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2017 HCHB_digital

Contraception & Sexual

Contraception & Sexual Wellbeing Contraception: barrier contraception Barrier contraceptives prevent sperm from reaching a woman’s uterus and fallopian tubes. Condoms are currently the only type of barrier contraceptive available in New Zealand; diaphragms (silicone domes which cover the cervix) are no longer sold here. Condoms are made of either latex rubber, polyurethane, or polyisoprene. They are put on over a man’s erect penis before intercourse to stop sperm entering a woman’s vagina. Latex condoms are more widely available and usually less expensive than nonlatex polyurethane or polyisoprene condoms. However, they perish easily and can only be used with water or silicone-based lubricants. Oil-based lubricants, such as vaseline or baby oil can break down the latex increasing the risk of contraceptive failure. Latex condoms must also be stored away from heat and sunlight, and used before their expiry date. Polyurethane is a non-latex plastic material. They tend to be thinner than some latex condoms, so may offer better sensitivity; however, they are usually more expensive than latex condoms and slightly less flexible so more lubrication may be needed. Oil, water or silicone-based lubricants can be used with polyurethane condoms. Polyisoprene is a synthetic material and condoms made from polyisoprene have a soft, natural feel and conform to the skin easily, in a similar way to latex condoms. They are suitable for people with latex allergies but must be kept away from heat and sunlight. Strength is comparable to latex condoms and they are reportedly easier to use than polyurethane condoms. Although not 100% effective, condoms greatly reduce the risk of sexually transmitted infections (STIs) such as HIV, chlamydia, and gonorrhoea, and lessen the chances of contracting syphilis, herpes and genital warts. Male condom use should be encouraged even during sex with women taking hormonal methods of contraception or who are postmenopausal to reduce the risk of contracting an STI. Hormonal contraceptives protect only against pregnancy, not STIs. The chance of becoming pregnant depends a lot on how carefully the condom is used; most sources quote a failure rate of between 2% and 18%. Spermicides are no longer recommended to be used with condoms as they can cause irritation and increase the risk of acquiring an STI. The only type of female condom currently available in New Zealand is the FC2, made of nitrile (latex-free). A flexible ring at each end keeps it in place. Advice for customers • If unprotected sex occurs, or if a condom breaks, women should see a doctor as soon as possible. »» The ECP is available from accredited pharmacists and accredited nurses without prescription, but must be taken within 72 hours of unprotected sexual intercourse (see Contraception: Emergency). • Remind customers to store condoms away from heat and sunlight (ie, not in a car glove box), and to only use condoms that have not passed their expiry date. • Suggest water-based lubricants to decrease the risk of latex condom breakage. TREATMENT OPTIONS Category Examples Comments Male condoms (latex) eg, Durex Extra Safe*, Ansell range, Marquis Condoms Home-made lubricants, such as vaseline or cooking oils, may damage latex condoms. Condoms routinely no longer contain spermicide. Some vaginal antifungal creams can damage condoms and diaphragms – refer to the pharmacist if the customer or their partner is using this type of product. Many brands are fully subsidised on a prescription (144 condoms per script). Male condoms (non-latex) eg, polyisoprene (Durex Real Feel*) Non-latex condoms are suitable for people with latex allergies and are safe to use with both water and oil-based lubricants. Female condoms eg, FC2 Latex-free. Strong, odourless and causes no allergic reactions. May be used with water or oil based lubricants. Can be inserted up to eight hours prior to sex. Lubricants eg, Anime Lubricant*, Durex Perfect Glide* Reduce friction during sexual intercourse enhancing pleasure and reducing the risk of condom damage. Use only water or silicone-based lubricants with latex condoms. Oral contraceptives (OC) (desogestrel, ethinylestradiol, levonorgestrel, norethisterone) Products for erectile dysfunction [Restricted when sold by suitably trained pharmacists for women over the age of 16 previously prescribed an OC within the last three years] [Prescription medicine except when supplied by a pharmacist who has successfully completed training in the treatment of ED in males aged 35–70] eg, sildenafil (Silvasta, Vedafil) Selected OCs must be supplied in a pack approved as a restricted medicine, containing no more than six months' supply and including an explanation of side effects and when to seek further medical advice. Refer women with newly identified contraindications to the OC to a doctor and encourage regular cervical screenings and cardiovascular risk assessments. Use the recommended screening tool to screen out at-risk men who are smokers, have self-reported high cholesterol, have diabetes, and who have had a previous coronary intervention. Provide encouragement for all men presenting with ED to visit their doctor for a heart health and diabetes check. Products with an asterisk have a detailed listing in the Sexual Wellbeing, Contraception and Lubricant section of OTC Products, starting on page 257. EXPLORE THE DUREX RANGE OF CONDOMS Page 40 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION Contraception: oral contraceptives Oral contraceptives (OC) – also called birth control pills – contain hormones that prevent pregnancy. The combined OC (COC) contains an oestrogen and a progestogen to prevent ovulation (the release of eggs from the ovaries), thin the uterine lining, and thicken cervical mucus making it impenetrable to sperm. The progestogen-only pill (POP) – also called the mini-pill – contains just one hormone, progestogen. Most POPs work by thickening cervical mucus, preventing sperm from entering the womb. Some POPs (eg, desogestrel) also prevent ovulation, and offer a higher level of contraceptive efficacy than other POPs, and may be preferred in women unable to tolerate oestrogens or who are breastfeeding. Although oral contraceptives are a very effective method of birth control they do not prevent the spread of diseases (such as HIV or other STIs), so use with condoms should be encouraged. Sexual wellbeing Sex is an important part of being human, and it is also one of the biggest influences on our physical, mental and emotional health. When sex is part of a mutual, loving relationship, it improves cardiovascular function, boosts the immune system and relieves stress. However, sex also carries a risk of illnesses, mixed emotions, and unintended consequences that can all negatively impact on our quality of life. Sexually transmitted infections (STIs) are most prevalent in young people under the age of 25; however, rates have dramatically increased in the past decade among 40 to 50 year olds, perhaps due to a lack of safe sex practices including poor condom use. While chlamydia remains the most frequently diagnosed infection, genital herpes, genital warts and gonorrhea are also common. Testing for STIs is free for those under the age of 22 from many providers throughout New Zealand. Encourage anyone not in a monogamous relationship to use condoms and to consider regular STI testing. Vaginal health Good vaginal health is an important contributor to a woman's overall state of health and a change in the colour, smell, or consistency of vaginal discharge is often the first sign that something is wrong (see Vaginal Health). Lubricants may help reduce sexual discomfort associated with menopause. Erectile dysfunction Erectile dysfunction (ED) refers to an inability to get or keep an erection firm enough to have sexual intercourse. Occasional ED is not uncommon and can occur if a man is stressed, tired, distracted, or after drinking too much alcohol. Persistent ED becomes more common with age, affecting approximately 50% of men aged 40–70 and up to 70% of men over the age of 70. ED can be caused by an underlying condition (organic cause) or have a psychological cause. Men with an organic cause are more likely to complain of Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment or a caregiver's history may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Has the customer had unprotected sex and wants information about the emergency contraceptive pill (ECP)? • Has the customer had unprotected sex and is worried about having been exposed to a sexually transmittable infection? • Has the customer had sex against her will and is wanting further advice? • Is the customer wanting to buy a supply of oral contraceptive pills over-the-counter? • Is the customer wanting information about erectile dysfunction treatments? a gradual onset and progressive worsening of their symptoms as well as a lack of early morning erections. These customers need to be referred to a doctor. Psychological ED tends to present suddenly or vary depending on the partner or situation. Early morning erections are usually maintained. However, both causes are not mutually exclusive and many men have components of the two. Customers wishing to purchase sildenafil over-the-counter need to undergo screening for eligibility from a pharmacist trained in the management of ED. Initial assessment While some people have no qualms about discussing their sexual health with pharmacy staff, others do. Politely asking if you can help or would they prefer to talk to a pharmacist may be the best approach in people who appear embarrassed or shy. All women requesting oral contraceptives and all men requesting treatments for ED must be referred to a pharmacist. For customers wanting more information about condoms, explain the different types available (latex or latex-free) and offer Family Planning information leaflets. Advise the person to read the packet instructions to ensure the condom is used correctly. EASY-ON S H A P E Durex condoms are a method of contraception that may help reduce the risk of pregnancy and transmission of STIs. No method of contraception can give you 100% protection against pregnancy, HIV or STIs. Always read the label. Use only as directed. Reckitt Benckiser, Auckland. TAPS DA1703DB. EASY-ON Page 41

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