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3A REVISION > SEXUAL/REPRODUCTIVE MEDICINE > Flashcards

SEXUAL/REPRODUCTIVE MEDICINE Flashcards

(174 cards)

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1
Q

What is the triple swab assessment?

A

High vaginal swab
Endocervical swab
Chlamydia swab

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2
Q

What does high vaginal swab diagnose?

A

Trichomonas vaginalis, BV, candida, group b strep

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3
Q

What does endocervical swab diagnose?

A

Gonorrhoea

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4
Q

What is contact tracing?

A

Identification and notification of recent sexual contacts for screening and treatment, usually by patient

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5
Q

Asymptomatic female STI check? (3)

A

Self taken swab (can be clinician if preferred) for gonorrhoea and chlamydia
Bloods for syphilis and HIV
Test for hep B/C if at risk

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6
Q

Asymptomatic male STI check? (3)

A

First void urine for chlamydia and gonorrhoea
Bloods for syphilis and HIV
Hep b/c if at risk

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7
Q

Asymptomatic gay male STI check? (6)

A 
Throat swab 
First void urine
Rectal swab
Bloods for HIV and syphilis
Vaccine for hep b offered
Hep C if at risk
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8
Q

Symptomatic STI check? (10)

A

Examine external genitalia, swab from any ulcer/fissure for herpes
Female: Speculum exam of cervix if no herpes, clinician vaginal swab
Male: first void urine
Rectal, urethral, throat swabs if high risk for gonorrhoea
Bimanual exam if indicated
Bloods for syphilis and HIV
MSU if UTI/blood suspected
Pregnancy test if suspected
Hep/c if at risk

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9
Q

Symptoms of chlamydia trachomatis? (3)

A

Usually asymptomatic
Urethritis
Vaginal discharge

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10
Q

Complications of untreated chlamydia? (5)

A 
PID
Tubal damage 
Subfertility
Chronic pelvic pain
Reiter's syndrome - urethritis, arthritis, conjunctivitis
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11
Q

Management of chlamydia?

A

Azithromycin or doxycyline

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12
Q

Symptoms of neisseria gonorrhoeae? (5)

A 
Usually asymptomatic
Vaginal discharge
Urethritis
Bartholinitis
Cervicitis
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13
Q

Type of bacteria in gonorrhoea

A

Gram negative diplococcus

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14
Q

Complications of gonorrhoea? (2)

A

Bacteraemia

Septic arthritis

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15
Q

Treatment of gonorrhoea?

A

IM ceftriaxone

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16
Q

What are genital warts caused by?

A

HPV human papillomavirus

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17
Q

What types of HPV are associated with CIN?

A

16 and 18

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18
Q

Treatment of genital warts?

A

Cream - podophyllin

Cryotherapy or electrocautery

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19
Q

What is thrush?

A

Infection with candida albicans fungus, most common vaginal infection

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20
Q

Risk factors for thrush? (3)

A

Pregnancy
Diabetes
Antibiotics

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21
Q

Symptoms of thrush? (5)

A 
Cottage cheese discharge
Itching and irritation
Superficial dyspareunia
Dysuria
Inflammation
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22
Q

Treatment of thrush?

A

Topical imidazoles - clotrimazole

Oral fluconazole

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23
Q

What is bacterial vaginosis?

A

Normal lactobacilli in the vagina are overgrown by other mixed flora

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24
Q

Symptoms of bacterial vaginosis? (4)

A

Grey white discharge
Fishy odour
Raised pH
Clue cells on microscopy

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25
Treatment of BV?
Metranidozole
26
What type of herpes commonly causes genital infection?
HSV2
27
Symptoms of primary herpes infection? (4)
Multiple small painful ulcers around the introitus Lymphadenopathy Dysuria Systemic symptoms
28
Complications of herpes? (4)
Secondary bacterial infection Aseptic meningitis Acute urinary retention Neonatal herpes has high mortality
29
Explain herpes reactivation?
After primary infection virus lies dormant in dorsal root ganglia In 75% it reactivates Secondary attacks are less painful and severe
30
Treatment of herpes?
Aciclovir
31
What causes syphilis?
Infection with treponema pallidum
32
Symptoms of primary syphilis?
Solitary painless vulvar or penile ulcer - chancre
33
What happens if primary syphilis is left untreated?
Secondary syphilis - rash, flu like symptoms, warts around genitals and mouth
34
What happens after secondary syphilis?
Latent syphilis | Tertiary syphilis many years later
35
Symptoms of tertiary syphilis?
Aortic regurgitation, dementia, neurological effects, skin and bone gummata (swellings)
36
Treatment of syphilis?
IM penicillin
37
What is trichomonas vaginalis?
Flagellate protozoan
38
Symptoms of trichomonas? (5)
Offensive grey-green discharge Vulval irritation Superficial dyspareunia Cervicitis
39
Treatment of trichomonas?
Metronidazole
40
Risk factors for HIV? (4)
Multiple sexual partners Migration from high risk countries Lack of barrier contraception IV drug use
41
What 2 gynae conditions are more common with HIV?
Candida | CIN
42
Management of HIV?
Antiretrovirals | C section and no breastfeeding if pregnant
43
What is seroconversion?
Time period in which a specific antibody develops and is present in the blood In HIV, flu like symptoms and rash Women commonly no symptoms
44
How is AIDS diagnosed?
Development of opportunistic infection or malignancy or a CD4 <200
45
What is contraception?
Prevention of pregnancy, some reduce spread of STIs
46
Is breastfeeding contraceptive?
If fully breastfeeding, amenorrheic, less than 6 months postpartum it is >98% effective
47
Contraceptive contraindications in breastfeeding?
Avoid COCP before 6 weeks PP, relatively contraindicated 6 weeks - 6 months Progestogen only methods can be used
48
What is the COCP?
Combined oral contraceptive pill
49
How does the COCP work? (3)
Exert negative feedback effect on gonadotrophin release and inhibit ovulation Thin the endometrium Thicken cervical mucus
50
How is the COCP taken?
Daily tablet containing oestrogen and progesterone taken for 3 weeks, 1 week break with withdrawal bleed
51
Side effects of the COCP? (7)
``` Depression PMT symptoms Bleeding or amenorrhoea Acne Weight gain Breast pain Reduced libido ```
52
Missed COCP advice?
1 pill - take as soon as possible and continue 2 pills - continue packet as normal but use condoms for 7 days If less than 7 pills remaining, avoid break and start another pack
53
Complications of COCP? (6)
``` Venous thrombosis Myocardial infarction Cerebrovascular accidents Focal migraine Hypertension Cervical and breast carcinoma ```
54
Absolute contraindications to COCP? (10)
``` History of VTE, CVA, IHD, severe hypertension Migraine with aura Active breast/endometrial cancer Inherited thrombophiia Pregnancy Smokers >35 years and >15 a day BMI >40 Vascular complications of diabetes Active/chronic liver disease Breastfeeding up to 6 weeks ```
55
Relative contraindications to COCP? (7)
``` Smokers Chronic inflammatory disease Renal impairment Diabetes Age >40 BMI >35 Breastfeeding up to 6 months ```
56
What is the contraceptive patch?
Combined transdermal patch that releases oestrogen and progestogen, every week for 3 weeks then break
57
What is the contraceptive ring?
Nuvaring, releases daily dose of oestrogen and progestogen, worn for 3 weeks in the vagina then removed for 7 days and a new ring inserted after
58
What is the mini pill?
Progestogen only pill containing a slow dose of progestogen, taken every day without a break at the same time within 3 hours (cerazette within 12)
59
Contraceptive effects of the progestogen only pill?
Makes cervical mucus hostile to sperm | Inhibits ovulation in 50%
60
Side effects of the progesterone only pill?
``` Vaginal spotting Weight gain Breast pain PMT symptoms Functional ovarian cysts ```
61
Missed progestogen only pill advice?
If missed for more than 3 hours, take as soon as possible and use condoms for 2 days
62
What are LARCs?
Long acting reversible contraceptives, not user dependent and highly effective
63
What is Depo-Provera?
``` Medroxyprogesterone acetate (progestogen only) IM injection every 3 months ```
64
Side effects of depo-provera? (4)
Spotting Then amenorrhoea - may be prolonged after stopping Progestogenic side effect as mini pill Decrease bone density in first 2/3 months then stabilises, regained after stopping
65
What is the implant?
Nexplanon - rod containing progestogen inserted into the upper arm subdermally with anaesthetic, lasts 3 years
66
Side effects of the implant?
Progestogenic | Irregular bleeding
67
What is emergency contraception?
Drug or IUD used shortly after unprotected intercourse in an attempt to prevent pregnancy
68
What is the morning after pill?
Levonelle - single dose of progestogen, best taken within 24 hours can be up to 72 EllaOne - single dose selective progesterone receptor modulator, can be used up to 5 days after Efficacy of both decreases with time
69
What is an IUD?
Intrauterine device, copper, prevents implantation, can be used up to 5 days after unprotected sex or as a LARC changed every 5-10 years
70
How do IUDs work?
Copper devices, operate by preventing fertilisation as copper is toxic to sperm and also blocking implantation
71
What is an IUS?
Intrauterine system, progestogen released locally over 5 years
72
How do IUSs work? (2)
Changes to cervical mucus and uterotubal fluid which impair sperm migration Endometrial changes impeding implantation
73
Complications of intrauterine device/system? (6)
``` IUD - heavy bleeding Pain/cervical shock Expelled device Perforated uterus Risk of PID if current STI Ectopic more likely if pregnancy occurs as blocked implantation in the uterus ```
74
Considerations with IUD/IUS (6)
``` Previous ectopic Young/nulliparous Pelvic infection Endometrial/cervical cancer Undiagnosed bleeding Pregnancy ```
75
Barrier methods of contraception? (3)
Male condom - sheath over the penis, afford best protection against disease Female condom Diaphragms and caps - fitted before sex and stay for 6 hours after, used with spermicide
76
Permanent methods of contraception? (2)
Female sterilisation - clips on the fallopian tubes, hysterectomy if indicated Male sterilisation - vasectomy more effective than female- ligation and removal of section of vas deferens preventing sperm passage
77
What is natural family planning?
Using own body temperature, cervical mucus thickness, urinary hormones (LH, oestrogen) etc to predict ovulation and avoiding intercourse in specific times Less effective
78
What is the withdrawal method?
Removing penis just before ejaculation, not effective as sperm can be released before orgasm
79
Define subfertility
Subfertility is when conception does not occur within a year of regular unprotected intercourse in the absence of known reproductive pathology - low chance of conception but may also be infertile
80
Define primary and secondary subfertility
Primary if woman has never conceived | Secondary if previous pregnancy
81
Causes of subfertility
``` Male factor 30% Female factor 30% (anovulation, tubal factors, PID) 25% Unexplained 10% combined 5% other ```
82
Causes of anovulation (6)
``` PCOS Hypothalamic hypogonadism - low GnRH, low oestrogen Hyperprolactinaemia - inhibits GnRH Premature ovarian failure Pituitary damage - LH, FSH Hypo/hyperthyroidism ```
83
How is hypothalamic hypogonadism treated?
Normal weight | Give gonadotrophins
84
How is hyperprolactinaemia treated?
Give bromocriptine - inhibits prolactin
85
What is second line treatment of subfertility once primary causes have been treated?
ART e.g. IVF
86
Causes of male infertility (6)
``` Drug exposure - alcohol, smoking, steroids Varicocoele Antisperm antibodies Testicular abnormality Obstructions i.e. of vas deferens in CF Hypogonadism Impotence ```
87
Name 3 barriers to fertilisation
Tubal damage e.g. PID Endometriosis Previous surgery - adhesions
88
When is ART considered (5)
``` Other treatments failed Unexplained cause Male factor subfertility - ICSI Tubal damage - IVF Genetic problems ```
89
Physiology of sperm production? (4)
Spermatogenesis in the testis is dependent on pituitary LH and FSH LH stimulates testosterone production in Leydig cells in the testis FSH and testosterone control Sertoli cells which synthesise sperm Testosterone inhibits LH.
90
Types of abnormal semen in men? (3)
Azoospermia - no sperm Oligospermia - reduced levels of sperm Asthenospermia - low motility
91
Common causes of sperm abnormalities? (8)
``` Smoking/alcohol/drugs/chemicals Inadequate cooling of testis Genetics Antisperm antibodies Infection - epididymitis Klinefelters - XXY Hypogonadotrophic hypogonadism Retrograde ejaculation ```
92
What is varicocoele?
Varicosities of the pampiniform plexus, usually on left, present in 25% of infertile men
93
Management of male factor infertility?
Treat treatable causes Optimise lifestyle factors ART
94
Investigations for female infertility? (6)
``` Mid-luteal phase progesterone Urinary LH FSH, testosterone, prolactin, TFTs USS Hysterosalpingogram Laparoscopy ```
95
General treatment of infertility?
Lose weight Folic acid Treat treatable causes - i.e. clomifene, gonadotrophins, ovarian diathermy
96
What is IUI?
Intrauterine insemination, sperm are injected directly into the cavity of the uterus timed with ovulation or after gonadotrophin ovulation induction
97
When is IUI used?
Unepxlained subfertility | Mild-moderate sperm dysfunction
98
What is IVF?
In vitro fertilisation, embryos are fertilised outside the uterus then transferred back
99
When is IVF used?
If tubes not patent | Unexplained infertility
100
How does IVF work? (5 stages)
Multiple follicular development - 2 weeks of gonadotrophin injections (FSH and LH) With 21 day GnRH analogue to suppress pituitary and prevent LH surge before stimulation starts, or short daily GnRH antagonist from day 5 stimulation until egg collection Ovulation and egg collection once follicles optimal size confirmed with scan - single dose LH given to trigger ovulation and collected under aspiration Fertilisation and culture - eggs incubated with sperm and growth medium, spares can be frozen Embryo transfer - best blastocyst transferred (can be 2 if indicated) and progesterone given for luteal support
101
What is ICSI?
Intracytoplasmic sperm injection
102
How does ICSI work?
Injection of one sperm into oocyte cytoplasm, adjunct to IVF when sperm are not motile
103
What is oocyte donation?
Donor goes through ovarian stimulation and her eggs are fertilised with recipient's partner's sperm Recipient given oestrogen and progesterone to prepare endometrium and embryo transferred
104
What is surrogacy?
Another woman carries a biological child of the patients, when the patient has uterine problems or coexisting health issues so cannot carry a child
105
What is ovarian hyperstimulation syndrome?
Occurs with gonadotrophin ovulation induction, in PCOS or IVF - use lowest effective dose
106
Symptoms of OHSS? (5)
``` Overstimulates the follicles which become large and painful Hypovolaemia Electrolyte disturbance VTE Pulmonary oedema ```
107
Treatment of OHSS?
Admit for restoration of volume, monitoring, analgesia, thromboprophylaxis
108
What is PGD?
Preimplantation genetic diagnosis, can remove a cell or 2 from the developing blastocyst in IVF and examine DNA to look for genetic mutation, unaffected embryos transferred
109
When is PGD used?
Couples where single gene defects are carries (cystic fibrosis) or who have chromosome translocations so risk of an aneuploidic child high Sex linked conditions
110
What are the 4 broad categories sexual disorders fall into?
Chronic medical conditions Hormonal Iatrogenic Psychiatric
111
Investigations for sexual problems? (6)
``` Fasting glucose/lipid ratio Testosterone, SHBG, albumin Prolactin TFTs Oestrogen FBC ```
112
What is hypoactive sexual desire disorder?
Lack or loss of sexual desire, not secondary to physical problems, causing distress Does not exclude sexual enjoyment or arousal but makes initiation less likely
113
Causes of hypoactive sexual desire disorder? (9)
``` Diabetes, CVD, obesity Androgen deficiency Hypothyroid Hyperprolactinaemia Depression/anxiety/trauma Relationship issues Substance abuse Meds - COCP, tamoxifen, antidepressants Post surgery or birth ```
114
4 psychosexual treatment options?
Integrative - combination of psych and physical CBT Psychodynamic - past events, attachments Systemic - individual, couple, family
115
Treatment of hypoactive sexual desire disorder?
Testosterone replacement for males Flibanserin for women Psychosexual - CBT etc.
116
What is erectile disorder?
Difficulty in developing or maintaining an erection suitable for satisfactory intercourse
117
Causes of erectile disorder? (6)
CVD, Diabetes, Neuro conditions (cauda equina, MS) Low androgen, high prolactin Post surgery, antidepressants Age Ineffective sexual stimuli, relationship problems Pain
118
Treatment of erectile disorder?
Phosphodiesterase inhibitors - sildenafil 2nd line alprostadil injection or intraurethral Vacuum device, rings Psych treatments
119
Side effects and contraindications of sildenafil?
Headaches, flushing | CI - Hypotension, recent unstable angina
120
What is female sexual arousal disorder?
Failure of genital response (mainly vaginal dryness) and reduced interest in sexual activity, response to sex stimuli and reduced pleasure
121
Causes of female sexual arousal disorder? (5)
``` Diabetes, CVD, neuro Oestrogen deficiency i.e. menopause SSRIs Lactation Psychological ```
122
Treatment of female sexual arousal disorder?
Behavioural - sensate focus, eros therapy devise, lubricants | Psychosexual couples therapy
123
Common psychological causes of sexual problems? (8)
``` Depression/anxiety Substance misuse Previous abuse or trauma Couples script problems Decreased intimacy Relationship problems Stress Cultural/religious problems ```
124
What is sensate focus?
Behavioural intervention Programme of exercises to enable couple to identify sexual likes and explore new techniques Overcome negative thinking patterns
125
What is eros therapy?
Handheld device used for greater clitoral and genital engorgement, increased vaginal lubrication
126
What is female orgasmic disorder?
Orgasm either does not occur or is markedly delayed, reduced intensity
127
Causes of female orgasmic disorder? (6)
``` CVD, Diabetes, neuro Oestrogen/androgen insufficiency Pelvic floor weakness Age SSRIs Psych problems ```
128
Treatment of female orgasmic disorder? (3)
Topical oestrogen Education, guided masturbation, vibrators Psychotherapy - attitudes to sex
129
How does the menopause affect sexual function? (6)
``` Vaginal/pelvic pain Vaginal atrophy Dryness Change in self image Change in desire Sleeplessness, night sweats ```
130
What is sexual aversion disorder?
Disorder characterised by disgust, fear, revulsion, or lack of desire in relationships
131
Causes of sexual aversion?
Past trauma | Interpersonal problems - infidelity, violence, lack of hygiene of partner
132
Treatments of sexual aversion? (3)
Psychotherapy Couples counselling Medications for anxiety
133
What is rapid ejaculation?
Inability to control ejaculation sufficiently for both partners to enjoy sexual interaction Persistent 1 minute after vaginal peneration
134
Cause of rapid ejaculation? (5)
``` Genetic susceptibility Hyperthyroid Penile hypersensitivity Comorbid erectile dysfunction Performance anxiety, lack of experience, trauma ```
135
Treatment of rapid ejaculation? (4)
Topical local anaesthetic STUD 100 SSRIs - dapoxetine Couples therapy Behaviour - Stop/start technique, sensate focus
136
What is delayed ejaculation?
On almost all occasions without the individual desiring there is a marked delay (>30min) in ejaculation or infrequent/absent ejaculation
137
Causes of delayed ejaculation? (8)
``` Congenital disordres Trauma/surgery Age Infection Neuro disorders Depression/other psych SSRIs Low testosterone ```
138
Treatment for delayed ejaculation? (3)
Individual and couples therapy Kegel exercises Use of vibration/superstimulation
139
What is retrograde ejaculation?
Entry of semen into the bladder instead of going out through the urethra during ejaculation, causes aspermia
140
Cause of retrograde ejaculation? (4)
Malfunction of bladder sphincter - autonomic nervous system dysfunction, TURP (prostate surgery) Nerve damage S/e of tamsulosin, antidepressants Diabetes
141
Investigations of retrograde ejaculation?
Urine sample for presence of sperm and fructose - disinguishes between this and anejaculation
142
Treatment of retrograde ejaculation? (5)
``` Some untreatable - if radiation damage, cut nerves from surgery Tricyclic antidepressants Antihistamines Decongestants - ephedrine Infertility treatments ```
143
What is anejaculation?
Pathological inability to ejaculate in males, with or without orgasm
144
Causes of anejaculation? (7)
``` Sexual inhibition Medications - SSRIs. antipsychotics Autonomic nervous system Prostate surgery Duct obstruction Spinal cord injury Old age ```
145
Treatment of anejaculation? (3)
Penile vibratory stimulation | Electroejaculation, percutaneous epididymal sperm aspiration for sperm removal
146
What is vaginismus?
Spasm of the pelvic floor muscles that surround the vagina, causing occlusion of the vaginal opening, penile entry is painful/impossible
147
Causes of vaginismus? (5)
Irritated vulva - thrush, lichen sclerosis Painful conditions FGM Congenital abnormality Psych - fear, religious issues, previous trauma, relationship issues
148
Treatment of vaginismus?
Psychosexual therapy | Self exploration, vaginal dilator, graded penetration
149
What is dyspareunia?
Pain during intercourse, occurs in women and men, if there is no primary nonorganic sexual dysfunction
150
Cause of dyspareunia in women? (6)
``` STIs Episiotomy Vaginal atrophy Pelvic inflammatory disease Endometriosis Psych issues ```
151
Cause of dyspareunia in men? (4)
STIs Urethral strictures Varicocoele Psych issues
152
Treatment of dyspareunia?
Treat cause Lubricants Couples therapy Behavioural therapy - sensate focus
153
What is vulvodynia?
Chronic pain syndrome affecting the vulvar area, occurs without an identifiable cause
154
Cause of vulvodynia? (6)
History of STIs Sjogrens syndrome Autoimmune disorders causing inflammation Eczema Former oral contraceptive use before age of 16 Injury/neuropathy
155
Treatment of vulvodynia? (5)
``` Lubricants Psychotherapy Oestrogen creams/lidocaine cream Amitriptyline, gabapentin Vestibulectomy surgery - cut nerves ```
156
What is aspermia?
Complete lack of semen with ejaculation
157
Causes of aspermia? (4)
Retrograde ejaculation Ejaculatory duct obstruction Androgen deficiency Treatment of prostate cancer - maximal androgen blockade
158
What is Peyronie's disease?
Development of fibrous scar tissue inside the penis that causes curved, painful erections - can cause erectile dysfunction
159
Cause of Peyronie's disease? (4)
Repeated injury and disorganised healing Genetics Connective tissue disorders Age
160
Treatment of Peyronie's disease? (3)
Pentoxifylline to reduce scar tissue Penile injections - collagenase, verapamil, interferon (break down fibrous tissue) Surgery to suture unaffected side, excise tissue, implants
161
What is hypospadias?
Congenital condition in males in which the opening of the urethra is on the underside of the penis, normally diagnosed at birth
162
Treatment of hypospadias?
Surgical correction
163
What is sex?
Male/female based on external genitalia
164
What is gender identity?
Intrinsic sense of being male/female/alternative From genes, oestrogen, testosterone on developing brain
165
What is gender expression?
Personality, appearance, behaviour in a cultural and historical context
166
What are primary and secondary sex characteristics?
Primary - penis and scrotum and testis maturation, vagina/vulva/ovary maturation Secondary - enlargement of genitalia, pubic and armpit hair, breast development, voice pitch lowering in men
167
What is transgender?
Diverse gender variance including transsexual/agender/genderqueer
168
What is gender dysphoria?
Distress due to incongruence between gender identity and sex assigned at birth
169
What is transsexual?
Individuals who seek to change their primary/secondary sex characteristics Transmale - female at birth changing to male Transfemale - male at birth changing to female
170
What is sexual orientation?
Sex of persons to whom sexual fantasies, arousal, activities directed
171
When are the external genitalia and gonads developed?
8 weeks
172
How does masculinisation occur?
SRY gene - testes development | Mullerian inhibiting substance
173
Management for transmale?
``` Fertility options Androgens +/- GnRH analogue Voice Male chest reconstruction Hysterectomy and bilateral oophorectomy Phalloplasty ```
174
Management for transfemale?
``` Fertility options Oestrogens and antiandrogens Voice Facial hair removal Vaginoplasty Mammoplasty Facial feminisation surgery ```

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