Testosterone therapy is not a form of contraception for transgender males and should not be used during pregnancy due to its teratogenic effects. However, a family history of ovarian cancer and a history of depression are not contraindications for this treatment. Patients with gender dysphoria should be referred to specialists at the Gender Identity Clinic or equivalent for assessment and can access testosterone therapy through the NHS regardless of whether they have obtained a Gender Recognition Certificate or not. The Gender Recognition Certificate, which is part of the Gender Recognition Act 2004, grants legal rights to trans men and women, including the ability to obtain a new birth certificate, driving licence, and passport, as well as the right to marry in their new gender.

Contraceptive and Sexual Health Guidance for Transgender and Non-Binary Individuals

The Faculty of Sexual & Reproductive Healthcare has released guidance on contraceptive choices and sexual health for transgender and non-binary individuals. The guidance emphasizes the importance of sensitive communication and offering options that consider personal preferences, co-morbidities, and current medications or therapies. For those engaging in vaginal sex, condoms and dental dams are recommended to prevent sexually transmitted infections. Cervical screening and HPV vaccinations should also be offered. Those at risk of HIV transmission should be advised of pre-exposure prophylaxis and post-exposure prophylaxis.

For individuals assigned female at birth with a uterus, testosterone therapy doesn’t provide protection against pregnancy, and oestrogen-containing regimens are not recommended as they can antagonize the effect of testosterone therapy. Progesterone-only contraceptives are considered safe, and non-hormonal intrauterine devices may also suspend menstruation. Emergency contraception may be required following unprotected vaginal intercourse, and either oral formulation or the non-hormonal intrauterine device may be considered.

In patients assigned male at birth, hormone therapy may reduce or cease sperm production, but the variability of its effects means it cannot be relied upon as a method of contraception. Condoms are recommended for those engaging in vaginal sex to avoid the risk of pregnancy. The guidance stresses the importance of offering individuals options that take into account their personal circumstances and preferences.

Oral Candidiasis and Immune System Defects

Oral candidiasis, also known as thrush, is a fungal infection that can occur in the mouth and throat. While it can affect anyone, it should always raise suspicion of an underlying defect of the immune system in young healthy individuals. Further investigation is necessary to determine the cause of the infection.

In London, men who have sex with men have a high rate of HIV, with some estimates as high as 15%. Therefore, HIV infection is the most likely diagnosis for oral candidiasis in this population. It is important to consider this possibility and test for HIV to ensure proper treatment and management.

In addition to oral candidiasis, a weakened immune system can also lead to other health issues. For example, HIV infection is a predisposing factor for deep vein thrombosis (DVT), a blood clot that forms in a deep vein, typically in the leg. Recurrent attacks of shingles in a young person may also be a result of a weakened immune system. Therefore, it is important to investigate the underlying cause of these conditions to ensure proper treatment and management.

Emergency Contraception Options Post-Abortion

The Faculty of Sexual and Reproductive Healthcare (FSRH) recommends emergency contraception if unprotected sexual intercourse occurs from five days post-abortion. There are three safe options for emergency contraception: oral levonorgestrel 1.5 mg, ulipristal acetate 30 mg, and the copper intrauterine device. The copper intrauterine device is the most effective, with a pregnancy rate of approximately 1 in 1000 when used for emergency contraception. However, it carries the same contraindications as when used for regular contraception. It is important to consider all options and consult with a healthcare provider to determine the best choice for individual needs.

In 2014, sildenafil was removed from the list of restricted medications and can now be prescribed without limitations.

Phosphodiesterase type V inhibitors are medications used to treat erectile dysfunction and pulmonary hypertension. They work by increasing cGMP, which leads to relaxation of smooth muscles in blood vessels supplying the corpus cavernosum. The most well-known PDE5 inhibitor is sildenafil, also known as Viagra, which is taken about an hour before sexual activity. Other examples include tadalafil (Cialis) and vardenafil (Levitra), which have longer-lasting effects and can be taken regularly. However, these medications have contraindications, such as not being safe for patients taking nitrates or those with hypotension. They can also cause side effects such as visual disturbances, blue discolouration, and headaches. It is important to consult with a healthcare provider before taking PDE5 inhibitors.

Emergency Contraception for Naomi

Naomi has presented more than 72 hours after unprotected sexual intercourse (UPSI), making Levonelle ineffective. Additionally, she is taking a proton pump inhibitor (PPI) which can reduce the effectiveness of ulipristal acetate. Therefore, the most appropriate management for her is the emergency intrauterine device (IUD), which is the most effective emergency contraceptive and provides ongoing contraceptive cover. It is important to note that progesterone-containing contraception should be delayed until after 5/7 after ellaone (ulipristal acetate) to reduce the risk of it being less effective as an emergency contraceptive.

Choosing the Right Contraceptive for a Smoker with Elevated BMI

Combined oral contraceptive pills are not recommended for smokers over 35 years old due to the increased risk of venous thromboembolism. This risk is further elevated in women with an elevated BMI. While the progesterone-only pill is an alternative, its effectiveness is reduced due to poor compliance. Therefore, the most appropriate choice for this patient would be an IUD or IUS. The IUS may result in reduced menstrual flow after the first few months, and in some cases, periods may become very light or stop altogether. Overall, careful consideration of the patient’s medical history and lifestyle is necessary when selecting the most appropriate contraceptive method.

Treatment Options for Premature Ejaculation

Premature ejaculation affects a small percentage of men and can cause significant psychological distress. There are several treatment options available, including dapoxetine, fluoxetine, frenulectomy, psychosexual therapy (PST), and sildenafil. Dapoxetine is a short-acting selective serotonin re-uptake inhibitor (SSRI) that is taken on an ‘as required’ basis and has shown to be effective in clinical trials. Fluoxetine is commonly used off-licence and takes one to two weeks to become effective. Frenulectomy may be effective in reducing symptom burden, but more evidence is needed. PST may help in mild or intermittent cases, but is not recommended as the sole first-line treatment. Sildenafil can be used if there are concurrent problems with erectile dysfunction. It is important to consult with a healthcare provider to determine the best treatment option for individual cases.

Contraindication of Sildenafil with Nitrates

Sildenafil should not be taken by patients who are also taking nitrates or nitrate derivatives such as nicorandil. If a patient is taking nitrates, they should stop taking them during the period when they are using sildenafil. This is because the combination of sildenafil and nitrates can cause a dangerous drop in blood pressure, which can lead to serious health complications. It is important for patients to inform their healthcare provider of all medications they are taking before starting sildenafil to avoid any potential contraindications.

Men with sickle cell disease should be prescribed PDE-5 inhibitors with caution due to their increased risk of priapism, a painful and persistent erection that requires urgent medical attention. Similarly, individuals with a predisposition to priapism, such as those with multiple myeloma or leukemia, should also use these medications with caution. While PDE-5 inhibitors may be used in men with Peyronie’s disease or other anatomical abnormalities of the penis, caution should still be exercised. It is important to note that diabetes doesn’t increase the risk of priapism, but it is a risk factor for erectile dysfunction.

Phosphodiesterase type V inhibitors are medications used to treat erectile dysfunction and pulmonary hypertension. They work by increasing cGMP, which leads to relaxation of smooth muscles in blood vessels supplying the corpus cavernosum. The most well-known PDE5 inhibitor is sildenafil, also known as Viagra, which is taken about an hour before sexual activity. Other examples include tadalafil (Cialis) and vardenafil (Levitra), which have longer-lasting effects and can be taken regularly. However, these medications have contraindications, such as not being safe for patients taking nitrates or those with hypotension. They can also cause side effects such as visual disturbances, blue discolouration, and headaches. It is important to consult with a healthcare provider before taking PDE5 inhibitors.

When it comes to genital ulcers, herpes is more common and typically causes pain. Chancroid, on the other hand, is less common and also painful. However, if the genital ulcer is painless, it is more likely to be caused by syphilis rather than lymphogranuloma venereum.

Understanding STI Ulcers

Genital ulcers are a common symptom of several sexually transmitted infections (STIs). One of the most well-known causes is the herpes simplex virus (HSV) type 2, which can cause severe primary attacks with fever and subsequent attacks with multiple painful ulcers. Syphilis, caused by the spirochaete Treponema pallidum, has primary, secondary, and tertiary stages, with a painless ulcer (chancre) appearing in the primary stage. Chancroid, a tropical disease caused by Haemophilus ducreyi, causes painful genital ulcers with a sharply defined, ragged, undermined border and unilateral, painful inguinal lymph node enlargement. Lymphogranuloma venereum (LGV), caused by Chlamydia trachomatis, has three stages, with the first stage showing a small painless pustule that later forms an ulcer, followed by painful inguinal lymphadenopathy in the second stage and proctocolitis in the third stage. LGV is treated with doxycycline. Other causes of genital ulcers include Behcet’s disease, carcinoma, and granuloma inguinale (previously called Calymmatobacterium granulomatis). Understanding the different causes of STI ulcers is crucial in diagnosing and treating these infections.