(2) Wk 8 discussion peers replies

1 peer:

Case Scenario 2

Table 1

Term	Definition
Sexuality	Pertaining to quality of life and sexuality, this term encompasses a holistic state of physical, emotional, mental and social well-being (Alexander, 2023).
Sexual health	Sexual health relates to feeling safe and having a healthy sexual relationships that are freely engaged in without coercion or discrimination (Alexander, 2023).
Sexual identity	Sexual identity is how a person relates based on their chosen or biological gender or non-binary association (Alexander, 2023).
Sexual orientation	Sexual orientation is how someone chooses to identify as a heterosexual, bi-sexual, gay, non-binary or transgender person (Alexander, 2023).
Sexual agency	Sexual agency is described as the ability to identify, communicate, and negotiate one’s sexual needs, and to initiate behaviors that allow for the satisfaction of those needs. It aids in the development of their own sexual identities and practices.
Sex	Biological or non-biological gender assignment
Gender Identity	How an individual identifies related to their assigned or chosen gender.
Transgender	This term describes a person whose gender identity and sex assigned at birth do not correspond to their personal feelings, associations and societal expectations (Alexander, 2023)
Gender dysphoria	This relates to the distress a person may feel if they do not identify with their biological gender that is assigned at birth (Alexander, 2023).
Cisgender	This refers to a person’s assigned gender correlating with their biological sex (Alexander, 2023).
Transmale	A person who identifies as male, he, his, him.
Transfemale	A person who identifies as female, she, her, hers.

Table 2

Name 5 medical (physical) causes of female sexual dysfunction	1.Genitopelvic pain/Penetration disorder. 2. Vulvodynia 3. Vestibulodynia 4. Female Sexual Interest Arousal Disorder 5. Female Orgasmic disorder
Name 5 medication-induced sexual dysfunction	1.Cancer induced chemotherapy 2. Anticonvulsants 3. Pain medications 4. Psychotropic medications 5. Cardiovascular medications
Name 5 psychological cases of female sexual dysfunction	Stress Depression/Anxiety Previous sexual or physical abuse Relationship conflict Religious or societal conflicts
Name at least 4 management plan to help with sexual dysfunction (include 2 pharmacologic and 2 non pharmacologic interventions)	Pharmacologic: Estrogen and androgen therapy can restore vaginal lubrication, pH, microbial flora and urinary continence. Testosterone gel apply 0.5% daily or every other day may increase libido. DHEA 10-25 mg PO at bedtime has been researched to increase arousal, lubrication and libido in some women. Non-pharmocologic: Eros-Clitoral Therapy device increases blood flow to the clitoris and improves genital sensation when used 3-4 x per week. Psychological counseling and therapy for couples can improve communication and the desire to be intimate in couples (Alexander, 2023).

Table 3

Define Vulvodynia- Described as generalized, localized or mixed the anatomical structure are normal in appearance but the patient reports a constant, burning pain involving the vulva and vestibule, the cause is often uncertain but believed to be triggered by pain, trauma, medication or yeast infections (Alexander, 2023).

Define Vaginismus- An automatic tightening of the vaginal and pelvic muscles in anticipation or fear of penetration.

Define Vestibulodynia- The most common cause of intercourse in premenopausal individuals due to vaginal atrophy and diminished lubrication.

What are treatment options? Vulvodynia-Cognitive behavioral therapy, numbing creams, antidepressants, vestibulectomy. Vaginismus-Cognitive behavioral therapy. Vestibulodynia- Cognitive behavioral therapy, numbing creams, loose fitting clothing, cotton underwear (Schlaeger et al., 2022).

Ty is a 22-year-old who comes to your office for an annual physical exam. On the intake paperwork, you note the gender box is blank. Ty was female assigned as birth but identifies as They/Them. The patient selected both the “have sex with females” and the “have sex with males” box in the sexual history.

How will you verify the patient’s name and preferred name?

I will ask the patient if they can please tell me their full name and date of birth and if they have a preferred name other than the legal name on their medical documents.

How will you ask for the patient’s gender?

I will ask the patient if they identify as male, female, or non-binary.

This patient identifies as non-binary.

How will you ask for the patient’s preferred pronouns?

I will ask the patient how they would like to be addressed and if they have any preferred pronouns. This patient prefers to be addressed with the pronouns “they, them, theirs.”

Small interventions, such as offering personal pronouns and asking patients about their preferred pronouns help to validate and affirm (LGBTQIA+ or LGBTQ+) patients and positively impact their experience and health (Bhatt et al., 2023).

Subjective

CC: The patient presents today for their annual health exam.

HPI: A 22-year-old non-binary patient presents today for an annual physical exam. The patient identifies as “they, them, theirs”. The patient presents with vulva pain x 3 months and complains of, dyspareunia “7/10” for 3 months. The patient has tried OTC Ibuprofen 500 mg as needed for two months, without relief. The patient reports that the pain is not better or worse with different sexual positions or sex toys. The patient is sexually active with a male and female partner for one year. They do not use condoms when having intercourse or using sex toys. The patient is polyamorous and engages in oral, vaginal, and anal receptive sex. +h/o Chlamydia. Treated infection 1 yrs ago. The last STI screening was 6 months ago. The patient states they have had two new partners male and female since the last STI screening.

Pmhx: Generalized Anxiety Disorder

Surgical hx: none

Meds: Sertraline 25 mg tablet PO once daily. Followed by Psychiatrist.

Allergies: NKDA

OB/Gyn Hx: G0P0A0. LMP 4/7/2024. Menarche at age 13. Menses occur every 28 days. Regular to light flow lasting 3-5 days.

Sexual Hx:. 3 lifetime partners (2 men and 1 woman including their present partners), +h/o Chlamydia, last screened 6 months ago. Two new partners since the last negative screening. The patient engages in oral, vaginal, and anal receptive sex and uses sex toys with both male and female partners. The patient reports that the pain is not better or worse with different sexual positions, duration or frequency of sex. The patient declines contraceptive counseling today, but would like STI screenings.

Family Hx: (include 3 generations of fam hx)

Mom- 48, alive, no medical conditions.

Dad- 50, hypertension.

No siblings.
Maternal Grandmother 76, no medical conditions.

Maternal Grandfather 81, hyperlipidemia, hx of CVA.

Paternal Grandmother 79, hypertension.

Maternal Grandfather, deceased d/t MI.

Health Maintenance: Never had Pap. Flu shot 9/2023, Covid x 3 with last shot 9/2023, Tdap 2019, Gardasil x 2 in 2014. Eye exam 1/2023, dental exam 6/2023. Last Annual Physical Exam 2019.

Social hx: Single. Lives with current partners in an apartment and works part-time as a Barista. The patient attends community college for 2-3 drinks once a week, -smoking,–other drugs use. Exercises 5x/week cardio for 1 hour in the gym. Eats a vegan diet. They feel safe with their current partners, -IPV.

ROS:

Constitutional/general: -unintentional weight loss, -fever, chills, nausea, vomiting, fatigue.

Heart/Lung: – chest pain, -heart palpitations, -SOB. –coughing/wheezing.

Abd: -pain as noted above

Gyn: +vulva burning, -odor, – abnormal discharge, – dysuria, +dyspareunia. +h/o Chlamydia. -douching, -bubble baths.

Psych: Denies any suicidal ideations or thoughts of harming self or others.

Objective:

The 22-year-old non-binary patient is well developed, with appropriate affect.

VS: BP 116, 72, HR 74, T 98.6, BMI, 19.3 (healthy weight) Height: 5’7” Weight”124 lbs

Heart: S1 S2 R, -m/r/g

Lungs: CTAB

Abd: +soft,- guarding, – rebound tenderness, – distension, +BS x 4, -masses, -hernias.

Pelvic Exam:

External genitalia: -lesions,- excoriation, -inflammation, -erythema, normal hair distribution.

Vagina: -abnormal discharge in vaginal vault, -odor

Cervix: –CMT, nulliparous OS, cervix smooth pink and non-friable.

Uterus: small, midline

Adnexa: – tenderness or masses bilaterally

PCOT: Wet mount: -clue cells, -whiff test. -hyphae/ buds. pH 4.5,- Urine pregnancy, -HIV. -Urine dipstick leukocytes, -Nitrates. urine is clear and light yellow. PHQ-9 and GAD-7 screenings for anxiety and depression were performed per USPSTF guidelines (USPSTF, 2024).

Assessment (Diagnoses):

1. Vulvodynia N94.81 Pain localized to the vulvar vestibule with an absence of an identifiable cause lasting for >3 months (Patla et al., 2023). Pertinent + The patient reports pain to their vulva occurring for 3 months that is exacerbated by sex.

DDX:

1. Vulvovaginal candidiasis B37.3 One of the most common causes of vulvovaginal burning in patients with female genitalia. Pertinent negative – yeast buds and hyphae on Wet Mount (Epocrates, 2024).
2. Lichen Sclerosis L90.0 Benign chronic or progressive dermatologic condition causing pruritus and pain in the vulva and labia major. Pertinent – No rashes, inflammation, pigment changes, or excoriation noted during pelvic exam (Epocrates, 2024).

Plan

Diagnostic Tests: Pap Smear, NAAT for Chlamydia, Gonorrhea, Trichomonas, and Syphilis per CDC STI guidelines (CDC, 2024).

Pharmacologic: Lidocaine 5% topical ointment (1 50 g tube with 1 refill). Apply a thin ribbon (5 grams) to the affected area as needed. Wash hands after application. Topical lidocaine ointment is shown to mitigate pain and discomfort associated with vulvodynia (Schlaeger et al., 2022). The patient is already taking an SSRI which is considered to be a second line of therapy for Vulvodynia. Referral made to a Psychiatrist to discuss increasing dosage based on new symptoms if topical lidocaine therapy is ineffective (Epocrates, 2024).

Non-Pharmacologic: Referral to Psychiatrist for psychotherapy and increasing dosage of SSRI. Sex counseling with your partners may also be beneficial to reduce anxiety surrounding sex and penetration (Patla et al., 2023). Discuss complementary and alternative therapies such as transcutaneous electrical nerve stimulation, acupuncture, and meditation techniques which have been researched to provide some relief to patients with vulvodynia symptoms (Schlaeger et al., 2022). Research shows that the severity of vulvodynia pain is correlated with high-stress levels in patients <25 years and that stress reduction techniques can help reduce the severity of symptoms (Patla et al., 2023).Surgery may be considered as a last resort if symptoms do not improve with conservative treatments (Epocrates, 2024).

Patient Education: Topical treatments are the first line of therapy for vulvodynia. Lidocaine 5% should not be applied more than a small ribbon to the affected area more than 3x daily or exceed 20 grams per day. Wash your hands after applying. Side effects may include lightheadedness, dizziness, local erythema, or a hypersensitivity reaction. Stop using and notify your provider if symptoms worsen. Call 911 if you experience any symptoms of anaphylaxis such as hives, airway restriction, chest palpitations, or severe GI upset that causes vomiting and diarrhea (Epocrates, 2024). SSRIs may also help reduce neuropathic pain by influencing neurotransmitters affecting pain in the central and peripheral nervous systems (Schlaeger et al., 2022). If these are not effective in improving your symptoms, many other therapies such as Gabapentin and Vaginal Diazepam may help. Pelvic floor therapies and dilators desensitize the vulva to touch and pressure and aid in stretching the pelvic floor muscles to reduce dyspareunia (Schlaeger et al., 2022).

Follow-Up/RTC: Follow up in two weeks to discuss diagnostic findings and evaluate for effectiveness of lidocaine therapy in reducing symptoms. Make additional referrals to OB/GYN for pelvic floor therapy, as needed.

Risks of not complying with treatment: Patients who do not seek treatment for vulvodynia have a significant decrease in quality of life and sexual satisfaction. There are comorbidities associated with vulvodynia that may include irritable bowel syndrome, chronic yeast infections, and urinary tract infections (Patla et al., 2023).

Referral: Referral to Psychiatrist for Psychotherapy and to evaluate for SSRI dosage increase if topical Lidocaine medication does not improve symptoms. Refer to OB/GYN for pelvic floor therapies and/or fitting for a dilator if lidocaine topical medication and SSRI medication do not reduce symptoms. Dilators desensitize the vulva to touch and pressure and stretch hypertonic pelvic floor muscles and the vagina (Schlaeger et al., 2022).

Health Maintenance: Influenza due 09/2024. Next Pap due in 3 years (if findings are normal). The next Eye exam is due now, referral provided. The next dental exam is due on 6/2024. The next annual exam is due on 4/2025. Health Diet and Physical activity and skin cancer prevention education provided (USPSTF, 2024).

 

2nd peer:

Case Scenario 2

Table 1

Term	Definition
Sexuality	individual’s sexual feelings, desires, attractions, and behaviors. It encompasses emotional, romantic, and sexual aspects of a person’s life.
Sexual health	encompasses physical, emotional, mental, and social well-being concerning sexuality. It involves having a positive and respectful approach to sexuality, seeking pleasurable and safe experiences, and having satisfying sexual relationships free from coercion, discrimination, and violence.
Sexual identity	individual’s self-perceived sense of sexuality. It encompasses how individuals understand and label themselves regarding their sexual orientation, desires, and attractions.
Sexual orientation	an individual’s enduring pattern of emotional, romantic, and sexual attraction to men, women, both genders, or neither gender. Common sexual orientations include heterosexual (appeal to the opposite gender), homosexual (attraction to the same gender), and bisexual (attraction to both genders), among others.
Sexual agency	to individuals’ ability to make informed decisions about their sexual life and engage in consensual sexual activities based on their desires and preferences. It emphasizes the importance of autonomy, consent, and empowerment in sexual experiences.
Sex	the biological attributes of being male or female, typically determined by reproductive anatomy and physiology.
Gender Identity	Gender identity refers to an individual’s deeply felt sense of gender, which may or may not align with the sex assigned at birth. It is an internal and personal experience of gender, which can include being male, female, a combination of both genders, and neither gender.
Transgender	Transgender is an umbrella term used to describe individuals whose gender identity differs from the sex assigned to them at birth. Transgender individuals may identify as male, female, non-binary, or other gender.
Gender dysphoria	Gender dysphoria is a clinical term used to describe distress or discomfort experienced by individuals when their gender identity does not align with the sex assigned to them at birth. It is recognized as a medical condition commonly associated with transgender individuals.
Cisgender	individuals whose gender identity aligns with the sex assigned to them at birth. For example, someone assigned a female at birth and identified as a woman is considered cisgender.
Transmale	term used to describe an individual assigned female at birth but identifies as male.
Transfemale	term used to describe an individual who was assigned male at birth but identifies as female.

Table 2

Name 5 medical (physical) causes of female sexual dysfunction	1. Hormonal imbalances (e.g., low estrogen levels during menopause) 2. Gynecological conditions (e.g., endometriosis, pelvic inflammatory disease) 3. Neurological disorders (e.g., multiple sclerosis, spinal cord injury) 4. Chronic illnesses (e.g., diabetes, cardiovascular disease) 5. Genital abnormalities or anatomical issues (e.g., vaginal dryness, vaginal atrophy)
Name 5 medication-induced sexual dysfunction	1. Antidepressants (e.g., selective serotonin reuptake inhibitors like fluoxetine) 2. Antipsychotics (e.g., risperidone, olanzapine) 3. Hormonal contraceptives (e.g., birth control pills, hormonal IUDs) 4. Blood pressure medications (e.g., beta-blockers, diuretics) 5. Chemotherapy drugs (e.g., tamoxifen, aromatase inhibitors)
Name 5 psychological cases of female sexual dysfunction	1. Anxiety disorders 2. Depression 3. History of sexual trauma or abuse 4. Body image issues or low self-esteem 5. Relationship problems or communication difficulties with partner
Name at least 4 management plan to help with sexual dysfunction (include 2 pharmacologic and 2 non pharmacologic interventions)	Pharmacologic Interventions: Hormone replacement treatment (HRT): For disorders such as menopausal symptoms or hormonal imbalances, HRT may be administered to treat symptoms including reduced libido and dry vagina. Medication adjustments: If a healthcare professional suspects that a drug is causing sexual dysfunction, they may want to change the medicine or change the dosage to one that has fewer negative affects on sexual function. Non-Pharmacologic Interventions: Psychotherapy or counseling: Cognitive-behavioral therapy (CBT) or other forms of psychotherapy can help address underlying psychological factors contributing to sexual dysfunction, such as anxiety, depression, or trauma. Couples therapy: Couples therapy can offer a supportive setting for partners to address difficulties, improve communication, and increase intimacy when problems with relationships or communication are affecting sexual function. Pelvic floor physical therapy can assist relax and strengthen the muscles, enhance blood flow, and lessen pain during sexual activity for illnesses involving pelvic floor muscular dysfunction, such as vaginismus or pelvic pain disorders. Education and self-help strategies: Providing education about sexual anatomy, function, and techniques for arousal and pleasure can empower individuals to take an active role in managing their sexual health. Self-help strategies may include mindfulness techniques, relaxation exercises, and sensate focus exercises to enhance sexual awareness and intimacy.

Table 3

Define Vulvodynia refers to chronic pain or discomfort in the vulva, which is the external genital area of a woman. This pain can be localized to a specific area or spread throughout the vulva.

Define Vaginismus is characterized by involuntary muscle spasms in the pelvic floor muscles surrounding the vagina. These spasms can make it difficult or impossible for a woman to engage in vaginal penetration, including sexual intercourse or insertion of tampons.

What is the difference between the 2 diagnoses? The main difference between vulvodynia and vaginismus lies in their underlying causes and symptoms. Vulvodynia primarily involves pain in the vulvar region, whereas vaginismus involves muscle spasms specifically related to vaginal penetration.

What are treatment options? A combination of methods may be used to treat vulvodynia, depending on the needs and symptoms of the patient. Topical treatments: to numb the region and lessen pain, use lotions or ointments containing lidocaine. Physical therapy: methods for addressing pain and muscle tension, such as biofeedback or exercises for the pelvic floor muscles. Drugs: antidepressants and anticonvulsants are examples of medications that can assist modify nerve signals and lessen pain. Lifestyle modifications include things like putting on baggy clothes, staying away from irritants like scented detergents and soaps, and adopting stress-reduction strategies. A comprehensive approach that addresses both the physical and psychological elements of vaginismus treatment is common. This could consist of: Pelvic floor physical therapy uses manual techniques and exercises to strengthen and relax the pelvic floor muscles. Therapy or counseling: to treat any underlying psychological issues, such as worry, fear, or traumatic experiences in the past, that may be causing the illness. Gradual exposure therapy is a technique used to desensitize the body to vaginal insertion by introducing it progressively in a safe and encouraging setting. Dilator therapy is the process of gradually stretching and desensitizing the vaginal muscles with a set of graded dilators.

Ty is 22-year-old who comes to your office for an annual physical exam. On the intake paperwork, you note the gender box is blank. Ty was female assigned as birth but identifies as They/Them. The patient selected both the “have sex with females” and the “have sex with males” box in the sexual history.

CC: well women exam

History of Present Illness (HPI): Ty, a 22-year-old individual identifying as non-binary, is here today for their annual physical exam. G0P0, pt reports being pansexual, pt reports they do not want to become pregnant at this time and reports having sexual relations with persons who can get them pregnant, reports occasional use of condoms when with male partners only. Ty admits to having regular sexual encounters and emphasizes the significance of having safe sex with all partners. They express concern about the potential risks of sexually transmitted infections and have been careful to use barrier techniques during sexual interactions. Denies hx of STIs. However, is not sure if they sexual partners STI history. States has never had a pap smear conducted. LMP: 04/10/2024. reports having regular 28 day menstrual cycles with approx 4 day cycle, reports they would like to not have periods at this time.

Past Medical History (PMH): Ty has no significant medical or surgical history. They are not currently on any medications and have no known allergies. Ty’s immunizations are up to date.

GYN/OB Hx: G0P0, pt reports being pansexual, pt reports they do not want to become pregnant at this time and reports having sexual relations with persons who can get them pregnant, reports occasional use of condoms when with male partners only. Patient admits to having regular sexual encounters and emphasizes the significance of having safe sex with all partners. They express concern about the potential risks of sexually transmitted infections and have been careful to use barrier techniques during sexual interactions. Denies hx of STIs. However, is not sure if they sexual partners STI history. States has never had a pap smear conducted. LMP: 04/10/2024. reports having regular 28 day menstrual cycles with approx 4 day cycle, reports they would like to not have periods at this time.

Family Hx: father living HTN and HLD, mother living hx of cervical cancer, HTN

Social Hx: lives at with two roommates, social alcohol use, denies smoking/vaping, denies use of illegal drugs, works as a waiter and attends college. Ty has a history of sexual activity with females and males, is not sure if theys sexual partners STI history.

Review of Systems (ROS):

• General: No fever, weight changes, or fatigue.
• Cardiovascular: No chest pain, palpitations, or edema.
• Respiratory: No cough, dyspnea, or wheezing.
• Gastrointestinal: No abdominal pain, nausea, or vomiting.
• Genitourinary: No dysuria, hematuria, or urinary frequency.
• OB/GYN: G0P0, sexually active with both male and female partners, reports having regular 28 day menstrual cycles with apx 4 day cycle, reports they would like to not have periods at this time, no changes in discharge/itching/foul smell. Denies hx of STIs. However, is not sure if they sexual partners STI history. States has never had a pap smear conducted. LMP: 04/10/2024. reports having regular 28 day menstrual cycles with approx 4 day cycle, reports they would like to not have periods at this time.
• Neurological: There are no complaints of headaches, numbness, tingling, weakness, or difficulty with coordination or balance. No history of seizures, stroke, or neurological disorders.
• Psychiatric: Denies ongoing or current symptoms of depression, anxiety, or other mental health conditions—no history of psychiatric hospitalizations or suicidal thoughts.

Objective

Physical findings

Vital Signs: BP 122/70, HR 72, temp 98.4, RR 16, Sp02 100%, weight 130 lbs, height 5ft 6in

General: Awake, alert, and oriented x4, no acute distress
CV: S1S2, regular rate and rhythm without murmur
Resp: Breath sounds are equal /symmetrical and clear to auscultation in all lobes
Neuro/Psych: CN intact, headaches occasional without AURA.
OB/GYN: G0P0, sexually active, pelvic exam of external genitalia, no lesions, no redness, no areas identified as irritated, no foul smell. Internal exam with vaginal speculum, vault was free of any bleeding or discharge. Pt reported no discomfort with exam. Digital exam produced no discomfort and pt reports no pain with abdominal pressure. Pap and STI testing collected
Breast: no skin dimpling or pulling, no nipple discharge, no masses upon palpation
GI/GU: abdomen soft, non distended, no complaint of abdominal pain with external upper quadrant palpation

Assessment

Differential:
1). Z20.2 Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission

Diagnosis:

1. Z30.9 Encounter for contraceptive management
2. Z01.419 Encounter for gynecological examination (general) (routine) without abnormal finding

Plan

According to Chlamydia and Gonorrhea: Screening – Healthy People 2030 | Health.gov (n.d.), the following diagnostic tests are recommended for a 22-year-old female:

1. Pap Smear (Cervical Cancer Screening): pending results
   • A Pap smear is typically recommended starting at age 21 and should be repeated every three years until age 29. It is used to detect cervical abnormalities and early signs of cervical cancer. (Chlamydia and Gonorrhea: Screening – Healthy People 2030 | Health.gov, n.d.)
2. Sexually Transmitted Infection (STI) Screening: pending results
   • For those who are sexually active, including a 22-year-old woman, STI screening is advised. Depending on a person’s sexual history, area prevalence rates, and personal risk factors, the exact tests and frequency may change. Screenings for HIV, syphilis, chlamydia, and gonorrhea are common STI tests. (Chlamydia and Gonorrhea: Screening – Healthy People 2030 | Health.gov, n.d.)
3. Breast Examination: no abnormal findings. WNL
   • For women in their 20s, a clinical breast examination by a healthcare professional is not usually advised unless there are particular concerns or symptoms. For the early identification of any anomalies, self-breast awareness and knowledge of breast changes are crucial. (Chlamydia and Gonorrhea: Screening – Healthy People 2030 | Health.gov, n.d.)

Lab review: CBC, CMP, Lipid Panel, STI screening, urinalysis C&S pending results

POC: Urine Pregnancy-negative, Urine Dipstick Negative

Medication:

Contraceptive Medications: Depending on Ty’s preferences and contraceptive needs, discussed with they, may consider hormonal contraceptives such as birth control pills, contraceptive patches, vaginal rings, or injectable contraceptives. Discussing the options, their effectiveness, and potential side effects with a healthcare provider is important to determine the most suitable contraceptive method for Ty. Patient mentioned she is not ready to make theys decision at the moment and will schedule a FU appt.

Education:

• Reviewed with Pt. need for pap smear today and every 3 years as long as results are negative for abnormal cells

• Hormonal Methods:
• Continuous Birth Control Pills: Some birth control pill brands are designed to be taken continuously, without the usual 7-day break for menstruation. By skipping the placebo pills and starting a new pack immediately, you can avoid having a monthly period.
• Hormonal IUD: Hormonal intrauterine devices (IUDs) such as Mirena or Skyla release progestin locally into the uterus, which can reduce menstrual bleeding and cramping. In some cases, periods may stop altogether.
• Implant: The contraceptive implant, such as Nexplanon, releases progestin into the body, often resulting in lighter periods or even no periods for some individuals.
• Non-Hormonal Methods:
• Copper IUD: While not typically associated with stopping periods, the copper IUD can lead to heavier periods initially. However, for some individuals, periods may become lighter over time or cease altogether.
• Tubal Ligation or Hysterectomy: Permanent surgical methods like tubal ligation (for females) or hysterectomy (removal of the uterus) eliminate the need for contraception and periods. However, these procedures are irreversible and should be considered carefully.
• contraceptives provide protection against pregnancy, they may not protect against STIs. Consistent and correct use of condoms is recommended for reducing the risk of STIs.
• Sexual Health Education: Provide comprehensive sexual health education, including information about safe sex practices, contraception options, and the importance of regular STI screening.
• Discuss the potential risks and preventive measures for sexually transmitted infections (STIs) based on Ty’s sexual history.
• Emphasize the importance of open communication and consent in sexual relationships.
• LGBTQ+ Health Education: Educate Ty about LGBTQ+ health concerns, including mental health challenges, discrimination, and available resources for support.
• Provide information about LGBTQ+-friendly healthcare providers and support networks.
• Address any specific questions or concerns Ty may have regarding her sexual orientation or struggles with identity.

Follow up:

Schedule a follow-up appointment to review the results of the gynecological examination and any additional tests performed. Use this opportunity to address any concerns or questions Ty may have regarding her reproductive health.

Schedule FU appt when patient is ready to start a contraceptive method of theys choice.

Health Maintenance

1. Regular Gynecological Exams: Emphasize the significance of routine gynecological exams, including Pap smears, breast examinations, and screenings for STIs.
2. Preventive Care: Encourage Ty to maintain a healthy lifestyle by exercising regularly, eating a balanced diet, and managing stress levels.
3. Stress the importance of regular check-ups, including vaccinations, blood pressure monitoring, and cholesterol screenings.

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