Write a discussion reply to Mishela explaining What Birth Control Failure Rates Really Mean.

Dear writer i need a discussion reply to a fellow classmates’ class post. Please, do not critique their paper but rather expand to their original point. I will add the class assignment intructions the student is answering to and you are to reply to them.

You are seeing a 15-year-old female patient for a gynecological exam and to explore birth control options. The patient’s mother scheduled the appointment after learning that her daughter has become sexually active. The patient is current with all immunizations, including Gardasil, and has no significant health history that would contraindicate the use of birth control.

This is the patient’s first gynecological exam, and she expresses feeling nervous and embarrassed that her mother has shared her sexual experience with strangers. Taking this into account, how would you begin the patient encounter?
As you begin asking questions to determine the patient’s gynecological history, the patient appears frustrated and embarrassed and reminds you that she has only had sex one time. What should the patient understand about the importance of reviewing gynecological history?
What are the most popular birth control methods prescribed in the United States? What determines the success or failure of a birth control method?
The patient expresses a desire for the most effective form of birth control but is concerned about weight gain and other side effects. How should you respond to her concerns?
The patient seems unsure about the best option for birth control and asks if she can take some time to think about the choices. As the use of birth control is ultimately the patient’s choice, you offer to answer any questions and agree to a follow-up visit or call. The patient asks whether using a condom is okay if she decides to have sexual intercourse before selecting a method of birth control. What should you tell her?

Student to reply to:

This is the patient’s first gynecological exam, and she expresses feeling nervous and embarrassed that her mother has shared her sexual experience with strangers. Taking this into account, how would you begin the patient encounter?
To begin the patient encounter, it is important to ask the patient’s mother to step out of the room so the patient can have privacy. Since the patient expresses feeling nervous and embarrassed, asking her to elaborate what exactly she is nervous about is a good step in order to explain the process and alleviate any of her concerns. In a qualitative study, Bryan and Chor (2018) found that almost half of adolescents described their first gynecological exam as a negative experience. Their findings led to recommendations including establishing rapport with the patient, educating them about the process, and establishing practices to orient the patient. Such strategies would be beneficial to begin the patient encounter. The additional recommendations, including avoiding assumptions about identity and eliciting continuous feedback, are crucial elements throughout the exam.
As you begin asking questions to determine the patient’s gynecological history, the patient appears frustrated and embarrassed and reminds you that she has only had sex one time. What should the patient understand about the importance of reviewing gynecological history?
Prior to explaining the importance of reviewing gynecological history, empathizing with the patient is necessary. The first gynecological exam is a nerve-wracking time for many women and adolescents. This patient also previously reported feeling embarrassed that her mother shared her sexual history without her consent, and as a provider, one should be understanding of the patient’s current state given the circumstances. The patient should know that the purpose of the history isn’t to shame or judge her for any of her practices, and that the information she reveals is confidential and will not be divulged to her parent without her consent. Aside from sexual activity, the gynecological history includes questions regarding age of menarche, and cycle length and flow of menses (American College of Obstetricians and Gynecologist [ACOG], 2019). The patient should be informed that her history is necessary in determining her risk profile, and in identifying any concerns that can be resolved. For example, dysmenorrhea is the most common menstrual symptom among adolescents and young women. Although many believe that this is normal and something they have to deal with, it can be alleviated with methods such as birth control, and can also be indicative of conditions such as endometriosis or fibroids if other symptoms are also present (ACOG, 2019). As Dunphy et al. (2019) state, the gynecological history is also useful in identifying needs for health promotion and sexual or body image concerns. Creating a supportive environment and letting the patient know that although it seems embarrassing and is a sensitive topic, you are only there to help her with her health, understanding her body and sexuality, and to aid in any concerns she may have is essential.
What are the most popular birth control methods prescribed in the United States? What determines the success or failure of a birth control method?
From 2015-2017, the National Survey of Family Growth reports that 64.9% of women aged 15-49 were using contraception (Center for Disease Control and Prevention [CDC], 2018). The most common methods were sterilization (18.3%), oral contraceptive pills (12.6%), long-acting reversible contraceptives (10.3%) and male condoms (8.7%). Long-acting reversible contraceptives include measures such as hormonal injections and IUDs. Out of the prescribed forms, oral birth control and long-acting reversible methods are the most common. Data from the Guttmacher Institute (2014) states that of the prescriptive methods, contraceptive pills were the most common (25.3%) in women ages 15-44, followed by IUDs (11.8%). A variety of factors determine the success and failure rates of different birth control methods. Considering these rates and what they mean are important in choosing a form of birth control. Failure rates of birth control define the percentage of women who become pregnant within the first year of using a specific method. Stacey (2020) mentions factors that affect failure rate include experience, difficulty and effort, and whether the method is used consistently and properly. Success rates tend to be lower in the first year using a specific contraceptive method due to these factors. Failure rates of specific birth controls are given in a range due to typical vs perfect use. Perfect use failure rates reflect pregnancies occurring with correct use of the method (Stacey, 2020). For example, combination birth control pills have a perfect failure rate of 0.1%, meaning the active pills are taken every day around the same time. For some women, remembering to take their birth control every day may be difficult, resulting in imperfect usage, and a typical failure rate of 5%.
The patient expresses a desire for the most effective form of birth control but is concerned about weight gain and other side effects. How should you respond to her concerns?
Hormonal contraceptives are often associated with weight gain, and several mechanisms have been proposed to explain this. Estrogen is associated with increased subcutaneous fat in areas such as the hips, breasts and thighs. In addition, it can also contribute to fluid retention thorough its mineralocorticoid activity. The anabolic properties of hormonal birth control methods can also result in increased food intake by affecting appetite (Gallo et al., 2014). However, it is important to note and inform the patient that despite this, a Cochrane review reports no causal relationship has been established between combination contraceptives and weight gain (Gallo et al., 2014). The patient should also be aware that any hormonal preparation can result in a variety of side effects and if they develop or become bothersome, another method or combination can be discussed. In addition, the most effective non-permanent form of birth control after the hormonal implant is the IUD, of which a non-hormonal copper form exists (CDC, 2018).
The patient seems unsure about the best option for birth control and asks if she can take some time to think about the choices. As the use of birth control is ultimately the patient’s choice, you offer to answer any questions and agree to a follow-up visit or call. The patient asks whether using a condom is okay if she decides to have sexual intercourse before selecting a method of birth control. What should you tell her?
The patient should be educated on the proper use of condoms in order for this method to be effective. She should know how to ensure correct usage, and make sure to use this method each time she engages in sexual intercourse. It is also important for the patient to know that condoms are the only way to prevent an STI, and this should be enforced during the conversation, as well as when she decides on a birth control method. The patient should receive education in a nonjudgmental manner that pregnancy isn’t the only risk with heterosexual intercourse; contraceptive methods are useful in preventing pregnancy when used correctly, however they infer no protection against sexually transmitted diseases. This presents an opportunity to empower the patient with regard to her sexual health, and promote getting tested with her partners and the use of condoms in any sexual encounter.
References
American College of Obstetricians and Gynecologists. (2019). Your First Gynecologic Visit. ACOG. https://www.acog.org/patient-resources/faqs/especially-for-teens/your-first-gynecologic-visit.
Bryan, A. F., & Chor, J. (2019). Factors Influencing Adolescent and Young Adults’ First Pelvic Examination Experiences: A Qualitative Study. Journal of pediatric and adolescent gynecology, 32(3), 278–283. https://doi.org/10.1016/j.jpag.2018.10.008
Center for Disease Control and Prevention. (2018). Products – Data Briefs – Number 327 – December 2018. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db327.htm.
Dunphy, L. M. H., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary care: the art and science of advanced practice nursing – an interprofessional approach. F.A. Davis Company.
Gallo, M. F., Lopez, L. M., Grimes, D. A., Carayon, F., Schulz, K. F., & Helmerhorst, F. M. (2014). Combination contraceptives: effects on weight. Cochrane Database of Systematic Reviews, (1).
Stacey, D. (2020). Explaining What Birth Control Failure Rates Really Mean. Verywell Health. https://www.verywellhealth.com/how-do-you-interpret-birth-control-failure-rates-906657.