Information 1-7

  • Checking reproductive health allows the clinician to identify chronic conditions or disorders of reproductive organs
  • Patients may not routinely have a Sexual and reproductive health check due to no obvious symptoms, embarrassment or reluctance to seek help

Note

  • Refer to the MO/NP if not confident, embarrassed or restricted by culture to assess for reproductive health

Health check recommendations

  • All Aboriginal and Torres Strait Islander people > 15 years of age annually
  • All people > 15 years of age opportunistically

1. Procedure

  • Ask the questions as per Table 1. Be prepared to explore issues
  • Provide brief intervention as required
  • Determine if the patient requires a referral and place onto a follow-up and recall register

2. Results and brief intervention for women

  1. Breast cancer 1
    • The risk of developing breast cancer increases with age
    • Women > 40 years can have a free mammogram every 2 years
    • Women aged 50–74 are actively invited to screen
    • Immediately refer any woman with recent changes to the breast or nipples i.e. lumps, masses, hard areas, swelling, pain or nipple discharge
    • Provide Resource 1.
  2. Cervical cancer 2
    • The National Cervical Screening Policy (NCSP) recommends that people with a cervix:
      • have an human papillomavirus (HPV) test every 5 years
      • start cervical screening at age 25
      • have an exit test between 70 and 74 years of age
      • have an HPV test at any age if they have symptoms of cervical cancer, even if they screen regularly
      • Provide Resources 2–3

Table 1. Reproductive health questions

Question

Explore

Women

Has the woman noticed any recent breast changes?

  • Any lumps, masses, hard areas, any recent changes, swelling, pain, nipple discharge

Has the woman had a breast screen in the last 2 years? (40+)

  • Results? Familial breast cancer (BRCA1 or BRCA2) if known?
  • Any treatment?

Has the woman had any abnormal vaginal bleeding, discharge or lower abdominal pain?

  • When? How much? How often?
  • Type? Describe?

Has the woman had cervical screening in the last 5 years? (25+)

  • Where? Result?
  • Any treatment?

Men

Has the man noted any changes to testes?

  • Swelling, masses, lumps, pain, trauma?

Has the man had any penile discharge or dysfunction?

  • Loss of sexual drive?
  • Premature ejaculation?
  • Erectile dysfunction?

Has the man’s (40–69) father or brother been diagnosed with prostate cancer?

  • Results? Familial breast cancer (positive BRCA1 or BRCA2) if known?
  • Any treatment?

3. Results and brief intervention for men

  1. Testes 3
    • Testicular lumps, swelling or pain may be a precursor to testicular cancer or signs of infection
  2. Sexual dysfunction 4,5
    • Asked to identify any underlying pathology related to dysfunction e.g. Diabetes and Coronary heart disease
  3. Prostate disease 6,7
    • Prostate disease includes:
      • a non-cancerous, non life-threatening enlargement of the prostate gland (benign prostate hyperplasia) that impacts on quality of life
      • life-threatening inflammation of the prostate gland (prostatitis) due to infection
      • prostate cancer
    • Benefits of Prostate-Specific Antigen (PSA) testing:
      • can provide reassurance
      • early treatment if prostate cancer detected
    • Harms of PSA testing:
      • uncertainty. Some men with elevated PSA levels may not have prostate cancer, while some men with a normal PSA may have prostate cancer
      • a positive PSA result can lead to a cancer diagnosis, progressing so slowly it would not have caused health problems if left undetected and untreated
      • unnecessary treatment of slowly progressing cancer can result in harmful effects without health benefits
    • If after being informed of the benefits and harms of PSA testing, a patient can be offered 2nd yearly PSA testing if they:
      • are aged 50–69 years
      • are aged 45–69 years with concerns about their risk for prostate cancer or
      • are aged 45–69 years and have a father or brother diagnosed with prostate cancerAdvise men > 70 years that harms of PSA testing may be greater than the benefits of testing in men of their age
    • A digital rectal examination is not recommended as a standard test for men who don’t have symptoms of prostate cancer
    • See Sexual and reproductive health. Provide Resources 3–5.

4. Referral

  • For any vaginal or penile discharge refer to the Primary Clinical Care Manual
    1. Women
      • Refer to the MO/NP if:
        • they meet the criteria or are overdue for a breast examination, mammogram or cervical screening
        • there is a suspicion of a condition requiring further investigation:
          • concerns about changes to the breasts or nipples
          • positive findings on breast examination
          • unusual or persistent vaginal bleeding or discharge despite appropriate treatments
          • Known familial breast cancer (BRCA1 or BRCA2)
    2. Men
      • Refer to the MO/NP if:
        • they answer ‘yes’ to penile dysfunction or teste changes
        • they have a family history of prostate disease or would benefit from further discussion on the risks and benefits of prostate cancer screening
        • there is a suspicion of a condition requiring further investigation e.g. Diabetes, Coronary heart disease, known familial breast cancer (BRCA1 or BRCA2)

5. Follow-up

  • Place the person on a recall register if required
  • Ensure all referrals are actioned
  • Provide the person with details for the next scheduled follow-up appointment

6. References

7. Resources

  1. Breast screening information available from Cancer Council Australia or at  BreastScreen Queensland
  2. Pap smear and cervical cancer information
  3. The National Cancer Screening Program
  4. Mens health resources available from Healthy Male
  5. Engaging Aboriginal and Torres Strait Islander men

Last updated: September 2024

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