Midwife Licensure Exam Reproductive Anatomy & Physiology — Human Sexuality & Family Planning MethodsConcept Map

Concept

Human Sexuality Concepts

Sub Concepts

• Sex (biological distinction)
• Gender (socially constructed roles)
• Sexual Orientation (attraction patterns)
• Sexual Response Cycle (Masters & Johnson: Excitement, Plateau, Orgasm, Resolution)
• Lifespan Sexuality (affected by illness, medications, pregnancy, ageing, culture)
• Non-judgmental Nursing Care (PLISSIT model: Permission, Limited Information, Specific Suggestions, Intensive Therapy)

Relationship To Central

Foundation for understanding reproductive health and client counseling

Concept

Contraceptive Effectiveness Principles

Sub Concepts

• Perfect Use (correct, consistent use)
• Typical Use (real-world use with human error)
• Long-Acting Reversible Contraceptives (LARC) - IUD and implant
• User-Dependent Methods (hormonal, barrier)
• Informed Choice Principle (RA 10354)
• Voluntarism (no coercion, RA 10354)

Relationship To Central

Core framework for method selection and counseling

Concept

Natural (Fertility Awareness-Based) Methods

Sub Concepts

• Calendar (Rhythm) Method: Formula = (shortest cycle − 18) to (longest cycle − 11)
• Basal Body Temperature (BBT): Rise 0.3–0.5°C signals ovulation
• Cervical Mucus (Billings) Method: Clear, slippery, stretchy mucus indicates fertility
• Symptothermal Method: Combines BBT + mucus + other signs
• Standard Days Method: Days 8–19 of 26–32 day cycles (CycleBeads)
• Lactational Amenorrhea Method (LAM): Three conditions required (baby <6 months, exclusive breastfeeding, no menses return)
• Coitus Interruptus (Withdrawal): Lowest effectiveness, no STI protection

Relationship To Central

Non-hormonal, non-device options for clients preferring natural approaches

Concept

Hormonal Contraceptive Methods

Sub Concepts

• Combined Oral Contraceptives (COCs): Oestrogen + progestin; start day 1 of menses
• Missed Pill Management: If 1 pill missed take immediately; if 2+ missed use backup
• ACHES Danger Signs: Abdominal pain, Chest pain/SOB, Headache (severe), Eye problems, Severe leg pain (thromboembolism risk)
• COC Contraindications: Thromboembolism history, uncontrolled hypertension, smokers >35 years, breast cancer, active liver disease, pregnancy
• Progestin-Only Pills (POPs): Safe in breastfeeding; strict timing required
• Injectable DMPA: 150 mg IM every 3 months; bone density monitoring; delayed fertility return
• Subdermal Implant: 3–5 years duration; LARC method
• Transdermal Patch: Changed weekly
• Vaginal Ring: Changed monthly
• Oestrogen Contraindication in Early Breastfeeding: Reduces milk supply

Relationship To Central

High-effectiveness options; mechanism of action and safety monitoring essential

Concept

Barrier Methods

Sub Concepts

• Male Condom: Water-based lubricant only; leave reservoir tip; single use
• Female Condom: Woman-controlled; can be inserted ahead of intercourse
• Diaphragm/Cervical Cap: Used with spermicide; stay in place ≥6 hours (max 24 h diaphragm); refit after childbirth
• Spermicides (Nonoxynol-9): Low effectiveness alone; frequent use increases HIV risk
• STI/HIV Protection: Only condoms provide dual protection

Relationship To Central

Only methods with dual protection against pregnancy and STIs/HIV

Concept

Intrauterine Device (IUD)

Sub Concepts

• Copper IUD: Non-hormonal; spermicidal; 10–12 years duration; emergency contraception if inserted within 5 days
• Levonorgestrel-Releasing IUD: Progestin-releasing; lightens/stops menses; 3–8 years duration
• Monthly String Checks: Essential for client safety
• PAINS Warning Signs: Period abnormal, Abdominal pain/dyspareunia, Infection/abnormal discharge, Not feeling well/fever, String missing/shorter/longer
• Contraindications: Active pelvic infection, unexplained bleeding
• Emergency Contraceptive Role: Copper IUD most effective emergency method within 5 days

Relationship To Central

Most effective reversible method; LARC with distinct advantages and monitoring requirements

Concept

Permanent (Surgical) Methods

Sub Concepts

• Vasectomy: Vas deferens cut/tied; local anaesthesia; not immediately effective
• Vasectomy Effectiveness Timeline: Confirm azoospermia after ~20 ejaculations or ~3 months before discontinuing backup
• Vasectomy Effects: No change in erection, libido, or ejaculate volume
• Bilateral Tubal Ligation (BTL): Fallopian tubes cut/blocked; immediately effective
• BTL Outcomes: Menstruation and hormones continue normally; any post-BTL pregnancy presumed ectopic
• Informed Consent Requirements: Thorough discussion of irreversibility and alternatives

Relationship To Central

Irreversible options requiring thorough informed consent; counseling critical

Concept

Emergency Contraception

Sub Concepts

• Emergency Contraceptive Pills: Progestin-only levonorgestrel or combined; most effective within 72 hours (some up to 120 hours)
• Mechanism of Emergency Pills: Mainly delay ovulation; not abortifacient
• Copper IUD for Emergency: Most effective method; effective up to 5 days post-intercourse
• Ongoing Contraceptive Benefit: Copper IUD provides long-term protection after emergency use

Relationship To Central

Time-sensitive intervention for prevention of unplanned pregnancy

Concept

RA 10354 (Responsible Parenthood & Reproductive Health Act, 2012) & Philippine Context

Sub Concepts

• Universal Access Guarantee: Modern FP, maternal health, RH information free/subsidised in public facilities
• Core Principles: Informed choice, voluntarism, respect for client decision
• Full Range of Methods: Both natural and artificial methods available
• Age- and Development-Appropriate RH Education: Mandated by DOH and LGUs
• Informed Consent Protection: Right to refuse; no coercion
• Conscientious Objector Referral: Must refer to another provider if objecting
• DOH Programs: Integration with maternal, newborn, child health services
• Postpartum Family Planning: Common nursing role in health centers and postpartum visits
• Alignment with RA 9173: Nursing regulation and standards of practice

Relationship To Central

Legal and policy framework guiding all FP services and nursing practice in the Philippines

Concept

Nursing Management & Counseling

Sub Concepts

• Health History Screening: Contraindications (thromboembolism, hypertension, smoking, breastfeeding, liver disease, pregnancy)
• GATHER Approach: Greet, Ask, Tell (about methods), Help choose, Explain use, Return/refer for follow-up
• Correct Use Teaching: Method-specific instructions, timing, administration
• Side Effects vs Danger Signs: Client education to distinguish normal from urgent
• Dual Protection Education: Condom plus another method when STI risk exists
• Cultural and Religious Sensitivity: Non-judgmental presentation of all options
• Consistency Emphasis: Most failures from inconsistent/incorrect use, not method failure
• Nursing Diagnosis Examples: Deficient Knowledge, Risk for Unplanned Pregnancy, Ineffective Individual Coping related to contraceptive choice
• Client-Centred Care: Respect autonomy and decision-making authority

Relationship To Central

Application of nursing process in reproductive health and FP service delivery

Concept

High-Yield NLE Examination Points

Sub Concepts

• RA 10354: Full range + informed choice + voluntarism + referral obligation
• STI/HIV Protection: Condoms only (male and female)
• COC ACHES Mnemonic: Thromboembolism red flags
• IUD PAINS Mnemonic: Expulsion, infection, perforation signs
• Oestrogen Contraindication: Early breastfeeding (milk supply reduction)
• DMPA Dosing: 150 mg IM every 3 months; no site massage
• LAM Three Conditions: <6 months + exclusive breastfeeding + no menses
• Vasectomy Timeline: ~3 months or 20 ejaculations to confirm azoospermia
• Copper IUD Emergency Window: Within 5 days post-intercourse
• Emergency Pills Timeline: Within 72 hours (up to 120 hours)
• LARC Effectiveness: Removes user-dependent error
• Post-BTL Pregnancy: Presume ectopic until proven otherwise
• Calendar Method Formula: (Shortest − 18) to (Longest − 11) after tracking ≥6 cycles

Relationship To Central

Critical knowledge for NLE success; commonly tested concepts

To

Informed Choice Principle

From

RA 10354 (RH Law)

Strength

strong

Relationship

Legal mandate requiring that all FP methods be presented factually and clients allowed to choose freely

To

LARC Methods (IUD & Implant)

From

Contraceptive Effectiveness Principles

Strength

strong

Relationship

LARC methods eliminate user error, providing near-perfect effectiveness rates even with typical use

To

ACHES Danger Signs

From

Hormonal Methods

Strength

strong

Relationship

ACHES mnemonic identifies thromboembolism complications specific to oestrogen-containing contraceptives

To

PAINS Warning Signs

From

IUD Method

Strength

strong

Relationship

PAINS mnemonic identifies expulsion, infection, and perforation complications specific to IUD users

To

Calendar Method Formula

From

Natural Methods

Strength

strong

Relationship

Calendar method calculation (shortest − 18 to longest − 11) requires tracking 6+ cycles for accuracy

To

STI/HIV Protection

From

Barrier Methods

Strength

strong

Relationship

Male and female condoms are the ONLY methods providing dual protection against pregnancy AND STIs/HIV

To

Early Breastfeeding Contraindication

From

Oestrogen-Containing Pills

Strength

strong

Relationship

Oestrogen reduces milk production, requiring progestin-only alternatives during early postpartum breastfeeding

To

Azoospermia Confirmation Timeline

From

Vasectomy

Strength

strong

Relationship

Vasectomy requires ~3 months or 20 ejaculations and semen analysis confirmation before discontinuing backup method

To

Ectopic Pregnancy Risk

From

Bilateral Tubal Ligation (BTL)

Strength

strong

Relationship

Any pregnancy after BTL must be presumed ectopic until imaging confirms intrauterine location

To

Emergency Contraception

From

Copper IUD

Strength

strong

Relationship

Copper IUD is the most effective emergency contraceptive method (up to 5 days) and provides ongoing protection

To

Mechanism: Ovulation Delay

From

Emergency Contraceptive Pills

Strength

strong

Relationship

Emergency pills work mainly by delaying ovulation and are not abortifacient; they do not disrupt established pregnancy

To

Three Mandatory Conditions

From

Lactational Amenorrhea Method (LAM)

Strength

strong

Relationship

LAM effectiveness requires ALL three: baby <6 months, exclusive breastfeeding, and no return of menses

To

Bone Density Monitoring

From

DMPA Injectable

Strength

strong

Relationship

Long-term DMPA use causes reversible bone density loss requiring calcium, vitamin D, and weight-bearing exercise counseling

To

GATHER Counseling Approach

From

Nursing Management

Strength

strong

Relationship

GATHER (Greet, Ask, Tell, Help, Explain, Return) is the structured counseling framework for FP client education

To

Lifespan Sexuality

From

Sexual Response Cycle

Strength

moderate

Relationship

Masters & Johnson cycle phases are affected throughout the lifespan by illness, medications, pregnancy, ageing, and culture

To

STI Prevention Counseling

From

Dual Protection Education

Strength

strong

Relationship

When STI risk exists, counseling emphasizes using condom PLUS another FP method for pregnancy and infection prevention

To

Contraceptive Effectiveness

From

Missed Pill Management

Strength

strong

Relationship

Missing 2+ COC pills requires backup method use due to increased pregnancy risk from loss of ovulation suppression

To

RA 10354 Referral Obligation

From

Conscientious Objection

Strength

strong

Relationship

Healthcare providers with moral objections to FP must refer clients to another provider respecting RA 10354 principles

To

Breastfeeding Safety

From

Progestin-Only Pills

Strength

strong

Relationship

Progestin-only pills are safe during breastfeeding because progestin does not reduce milk supply like oestrogen

To

Irregular Cycle Unsuitability

From

Calendar Method

Strength

strong

Relationship

Calendar method requires regular cycles; irregular cycles make the fertile window calculation unreliable

To

Peak Day Recognition

From

Cervical Mucus Method

Strength

strong

Relationship

Peak day (last slippery mucus day) signals approaching ovulation; abstinence begins when mucus appears and continues 4 days after peak

To

CycleBeads Visual Tool

From

Standard Days Method

Strength

moderate

Relationship

CycleBeads provide tangible visual tracking of 26-32 day cycles with color coding for fertile days 8-19

To

Placement Duration Rules

From

Diaphragm/Cervical Cap

Strength

strong

Relationship

Diaphragm must remain in place 6-24 hours post-intercourse; longer placement risks toxic shock syndrome

To

Monthly Monitoring Protocol

From

IUD String Checks

Strength

strong

Relationship

Clients perform monthly palpation of IUD string after menses to detect expulsion or malposition early

To

Permanent Methods

From

Informed Consent

Strength

strong

Relationship

Vasectomy and BTL require thorough counseling on irreversibility and alternatives before informed consent

To

Non-judgmental Attitude

From

Client-Centred Care

Strength

strong

Relationship

PLISSIT model emphasizes permission and non-judgment as foundational to sexual and reproductive health counseling

To

DOH Integration with MNCH

From

Postpartum Family Planning

Strength

strong

Relationship

RA 10354 mandates FP counseling integrated with maternal, newborn, and child health services in public facilities

To

Menstrual Suppression Benefit

From

Levonorgestrel-Releasing IUD

Strength

moderate

Relationship

Levonorgestrel IUD lightens or stops menses in 40-50% of users, providing therapeutic benefit beyond contraception

To

Method Counseling Priority

From

Effectiveness vs Adherence

Strength

strong

Relationship

High-effectiveness methods (LARC) reduce contraceptive failure from inconsistent use; priority for clients with adherence concerns