Counselling · Intermediate · O&G

Unprotected Intercourse and Emergency Contraception

Practise this PLAB 2 counselling station on Emergency Contraception. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in a sexual health clinic. Miss Eleanor Henderson, a 21-year-old university student, has come requesting emergency contraception following unprotected intercourse two days ago. Please take a brief relevant history, discuss the options available (including timing, efficacy, and side effects), and help her make an informed choice about which emergency contraceptive to use.

Background notes: PMH: Healthy, no significant illness. Menarche normal, regular cycles every 28 days

What this station tests

  • Three EC methods ranked by effectiveness: copper IUD > ulipristal > levonorgestrel
  • Copper IUD as most effective, especially around ovulation (day 14)
  • Ulipristal-hormonal contraception interaction: cannot start hormonal contraception for 5 days after ulipristal
  • Timing in cycle affects method choice: levonorgestrel is least effective around ovulation
  • Pregnancy test at 3 weeks regardless of method: no EC is 100% effective

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself, establish what patient already knows and understands.
  • 1-3 min — Explain Condition: Explain diagnosis or condition using chunk-and-check technique. Use simple language, avoid jargon.
  • 3-5 min — Management Options: Discuss treatment options. Shared decision-making. Risks, benefits, alternatives.
  • 5-7 min — Address Concerns: Explore and address specific concerns. Check understanding. Discuss lifestyle implications.
  • 7-8 min — Closing: Summarise agreed plan. Safety netting. Arrange follow-up. Written information offer.

Consultation approach

The opening

Emergency contraception counselling requires establishing the timing (determines which method is most effective), providing options, and addressing ongoing contraception. Miss Henderson is 21, a university student, requesting emergency contraception after a condom broke last night. Open with: 'Eleanor, you have done the right thing coming in quickly. Let me work out the best option for you.'

Core approach

Establish timing precisely. When did the unprotected intercourse occur? (Last night, approximately 14 hours ago.) Where is she in her menstrual cycle? (Day 14 of a 28-day cycle, which is around ovulation, the highest-risk time.) This information determines the best method.

Three options, ranked by effectiveness. Copper IUD: most effective (>99%), can be inserted up to 5 days after UPSI or up to 5 days after estimated ovulation. Also provides ongoing contraception. Ulipristal acetate (EllaOne): effective up to 120 hours (5 days), more effective than levonorgestrel, but effectiveness reduces with time. Levonorgestrel (Levonelle): effective up to 72 hours (3 days), least effective of the three, particularly around ovulation.

At day 14 (likely ovulation), the copper IUD is the most effective option. Ulipristal is second choice. Levonorgestrel is least effective around ovulation. Present all options with their relative effectiveness.

Closing and safety netting

If she chooses the copper IUD: arrange same-day fitting. If oral EC: prescribe with instructions (single dose, may cause nausea, vomiting within 2 hours requires repeat dose). Ulipristal: cannot use hormonal contraception for 5 days after (delays ovulation). Levonorgestrel: no such restriction.

Ongoing contraception discussion: 'This is a good time to discuss a more reliable method for the future.' Offer LARC options. Pregnancy test in 3 weeks regardless of which EC method used (no method is 100%).

STI consideration: condom broke, so there was barrier failure. Offer STI screen if new partner or concerns. Safety net: 'If your period is more than 7 days late, do a pregnancy test.' Follow-up for ongoing contraception.

How examiners mark this station

Examiners will assess your ability to explain emergency contraception and its management in a patient-centred way. Domain 2 (Clinical Management) and Domain 3 (Interpersonal Skills) are equally weighted and primary. Expect marks for accurate information delivery, shared decision-making, chunk-and-check technique, and addressing the patient's specific concerns. Domain 1 (Data Gathering) is assessed through how well you establish the patient's baseline understanding and elicit their concerns.

Domain 1 (Primary focus)

Scores well: Timing of UPSI established. Cycle day calculated. All three options presented with ranking. Ongoing contraception discussed. STI risk assessed.

Costs marks: Not establishing timing. Not calculating cycle day. Only one option presented.

Domain 2 (Primary focus)

Scores well: Most effective method recommended based on timing. Practical instructions for chosen method. Pregnancy test at 3 weeks. Ongoing contraception planned.

Costs marks: Least effective method offered without explanation. No pregnancy test. No ongoing plan.

Domain 3 (Throughout)

Scores well: Non-judgmental. Validating her decision to come quickly. Practical and efficient. Using this as an opportunity for ongoing contraception discussion.

Costs marks: Judgmental. Lecturing about condom use. Making her feel irresponsible.

Common examiner feedback (and how to fix it)

Did not provide adequate explanation or plan to the patient

Fix: Use chunk-and-check: deliver one concept, check understanding, then move to the next. Offer all relevant treatment options with risks and benefits before helping the patient decide.

Did not sufficiently recognise or respond to the patient's feelings, concerns, or expectations

Fix: Before and during counselling, explicitly ask what concerns the patient most. Respond to emotional cues with empathic statements before continuing with information.

Common mistakes in this station

  1. Only offering levonorgestrel: the copper IUD and ulipristal are more effective and should be presented
  2. Not considering cycle timing: at day 14 (ovulation), levonorgestrel is particularly unreliable
  3. Not arranging pregnancy test at 3 weeks: all EC methods can fail

Resitting PLAB 2?

If counselling stations have been a challenge, the most common issue is information overload: delivering too much clinical detail without checking understanding. Practise the chunk-and-check technique until it becomes automatic. Remember that shared decision-making, not lecturing, is what scores highly in Domain 3.

Example opening

Hello, my name is Dr [Name]. I understand you've come in today to discuss [topic]. Before I explain things, could you tell me what you've been told so far, so I know where to start?

Frequently asked questions

How do I open and run an emergency contraception counselling station in PLAB 2?

Emergency contraception counselling requires establishing the timing (determines which method is most effective), providing options, and addressing ongoing contraception. Miss Henderson is 21, a university student, requesting emergency contraception after a condom broke last night.

What does a strong performance look like to the examiner in this station?

Strong performances show: Timing of UPSI established. Cycle day calculated. All three options presented with ranking. Ongoing contraception discussed. STI risk assessed. Weak performances: Not establishing timing. Not calculating cycle day. Only one option presented.

What is the biggest pitfall in this emergency contraception station?

Only offering levonorgestrel: the copper IUD and ulipristal are more effective and should be presented.

How should I prepare for emergency contraception if I have never seen it in practice?

This station rewards process over personal experience. The skill being assessed: Copper IUD as most effective, especially around ovulation (day 14). Use the domain breakdown on this page to target your preparation, then practise the station aloud so your structure survives exam pressure.

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