A 20-year-old G0 and her partner, a 20-year-old man, present for counseling for sexual dysfunction. Prior to their relationship, neither had been sexually active. Both report no medical problems.
In medical experience, which type of male or female sexual dysfunction has the lowest cure rate?
In a 5-year follow-up study of couples treated by Masters and Johnson, the cure rates for vaginismus and premature ejaculation approached 100%. Orgasmic dysfunction was corrected in 80% of women, and secondary impotence (impotence despite a history of previous coital success) resolved in 70% of men. Primary impotence (chronic and complete inability to maintain an erection sufficient for intercourse) had the worst prognosis, with cure reported in only approximately 50% of cases. Other therapists report very similar statistics.
A 28-year-old G3P3 presents to your office for contraceptive counseling. She has no history of medical problems or sexually transmitted diseases. You counsel her on the risks and benefits of all contraceptive methods.
Which of the following is the most common form of contraception used by reproductive-age women in the United States?
The most recent report from the CDC in 2010 demonstrated that the pills remain the most commonly used form of contraception among reproductive-age women in the United States with 28% of women choosing this method. Female sterilization (27%) and condoms (16%) were the next most commonly used methods of contraception used by women in the United States.
A 21-year-old woman presents to your office for her well-woman examination. She has recently become sexually active and desires an effective contraceptive method. She has no medical problems, but family history is significant for breast cancer in a maternal aunt at the age of 42 years. She is worried about getting cancer from taking birth control pills. You discuss with her the risks and benefits of contraceptive pills.
You tell her that which of the following neoplasms has been associated with the use of oral contraceptives?
COC pills have been extensively studied to determine if there is an increased risk of neoplasms or cancer with use of these medications. Epidemiologic studies demonstrate that use of COCs actually decreases the risk of ovarian and endometrial cancers. There have been no studies that clearly demonstrate an association between the use of COCs and breast cancer. A slightly higher risk of cervical cancer has been observed in some studies of users of oral contraceptives. The risk of developing benign liver adenomas (which can cause life-threatening hemorrhage if they rupture) is increased somewhat in users of oral contraceptives, but the risk of hepatic carcinoma is not increased.
A 35-year-old G2P2 presents for a contraceptive counseling visit. She and her husband desire a long-term contraceptive method, and are uncertain if they want more children. She has been happily married for 10 years. Her only medical problem is mild hypertension, for which she takes a diuretic, and she has never had a sexually transmitted disease. She is considering the copper IUD and wants to know how it works.
Which of the following mechanisms does not potentially contribute to the mechanism of the action of the copper IUD?
Several mechanisms of action have been proposed for a copper IUD. These include inhibition of sperm migration and viability, change in transport speed of the ovum, and damage to or destruction of the ovum. The data demonstrates that these prefertilization mechanisms constitute the primary mechanism of action for prevention of pregnancy with the copper IUD; however, postfertilization effects, including damage or destruction of the fertilized ovum, may also occur. All of these effects occur before implantation. IUDs have few contraindications, and almost all women are eligible. Paragard should not be used in the following situations: pregnancy or suspected pregnancy, uterine abnormalities resulting in distortion of the uterine cavity, acute pelvic inflammatory disease, postpartum endometritis in the last 3 months, genital bleeding of unknown etiology, known or suspected uterine or cervical malignancy, mucopurulent cervicitis, or Wilson disease. The reported failure rate of a copper IUD at 1 year is very low, at 0.8 per 100 women. Although there is an increased risk of spontaneous abortion, and a small risk of infection, an intrauterine pregnancy can occur and continue successfully to term with an IUD in place. However, if the patient wishes to keep the pregnancy and if the string is visible, the IUD should be removed in an attempt to reduce the risk of infection, abortion, or both. Although the incidence of ectopic pregnancies with an IUD was at one time thought to be increased, it is now recognized that in fact the overall incidence is unchanged. The apparent increase is the result of the dramatic decrease in intrauterine implantation without affecting ectopic implantation. Thus, while the overall probability of pregnancy is dramatically decreased, when a pregnancy does occur with an IUD in place, there is a higher probability that it will be ectopic. With this in mind, in the absence of signs and symptoms suggestive of an ectopic pregnancy, especially after ultrasound documentation of an intrauterine pregnancy, laparoscopy is not indicated. The incidence of heterotopic pregnancy, in which intrauterine and extrauterine implantation occur simultaneously, is not increased.
The patient asks if she is a good candidate for an IUD. In which of the following situations would use of an IUD be contraindicated?
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