You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

Bits and Pieces

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

Consultation to lift ban on HIV-positive doctors and dentists:
according to media reports last week the DH is set to launch a consultation on lifting the ban imposed 20 years ago. Many believe the ban to be discriminatory, no longer justified on public health grounds and ignored in most hospitals who reportedly have a ‘don’t ask, don’t tell’ approach. The DH’s own expert group concluded that the risk of infection was in the region of one case in every 2400 years.

Correlation of Age at Oral Contraceptive Pill Start with Age at Breast Cancer Diagnosis
Based on a review of 1010 cases at the Breast Unit in Ashford, Kent and published in The Breast Journal – early view this week, the authors concluded that the age when the OCP was started was positively associated with the age when breast cancer was first diagnosed. They state that this effect may show a causal link but may also reflect other associated lifestyle factors associated with early OCP use.

Faculty Members Questionnaire
The FSRH are conducting a short questionnaire to elicit members’ views of its activities and possible future plans.

Joint BASHH and Faculty Meeting 2012
The next joint meeting between BASHH and the Faculty is being held on Friday 20th January 2012 at the Royal Society of Medicine. The theme for the meeting is ‘Recurring issues in Sexual Health‘ .

Systematic Review of Induced Abortion and Women’s Mental Health Published
The world’s largest, most comprehensive and systematic review into the mental health outcomes of induced abortion was published yesterday by the Academy of Medical Royal Colleges. The review concludes that having an abortion does not increase the risk of mental health problems. The best current evidence suggests that it makes no difference to a woman’s mental health whether she chooses to have an abortion or to continue with the pregnancy.

Should all nuns take the pill?

This was some of the media’s interpretation of an article published at The Lancet – Early Online this week. Britt and Short describe the well known health risks for nuns associated with their life of chastity, first documented in 1713. They also note that despite the roman catholic stance on not using any form of contraception apart from abstinence, dating from the Humanae Vitae document of 1968, this may be possible as the same document also states:

the Church in no way regards as unlawful therapeutic means considered necessary to cure organic diseases, even though they also have a contraceptive effect.

COC / VTE Controversy continues

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

Following publication of the extended analysis of the Danish Cohort Study on VTE risk (with combined oral contraceptives with different progestogens and oestrogen doses) in the BMJ and the rapid responses since, Shapiro S and Dinger J have now produced a Commentary for the January 2012 edition of the Journal of Family Planning and Reproductive Healthcare (JFPRHC). This is now published at BMJ Online First.

To accompany the commentary Anne Szarewski, Editor in Chief of the JFPRHC writes

VTE and the Pill … again

The re-analysis of the Danish Cohort Study has recently been published in the British Medical Journal (BMJ). Unfortunately, there are still many methodological issues with it, as discussed in this commentary by Dinger and Shapiro. They also point out that the important analysis that was actually requested by the regulatory authority (but not published in the BMJ paper) showed no difference in risk between combined oral contraceptives.

FSRH Workforce Planning Committee

The Faculty has vacancies for 2 members on its Workforce Planning Committe (1 associate member and 1 diplomate, member or fellow). Details available on the Faculty website.

2 New Publications for Nurses -

as reported by Wendy Moore, Vice Chair of the Faculty Associate Members’ Working Group

RCN Competences for nurses undertaking bimanual pelvic examinations

Nurses working in sexual and reproductive health are increasingly extending their role, benefitting both the nurses and their client groups. The ability to carry out pelvic and bimanual examinations is now a key requirement for nurses working in these specialisms in primary, secondary and community care. The purpose of the competency framework is to ensure that women requiring a pelvic exam are cared for safely and that training and assessment processes are in line with local guidance.

RCN Competences for nurses assessing and counselling women who request and/or receive long-acting reversible methods of contraception (LARC)

Aimed at sexual and reproductive health practitioners this new set of competences is aimed at nurses who are assessing and counselling women who have requested or received long-acting reversible methods of contraception (LARC). The purpose of this competency framework is to ensure such women are cared for safely and helps professionals to identify their training needs, ensuring they have the skills and knowledge to undertake the delivery of contraception services competently and safely.

And finally we hope that reports from America that Apple’s new voice recognition software, Siri, is anti-abortion are exaggerated – the ‘tech’ giant says it will improve the software’s unintentional omissions so that it doesn’t say it cannot find abortion clinics. Knowing the age we live in we suspect this ‘issue’ will run for a while in blogs and tweets around the world.

Online First & Museums

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

The following 2 articles were published via jfprhc Online First this week:

Advances in intrauterine technique training (Connolly)

This article describes an innovative new way for doctors and nurses to be able to learn how to fit intrauterine devices and systems with realistic simulation, which is much better than a ‘Zoe’. This should increase their confidence and make the first encounter with the ‘live’ patient less stressful for all concerned.  Anne Szarewski (Editor in Chief, jfprhc)

US Administration’s attitude to family planning  (Joseph)

The winner of the 2010 Margaret Jackson Prize Essay for undergraduate medical students has looked at the differences between the Bush and Obama administrations’ attitudes to family planning and abortion. It is taking a long time to reverse the damaging initiatives put in place by the Bush administration: we can only hope that the Right Wing does not triumph in the next election. Anne Szarewski (Editor in Chief, jfprhc)

The following Museum piece was spotted by Toni Belfield (Specialist in sexual health information):
The Phallus Museum in Iceland!

The Icelandic Phallological Museum has the collection of penises of all animals whether on land, sea or air…..  They have plans for a future specimen belonging to Homo sapiens……as reported in The Times 15th November 2011.

and not to forget the more conventional:

Museum of contraception and Abortion (based in Vienna)

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.

Horror in the 21st Century

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

As Halloween and Trick or Treat approach we face an even greater horror, as Monday 31st October 2011 is the day the world’s population is forecast to crash the 7 billion barrier only 12 years after it passed 6 billion.

Despite overall rates of fertility falling and the basic right of all women to manage their own fertility having been officially recognised at the Cairo Conference in 1994, 215 million women in ‘high fertility’ countries still don’t have access to voluntary contraception. In addition “millions of adolescent girls and boys have little access to sex education and information on how to prevent pregnancies or protect themselves from HIV.” UNFPA report – The State of World Population 2011

As the number of commentators that report and respond to this prediction increases will politicians and others in power finally listen to what ‘family planners’ have been saying for years and concentrate budgets where they can do some good. Or are we in danger of ignoring this situation until it is too late. This, of course, echoes the post of 4 weeks ago that reported Mary Robinson ‘s warning to the UN on the same issue on the 20 year anniversary of the Rio summit and declaration .

UK’s Breast Screening Programme to be Reviewed

The UK’s National Cancer Director, Professor Sir Mike Richards, has ordered an independent review as questions were raised by the Nordic Cochrane Centre’s systematic review over whether screening may do more harm than good. As this controversy could undermine the excellent effects that are achieved by screening it is important to investigate and resolve any uncertainties. As Sara Hiom of Cancer Research UK (who will jointly lead the Review) said “We mustn’t lose sight of the fact that the fundamental principle underpinning screening – that earlier diagnosis helps improve outcomes – is right and that screening does help save lives”.

MHRA warns against purchasing HIV and non-compliant tests over the internet

We also hear that non-CE marked tests which claim to diagnose HIV and other STIs, available from a UK-hosted website, could give inaccurate results according to a press release from the MHRA . This is aside from the fact that it is illegal to market HIV tests to the public. The HPA has also been involved in contacting all those known to have purchased the tests but warn others considering using the internet as a way of accessing anonymous testing to check that any product is compliant with regulations.

Good News: another new study confirms what we already knew that The Pill and pregnancy have the biggest impact on reducing ovarian cancer risk -  published in the British Journal of Cancer and part-funded by Cancer Research UK. The greatest protection was afforded by taking the pill for more than 10 years followed by ever users then getting pregnant and having more than one child.

Around the Globe

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

The latest edition of the American Journal of Obstetrics and Gynecology includes a supplement entitled: A Hormonal Contraception Update: A Decade of Innovation & Transformation.

In addition AJOG published (online 11th July 2011) a study on the impact of long-acting reversible contraception on return for repeat abortion by Rose S B and Lawton B A. The objective of the study was to determine the rate of return for repeat abortion in relation to postabortion contraceptive method choice 24 months onward from an intervention study.  Its conclusion states: “This study provides strong support for the promotion of immediate postabortion access to LARC methods (particularly intrauterine devices) to prevent repeat abortion.”

September saw the European Society of Contraception (ESC) hold its 11th Seminar in Kaunas, Lithuania. One of the most notable features was the number of participants for a regional symposium  – 533, with the majority being from Poland and Latvia. A number of our colleagues from the UK were involved in either presentations or workshops: Dr Sarah Randall, Dr Anne Webb and Dr Simone Reuter. In addition there was a Board of Directors’ meeting which involved the 2 UK representatives, Dr Meera Kishen and Shelley Mehigan.

Kaunas itself was fascinating for its combination of old and new: elements left over from its communist-dominated past with many crumbling, abandoned buildings and its, especially young, people who are trying to adapt to a new world with western influences. This was particularly evident in the apparent twin obsessions of pizza and eating outside – as well as this may work if the pizzas are made in the Italian way and the cafes are in the Mediterranean it suffers a little in translation to a chilly Baltic state with locally made fare.  This was partly corrected by an apparent benefit to the local blanket industry!

The next full Congress will be in Athens in June 2012.

Meanwhile at home:

Have you completed elements of the new DFSRH: e-SRH; Course of 5; Clinical Exerience and Assessment; e-Portfolio or the LoC SDI or IUT? The Faculty would like to hear from you. They have commissioned an independent review by Professor Ed Piele of the University of Warwick. Visit the Faculty website to give your feedback on your experiences.

UK Agony Aunts bed-in to make sexual health a priority -

What would be the correct, collective noun for a group of agony aunts?

Well in this case it could be a ‘bedful’ or maybe a ‘boudoir’ as 8 of the UKs finest gather to add their support to a group of sexual health charities – Brook, FPA (Family Planning Association), Terrence Higgins Trust, and MedFASH – calling on the government to protect sexual health services as many have seen reduced funding lead to cuts in vital services. This at a time when:
i) a survey by Brook confirms that only 6% of children learn the facts of life from their parents – the internet, TV and friends being the usual source of information (sometimes misinformation) and
ii) the House of Lords HIV and Aids Select Committee report last month found efforts to control the spread of HIV are woefully inadequate as £2.9m is spent on prevention compared with £762m on treatment.

Fiction Book Reviews

Have you enjoyed reading the fiction book reviews in the Journal? Did you agree with the reviews this time of The Room by Emma Donaghue and The Hand That First Held Mine by Maggie O’Farrell? The book for January 2012 will be Pain of Death by Adam Creed (Faber & Faber).

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.

Welcome to the Journal of Family Planning blog

28 Sep, 11 | by shellraine, e-Media Editor

My aim is to bring you news, views and information in the field of contraception and sexual health – some of which you may have seen and some not. I hope that as well as highlighting articles and issues from our journal this will signpost current issues and initiatives from the UK and around the world.

It has been an eventful year in contraception with a number of changes for clinical practice and over the coming weeks I will revisit the most important of these.

A round-up of some recent news items includes:

Mary Robinson calls for more funds for Family Planning.

As world leaders collected at the UN in New York last week Mary Robinson, the first woman president of Ireland (1990-1997), UN High Commissioner for Human Rights from 1997-2002, and chairwoman of the Global Leaders Council for Reproductive Health called for them to make good on their promise of 17 years ago at the UN International Conference on Population and Development in Cairo, when they agreed to make contraceptive services available for women all over the world by 2015. http://www.newsday.com/opinion/oped/robinson-more-funds-for-family-planning-1.3187083

WHO Medical Eligibility Criteria for Contraceptive Use 4th ed wins first prize in the BMA Book Awards (O&G category).

The WHO MEC are the basis from which the UK MEC were developed and underpin clinical practice in contraception and sexual health. The most recent version of the UKMEC was published 2009:http://www.fsrh.org/pdfs/UKMEC2009.pdf

Medscape Education Clinical Briefs report a pooled analysis of 2 studies which seem to demonstrate that Intrauterine Devices Lower Cervical Cancer Risk. This involved 10 case-control studies done in 8 countries, and 16 studies of HPV prevalence from 16 countries looking at risks for cancer of the cervix and HPV in IUD users. http://www.medscape.org/viewarticle/749724?src=cmemp

In Rwanda, Africa’s most densely populated country, men are being encouraged to have vasectomies. The no-scalpel procedure is being offered for free according to a report in the Independent Newspaper on 7th September.

Unapproved emergency birth control medicine in U.S. may be ineffective and unsafe. In July the FDA issued a warning to consumers not to buy a product named Evital as they may have been counterfeit. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm265847.htm

I welcome comments from readers and will publish those that I feel will be helpful to others.

Latest from JFPRHC

Latest from JFPRHC