Taking a history for Emergency Contraception
When addressing a patient requesting emergency or post-coital contraception, a focused, non-judgemental history can direct both you and the patient towards making an agreeable decision about clinical management. This is also an excellent time to review sexual risk factors, and build a solid rapport so that, should the patient be faced with a pregnancy, she will contact you quickly, reducing the potential for a second-trimester procedure.
Details regarding sexual encounter
Type of intercourse (oral, vaginal, anal, voluntary, involuntary)
Was contraception used?
If so, was there an obvious contraceptive failure? (missed pill, condom slippage/breakage, ejaculation prior to withdrawal)
Delay in seeking emergency contraception
Day 0-3 (72 hours) - most effective interval for Emergency Oral Contraception
Day 3-5 - an IUD may be inserted at this point.
Menstrual history - This will help you to stratify the risk of pregnancy, but should NOT change your clinical management
Last Normal Menstrual Period
Are periods regular?
Always Ask About Abuse [1]
"In general, how would you describe your relationship: a lot of tension, some tension, no tension?"
"Do you and your partner work out arguments: with great difficulty, some difficulty, no difficulty?"
Remember: Risk of conception = Risk of STI
For women: Last Pap Smear? What was the result?
For women and men: Offer to conduct STI testing (including HIV, for which explicit consent is needed)
Validate and address any additional concerns the patient has.
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1. Lent, B. Brown, J. Department of Family Medicine, University of Western Ontario
