Concepts of Contraception for Adolescent and Young Adult Women with Chronic Illness and Disability
Michigan State University College of Human Medicine, Kalamazoo, MI, USA. Disease-a-month: DM
(Impact Factor: 0.95).
05/2012; 58(5):258-320. DOI: 10.1016/j.disamonth.2012.02.001
Sexual behavior is common in adolescents and young adults with or without chronic illness or disability, resulting in high levels of unplanned pregnancy and STDs. Individuals with chronic illness or disability should not receive suboptimal preventive health care. These individuals have a need for counseling regarding issues of sexuality and contraception. Sexually active adolescent and young adult women can be offered safe and effective contraception if they wish to avoid pregnancy. Women with chronic illnesses and disabilities who are sexually active should also be offered contraception based on their specific medical issues. Condoms are also recommended to reduce STD risks. Table 36 summarizes basic principles of contraception application for specific illnesses, which have been identified since the release of the combined OC in 1960. Clinicians should also consider the noncontraceptive benefits of this remarkable and life-changing technology that allows all reproductive age women to improve their lives, including those with chronic illnesses and disabilities.
Available from: Mary V. Seeman
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ABSTRACT: Sexual dysfunction is common among women with schizophrenia treated with antipsychotic medication. Multiple factors influence sexual function and reproductive health in this patient population, including the effects of medications on prolactin secretion and the complexities of making contraceptive decisions in the context of a serious mental illness. The author explores the causes and management of loss of libido as illustrated by a case vignette and describes the course and outcome of a clinical intervention that was implemented to alleviate the sexual dysfunction. Possible approaches and potential pitfalls of the intervention are described. Clinicians must be open to discussions regarding sexual concerns, relationships with sexual partners, and reproductive issues with women suffering from schizophrenia. Both patients and clinicians need to be aware of unintended effects of intervention. Opportunities exist for improved education among clinicians to achieve a more proactive approach to sexual health in women receiving antipsychotic medication.
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To present a list of factors that go beyond the medical conditions established by the World Health Organization to assist decision-making during the process of contraceptive counseling.
A Delphi study was carried out, in which 27 experts responded to 24 questions posed by the study coordinators. At least 50% agreement among the experts on a nominal scale was required in each of the questions.
After the Delphi process, 20 recommendations were made on issues related to contraceptive counseling: medical conditions, stage of life, lifestyle, employment status, educational level, economic status, sexual activity, contraceptive methods and contraceptive adherence.
In addition to medical conditions, contraceptive counseling should include issues related to women's lifestyles in order to improve adherence to the most appropriate contraceptive method.
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