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    Vaginal Itching/ Birth Control
    whitney91 posted:
    I was fitted for a diaphragm on Monday (which was not for me). The next day I went to the bathroom and had this annoying itch. I've never had an itch in my vaginal area before and it is very annoying. I've been using Vagisil wipes to help ease the itching, is there anything else I can use? I also recently changed from the pill to the patch, it says not to use the patch until the Sunday after your menstrual cycle, but I haven't been on my pills for almost 3 weeks. What should I do about the patch? Do I use it before my period or do I have to wait?
    Jane Harrison Hohner, RN, RNP responded:
    Dear whitney: Thanks for awaiting a reply. There are a few POSSIBLE explanations for the sudden onset itching:

    1. Reaction to the lubricant used in fitting or practicing diaphragm insertion. This seem less likely as it is usually the same gel used in speculum insertion and pelvic exams. On the off chance that you used a spermicidal jelly that can sometimes cause local irritation/reactions.

    2. Irritation from the repeated insertions and removals of the various sized diaphragms during a fitting session.

    3. New onset yeast infection coincident to the GYN visit. If you have never had a yeast infection before it is best to get a for sure diagnosis from a GYN or clinic before trying an over the counter treatment with active ingredients such as clotrimazole or miconazole. Having said that, some women will try an over the counter cream or suppository with an established active ingredient--ask your pharmacist for suggestions at your drug store.

    In terms of when to initiate patch use you have two options. The first is to wait until you have a flow. Just be aware that it can take longer than four weeks to have your first period after stopping birth control pills. Put the patch on during the first day of your flow for the best contraceptive coverage in that first patch cycle.

    Second would be to utilize the "Quick Start" regimen. Here is a citation on this from the National Library of Medicine site:

    Initiation of oral contraceptives using a quick start compared with a conventional start: a randomized controlled trial.

    Westhoff C, Heartwell S, Edwards S, Zieman M, Cushman L, Robilotto C, Stuart G, Morroni C, Kalmuss D.

    Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA.

    OBJECTIVE: To estimate whether young women taking the first pill on the day of prescription had higher continuation rates and lower pregnancy rates than women who waited until menses to start the oral contraceptive pill (OCP). METHODS: We recruited 1,716 women aged younger than 25 years seeking to initiate the oral contraceptive at three publicly funded family planning clinics, and randomly assigned them to conventional initiation of the pill (conventional start) or immediate, directly observed ingestion of the first pill (quick start) during the clinic visit. Women underwent follow-up interviews at 3 and 6 months. RESULTS: Sixty percent of participants discontinued the pill, and 8% became pregnant during follow-up. Women who took the first pill in the clinic were more likely to continue to the second OCP pack (odds ratio 1.5, 95% confidence interval 1.0-2.1.); however, the Quick Start approach did not improve OCP continuation rates at 3 and 6 months. Those assigned to Quick Start were slightly less likely to become pregnant within 6 months from the time they started the pill (hazard ratio 0.90, 95% confidence interval 0.64-1.25). Eighty-one percent of women rated the Quick Start approach as acceptable or preferable to waiting. Rates of serious adverse events were low and similar in the two groups. CONCLUSION: Protocols that require a woman to wait until the next menses to start hormonal contraceptives are an obstacle to contraceptive initiation. Directly observed, immediate initiation of the pill improves short-term continuation.

    whitney, to do "Quick Start" one first has to be assured that they are not pregnant. The birth control can be started at anytime but must be followed by a seven day usage of a reliable back up method. If there has been any unprotected sex since being off your active birth control pills one needs to do a pregnancy test two weeks after starting the "Quick Start" regimen. This method has also been studied with the Nuva Ring and OrthoEvra Patch.

    As always it is best to consult with the GYN or clinic who wrote your patch prescription about what they recommend.

    whitney91 replied to Jane Harrison Hohner, RN, RNP's response:
    Dear Jane,
    Thank you for answering my questions. I have to speak with my GYN about my patches, it's driving me crazy because I have the patches and I'm not sure if to wait to have a flow or just go ahead and put it on and wait for my period to start. And the itching has subsided since I have been using a 3 day treatment for the yeast infection. Again, thank you very much for answering my questions.
    Jane Harrison Hohner, RN, RNP replied to whitney91's response:
    Dear Whitney: Thanks for the follow up. Yes, do consider asking your GYN or clinic about doing the "Quick Start" option, rather than waiting until your first, real, post-Pill flow arrives.


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