- U=U (Undetectable = Untransmittable)
Talking with your patients with HIV about their transmission risk
People living with HIV often have questions about the risk of passing HIV to their negative partners. Recent research has shown HIV treatment with antiretriviral therapy (ART) antiretroviral therapy (ART) to maintain consistently undetectable levels of HIV are effectively unable to transmit HIV to their sexual partners, commonly referred to as U=U or “Undetectable = Untransmittable.read the full article »
- Why (and how) providers should get consent in the exam room
Using the principles of explicit consent to give patients better care
From the #metoo movement to reports of sexual assault being front and center on national television with the confirmation hearings of Supreme Court Justice Brett Kavanaugh, consent has been making the news headlines. Health care providers have an opportunity to provide a safe space to discuss enthusiastic consent in relationships and to model it in the exam room by obtaining explicit consent from our patients prior to performing intimate exams in the office. Consent is an important component of establishing a respectful and trusting relationship with your patient—one that improves satisfaction, adherence, and ultimately, outcomes.read the full article »
- Your patient has the answer
We can only listen when we create a space for the patient to speak. Listening can be augmented through open-ended questions. During a period of listening, consider opting for one open-ended question in lieu of a series of closed-ended questions. read the full article »
- What makes the Liletta IUD different from Mirena?
Here’s what you and your patients should know about these two (very similar) hormonal IUDs.
Many of you are likely already stocking and placing Liletta, the levonorgestrel intrauterine system (IUS, a.k.a. IUD) introduced in 2015. But you and your patients may still be trying to sort out how Liletta is different from—or very similar to—another IUD that’s been out there for years, the Mirena. Here are the details.read the full article »
- Starting birth control after using ‘ella’ for EC
Here’s what you need to know to help your patients balance risks and uncertainties related to starting hormonal birth control after ella.
In March 2015, the FDA changed the label for one brand of emergency contraception (EC)—ulipristal acetate (UPA), sold as ella. The new label warned against starting a hormonal birth control method within 5 days of taking UPA. Why the change, and what does this mean for your practice?read the full article »
- What does respect have to do with birth control counseling?
Being warm and listening to patients has a bigger impact than you might expect.
Having a good rapport with your patient is considered a pillar of high quality health care, especially when that care includes counseling around personal matters like sexual health. But what if I told you that our rapport—and the quality of the care we provide overall—actually affects our patients’ long-term birth control use? read the full article »
- Is LARC a silver bullet to end unplanned pregnancy?
Experts weigh in on how many women would use IUDs and implants in the absence of barriers.
What do experts think would really happen to national LARC use if all the barriers were removed? A team of researchers at University of California, San Francisco—including me—decided to ask. read the full article »
- Racism in family planning care
Here’s what we can all do to break the cycle.
Today in the United States we see a resurgence of the discussion around our country’s oldest problem: racism. Whether we’re talking about how communities of color are being over-policed and disproportionately imprisoned, or the continuation of economic inequality, it’s clear that institutional racism is an unyielding problem in our society. It is also our shame as a nation, and this shame prevents us from tackling the problem head on.read the full article »
- Can premedication make IUD insertion less painful?
Contrary to popular belief, ibuprofen does NOT work.
From a clinician’s perspective, inserting an IUD is a relatively quick procedure. However, during that short time, some patients may experience serious pain... Is there something we can recommend that actually works to make insertion more comfortable?read the full article »
- Reproductive counseling in the age of Zika virus
Sex, contraception, pregnancy, fear… Here’s what health care providers can do for their patients.
With news of Zika virus making headlines on a daily basis, health care providers face growing questions from patients who understandably fear Zika’s potential impact on their current or future pregnancies.read the full article »
- Nobody’s perfect: Pill efficacy for the real world
Our patients shouldn’t have to be perfect to protect themselves from accidental pregnancy.
It’s no secret that many women’s health care providers use IUDs, likely because they have the highest efficacy and continuation rates. But the most common method of birth control among our patients remains the pill. The pill is advertised as having 99% efficacy, but in real life we know that about it’s closer to 90%. That means about one in 10 women will have an unplanned pregnancy while using this method. How can the advertised number and real life numbers so different? And what can we do to help our patients narrow the gap between these numbers?read the full article »
- Excellent care for LGBTQ patients
Here's how to be part of the solution when it comes to the health disparities LGBTQ people face.
We’ve known for a long time that LGBTQ people have health disparities compared to heterosexual and cis-gendered people. So what can you as a provider do to reduce these disparities? read the full article »
- What does evidence say about combined vs. progestin-only pills?
COCs or POPs? Here are some things to consider when helping a patient pick a pill.
By discussing the side effects and benefits of different kinds of pills with your patient, you can help her choose one that fits her life. read the full article »
- Changing the conversation about contraception
The most useful tool for providing contraceptive care may be to ask the right questions.
Talking to women about their pregnancy intentions is an important part of responding to their requests for contraception.read the full article »
- Extended use of the implant and LNG-IUS
New evidence shows these long-acting methods keep working for at least a year after their expiration.
Although the implant is currently approved by the U.S. Food and Drug Administration (FDA) for only 3 years, there is new evidence suggesting that it’s safe and effective to use for at least 4 years. The same is true for the 52mg levonorgestrel intrauterine device (LNG-IUD)—it’s FDA-approved to last up to 5 years but safe and effective to use for at least 6. read the full article »
- Who is at increased risk of IUD expulsion?
New research holds some surprises about who’s at highest risk of expelling an IUD.
An expulsion is when an intrauterine device (IUD) comes out of the uterus on its own and it happens for about 1 in 20 IUD users. Expulsion leaves the patient vulnerable to unintended pregnancy.read the full article »
- Birth Control Without Barriers
Providers play an important role in empowering women to choose the contraceptive best for them.
Providers play an important role in empowering women to choose the contraceptive best for them.read the full article »
- What do YOU use for birth control?
Pros, cons, and alternatives when it comes to telling your patients about your own birth control method.
Self-disclosure by providers is a controversial topic in all areas of medicine. In the field of reproductive health, in which it’s common to discuss the most intimate of topics with our patients, self-disclosure is an especially important consideration. Studies by Evans and by Zapata suggest that, when appropriate, provider self-disclosure about contraception can be done without negative consequences. But how can we be certain that a situation is appropriate? And in circumstances when a clinician isn’t using birth control (e.g., she is trying to conceive; she is infertile; or, like me, she has a female partner), how should she handle the situation?read the full article »
- Talking fertility awareness methods with your patients
You may have your doubts about FAM, but what if your patients want to use it?
In the last few years, one of the most ancient contraceptive methods has taken a modern turn. At last count, there are over 200 fertility awareness method (FAM) mobile applications (“apps”) for measuring, monitoring, and tracking women’s cycles. Before we dive into the apps, here’s an oh-so-brief overview of FAM.read the full article »
- Misinformed: What do pharmacy staff say about emergency contraception?
Do you know what info your patients are getting about EC?
Many patients head straight to the pharmacy when they need EC. It’s convenient and may be more affordable for them, depending on their health care coverage. So what do we know about women’s ability to access EC at pharmacies?read the full article »
- Sex, Gender, and Orientation 101
But when it comes to human sexuality, words are important.
For folks who have never questioned their sex, gender, orientation, or preferred pronoun, it may be a challenge to keep up with patients who have spent years thinking about these questions themselves. But when it comes to human sexuality, words are an important tool that we as providers can use to better understand our patients.read the full article »
- Deciding on emergency contraception
How do we help our patients make the best decision they can for their emergency contraception?
How do we help our patients make the best decision they can for their emergency contraception (EC)?read the full article »
- Contraception as empowerment
Put the power in her hands by changing the birth control conversation from reactive to proactive.
Using contraception should not be reactionary. It should have nothing to do with this guy or even this relationship. I hope that my patients do not get pregnant until they are ready. Instead of the default position being I will get pregnant unless I do something to prevent it, I want my patients to be able to say "I won't get pregnant until I am ready to get pregnant." This is the power of contraception used consistently and correctly. read the full article »
- No more fainting in your practice
How to halt vasovagal reactions in three easy steps.
It happens all the time: just as you are preparing to place an IUD, your patient faints. All of us who have been involved with patient care for any length of time know how scary, disruptive, and unpleasant for a patient a vasovagal reaction can be. The good news is that if you are alert to the signs of an impending vagal, you can almost always prevent loss of consciousness.read the full article »
- LARC Supplement from the Journal of Adolescent Health
Read ten expert reviews about LARC use and young people.
Adolescents and young adults deserve guidance from clinicians about contraception, and clinicians deserve the latest information about how to best serve this population. I tell my adolescent and young adult patients that one very important category of options, long-acting reversible contraception (LARC), provides THE most effective birth control in a manner that is “forgettable” and easy. I had the pleasure of editing a supplement to the Journal of Adolescent Health that provides reviews from experts on LARC contraception (LARC supplement). The following reviews are available free online.
read the full article »