Health Promotion, Sexual and Reproductive Health
This domain tests health promotion and sexual and reproductive health: contraception, emergency contraception, sexually transmitted infection screening, vaccination and preconception advice. Questions often ask what to offer, how soon, and which method is most effective, so know the time windows and UKMEC restrictions.
Core rules and concepts
- Contraception: long-acting reversible contraception (implant, copper IUD, levonorgestrel IUS) is more effective than user-dependent methods. Check UKMEC: 1–2 suitable, 3–4 caution or avoid.
- Combined pill: missed pill rules depend on the number missed and the week. Use condoms or abstinence until seven active pills have been taken.
- Progestogen-only pill: traditional pills have a 3-hour window; desogestrel has a 12-hour window.
- Emergency contraception: levonorgestrel 1.5 mg within 72 hours; ulipristal acetate 30 mg within 120 hours; copper IUD within 5 days and is the most effective.
- Sexually transmitted infection screening: offer chlamydia, gonorrhoea, HIV and syphilis testing to those at risk; arrange partner notification and re-test after treatment.
- Vaccination: HPV vaccination reduces cervical cancer risk but does not replace cervical screening at 25–64 years; influenza and pertussis vaccines are offered in pregnancy.
- Preconception: folic acid 400 micrograms, stop smoking and alcohol, review medicines, check rubella immunity and optimise weight.
- Sexual history: use a non-judgemental approach; ask about consent, coercion and symptoms.
Worked example
A 24-year-old on the combined pill misses two pills in week 1 and had unprotected sex 60 hours ago. Reasoning: two missed pills in week 1 mean emergency contraception is needed. Levonorgestrel is licensed to 72 hours, ulipristal to 120 hours, and a copper IUD is the most effective. She should also use condoms until seven active pills have been taken.
Traps
- Offering only levonorgestrel when the copper IUD is more effective.
- Missing the 120-hour window for ulipristal.
- Assuming HPV vaccination removes the need for cervical screening.
- Giving live vaccines in pregnancy.
- Taking a sexual history without asking about coercion.
Key points
- Long-acting reversible contraception is most effective; check UKMEC before prescribing.
- Emergency contraception: levonorgestrel up to 72 hours, ulipristal up to 120 hours, copper IUD up to 5 days.
- HPV vaccination does not replace cervical screening.
- Preconception: folic acid 400 micrograms and stop smoking and alcohol.
- Ask about consent and coercion in the sexual history.