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Method Male condom

Mechanism of Action -Mechanical barrier -Different shapes, lubricants, latex, polyurethane (Avanti) for latex allergy, natural skin (lamb cecum)

Female condom

-Barrier -Polyurethane -Same as male condom

Advantages -Participation of male in BC responsibility -inexpensive -Available to anyone -Effective protection against STDs (latex and polyurethane, not natural membrane) -May prevent cervical cancer (d/t infections/inflammation) -No health hazard (latex allergies) -HIV/STD protection -Female in control of protection -Less messy than other female methods such as spermicides -No known adverse effects -DON T prevent transmission of some STDs (bacterial) or HIV (were originally thought to do so) -May disrupt genital epithelium which may be associated with HIV transmission -Provide vaginal lubrication -Male partner need not be involved -Simple option if forget BCP

Disadvantages/ Complications -Complaints of reduced sensitivity -Natural skin condoms transmit heat/thin but don t protect against viruses/HIV (its too porous) -Interruption to put on

Instructions for Use Products Available -Use every time -Put on before any activity -Leave a little space in non-tipped types -Store in a cool place -Don t use with petroleum jelly or other non-water soluble lubricants/products-will destroy condoms (only use with watersoluble lubricant)

Spermicides (various dosage forms)

-2 components: 1. Inert base (foam, cream, gel/jelly, suppository, tablet, film) 2. Spermicidal chemical (nonionic surfactants) nonoxynol9, octoxynol, benzalkonium chloride, most in US are nonoxynol 9 (destroys sperm cell membrane) -Choice of product depends on preference

-Expense (more than male condoms) -Cumbersome, unattractive -Vaginal irritation -Decreased sensation ? -Difficulty with insertion -Allergy to spermicide (switch products, allergy usu d/t inactive ingredients not spermicide) -Difficulty in proper use -Messy -HIV exposure is possible still -Irritation of effervescent products -Melting time before use of suppositories -Interruption

-Insert prior to intercourse -Closed end inserted over cervix -Can be inserted up to 8 hours prior to use

-Depends on the product, be familiar before needed -Use prior to any intercourse, repeat with each time -No douching for 6 hours or more (non rec anyway) -Wide range of failure d/t improper use, careless use -Most effective if used w/ a condom

Foam -Shake well -Insert 1 applicatorful (or more) as directed -Insert deep in vagina near cervix -Use with each act of intercourse-Nondetectable during use -Not very lubricating, a little messy (cream, gel more lubricating

Film -Translucent square of filmdissolves into gel -Use clean, dry finger tip -Place high into the vagina (slide along back wall as far as possible) 15 min and not more than 1 hr. Active up to 1 hr.

Suppository/ Tablet/ Insert -Must dissolve 10-15 min prior to intercourse -Insert into vagina as far as possible -usu last 1 hr (uses moisture, heat to dissolve; may not work if pt has aberrant vaginal conditions)

Gel/Jelly & Creams -Don t have to wait to dissolve -Some are for use alone, others are for use with a diaphragm -Creams are more lubricanting, but messier -Gel/jelly-water soluble and less messy but less lubricating

Sponge

-Barrier -Contains spermicide -Soaks up sperm -One size fits all -Older studies showed less effective in women who had children

-No need for MD appointment for fitting -Can be used for mulitple acts of intercourse w/o removing or adding spermicide -Can be left in place for 24h and can insert many hrs prior to intercourse

-Difficult removal (loop, suction) -Absorbs natural vaginal lubrication -If infection present, medium for growth (spermicide will help reduce) -Don t use during menstruation -Increased pregnancy rate in women who have had children -Possible Toxic Shock risk

-Add approx 2 TBSP clean water, squeeze once (foams) -Insert high into vagina along back wall until rests against cervix, dimple side next to cervix, loop away from cervix -Leave in at least 6 hours after last intercourse

Toxic Shock Syndrome -severe life-threatening multisystem illness assoc w/ infections w/ toxin producing strains of S. aureus -Assoc w/ use of tampons (esp higher absorbancy products) and barrier contraceptives -sxs: high fever, muscle aches, sunburn like rash, weakness, fatigue, n/v/d Diaphragm/ Cervical cap (Rx) -not OTC but used with OTC jelly/cream -Barrier and spermicide holder -Must be properly fitted by ND or NP -Used with contraceptive jelly/cream -Long lasting (re-use over and over) -Relatively inexpensive -Immediately effective -Some protection against STDs possible-still need studies to evaluate -Insert before and leave in place up to 2 h w/o adding more spermicide -Requires MD visit for fitting -Rubber allergy -Must be able to insert properly -May be a problem if person has repeated bacterial UTIs -Re-measure if gain/lose >10 lbs or have a baby -TSS caution -No HIV protection -Side effects: N/V -Will not harm developing fetus and won t interrupt an established pregnancy (not Abortion Pill ) -Not as effective as regular contraceptive use so shouldn t be used as a method of contraception -Add 1 tsp (or more) inside dome of diaphragm, insert and check placement -If >1 act of intercourse in 6 h, insert more spermicide vaginally -Leave in place at least 6h after last intercourse then remove -Don t use oil-based lubricants, vaginal products -Wash diaphragm with warm water after use and check for holes -Sizes -Don t interchange brands -Spring/folding patterns Progestin only (Plan B) levonorgestrel 0.75 mg -Dose: 1 tab(x2) or 2 tab at once -1st dose given w/in 72h of intercourse, 2nd dose 12h later -Latest info: Plan B can be used as 2 tabs at once, given up to 12 hours after intercourse (earlier is better but still effective up to 5d later) Estrogen + Progestin (Preven) no longer manufactured. -Dose: 2 tabs taken at once than 2 tabs in 12h -Can use equivalent doses of BC pills (2 doses)

Emergency -Prevent or delay ovulation Contraception -possibly inhibit fertilization, transport of fertilized egg to uterus or implantation

Vaginal Fungal Infections (Yeast Infections)

Sxs: -intense itching, thick white discharge (cottage cheese like), no odor, vulvar or vaginal erythema At risk populations: -DM, tight clothing, immunologic defects, BC pills, Antibiotics, HIV Dx- Microscopic exam of sample w/ KOH, hyphae or budding spores Candidates for self-tx: -prev MD dx d yeast infxn -infrequent infxns (no>3/yr) -sxs constitent w/ characteristic mild yeast infxn Refer: If 2-3 infections /year <12 yrs Concurrent pain Fever Ppl w/ other medical conditions that predispose them to yeast infxn Pregnant

Questions to ask pt before rec an OTC vaginal product: -What sxs do you have? -Are you sexually active and if yes, what contraceptive method do you use? -What conditions do you have? What medications are you taking? Cream or suppostitory? -Depends on whether there are external sxs -External sxs respond well to external application of cream in addition to vaginal use (BID external) -Severe or chronic cases may respond better to longer courses of treatment (not much evidence. Just refer)

Products: Miconazole (supp or cream) -2% or 100 mg (7 day tx) Monistat 7 -4% or 200 mg (3 day tx) Monistat 3 -1200 mg supp (1 day tx) Monistat 1 + crm 2% Clotrimazole (supp or cream) -1 % or 100mg supp (7 day tx) -Gyne-Lotrimin, Mycelex 7 cream or supp -200 mg supp (3 day tx) Gyne-Lotrimin 3 Butoconazole 2% (crm) 3day tx -Femstat 3, Mycelex-3 Tioconazole 6.5% (oint) 1day tx -Vagistat-1 (1-3d tx probably have better compliance. Also recommend one that has extra tube of cream to put on outside area)

Usage: -Insert 1 applicatorful/ suppository high into the vagina at hs (for time period of product 7,3,1 day) -Use during menses (light days),don t use a tampon -May need to use a mini-pad to protect undergarments -Abstain from intercourse during treatment (treatment may damage condom or diaphragm) Prevention: -Wear cotton crotched underwear -Don t wear wet gym clothes or swim suits for a long period of time -Baths may worsen sxs (though can use baking soda/sitz bath to relieve some sxs) -DM and BCP users may be at higher risk -Tight clothes my predispose -Broad Spec Abx may increase infxn risk