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?

Audit Ideas 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

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.