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BLOCK 4_PBL 6

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block 4 pbl 6 - medicine
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  COMMON METHODS OF CONTRACEPTIONMETHODS WITH NO USER FAILUREMETHOD EFFECTIVENESS HOW IT WORKS ADVANTAGES DISADVANTAGES CONTRACEPTIVE INJECTION OVER 99% EFFECTIVE Releases progesterone whichprevents ovulation, thickensthe cervical mucosa and thinsthe lining of the uterus toprevent implantation    Lasts 8-12 weeksdepending on typeof injection    Can be used whenbreast feeding    Periods may stop, beirregular, or longer    Periods and fertilitymay take some timeto return    Potential weight gainIMPLANT OVER 99% EFFECTIVE Small flexible rod insertedunder the skin of the upperarm. Releases progesteronewhich produces same effectsas injectionInserted using a localanesthetic    Effective for threeyears, but can beremoved sooner    Don’t hve to thinkaboutcontraception aslong as implant is inplace    Fertility returnsonce removed    Periods may stop, beirregular, or longer    Acne may occur orworsen    Requires a procedurewhich may be off-puttingINTRAUTERINE SYSTEM (IUS) OVER 99% EFFECTIVE A small device inserted intothe uterus which slowlyreleases the hormoneprogesterone    Effective for 5 yearsbut can be takenout sooner    Periods usuallylighter, shorter, andsometimes lesspainful    Fertility returnsonce removed    Irregular bleedingcommon in first 6months    Periods ,ay stopaltogether    Small chance of infection 20 days afterinsertion    Ovarian cysts    Insertion can beuncomfortableINTRAUTERINE DEVICE Over 99% effective Small plastic and copperdevice placed into uterus.Stops sperm reaching the eggand may also preventimplantation    Effectiveimmediately and for5-10 yearsdepending on type    Fertility returnsonce removed    Not affected bymedications    May not be suitablefor women at risk of STI    Periods may beheavier, longer andpainful    Insertion can beuncomfortable    Small risk of infectionupon insertionFEMALE STERILIZATION (TUBALOCCLUSION)FAILURE RATE IS 1 IN200. THIS IS APERMANENTMETHODFallopian tubes are cut, sealed,or blocked. Stops meeting of the sperm and egg    Does not interruptsex    Cannot easily bereversed    Periods unaffected    No need forcontraception    Operation risk    Small increased risk of ectopic pregnancy if sterilization fails    General or localanestheticMALE STERILIZATION FAILURE RATE OF 1 IN2,000PERMANENTMETHODVas deferens cut, sealed, andtied    Does not interruptsex    Cannot be reversed    No need forcontraception    Performed under alocal anesthetic    Contraception mustbe used until sementest shows no spermare remaining. Cantake up to 8 weeks    Some men experienceongoing testicle pain    METHODS WITH USER FAILUREMETHOD EFFECTIVENESS HOW IT WORKS ADVANTAGES DISADVANTAGES CONTRACEPTIVE VAGINAL RING 99% EFFECTIVE ISUSED CORRECTLY(1 woman in 100 /year)Small flexible plastic ringinserted into vaginareleases estrogen andprogesterone. Stopsovulation, thickens cervicalmucosa and thins lining of the uterus to preventimplantation    Not affected by illnesssuch as sickness anddiarrhea    Can make bleedsregular, lighter, andless painful    May reduce risk of ovarian and uterinecancers    Not suitable foroverweight women orsmokers over 35    Low risk of serious side-effects such as blood los,breast and cervical cancer    Temporary side-effectssuch as vaginal discharge,headaches, nausea, breasttenderness and moodchanges    Some medicines can makeit less effectiveCONTRACEPTIVE PATCH OVER 99% EFFECTIVELESS THAN 1 WOMANIN 100/ YEARSmall patch placed ontoskin releases estrogen andprogesterone. Preventsovulation, thickens cervicalmucus and thins lining of the uterus to preventimplantation    Not affected bysickness    Periods usually moreregular, lighter and lesspainful    May reduce risk of cancers    Not suitable foroverweight women, orsmokers over the age of 35    Low risk of side-effects    Temporary side-effectse.g. headaches    Possible skin reactionCOMBINED PILL OVER 99% EFFECTIVEIF TAKEN CORRECTLY<1 WOMAN IN 100 /YEARContains estrogen andprogesterone.    Periods usually moreregular, lighter and lesspainful    Reduces risk of cancers    Suitable for healthynon-smokers up tomenopause    Fertility returns oncestopped    Not suitable foroverweight and smokers    Low risk of serious side-effects    Temporary side effectssuch as headache    Missing pills make it lesseffectivePROGESTERONE-ONLY PILL OVER 99% EFFECTIVEIF TAKEN CORRECTLY<1 WOMAN IN 100 /YEARContains progesterone, insome cycles stopsovulation    Can be used bt womenwho cannot useestrogen    Can be used by womenwho smoke and areover 35    Can be used whenbreast feeding    Periods may stop, beirregular, light or morefrequent    Temporary side-effectssuch as acne, breasttenderness, weightchange    Risk of ovarian cysts    Needs to be taken atsame time each day    Some medicines reduceeffectivenessMALE CONDOM 98% EFFECTIVE(although suggested15% failure rate)Made of latex orpolyurethane. Placed overerect penis to prevententry of sperm    Free fromcontraception andsexual health clinicsand sold widely    Protects from STI’s      No serious side-effects    Spermicide s notneeded    Putting it on can interruptsex    May slip off or split if notused correctly, or is wrongsize or shape    Man needs to withdrawimmediately afterejaculation and before thepenis softens    Oil based productsdamage latex condomsFEMALE CONDOM 95% EFFECTIVE IFUSED ACCORDING TOINSTRUCTION5 women in 100/ yearSoft, thin polyurethanesheath loosely lines thevagina and covers the area just outside and stopsentry of sperm    Can be put in any timebefore sex    Protects both partners from STI’s      Oil-based products canbe used with femalecondoms    Spermicide not needed    Putting it on can interruptsex    Need to make sure thepenis enters the condomand not the spacebetween the condom andvagina    May get pushed intovagina    Not as widely available  DIAPHRAGM/ CAP WITHSPERMICIDE92-96% EFFECTIVEWHEN USED WITHSPERMICIDE4-8 WOMENPREGENANT PERYEARFlexible latex or siliconedevice, used withspermicide, put into vaginato cover cervix.Stops sperm entering theuterus    Can be put in anytimebefore sex    Only have to use itwhen you have sex    Can be used duringmenstruation    Putting it on can interruptsex    Some people sensitive tospermicide    Can take time to learnhow to use correctly    Needs to be left in for 6hours after sexNATURAL FAMILY PLANNING UP TO 99% EFFECTIVE Fertile and infertile timesof the menstrual cycle areidentified by notingdifferent fertility indicatorsThis shows when you canhave sex without riskingpregnancy    No physical side-effects    No chemicals orproducts needed    Gives woman a greaterawareness of her body    Can be used to planpregnancy    Need to avoid having sex,or use a condom duringfertile times    Takes 3-6 menstrual cyclesto learn effectively    Must keep daily recordsEMERGENCY CONTRACEPTIONDesigned for use after unprotected intercourse:    IUD o   Reliable o   Kills sperm    HORMONES (morning after pill)    E.g. LEVONELLE  – synthetic version of the natural hormone progesterone o   High dose of combined contraceptive given in two doses o   12 hours apart o   Within 72 hours of unprotected sex o   Makes endometrium less stable and delays ovulation o   Side effects include:    Nausea    Menstrual disturbances    Abdominal cramps    Mood swings    Breast tenderness  COMPONENTS OF THE SEXUAL HEALTH SCREEN1.   GUM (genitourinary medicine) clinics and STI clinics hold drop-in sessions and scheduled appointments  2.   The clinic is open to the wide public, and even under 16’s can attend without risking confidentiality if  thecircumstance is fit  3.   Confidentiality of under 16’s will be breached only if harm to any party is suspected. The attendee must first be informed of this  4.   GP’s are not told of patient visits without permission  5.   Fake names are common place 6.   TESTS MAY INCLUDE:  a.   Urine sampling  b.   Blood samples  c.   Vaginal and urethral swabs  d.   A genital examination 7.   Results can be reveived on the same day as testing, depeidng on the type of test  8.   Testing positive for an STI will necessitate the need to return to the clinic and discuss treatment options  9.   Many STI’s can be cured with antibiotics  10.   Clinics also offer safe sex advice including the use of condoms OTHER SERVICES OFFERED INCLUDE: ã   Specialist advice ã   Screening for sexually transmitted infections ã   Chlamydia screening ã   Contraception ã   Emergency contraception ã   Pregnancy testing ã   Free condoms ã   Young men’s drop -in ã   Advice and referral to termination services ã   Psychosexual clinics - GP/consultant or family planning doctor referral only  LEGALITY, CONFIDENTIALITY, AND CONSENT WITH REGARDS TO ADOLESCENTS    ISSUES SURROUNDING PRESCRIPTION OF CONTRACEPTIVES TO TEENAGERS   o   Is it legal for doctors to prescribe to them? (Consent and Competence)   o   Will the doctor tell the parents? (Confidentiality)    CONSENT   o   Age of Legal Capacity (Scotland) Act 1991      16   o   Gilick Competency      Contraception can only be given without parental consent IF child is deemed competent      Parents rights were not absolute but exist only in the benefits of the child      DOCTORS NOT LEGALLY OBLIGED TO TELL PARENTS IF FOLLOWING 5 CONDITIONS ARE MET:    THE ADVICE GIVEN IS UNDERSTOOD    THE GIRL CANNOT BE PERSUADED TO TELL HER PARENTS    SHE IS LIKELY TO HAVE SEXUAL INTERCOURSE WITH OR WITHOUTCONTRACEPTION    IF NOT GIVEN THE ADVICE SHE SEEKS, HER MENTAL HEALTH WILL SUFFER    IT IS IN HER BEST INTERESTS FOR HER TO RECEIVE THE ADVICE

Chap06

Nov 17, 2017

June13 issue

Nov 17, 2017
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