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Barrier Methods. Protection against STD “Messy” Loss of spontaneity No drugs No side effects Reliability depends on usage. Barrier Methods. Condoms Caps and diaphragms: specialist skills needed, to fit and educate about use. Non-hormonal Non-invasive Used only when necessary.
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Barrier Methods • Protection against STD • “Messy” • Loss of spontaneity • No drugs • No side effects • Reliability depends on usage
Barrier Methods • Condoms • Caps and diaphragms: specialist skills needed, to fit and educate about use. • Non-hormonal • Non-invasive • Used only when necessary
Sterilisation • Non-reversible • At discretion of the surgeon to people who have no children
Sterilisation • GPs need to know the pros and cons • Need to understand the follow-up requirements post vasectomy • Post-op care • Myths (heavy periods, prostate cancer, de-sexed etc etc)
Natural Methods Women rarely ask • Rhythm or calendar method • Temperature method • Cervical mucus or billings’ method • The electronic “persona” • A combination “Symptothermal method”
Natural Methods • Usually beyond the scope of GPs • Need to know the pros and cons • Need to know where to refer for help • Should not dismiss these methods • Sensitive to patients beliefs and needs
Special Groups • Underage • Peri-menopausal • Postnatal • Emergency • Changing method • Cultural differences
Homework • Prepare a patient information leaflet explaining the “7 day rule”. • What exactly did the Gillick ruling say?
Homework • What would you cover in a consultation about pre conceptual counselling?
Homework • Personal list of COP to use and reasons for selection • Personal list of POP to use and reasons for selection
Homework • Draw up a list of problems people come back with about the COP, causes and possible solutions.
Homework • Need for further reading • Courses • Diploma in Family planning and reproductive health care
Stories Maria, a 37-year old mother, had her second child 6 months ago. She wishes to discuss contraception with you. “I don’t really want to back on the pill, but I’m not sure that we want anything more permanent yet.”
Stories • Elizabeth a 21 year old shop worker consults with a single episode of an extra bleed between her normal bleeds with Microgynon. She has had one smear 18 months ago which was normal.
Stories Jill, a 42 year old manager is using Micronor, her periods have become increasingly heavy, she has 2 children. She is fearful of operations.
Stories • Susan a 41 year old with a Mirena IUS for the last 3 years consults because of 2 episodes of post-coital bleeding. • What do you discuss? • What are the options?
Stories • A 23 year old comes to see you, she has just had 4 days of D+V. She is on Loestrin 20 and is mid-cycle. She wants something for the diarrhoea. • What do you need to know? • What are the options?
Income maximisation What should be covered at OCP follow-up? What brands of OCP are in use? Why? Contraceptive failures Leaflets, ? Understandable? Clear? Used? Useful? IUD / IUS continuation rates Audit Ideas
Further Reading • Contraception: a users handbook Szarewski & Guillebrand, OUP, 1998 • RCGP handbook of sexual health in primary care. Carter et al RCGP 1998 • Family planning handbook. IPPA 1997.