Self-Care 2025: Vulvovaginal Disorders & OTC Contraception

What are some counseling points for emergency contraception (EC)?

-Take the EC tablet as soon as possible

-EC may or may not affect the patient's monthly cycle

-EC is not 100% effective

Plan B (levonorgestrel)

*Good EC (of the options given)

-Prevents pregnancy up to 5 days after unprotected sex, works better the sooner you take it

-Don't need a prescription, can get at most drug stores/online

Levonorgestrel (Plan B) may be less effective as emergency contraception in patients with a BMI of ___ or greater.

26

Ella (Ulipristal acetate)

*Better EC (of the options given)

-Prevents pregnancy up to 5 days after unprotected sex

-More effective than Plan B

-Need a prescription from a nurse or doctor

Ulipristal (ella, Rx only) may start to lose effectiveness at a BMI of ___ and may become ineffective at a BMI of ___.

30, 35

Paragard Copper IUD

*Best EC (of the options given)

-Prevents pregnancy 99% of the time when you get within 5 days of unprotected sex

-A nurse or doctor puts in uterus

-Keep using as birth control for up to 12 yrs

Which emergency contraceptive option (Rx or OTC) has NO issue with BMI?

ParaGard Copper IUD

Emergency contraceptives are most effective when used within ___ hours of unprotected sex.

72

Counseling Points for Opill

-Must take at same time each day

-Use backup method for first 48hrs and if missed dose

-Common side effects: irregular bleeding/spotting, abdominal cramps, increased appetite

-Contraindications include hx of breast cancer, liver tumors, or severe cirrhosis

-Don't take with strong 3A4 inhibitors

-Doesn't protect against STIs/HIV

Pros of Male Condoms

-Prevents fluid sharing and limits skin-skin contact

-Protection from pregnancy and STIs

-Used for vaginal or anal sex

-Can be used with other methods

-Easily available

-Cheap

Failure rate of male condoms

18%

Cons of Male Condoms

-One time use only

-Must be used correctly and consistently

-Non-latex options are harder to find

Where should male condoms be stored?

cool, dry place (not a wallet or vehicle glove compartment)

Are oil-based or water-based lubricants better to use with most male condoms?

water-based (oil-based will weaken latex)

Pros of Female Condoms

-Prevents fluid sharing and limits skin-skin contact

-Protection from pregnancy and STIs

-Used for vaginal or anal sex

-Can be used with other methods

-Non-latex, conducts heat

Failure rate of female condoms

21%

Cons of Female Condoms

-One time use

-Harder to find

-More expensive than external condoms

-"Weird"

Female condoms may be inserted up to how many hours before intercourse?

2 hours

Pros of a Sponge

-Easy to use

-Can be inserted up to 24hrs before sex

-Inexpensive

-No prescription/fitting

Failure rate of a sponge

12% pre vaginal birth

24% post vaginal birth

Cons of a Sponge

-Spermicidal irritation

-Must be left in place for 6 hrs after sex

-Increased STI risk

-Too messy or too dry

The contraceptive sponge is less effective for women who have:

Given birth vaginally

What's an important counseling point for removing the contraceptive sponge?

Make sure entire sponge is removed as fragments may serve as a source for infection.

Which OTC contraceptive options are best for patients at risk of contracting STIs?

Male and female condoms

Patients should be encouraged to seek a longer-term contraceptive option if they are:

using emergency contraceptives multiple times per month

If a patient's period is ___ days late after using an emergency contraceptive, they should use a pregnancy test

21

What are some of the signs and symptoms of bacterial vaginosis?

Thin (watery), white or gray, sometimes foamy discharge;

Unpleasant "fishy" odor that increases after intercourse or menses;

Increased vaginal pH (e.g., with menses)

Absence of ___ rules out bacterial infection

Odor

Bacterial vaginosis is a polymicrobial infection resulting from a(n):

Imbalance in normal vaginal flora

What are the risk factors of bacterial vaginosis?

-Multiple or new sexual partners

-Use of an IUD

-Douching

-Tobacco use

-Previous pregnancy

Who does bacterial vaginosis predominantly affect?

Sexually active women but can arise spontaneously regardless of sexual activity

What are the signs and symptoms of trichomoniasis?

-Frothy, malodorous, yellow-green (or discolored) discharge

-Pruritus

-Possible vaginal irritation

-Dysuria

-Odor

-Usually erythema/edema (discomfort/mild pain)

Most ____ with trichomoniasis are asymptomatic

men (serve as reservoirs of infection)

*initially asymptomatic for ~50% of affected women

Risk factors for trichomoniasis:

-Multiple or new sex partners

-Nonuse of barrier contraceptives

-Presence of other STIs

Which types of vaginal infections are typically associated with an increase in vaginal pH?

Bacterial vaginosis, trichomoniasis

What are the signs and symptoms of candidiasis?

-White discharge that has a more solid appearance

-"Cottage cheese" appearance

-Does NOT have odor

-Itching and irritation/burning

-Absence of malodor

What is vulvovaginal candidiasis also known as?

Yeast Infection

What are the risk factors for vulvovaginal candidiasis?

-Pregnancy

-Medications such as antibiotics and immunosuppressives

Treatment Goals for Fungal Vaginal Infections

-Relief of symptoms

-Eradication of the infection

-Re-establishment of normal vaginal flora

Treatment Exclusions for Vulvovaginal Candidiasis (VVC)

-Pregnancy

-Girls <12 yrs of age

-Concurrent symptoms: fever or pain in the pelvic area, lower abdomen, back, or shoulder

-Medications that increase risk of VVC (corticosteroids, antineoplastics)

-Medical disorders that can predispose to VVC (diabetes, HIV infection)

-Recurrent VVC (>3 infections/year, or 2 infections in past 2 months)

-First vulvovaginal episode

Which vaginal disorder is dysuria most associated with?

Vulvovaginal Candidiasis

Which vaginal disorder is LEAST likely to be associated with vulvovaginal erythema & edema?

Bacterial Vaginosis

Which vaginal disorder is most associated with vulvar itching or irritation?

Bacterial Vaginosis

When is the best time of day to apply topical vaginal antifungals?

At bedtime to reduce leakage

If symptoms of vulvovaginal candidiasis still persist after 1 week, patients should be:

Referred to their provider

When using male condoms, if not reservoir-tipped, ____ of space should be left between the end of the condom and tip of the penis

one half inch

How long should clotrimazole 1% cream be used to treat vulvovaginal candidiasis?

Up to 7 days; Apply BID as needed for itching

How long should clotrimazole 2% cream be used to treat vulvovaginal candidiasis?

Up to 3 days; Apply BID as needed for itching

How long should miconazole 2% cream be used to treat vulvovaginal candidiasis?

Up to 7 days; Apply BID as needed for itching

How long should miconazole 4% cream be used to treat vulvovaginal candidiasis?

Up to 3 days; Apply BID as needed for itching

What are the directions for use for Monistat-1 (Miconazole-1) Combination pack?

Insert suppository into vagina daily for 1 day; apply cream to vulva twice daily as needed to relieve itching up to 7 days

What are the directions for Monistat-3 (Miconazole-3) Combination Pack?

Insert ovule, suppository, or cream using applicator (depending on packaging) once daily for 3 days; apply external cream to vulva twice daily as needed for itching, up to 7 days

What are the directions for Monistat-7 (Miconazole-7) Combination Pack?

Insert cream into vagina using applicator once daily for 7 days; apply cream to vulva twice daily as needed for itching for up to 7 days

What are the directions for use for tioconazole ointment products when treating vulvovaginal candidiasis?

Insert entire contents of applicator into vagina once at bedtime

Counseling points for vaginal antifungals

-Wash the vaginal area with mild soap and dry before applying the product.

-Products should be continued during menstrual flow.