Knowledge Area 12 | Sexual & Reproductive Health
(Aligned with RCOG Core Curriculum 2019 )
Sexual & Reproductive Health (SRH) is an important topic for MRCOG. It integrates Contraception, Abortion care, Sexually transmitted infections (STIs), Psychosexual medicine, Safeguarding and consent, and UK legal frameworks
This module requires not only factual knowledge but also strong ethical reasoning and patient-centred communication.
What the RCOG Curriculum Expects
According to the RCOG Core Curriculum, trainees must demonstrate competence in:
- Providing evidence-based contraceptive counselling
- Applying UK Medical Eligibility Criteria (UKMEC)
- Managing complex contraception scenarios (co-morbidities, age extremes)
- Delivering abortion care safely
- Managing STIs and HIV
- Recognising safeguarding concerns
- Understanding consent and confidentiality laws
- Delivering non-judgmental, inclusive care
There is now stronger emphasis on:
- Shared decision-making
- Inclusivity (LGBTQ+, gender-diverse patients)
- Safeguarding in minors and vulnerable adults
- Coercion and reproductive autonomy
- Public health impact
How to Organise Your Study
Create a master folder: Sexual & Reproductive Health
Subfolders:
- Contraception
- Termination of Pregnancy
- Sexually Transmitted Infections
- HIV & Viral Hepatitis
- Psychosexual Medicine
- Legal, Consent & Safeguarding
For each topic in contraception, create a structured note template:
- Mechanism
- Indications
- Contraindications (UKMEC 3/4 critical)
- Efficacy (typical vs perfect use)
- Non-contraceptive benefits
- Risks
- Drug interactions
- Counselling points
Your own notes are essential for retention, as the guidelines are extensive.
Contraception (Core High-Yield Area)
Primary study source: College of Sexual and Reproductive Healthcare (CoSRH)
Key areas to master:
UKMEC Categories
- You must confidently recall:
- Category 1 → No restriction
- Category 2 → Advantages outweigh risks
- Category 3 → Risks usually outweigh benefits
- Category 4 → Absolute contraindication
- Commonly tested scenarios: Migraine with aura; BMI > 35; Hypertension; VTE history; Breast cancer; Postpartum status; Enzyme-inducing drugs
LARC (Very Frequently Tested)
- Includes: Implants; Injectable contraception; Intrauterine contraception (Cu-IUD & LNG-IUS)
- You must Know: Failure rates; Duration; Quick-start rules; Emergency contraception compatibility; Postpartum timing
Emergency Contraception
- Understand: Levonorgestrel; Ulipristal acetate; Copper IUD (most effective method)
- Know: Timing windows; Drug interactions; Breastfeeding advice
Age Extremes
- Contraception in under-16s (Gillick competence)
- Fraser guidelines
- Contraception over 40
- Perimenopause management
Safeguarding knowledge is mandatory here.
Contraception in Co-Morbidities
- High-yield exam areas: Cardiac disease; Obesity; IBD; Epilepsy; Diabetes; SLE; Breast cancer history
- You must apply UKMEC systematically.
Termination of Pregnancy (Abortion Care)
- You must understand: Legal framework (Abortion Act 1967 as amended); Gestational limits; Medical vs surgical methods; Mifepristone + misoprostol protocols; Anti-D indications; Pain management; Safeguarding; Contraception immediately post-abortion
- Increasing emphasis on: Telemedicine abortion pathways; Informed consent; Post-abortion contraception
Sexually Transmitted Infections
- Main reference body: British Association for Sexual Health and HIV (BASHH). You do NOT need to memorise entire guidelines. Focus on:
- Syndromic Approach: Urethritis; Vaginal discharge; Genital ulceration; PID
- Core Organisms: Chlamydia; Gonorrhoea; Syphilis; Trichomonas; HSV Mycoplasma genitalium
- Know: First-line treatment; Test of cure indications; Partner notification; Public health reporting
HIV & Viral Hepatitis
- Know: Testing pathways; Opt-out testing; Post-exposure prophylaxis (PEP); Pre-exposure prophylaxis (PrEP); Contraception considerations; Pregnancy considerations
- This is frequently integrated into contraception questions.
Psychosexual Medicine (Often Neglected)
- Curriculum expects awareness of: Dyspareunia; Vaginismus; Low libido; Sexual dysfunction after childbirth; Sexual dysfunction in menopause
- Know when to refer and how to initiate sensitive discussions.
Legal & Ethical Areas
- You must be well versed in: Confidentiality; Gillick competence; Fraser guidelines; Capacity assessment; Safeguarding referral; Sexual assault pathways; Documentation standards
- This module carries significant ethical weightage.
High-Yield Revision Tips
Before the exam:
- Memorise UKMEC 3 & 4 scenarios
- Revise emergency contraception timing
- Practise contraception in complex cases
- Know abortion legal framework
- Understand partner notification
- Review safeguarding language
Final MRCOG Strategy
- Sexual & Reproductive Health is High-yield in SBAs; Very common in ethics stations
- Approach it systematically; Legally aware; Patient-centred; Non-judgmentally.
- If mastered properly, this becomes one of the highest-scoring modules.
Contraception
Main study source is CoSRH Guidelines.
|
UKMEC UK Medical Eligibility Criteria for Contraceptive Use Summary Table |
|
Fertility Awareness Methods 2015 |
|
Barrier Methods for Contraception and STI Prevention 2015 |
|
Combined Hormonal Contraception 2023 Drug Interactions with Hormonal Contraception TOG Non-contraceptive uses & benefits of COCs 2012 |
|
Progestogen-only Implants 2023 |
|
Progestogen-only Injectables 2023 |
|
Progestogen-only Pills 2023 |
|
Intrauterine Contraception 2025 TOG Intrauterine Contraception 2021 |
|
Emergency Contraception 2023 |
|
Quick Starting Contraception |
|
Long Acting Reversible Contraception (LARC) |
|
NICE CG 20 Long Acting Reversible Contraception 2019 TOG Targeted encouragement of sexually active drug/alcohol dependent to use LARC 2014 |
|
Sterilization |
|
Male and Female Sterilisation 2014 Male and Female Sterilisation Summary of Recommendations Consent Advice # 3 Female Sterilisation TOG Update on Hysteroscopic Sterilization 2017 |
|
PostPartum Contraception |
|
Contraception After Pregnancy 2023 Executive Summary Contraception After Pregnancy BPP1 Postpartum Family Planning TOG Postpartum Contraception 2018 |
|
Age Extremes |
|
Contraceptive Choices for Young People Contraception for Women Aged Over 40 Years 2025 TOG Contraceptive Methods and issues around menopause 2017 |
|
Co-Morbidities |
|
Contraception and Breast Cancer 2023 Overweight, Obesity & Contraception 2019 Sexual and Reproductive Health for Individuals with Inflammatory Bowel Disease Contraceptive Choices for Women with Cardiac Disease 2014 TOG Contraceptive methods for women with Cardiac Disease 2018 |
|
Others Contraception for Women with Eating Disorders Contraception for women using known teratogenic drugs Contraceptive Choices and Sexual Health for Transgender and Non-Binary People Management of women taking anticoagulants or antiplatelet medications Pre-conception Care Contraceptive Options for Women with Prolactinoma |
|
Termination of Pregnancy / Abortion |
|
|
NICE |
#140 Abortion Care Sep 2019 |
|
RCOG |
Care of women Requesting Induced Abortion |
|
TOG |
Manual Vaccum Aspiration 2015 |
|
CA |
#10 Surgical Evacuation of Uterus after Early Pregnancy Loss |
|
BPP |
#2 Abortion Care 2022 #3 Postabortion Care 2022 Post-abortion Contraception 2022 Telemedicine for abortion care 2022 |
|
CGA |
#6 Obtaining Valid Consent |
Sexually transmitted Infections Including HIV
|
Urethritis and Cervicitis |
|
Neisseria Gonorrhoeae 2025 Chlamydia Trachomatis 2015 Non-Gonococcal Urethritis 2018 Mycoplasma Genitalium 2025 |
|
Vaginal Discharge |
|
Trichomonas Vaginalis 2021 Bacterial Vaginosis 2012 Vulvovaginal Candidiasis 2021 TOG Update on recurrent vulvovaginal candidiasis 2021 |
|
Genital Ulceration |
|
Anogenital Herpes 2024 Management of Genital Herpes in Pregnancy 2025 Syphilis Guideline 2024 Syphilis in Pregnancy 2024 STI Prevention | Doxycycline post-exposure prophylaxis 2025 Lymphogranuloma Venereum 2013 Chancroid 2017 Granuloma Inguinale (Donovanosis) 2018 |
|
Systemic Presentations & Complications |
|
Pelvic Inflammatory Disease 2019 TOG Diagnosis & Management of tubo-ovarian abscess 2018 |
|
HIV |
|
HIV Post-Exposure Prophylaxis 2021 HIV Testing Guidelines 2020 Use of HIV pre-exposure prophylaxis (PrEP) 2025 |
|
Skin Conditions |
|
Molluscum Contagiosum 2021 Vulval Conditions (Lichen Sclerosis, Lichen Simplex, Lichen Planus, Psoriasis, VIN) 2024 Anogenital Warts 2024 Scabies 2025 |
|
Viral Hepatitis |
|
Management of Viral Hepatitis 2017 |
|
Sexual history taking and STI testing |
|
Sexual History Taking Guidelines 2019 STI Testing Guidance 2023 Safer Sex Advice 2012 Sexually Acquired Reactive Arthritis (SARA) 2021 Self-sampling recommendations 2021 Sexual Violence 2022 STIs and Related Conditions in Children/Young Adults 2021 |
|
Psychosexual Disorders |
|
TOGs Child sexual exploitation – guide for OBGYN 2017 Management of common disorders in psychosexual medicine 2015 Sexual assault 2018 Transgender population 2019 Differences in sexual development and their clinical implications 2020 Female sexual dysfunction 2022 |