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Celebrating International Women’s Day

9 Mar, 12 | by shellraine, e-Media Editor

“This International Women’s Day, the world’s women have much to celebrate: maternal mortality rates are declining after years of stagnation; the importance of maternal health is receiving unprecedented attention; and one solution in our efforts to save women’s lives during childbirth, misoprostol, is gaining significant traction globally. But we have further to go for the world’s women.”  IWD website has links to a number of events happening around the globe and asks supporters to publish and share their initiatives

fpa and Brook join forces with Durex

Two of the country’s leading sexual health charities and the biggest condom brand in the UK have announced a major collaboration with a three year programme to deliver a number of sexual health initiatives; information events, public awareness campaigns and learning materials.

Media Reaction to Abortion – gender selection and legal issues

in the ongoing debate around gender-selection abortion an Open letter of support for doctors who provide abortion services was published by Reproductive Health Matters, the international journal for sexual and reproductive health and rights, signed by members of Voice for Choice, leaders in womens’ health and abortion care. The letter clarifies many of the misinterpretations of legal issues that have been voiced in much of the ‘popular’ press.

Sexual Health Trainersnew PGA Med Ed (SRH)

The FSRH website has details of the planned changes to ‘training the trainers’.  The current letter of competence (Loc MEd) will be replaced by the new Post Graduate Award in Medical Education (Sexual and Reproductive Health).  In collaboration with Keele University the course is aimed at doctors working in CASH, GP’s, those in GUM and nurses who wish to gain a recognised teachers qualification in sexual health. This PGA will, for doctors, be accepted as appropriate for Primary Trainers for DFSRH purposes.

The GMC Education Update (Feb 2012) includes notification of a consultation on the recognition and approval of trainers.

New Clinical Guidance – Management of Vaginal Discharge in Non-Genitourinary Medicine Settings

The FSRH Clinical Effectiveness Unit (CEU) have published their latest clinical guidance document which updates previous guidance from 2006. Changes include: new tests for gonorrhoea and chlamydia; changes to treatments available for vulvovaginal candidiasis (VVC) & bacterial vaginosis (BV); and new advice on combined hormonal contraception (CHC) and antibiotics.

BPAS website hacked

The British Pregnancy Advisory Service website has been the subject of attempted hacking.  A 27 yr old man has been arrested on suspicion of offences under the Computer Misuse Act.  In a statement issued today BPAS say that:

“Around 26,000 attempts to break into our website were made over a six hour period, but the hacker was unable to access any medical or personal information relating to women who had received treatment at bpas.”

Faculty News

10 Feb, 12 | by shellraine, e-Media Editor

Amendments to FSRH Guidance Documents: Drug Interactions and Emergency Contraception
Drug Interactions (2011): Page 9 of the original version of this CEU Guidance Document (issued in January 2011) incorrectly stated that the interaction between lamotrigine and combined hormonal contraception (CHC) only applies to lamotrigine monotherapy. CHC also reduces lamotrigine levels when lamotrigine is combined with antiepileptic drugs that
do not alter its metabolism.

Emergency Contraception (2011): The original version of this CEU Guidance Document (issued in August 2011) contained some inconsistencies that the CEU has corrected in this version. These amendments are as follows: additional recommendation regarding offering a Cu-IUD to eligible women presenting between 0 and 120 hours of UPSI or within 5 days of expected ovulation added (pages ii and 8); references 12 and 13 updated (page 11); and acknowledgement of chart designer added to Appendix 2 (page 15).

New Examiners for the Multiple Choice Question Paper (MCQ)
The Examination Committee invites applications to join the MCQ Examiner Group of the MFSRH Panel of Examiners. Applicants should be accredited Members of the Faculty and active clinically in the sphere of the Faculty or, to be Clinicians, of equivalent status, with an interest in Sexual and Reproductive Healthcare but whose speciality is GUM, Public Health Medicine, Gynaecology or Primary Care. Further information and application forms from the Faculty website, closing date 29th February.

Committee Vacancies

  • Clinical Standards: for a doctor and a nurse
  • Workforce Planning: for an Associate member and a Fellow/Member/Diplomate

Information and details of how to apply are available from the committee’s page of the Faculty website

and in other news

Oral Ulipristal Proves Highly Effective for Uterine Fibroids
According to 2 studies published this week in the New England Journal of Medicine the oral selective progesterone receptor modulator, ulipristal, proved highly effective as a treatment for symptomatic uterine fibroids rapidly reducing excessive bleeding and reducing the size of uterine fibroids, and was well tolerated. The drug was approved for emergency contraception in 2010. Known as ella (HRA Pharma) in the United States and ellaOne in Europe, ulipristal works by interrupting ovulation. For emergency contraception, a 30-mg dose is used. By contrast, the newly-published studies tested 5-mg and 10-mg daily doses for fibroid treatment. In one of the studies (placebo-controlled) the drug controlled excess menstrual bleeding in over 90% of cases with a high incidence of amenorrhoea. If and when a product becomes available in the UK (Esmya is already approved and licensed in other countries) the issue of contraception will need to be highlighted to those that might use it because of the interaction with hormonal contraception.

Review of the year 2011

6 Jan, 12 | by shellraine, e-Media Editor

It has been a busy and eventful year in sexual and reproductive health:

January

saw the launch of the new-look Journal of Family Planning & Reproductive Health Care as it joined the BMJ family. Readers will have noticed many improvements, not least the website and early online publishing.

February

The joint Faculty / e-Learning for Health, e-SRH, was named winner in the e-Government National Award: excellence, Learning & Skills section (now renamed UK Public Sector Digital Awards)

March saw the MDU statement: GPs need suitable training to fit contraceptive implants

April saw the Faculty response to EC being made available through pharmacies in Wales

May saw the publication of the new Missed Pill Recommendations

June

saw Chris Wilkinson become the newly elected President of the Faculty and in
July his appoinment was acknowledged in BMA News


August

saw the publication of the Emergency Contraception Guidelines



September
saw the publication of the amended Drug Interactions with Hormonal Contraception and the launch of this Blog !!

October saw the publication of the Combined Hormonal Contraception Guidelines as the world population broke the 7 billion mark.

November
saw the CEU being awarded NHS Accreditation for its guidelines and the publication of the Service Standards for SRH

December
saw the 23rd World AIDS Day with the theme: Getting to Zero

And so to 2012 – wishing all our readers a Happy New Year

Online First and Emergency Contraception for Christmas

16 Dec, 11 | by shellraine, e-Media Editor

The latest article to be published at Online First is:

Questions about intimate partner violence should be part of contraceptive counselling: findings from a community-based longitudinal study in Nicaragua by Mariano Salazar, Eliette Valladares, Ulf Högberg.

Neelima Deshapande (Associate editor) writes:

Effect of domestic violence on contraceptive choice

Sadly, domestic violence against women continues in many countries. This study from Nicaragua looks at the impact of intimate partner violence (IPV) on the choices that women make about their contraception. It appears that women who are abused tend to use more reversible contraception than women who are not and that women actually make conscious choices about delaying pregnancies far more often when their partner is violent than if they are in a non-violent relationship This study quantifies the high proportion of women suffering from IPV and adds strength to the argument that enquiry about domestic violence should be included in contraceptive choices consultations and steps taken to identify and refer appropriately.

Emergency Contraception in Advance:
The BPAS christmas campaign (at www.santacomes.org) to offer free EHC through the post caused the usual mixed tranche of reactions in the media – all of which will hopefully succeed in raising awareness, as described in Marge Berer’s wonderful blog on 12th December. The FSRH have issued a Faculty statement on the subject saying that at a time of limited access advance provision will be in the best interests of many women.

FPA/Brook have issued a response to the Systematic Review of Induced Abortion and Women’s Mental Health discussed last week.

FPA have, today, issued a reaction to the Health Survey for England 2010, published yesterday, which shows that 1 in 4 women claim to have lost their virginity before their 16th birthday. Like the BPAS EHC campaign, above, the Survey has brought out the worst of our tabloid and conservative press with predictable, extreme headlines. However, as reported in The Independent, the authors noted that surveys of sexual behaviour are hard to interpret as responses are subject to both exaggeration and concealment. In addition (but less reported) it showed 26% of women and 32% of men aged 16 to 24 say they have never had sex and across all age groups, men have typically had 9.3 female sexual partners in their lifetime, while women have slept with an average of 4.7 men and almost a quarter of all women (24%) have only ever had one sexual partner, compared to 17% of men. With regards to methods of contraception it showed that equal numbers of women (22%) were using condoms or pills compared with 7% using LARC.

Faculty Gains NHS Accreditation for Guidelines

11 Nov, 11 | by shellraine, e-Media Editor

The Clinical Effectiveness Unit (CEU) of the Faculty of Sexual & Reproductive Healthcare (FSRH) has achieved NHS Accreditation for the process used to produce its guidelines. The NHS Evidence Accreditation Scheme recognises organisations that demonstrate high standards in producing health or social care guidance. It is stated that users of accredited guidance can therefore have high confidence in the quality of the information. In future all CEU guidance will display the Accreditation Mark.

This coincides with the release of the latest clinical guidance: Combined Hormonal Contraception – an updated and extended version of the previous guidance on combined oral contraception published in 2006. There are now clinical guidelines on the vast majority of currently available methods as well as Drug Interactions, Quick Starting (methods), Emergency Contraception and others for specific, special groups. This is in addition to the UK Medical Eligibility Criteria.

The CEU was launched in 2002 and after initially being based in Aberdeen transferred to Sandyford in Glasgow in 2008. The director of the current unit is Dr Louise Melvin and its main tasks are producing evidence based guidance, new product reviews and running the Members Enquiry Service.

Clinical guidelines that are evidence-based are an important element of current clinical practice and underpin clinical competence and governance. Along with training they have the potential to raise standards and improve quality of care, though as their name suggests they are intended to guide clinical care not replace clinical judgement as they are applied to general situations rather than to individuals.  In sexual and reproductive health care CEU guidance and FSRH training is increasingly seen as the gold standard by which clinical care is likely to be judged. An example of this was seen earlier this year in a statement from the MDU in response to an increase in the number of claims related to problems with subdermal implants by GPs. The statement stresses the need for, particularly, GP members to ensure they have appropriate training and should ideally hold a Letter of Competence from the Faculty.

Risk of VTE with combined oral contraceptives

4 Nov, 11 | by shellraine, e-Media Editor

Readers are signposted to the Rapid Responses at BMJ Online following last week’s publication of an extended analysis of the Danish Cohort Study on VTE risk with combined oral contraceptives with different progestogens and oestrogen doses.

Volunteers required for CEU guidance
The CEU are looking for volunteers to be involved in the development of the next 3 guidance documents:
Contraceptive choices for women with cardiac disease; Intrauterine contraception; Progestogen-only implants. Details available via the Faculty website.

Young men and contraception  [Brown, published Online First 1 November 2011]
It is rare to see a study looking at young men and their contraceptive views. This pilot study indicates that engaging with young men may be a challenging task. Getting them to talk about contraception and responsibility will be even more so. The young men who participated in the pilot were willing to consider shared responsibility for contraception when talking with the researcher about their contraceptive choices. How these young men view women who take charge of their sexual health reveals a lot about the dynamics of relationship forming and the confusion around contraceptive responsibility felt by young people.
Neelima Deshpande (Associate Editor, JFPRHC)

Brook and FPA launch UK Sexual Health Awards to reward innovation and creativity in sexual health work. There are 6 categories for nominations which close on 31 December. Open to professionals, writers, young people or projects the first awards ceremony is to be held in March 2012, hosted by Davina McCall. Click on the image for more information.

From the Journal – October 2011 issue

6 Oct, 11 | by shellraine, e-Media Editor

The newly published Journal includes a number of articles related to abortion: a book review; a commentary on medical abortion in Ethiopia – for which there is also a podcast; an Israeli view of the status of a foetus; HIV testing in clinics and repeat attendance in Britain.

In addition there is a profile of FIAPAC, the international organisation for abortion providers who have their next biennial Congress in Edinburgh in October 2012.

In Letters to the Editor there is continuing correspondence discussing the emotive subject of the use of cervical analgesia for IUD/IUS fitting which seems to have polarised opinion more than any other issue for some time.

The printed journal was accompanied by the most recently published Faculty Guidance on Emergency Contraception (2011), available electronically from: http://www.fsrh.org/pdfs/CEUguidanceEmergencyContraception11.pdf. This updates the previous guidance from 2006, includes the new oral preparation, ulipristal acetate, a progesterone receptor modulator licensed for use up to 5 days after unprotected sex and refers to the guidance for Quick Starting Contraception (2010) which details how to ‘quick start’ after use of emergency contraception.

This Guidance follows neatly on from the CEU Statement on Missed Pill Recommendations (May 2011), which accompanied the last edition of the Journal which also included a commentary by Dr Diana Mansour; Revision of the ‘missed pill’ rules, which details the background to the changes.  The statement was published after the MHRA asked the Faculty Clinical Effectiveness Unit to review its previous guidance (2005), with a view to producing harmonised guidance. This the CEU subsequently did and the new guidance has been endorsed and adopted by the MHRA, fpa and BNF although unfortunately not by the pharmaceutical industry.

BNF 62 includes the amended instructions for starting and switching combined hormonal contraception to take into account the above recommendations.  Continuing the initiative of working closely with the Clinical Effectiveness Committee the BNF section on Contraception (7.3) is up to date and in line with FSRH guidance. This makes it an accurate resource particularly for GPs and Practice Nurses who use it more than any other group of clinicians.

CD ROMs

The latest Faculty Presidents Newsletter, which also accompanied the print journal, highlights the need for all services and clinicians to dispose of and not use any of the old training CD ROMs for IUDs, implants and EC. Trainees should only use the up-to-date training modules from the e-learning website: www.e-lfh.org.uk.

Latest from JFPRHC

Latest from JFPRHC