexual characteristics (female body habitus, breast development) - Primary amenorrhoea

Question 60

What is the most common cause of ambigious genitalia?

Answer 60

Congenital adrenal hyperplasia

Question 61

A woman with chlamydia delivers her baby by SVD. When does chlamydia conjunctivitis develop in newborns?

Answer 61

5-12 days after delivery

Question 62

Which cancers does the COCP put you at risk of?

Answer 62

Breast cancer Cervical cancer

Question 63

What proportion of transgender people are sexually abused at some point of their lives?

Answer 63

1/2 50%

Question 64

When do you give PEPSE as prophylaxis after sexual assault?

Answer 64

ASAP, but within 72 hours Continue for 4 weeks

Question 65

What proportion of sexual assaults result in genital injuries?

Answer 65

1/4 25%

Question 66

What are the two most common psychosexual complaints women have?

Answer 66

1) Lack of desire/interest in sex 2) Lack of orgasm To qualify as sexual dysfunction needs to be present for >75% of the time for >6 months

Question 67

What is the effectiveness of the coitus interruptus (withdrawal method)?

Answer 67

Perfect use - 96% Typical use - 78%

Question 68

What is the effectiveness of the COCP?

Answer 68

Perfect use - 99.7% Typical use - 91%

Question 69

What is the treatment of acute candidiasis in pregnancy?

Answer 69

Clotrimazole 500mg p.v. for 7 days

Question 70

What is the treatment of recurrent candidiasis in pregnancy?

Answer 70

Clotrimazole 500mg p.v. for 10-14 days then weekly

Question 71

What is the treatment of acute candidiasis in non-pregnant women?

Answer 71

Fluconazole 150mg pv stat

Question 72

What is the treatment of recurrent candidiasis in non-pregnant women?

Answer 72

Fluconazole 150mg pv every 3 days for 3 doses then weekly for 6 months

Question 73

What is the definition of recurrent candidiasis?

Answer 73

≥4 episodes in 12 months

Question 74

What proportion of women experience recurrent thrush?

Answer 74

6%

Question 75

What proportion of women will experience at least 1 episode of thrush in their lifetime?

Answer 75

75%

Question 76

What proportion of candidiasis is caused by candida albicans?

Answer 76

80-90%