Module 19 sexual health

Question 1

dysmenorrhea

Answer 1

painful mestration

- usually begins with the onset of menses or 1-2 days before

Question 2

dysmenorrhea associated s/s

Answer 2

nausea
vomiting
diarrhea
headaches
dizzy
back pain

Question 3

primary dysmenorrhea

Answer 3

recurrent, menstrual-related pain in the absence of pelvic pathology
- thought to be due to release of prostaglandins from the endometrium

Question 4

secondary dysmenorrhea

Answer 4

describes painful menstruation in the presence of pelvic pathology

• endometriosis
• ovarian cysts
• infection

Question 5

best contraception for young women

Answer 5

long-active reversible contraception

Question 6

progesterone only Hormonal contraception

Answer 6

implant
IUD
Depo
mini-pill

Question 7

combined hormonal contraception

Answer 7

oral contraceptive pills
skin patch
vaginal ring

Question 8

implant

Answer 8

subdermal space of the upper inner non-dominant arm
controlled release of etonogestrel over a period of 3 years
MOA: ovulation suppression
- prevent conception by thickening the cervical mucus and altering the endometrial lining

Question 9

Copper IUD

Answer 9

ParaGard
approved for 10 years
MOA: produce a sterile foreign body reaction within the uterine cavity -> hostile environment for the sperm

Question 10

Hormonal IUD

Answer 10

Liletta: 3 years
Mirena: 7 years
Skyla: 3 years
Kyleena: 5 years 
MOA: create a sterile foreign body reaction within the uterine cavity -> hostile environment for sperm

Question 11

DEPO

Answer 11

progestin-only contraceptive
injection every 3 months
- intramuscular (150mg) or subQ (104mg) 
Repeat injections every 11-13 weeks 
Can go as long as 15 weeks

Question 12

Transdermal contraceptive patch

Answer 12

Xulane
thin, beige adhesive patch w/ progestin norelgestromin and ethyl estradiol
- apply to torso, buttocks, upper arms
- change weekly

Question 13

Nuvaring

Answer 13

soft, clear, flexible ring that releases the progestins etonogestrel and ethinyl estradiol

• insterted into the vagina
• replaced monthly

Question 14

combined hormonal contraception MOA

Answer 14

progestin component provides the majority of the contraceptive effect by preventing ovulation via negative feedback on the HPO axis
estrogen component is added to stabilize the endometrium and all for better cycle control

Question 15

progestin only pills, mini-pill

Answer 15

MOA: thickening of cervical mucus, blocking sperm from entering uterus

Question 16

Emergency contraception

Answer 16

used after unprotected sex or if there is a method failure

MOA: delay or inhibit ovulation

Question 17

Copper IUD as emergency contraception

Answer 17

prevent sperm from fertilizing an egg and may prevent implantation if inserted within 5 days of unprotected sex

Question 18

Male condom

Answer 18

no age restrictions on buying
carry a condom with you if sex is possible
check expiration date
ensure package is not damaged
use a water-based lubricant
unroll on an erect penis
withdraw when the penis is still erect, holding onto the base

Question 19

vasectomy

Answer 19

interrupts the vas deferens

-> prevents passage of sperm into the seminal fluid

Question 20

vasectomy advantages vs disadvantage

Answer 20

Advantage
- highly effective
- performed in clinic
- cost effective 
- no effect on sexual function 
Disadvantage
- takes 2-4 months to be effective 
- f/u visit to ensure effectiveness 
- procedure complications
-> infection, hematoma, granuloma, swelling, persistent pain 
- non-reversible 
- no STI protection

Question 21

Female sterilization

Answer 21

surgery to remove or interrupt the patency of fallopian tubes

Question 22

Female sterilization advantages and disadvantages

Answer 22

Advantage
- dec. risk of ovarian cancer (40%)
Disadvantage
- Regret
- invasive surgical procedure
- no STI protection
- Complications
-> Minor: infection, wound separation
-> Major: hemorrhage, viscus injury, anesthesia complications

Question 23

Lactational amenorrhea method

Answer 23

breastfeeding delays return to fertility

• prolactin inhibits ovulation
• baby must be exclusively breast fed
• infant less than 6 months old
• woman must be amenorrheic

Question 24

LAM advantage vs disadvantage

Answer 24

Advantage
- free
- breastfeed advantages
Disadvantage
- return of ovulation unpredictable
- breastfeeding issues
- tender breasts may dec. sexual pleasure
- difficulties maintaining EBF
- no protection for STI

Question 25

fertility awareness methods

Answer 25

``` monitoring cycle and only having intercourse during infertile phases - woman must have regular cycle Methods - calendar - standard days - cervical mucous - two-day - basal body temp - post ovulation - symptothermal - marquette ```

Question 26

FAM advantage vs disadvantage

Answer 26

Advantage - no change on menstrual cycle - only acceptable method in certain religions/cultures - can assist in achieve pregnancy when used in reverse Disadvantage - requires discipline - peak libido tends to be during ovulation - may be impacted by stress: cycle change - no STI protection - high failure rate

Question 27

cervical caps and diaphragms

Answer 27

can be placed anytime before intercourse - usually in conj. with spermicide should be left 6-8 hours after sex may be left in up to 48 hours after

Question 28

cervical caps and diaphragms advantage vs disadvantage

Answer 28

``` Advantage - woman in control - active immediately - may be used while lactating Disadvantage - no STI protection - may develop odor - difficult to insert - UTI's may increase - require fitting in clinical setting ```

Question 29

contraceptive sponge

Answer 29

prefilled with spermicide | - leave in place 6-24 hours after intercourse

Question 30

Spermicides

Answer 30

MOA: attacks sperm flagella and body to reduce motility | - Women at high risk of HIV or HIV + CANNOT use this

Question 31

spermicides advantages vs disadvantages

Answer 31

``` Advantage - lubrication - easy application - OTC - low cost - may be used while lactating - immediately effective (foam, jelly) Disadvantages - needs 15 min to work (films, suppositories) - messy - unpleasant taste - vaginal, oral, anal, and penile irritation - high failure rate ```

Question 32

absolute NO to combined hormonal contraception

Answer 32

``` breast, cervical, endo CA hx blood clots breastfeeding migraine with aura uncontrolled HTN complicated cardiac surgeries will by laying for long periods ```