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Barrier Methods

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

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  1. Barrier Methods • Protection against STD • “Messy” • Loss of spontaneity • No drugs • No side effects • Reliability depends on usage

  2. Barrier Methods • Condoms • Caps and diaphragms: specialist skills needed, to fit and educate about use. • Non-hormonal • Non-invasive • Used only when necessary

  3. Sterilisation • Non-reversible • At discretion of the surgeon to people who have no children

  4. 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)

  5. Natural Methods Women rarely ask • Rhythm or calendar method • Temperature method • Cervical mucus or billings’ method • The electronic “persona” • A combination “Symptothermal method”

  6. 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

  7. Special Groups • Underage • Peri-menopausal • Postnatal • Emergency • Changing method • Cultural differences

  8. Homework • Prepare a patient information leaflet explaining the “7 day rule”. • What exactly did the Gillick ruling say?

  9. Homework • What would you cover in a consultation about pre conceptual counselling?

  10. Homework • Personal list of COP to use and reasons for selection • Personal list of POP to use and reasons for selection

  11. Homework • Draw up a list of problems people come back with about the COP, causes and possible solutions.

  12. Homework • Need for further reading • Courses • Diploma in Family planning and reproductive health care

  13. 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.”

  14. 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.

  15. 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.

  16. 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?

  17. 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?

  18. 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

  19. 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.

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