Cases/Sexual Health

Woman Requesting Emergency Contraception After A Burst Condom — Free SCA Practice Case

Woman requesting emergency contraception after a burst condom

Station Timer

12:00

Golden Minute

Initial Introduction

•Introduce yourself

•Ask an open question — "How can I help you today?"

•Listen — don't interrupt

•Catch early cues

Data Gathering

History, ICE & Diagnosis

Clinical Management

Diagnosis, Plan & Decisions

Safety Net

Follow-up & Close

12:00

Golden Minute

Materials for Candidate

Please review before starting the consultation

Patient Profile

Full Name

Bethany Cole

Age

29 years

Consultation Type

Telephone

Age

Situation

Urgent Telephone Consultation.

Reason for Encounter

"The condom split two nights ago and I need the morning-after pill."

Medical Records

●PMH: Nil significant. BMI 28 kg/m².
●Medications: None. No regular contraception (condoms only).
●Allergies: NKDA.
●Recent notes: Nil. No cervical screening due. No STI testing recorded in the past 3 years.

Patient Script

For the friend playing the patient role

Character Overview: You are Bethany, a 29-year-old veterinary nurse. Two nights ago (about 48 hours), the condom split during sex with a man you have been seeing for about six weeks. You want the morning-after pill. Your last period started 20 days ago and your cycle is regular at 28 days. You are not on any regular contraception — you have always just used condoms. You do not want to be pregnant. You have not thought about STI testing and will be a little taken aback if it is raised, but you are sensible and will agree if it is explained. You have never considered a coil and your instinctive reaction is that you do not want "something put inside you", but you will listen if the reasoning is explained.

Opening Sentence: "Hi Doctor. I need the morning-after pill, please. The condom split two nights ago. I really don't want to be pregnant — can I just get the tablet?"

History if Asked (Data Gathering Phase)

●The incident: "The condom split during sex, two nights ago — about 48 hours ago."
●Her cycle: "My last period started 20 days ago. My cycle is regular, 28 days."
●Contraception: "Nothing regular — we've always just used condoms."
●Other episodes: "No, just that one incident since my last period."
●Her partner: "Someone I've been seeing about six weeks."
●What she wants: "The morning-after pill. That's all I was expecting, really."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores her perspective.

●Ideas: Bethany assumes the morning-after pill is straightforward and reliable, and that it is all she needs. "I thought the tablet just sorts it — that's what everyone takes, isn't it?"
●Concerns: Her dominant concern is becoming pregnant, which she is clear she does not want. If explored, she is also uneasy about the idea of a coil. "I really don't want to be pregnant. And I'll be honest, the idea of a coil doesn't appeal."
●Expectations: She expects a prescription for the morning-after pill. "I just want the tablet."

If Asked — Emergency Contraception Assessment Screen

The patient answers these only when directly asked.

●If asked exactly how long ago the episode was: "About 48 hours." (Within 72 hours — all oral options and the coil available.)
●If asked about her last menstrual period and cycle length/regularity: "Started 20 days ago; regular 28-day cycle." (So she is around day 20 — likely post-ovulatory, which is the crux of the case.)
●If asked about any other episodes of unprotected sex since her last period: "No, just that one."
●If asked about her weight/BMI: "I'm about 80 kg — I think my BMI is around 28." (Relevant to levonorgestrel dosing.)
●If asked about enzyme-inducing medication (some anti-epileptics, rifampicin, St John's wort): "I'm not on anything at all, and no herbal remedies."
●If asked about recent progestogen use (including any hormonal contraception in the last week): "No, nothing hormonal."
●If asked about breastfeeding or possibility of existing pregnancy: "Not breastfeeding, and I don't think I'm already pregnant — my last period was normal."
●If asked about previous ectopic pregnancy, or medical history: "No, nothing like that. I'm well."
●If asked about severe asthma on oral steroids (relevant to ulipristal): "No asthma."
●If asked about STI risk (partner's history, condom use, previous testing): "We've used condoms until it split. I don't know his sexual history in detail. I haven't been tested for a few years."
●If asked about symptoms of infection (discharge, pain, bleeding, dysuria): "No symptoms at all."
●If asked about her plans for ongoing contraception: "I've never really thought about it properly — condoms have just been what we do."
●If asked about consent/safeguarding: "It was completely consensual, yes."

Responses to Management (The Negotiation Phase)

●If the Doctor explains the cycle timing and why the tablet may be less effective — the crux: "So because I'm probably past ovulation, the tablet might not work? I assumed it always worked." (The tested point is explaining that oral EC works by delaying ovulation and is much less likely to be effective if ovulation has already occurred.)
●If the Doctor recommends the copper coil as the most effective option: "A coil? I really wasn't expecting that, and I don't love the idea. Why is it better?" (The tested point is the LARC conversation — explaining that the copper IUD is the most effective emergency contraception and also provides ongoing contraception — while respecting her autonomy.)
●If the Doctor explains the oral options and the dose adjustment: "And if I do go for the tablet, I'd need a higher dose because of my weight? I didn't know that." (The tested point is correct levonorgestrel dosing by weight/BMI, and the ulipristal alternative.)
●If the Doctor raises STI testing: "I hadn't even thought about that. I suppose the condom splitting means I've been exposed." (The tested point is STI consideration alongside emergency contraception.)
●If the Doctor discusses ongoing contraception: "Maybe it is time I sorted out something more reliable than condoms."
●If the Doctor gives safety-netting: "What do I do if my period is late or different?"

Mark Scheme

Domain 1: Data Gathering and Diagnosis

0 / 20 indicators checked+0−0

Positive (0/10)

Negative (0/10)

Domain 2: Clinical Management and Medical Complexity

0 / 20 indicators checked+0−0

Positive (0/10)

Negative (0/10)

Domain 3: Relating to Others

0 / 12 indicators checked+0−0

Positive (0/6)

Negative (0/6)

Clinical Learning Points

Emergency Contraception Options and Time Windows

●Levonorgestrel 1.5 mg — licensed up to 72 hours after unprotected sex.
●Ulipristal acetate 30 mg — licensed up to 120 hours, and more effective than levonorgestrel, particularly closer to ovulation.
●Copper intrauterine device (Cu-IUD) — up to 120 hours after the episode, or up to 5 days after the earliest estimated date of ovulation, whichever is later. It is the most effective method of emergency contraception.

Mechanism Determines Effectiveness — the Key Reasoning

●Oral emergency contraception works principally by delaying ovulation, so it is much less likely to be effective if ovulation has already occurred. Estimating the cycle position (from LMP and cycle length) is therefore essential: a woman past ovulation should be strongly encouraged towards the copper coil, which works after ovulation by preventing implantation.

The Copper Coil Is Both the Most Effective EC and Ongoing Contraception

●Always offer the Cu-IUD, explain its superior effectiveness, and actively arrange access. If it cannot be inserted promptly, give oral EC as a bridge and arrange insertion. Respect the patient's right to decline.

Dose Adjustment and Interactions

●Levonorgestrel should be double-dosed (3 mg) where weight is over 70 kg or BMI over 26.
●Enzyme-inducing drugs (some anti-epileptics, rifampicin, St John's wort) reduce efficacy — the Cu-IUD is preferred; if oral EC is used, levonorgestrel is double-dosed and ulipristal is not recommended.
●Ulipristal is less effective if progestogen has been taken in the preceding 7 days, and hormonal contraception must not be started for 5 days afterwards (use barrier methods) — whereas after levonorgestrel, hormonal contraception can be quick-started immediately.

Condom Failure Is Also an STI Exposure

●Offer STI screening (chlamydia/gonorrhoea NAAT, HIV and syphilis serology), explain window periods, and arrange repeat testing as appropriate.

Use the Opportunity for Ongoing Contraception

●An emergency contraception consultation is a key moment to discuss ongoing contraception, including LARC, and to arrange initiation — reducing the need for future emergency contraception.

What to Expect and Safety-Netting

●Advise that the next period may be earlier, later, or different; a pregnancy test if the period is more than 5–7 days late, lighter than usual, or if unsure; a repeat dose if vomiting occurs within 3 hours; and urgent review for severe one-sided abdominal pain (ectopic pregnancy).

Common Candidate Mistakes in This Case

●Not calculating the cycle position: giving oral EC without recognising she is probably post-ovulatory, and so over-stating its effectiveness.
●Not offering the copper coil: omitting the most effective option, or mentioning it without arranging access.
●Getting the dose or interactions wrong: standard-dose levonorgestrel despite BMI over 26, or incorrect ulipristal quick-start advice.
●Ignoring STI risk: treating condom failure as a pregnancy risk only.
●Missing the ongoing-contraception conversation, or weak safety-netting: no LARC discussion, or no advice on pregnancy testing and ectopic symptoms.

Free MRCGP SCA practice case for GP registrars covering Woman Requesting Emergency Contraception After A Burst Condom — Sexual Health. Includes candidate brief, patient script, marking scheme mapped to the RCGP SCA marking domains, and learning points. Built directly from the RCGP curriculum topic stations listed under "How this might be tested in the MRCGP SCA," part of a free library of 79 SCA practice cases for simulated consultation assessment preparation.

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