1. Listen to the patient and explore the reasons for the concerns.
2 Medical, gynaecological and psychosexual history.
3 Explore mental health, relationship and sexual abuse issues followed up by adequate referrals.
4 Examine the patient confidently and respectfully
5 Use diagrams to educate the patient.
6. Reassure the patient.
7Address all the symptoms and concerns
8Refer the patient
9Explain what FGCS entails, potentials risks and complications.
10It is recommended GPs initially refer patients for a gynaecological assessment.
11 If the patient is younger than 18, they should be referred to a specialist adolescent gynaecologist. -
Answers Female genital cosmetic surgery
• high dependence on nicotine and heavy smoking (more than 20 cigarettes per day, short time to rst
cigarette)
• lack of knowledge of the bene ts of quitting or belief that action is not necessary
• enjoyment of nicotine or smoking behaviour
• psychological or emotional concerns (stress, depression, anxiety, psychiatric disorders)
• fear of weight gain
• fear that quit attempt will be unsuccessful
• substance use (alcohol and other drugs)
• living with other smokers
• circumstances that result in the smoker giving quitting a low priority, such as poverty and social
isolation. - Answers Barriers to quit smoking
After stopping smoking, within 24 hours by four (or more) of the following signs or symptoms:
• irritability,frustration,anger
• anxiety
, • difficulty in concentration
• increased appetite
• restlessness
• depressedmood
• insomnia. - Answers Withdrawal symptoms of smoking
1 Ask
2 Assess: signs of addiction (3 questions)
3 Advise: Best hing you can do for your health is to quit smoking
4 Assist (motivational interviewing)
5 Arrange followup: congratulate and af rm decision
- review progress and problems
- encourage continuance of pharmacotherapy - discuss relapse prevention
- encourage use of support services - Answers 5As to stop smoking
Smoking cessation using NRT to quit is always safer than continuing to smoke.
• All forms of NRT (at equivalent doses) are similarly effective in aiding long- term cessation.
• All forms of NRT monotherapy can increase the rate of quitting by 50-70%.
• Higher dose forms of NRT (4 mg) are more effective than lower dose forms (2 mg) for more addicted
smokers.
• More than one form of NRT can be used concurrently with increased success rates and no safety risks.
• Nicotine patches can be given several weeks prior to smoking cessation to help smokers prepare for
quitting.
• NRT can be used by people with cardiovascular disease. Caution is advised for people in hospital for
acute cardiovascular events, but if the alternative is active smoking, NRT can be used under medical
supervision.
• NRT can be used by smokers aged 12-17 years.
• NRT may be appropriate in pregnant smokers if they have been unsuccessful in stopping smok -
Answers Nicotine replacement therapy