Johannes Bitzer
Speeches:
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Contraception and sexuality: Effects on pleasure, spontaneity, and frequency
Johannes Bitzer (Switzerland)
Basel, Switzerland
jbitzer@uhbs.ch
Introduction. Contraception aims at the separation of sexuality and reproduction. Thus each family consultation deals indirectly with sexuality. In usual practice the consultation is however focused on the technical aspects of contraception assuming that the sexual experience and sexual function of the patients are either their private matter or somehow normally functioning anyway or a minor problem. Statistics showing the high prevalence of sexual dysfunctions in women of the reproductive age group indicate that this assumption is wrong. It seems therefore necessary that the family planning professional takes a more active role in the care for the sexual health of their patients.
Methods. Literature research about the relationship between contraceptive methods and Female Sexual Dysfunction. Regular case discussions and supervision by two trained sexologist in our family planning consultation unit elaborating a basic management program for clients with sexual problems.
Results. Results concerning the prevalence of FSD in women using different contraceptive methods are contradictory and variable due to methodological problems and lack of well designed studies. COCs seem to have a negative impact on desire and pleasure and even on pain in a small group of “vulnerable” women.
To respond to sexual complaints of patients the professional for contraception needs some special knowledge, understanding, communicative skills and technical competences.
- Knowledge about the types of sexual dysfunctions women may experience during different phases of their reproductive life;
- Understanding of the complex interplay between biological, psychological, relationship and sociocultural factors contributing to sexual problems including the possible impact of various contraceptive methods on different levels of the sexual response;
- Communicative skills to address sexual issues with patients in an open, non-judgemental, structured way being able to respond to and handle emotions.
- Technical competences to establish a biopsychosocial diagnosis of the sexual problem(s), provide basic counselling and treatment and refer to other specialists if necessary.
The training program will be presented.
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PS05.1
Integrating abortion training in sexual and reproductive health care
Johannes Bitzer
University Hospital Basel, Basel, SwitzerlandPreventing unwanted pregnancies is a main objective of sexual and reproductive health care. This is achieved by women and men-friendly contraceptive services including patient centred counselling, availability of all methods, shared decision making, follow-up care etc. In reality, women are still very often confronted with unwanted pregnancies which they experience as a threat to their global health. These women need a high standard of abortion care including easy and rapid access to abortion services; non discriminative, empathic care; shared decision making about the available methods; safe and professional procedures by well trained professionals; qualified and appropriate follow up including postabortion contraception.
These qualities should be provided by recognised abortion training for health care professionals in the field of sexual and reproductive health
Abortion training: The training has to be based on 3 elements:a) Knowledge:
- Knowledge about epidemiological data, early and late pregnancy development, endocrine and non endocrine factors involved in pregnancy development, diagnostic procedures to determine the pregnancy week, diagnosis of missed and threatened abortion
- Knowledge about medical and non medical abortion techniques (dosages, timing, procedure) efficacy, risks, side effects, Standard operating procedures
- Knowledge about postabortion contraceptionb) Skills:
- Case for medical abortion. Exact procedure
- Technique of surgical abortion (simulation) assisting, performing under supervision, performing alone
- IUD and implant insertionc) Attitudes:
Group discussion about ethical and psychosocial, sociocultural aspects of abortion and critical incident reporting -
Why are contraceptives not used ?
Prof. Dr. med. Johannes Bitzer, Switzerland
Head of Department of Obstetrics and Gynecology University Hospital Basel
Introduction: Contraceptive compliance describes the application of a contraceptive method in accordance with the prescription and/or the specific behavior given or described by a medical professional. Non compliance is the discrepancy between the „real“ use or behavior and the „ideal or prescribed“ use or behavior.
From the literature and clinical experience it is well known that this discrepancy is high reaching up to 50% of contraceptive users which do not comply. We wanted to explore the reasons for this considerable non compliance.
Methods: Search of the literature to unwanted pregnancy. abortion, discontinuation, reasons for non-compliance, solution strategies
Results: Several studies show a rate of 40-50% of unplanned pregancies; almost half of the unplanned pregnancies are teminated. Discontinuation of contraceptive methods lies around 50% during the first
year of use. The reasons are:
Method related factors: - Side effects
Person related factors: - Cognitive factors (lack of information, irrational beliefs)
Emotional factors: - Ambivalence regarding the wish for a child, sexual or relationship
conflicts, behavioral problems (forgetting etc)
Environmental factors: - Lack of accessability, distress, overload
Four major strategies to improve compliance can be distinguished:
a) Development of long acting methods independent of the user’s behavior
b) Diminution of side effects and improvement of quality of life during use
d) Adding heath or therapeutic benefits to the contraceptive effect of methods
e) Improvement of counselling quality by including motivational interviewing techniques
Conclusion: Non compliance is one of the major challenges in contraceptive care. The reasons are multi-dimensional and include person related, method related and environmental factors. Strategies to improve compliance have therefore to target different levels: Improving tolerability, health benefits and user friendliness of methods on one side and improving quality of counseling by intergrating communication techniques like information giving and motivational interviewing on the other hand.