Contraception and Family Planning — MCQs
On this page
Which of the following is a contraindication for coitus interruptus?
What is the ideal contraceptive for a couple who lives in different cities and meets only occasionally?
Contraceptive efficacy is expressed as:
Which of the following is NOT an ideal candidate for insertion of an Intrauterine Contraceptive Device (IUCD)?
What is a contraindication for laparoscopic tubal ligation?
IUCD must not be used in a woman with which of the following conditions?
What is the contraceptive of choice for a patient with heart disease?
What is the most common side effect of IUD insertion?
Low dose progestational contraceptives primarily act on which of the following?
Which of the following contraceptives provides complete protection against sexually transmitted diseases?
Contraception and Family Planning Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is a contraindication for coitus interruptus?
- A. Erectile dysfunction
- B. Perimenopausal age
- C. Premature ejaculation (Correct Answer)
- D. Illiterate male partner
Explanation: **Explanation:** **Coitus Interruptus (Withdrawal Method)** is a traditional contraceptive method where the male partner completely withdraws the penis from the vagina before ejaculation occurs. Its success depends entirely on the male partner's ability to sense the "point of inevitability" and withdraw in time. **Why Premature Ejaculation is the Correct Answer:** Premature ejaculation is a definitive contraindication because the male partner lacks voluntary control over the timing of ejaculation. In such cases, ejaculation may occur before or during the process of withdrawal, leading to the deposition of semen in the vagina or on the vulva, resulting in a high risk of unintended pregnancy. **Analysis of Incorrect Options:** * **A. Erectile Dysfunction:** While this may make intercourse difficult, it is not a contraindication for the method itself; rather, the inability to maintain an erection often precludes the need for contraception during that specific act. * **B. Perimenopausal Age:** Women in this age group can use coitus interruptus, though more reliable methods are often recommended due to irregular cycles. It is not a medical contraindication. * **D. Illiterate Male Partner:** Literacy is not a prerequisite for using this method. Success depends on self-control and physiological awareness, not formal education. **High-Yield Clinical Pearls for NEET-PG:** * **Failure Rate:** The typical use failure rate is high (approx. **20-22%**), while the perfect use failure rate is about **4%**. * **Pre-ejaculate:** A common reason for failure even with "perfect use" is the presence of live sperm in the pre-ejaculatory fluid (from the Cowper’s glands). * **Mechanism:** It is classified as a **behavioral/natural method** of contraception. * **Advantage:** No cost, no hormonal side effects, and available at all times. * **Disadvantage:** No protection against STIs/HIV.
Question 2: What is the ideal contraceptive for a couple who lives in different cities and meets only occasionally?
- A. Barrier method (Correct Answer)
- B. Intrauterine contraceptive device (IUCD)
- C. Oral contraceptive pills (OCP)
- D. Depot medroxyprogesterone acetate (DMPA)
Explanation: **Explanation:** The choice of contraceptive method depends on the frequency of intercourse, the need for long-term protection, and the patient's lifestyle. **Why Barrier Method is Correct:** For couples who meet **infrequently or occasionally**, the **Barrier method (Condoms)** is the ideal choice. This is because it is a "user-dependent, coitus-related" method. It does not require continuous medication or invasive procedures for a couple who does not need daily protection. Additionally, it provides the added benefit of protection against Sexually Transmitted Infections (STIs), which is a crucial consideration for couples living apart. **Why Other Options are Incorrect:** * **IUCD (Option B):** These are Long-Acting Reversible Contraceptives (LARC) best suited for couples seeking long-term spacing (3–10 years) with frequent intercourse. It is an invasive procedure and unnecessary for occasional use. * **OCPs (Option C):** Oral pills require strict daily compliance to maintain efficacy. For a couple meeting only occasionally, taking a daily hormone pill is an unnecessary systemic burden. * **DMPA (Option D):** This is an injectable contraceptive given every 3 months. Like OCPs, it provides continuous hormonal suppression, which is not indicated for infrequent exposure. **NEET-PG High-Yield Pearls:** * **Ideal for Newly Married:** OCPs (Centchroman/Chhaya is often preferred in the Indian government program). * **Ideal for Lactating Mothers:** Progestogen-only pills (POPs) or IUCD (Cu-T 380A). * **Post-Coital (Emergency) Choice:** Levonorgestrel (1.5mg) within 72 hours or Cu-T within 5 days. * **Pearl Index:** Used to measure contraceptive failure rates (Lower index = Higher efficacy). Condoms have a higher typical-use failure rate compared to LARC.
Question 3: Contraceptive efficacy is expressed as:
- A. 100 women-months
- B. 1000 women-years
- C. 100 women-years (Correct Answer)
- D. 10 women-years
Explanation: **Explanation:** The efficacy of a contraceptive method is traditionally expressed using the **Pearl Index**. This index calculates the number of unintended pregnancies that occur per **100 women-years** of exposure. **Why Option C is Correct:** The Pearl Index is the standard epidemiological measure for contraceptive failure. It represents the number of failures (pregnancies) per 100 women using a specific method over one year. * **Formula:** (Total number of pregnancies × 1200) / (Total number of months of exposure). * The "1200" in the formula converts the data into the standard unit of 100 women-years (100 women × 12 months). **Why Other Options are Incorrect:** * **Option A (100 women-months):** This is too short a duration to account for seasonal variations or long-term consistency in contraceptive use. * **Options B & D (1000 or 10 women-years):** These are not the standardized units used in global reproductive health statistics or clinical trials. **High-Yield Clinical Pearls for NEET-PG:** * **Pearl Index vs. Life Table Analysis:** While the Pearl Index is common, **Life Table Analysis** is considered more accurate as it calculates failure rates at specific intervals (e.g., at 6 months, 12 months) and accounts for "drop-outs." * **Most Effective:** Implants (Nexplanon) and Vasectomy have the lowest Pearl Indices (highest efficacy). * **Least Effective:** Barrier methods (condoms) and behavioral methods (withdrawal/rhythm) have higher Pearl Indices due to user inconsistency. * **Perfect Use vs. Typical Use:** Always distinguish between these; "Typical use" Pearl Indices are always higher because they account for human error.
Question 4: Which of the following is NOT an ideal candidate for insertion of an Intrauterine Contraceptive Device (IUCD)?
- A. Has normal menstrual periods
- B. No history of Pelvic Inflammatory Disease (PID)
- C. Has at least one child
- D. Cancer of the Cervix (Correct Answer)
Explanation: **Explanation:** The selection of an ideal candidate for an Intrauterine Contraceptive Device (IUCD) is based on minimizing the risk of infection, expulsion, and complications. According to the **WHO Medical Eligibility Criteria (MEC)**, certain conditions are absolute or relative contraindications. **Why "Cancer of the Cervix" is the correct answer:** Cervical cancer is classified as **WHO MEC Category 4** (unacceptable health risk) for the initiation of an IUCD. Insertion in a patient with cervical malignancy can lead to severe complications, including heavy bleeding due to the friability of the tumor, increased risk of infection (as the cancer acts as a nidus), and potential trauma to the malignant tissue. If a woman is diagnosed with cervical cancer while an IUCD is in situ, it should be removed before starting radiotherapy or surgery. **Analysis of Incorrect Options:** * **A. Normal menstrual periods:** This is an ideal characteristic. IUCDs (especially Copper-T) can increase menstrual flow and cramping; therefore, women with pre-existing menorrhagia or dysmenorrhea are generally poor candidates. * **B. No history of PID:** A history of Pelvic Inflammatory Disease is a major risk factor. An ideal candidate should have no current or recent history of PID to minimize the risk of ascending infection. * **C. Has at least one child:** While "nulliparity" is no longer an absolute contraindication, a **multiparous woman** is considered an ideal candidate because the uterine cavity and cervical canal are more accommodating, reducing the risk of expulsion and pain during insertion. **High-Yield Clinical Pearls for NEET-PG:** * **WHO MEC Category 4 (Absolute Contraindications):** Pregnancy, unexplained vaginal bleeding, current PID, purulent cervicitis, and gestational trophoblastic disease. * **Ideal Candidate Profile:** Often referred to as the "low-risk woman"—monogamous, multiparous, with no history of PID or ectopic pregnancy. * **Timing:** Most common time for insertion is **post-menstrual** (within 10 days of LMP) to ensure the patient is not pregnant and the cervix is slightly dilated.
Question 5: What is a contraindication for laparoscopic tubal ligation?
- A. Postpartum state (Correct Answer)
- B. Post MTP (Medical Termination of Pregnancy)
- C. Gynecologic malignancies
- D. Three previous childbirths
Explanation: ### Explanation The correct answer is **A. Postpartum state**. **Why Postpartum state is a contraindication for Laparoscopy:** In the immediate postpartum period (typically the first 48 hours to 7 days), the uterus is significantly enlarged and remains an intra-abdominal organ (reaching the level of the umbilicus). This makes **laparoscopic** tubal ligation technically difficult and dangerous due to: 1. **Risk of Uterine Perforation:** The soft, enlarged uterus is easily injured by the Veress needle or trocar. 2. **Limited Space:** The bulky uterus obscures the pelvic view and limits the working space for laparoscopic instruments. 3. **Alternative Gold Standard:** The preferred method for sterilization in the postpartum period is **Mini-laparotomy (Pomeroy’s technique)**, usually performed via a small sub-umbilical incision. **Analysis of Incorrect Options:** * **B. Post MTP:** Sterilization can be safely performed concurrently with MTP (Concurrent Tubal Ligation) via laparoscopy, as the uterus is not as large as in a full-term pregnancy. * **C. Gynecologic malignancies:** While surgery is complex, malignancy itself is not a contraindication to the *procedure* of tubal ligation, though the clinical focus usually shifts to treating the cancer (e.g., hysterectomy). * **D. Three previous childbirths:** High parity is an indication for sterilization, not a contraindication. **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** Postpartum sterilization is ideally done 24–48 hours after delivery. * **Laparoscopy Timing:** Laparoscopic sterilization is best performed as an **"Interval Sterilization"** (at least 6 weeks after delivery) when the uterus has undergone complete involution. * **Absolute Contraindications for Laparoscopy:** Intestinal obstruction and generalized peritonitis. * **Most common method used in India:** Laparoscopic ligation (Interval) and Pomeroy’s (Postpartum).
Question 6: IUCD must not be used in a woman with which of the following conditions?
- A. Genital herpes with severe non-purulent discharge
- B. Pelvic tuberculosis (Correct Answer)
- C. AIDS on ARV therapy
- D. Recto-vaginal fistula
Explanation: **Explanation:** The correct answer is **Pelvic tuberculosis**. According to the WHO Medical Eligibility Criteria (MEC) for contraceptive use, active Pelvic TB is classified as **MEC Category 4** (unacceptable health risk) for both the initiation and continuation of an Intrauterine Contraceptive Device (IUCD). **Why Pelvic TB is a Contraindication:** Pelvic tuberculosis often involves chronic inflammation, endometrial destruction, and a high risk of secondary bacterial infection. Inserting an IUCD into an already infected or structurally compromised uterus can exacerbate the infection, lead to flare-ups of latent TB, and increase the risk of uterine perforation or persistent pelvic pain. **Analysis of Incorrect Options:** * **Genital Herpes (Option A):** While active purulent cervicitis is a contraindication (MEC 4), simple genital herpes or non-purulent discharge is generally **MEC 2**. The IUCD can be inserted once the acute lesions have healed. * **AIDS on ARV therapy (Option B):** Women with HIV/AIDS who are clinically well on Antiretroviral Therapy (ART) can safely use an IUCD (**MEC 2**). The risk of Pelvic Inflammatory Disease (PID) in HIV-positive women is not significantly higher than in HIV-negative women. * **Recto-vaginal fistula (Option D):** This is a structural abnormality between the rectum and vagina. While it requires surgical repair, it does not involve the uterine cavity or the fallopian tubes; therefore, it is not a contraindication for IUCD use. **High-Yield NEET-PG Pearls:** * **MEC Category 4 (Absolute Contraindications):** Pregnancy, unexplained vaginal bleeding, current PID/STIs (cervicitis), gestational trophoblastic disease (malignant), and Pelvic TB. * **Wilson’s Disease:** A specific contraindication for **Copper-T** (use Levonorgestrel-IUS instead). * **Breast Cancer:** An absolute contraindication for **LNG-IUS** (hormonal). * **Ideal Time for Insertion:** Within 10 days of the menstrual cycle (Interval) or within 48 hours postpartum.
Question 7: What is the contraceptive of choice for a patient with heart disease?
- A. Sterilization (Correct Answer)
- B. Intrauterine contraceptive device (IUCD)
- C. Oral contraceptive pills (OCP)
- D. Norplant
Explanation: **Explanation:** The primary goal of contraception in a patient with heart disease is to prevent the significant hemodynamic stress associated with pregnancy, which can lead to cardiac decompensation or death. **1. Why Sterilization is the Correct Answer:** Sterilization (permanent contraception) is the method of choice because it offers the highest efficacy (lowest failure rate). For a cardiac patient, a failure of contraception resulting in an unplanned pregnancy poses a life-threatening risk. While the procedure itself carries surgical risks, it is considered the safest long-term strategy once the family is complete. **Vasectomy** (male sterilization) is technically the safest option as it involves no risk to the cardiac patient, but female sterilization remains the standard answer for the "method of choice" in this clinical context. **2. Why Other Options are Incorrect:** * **Oral Contraceptive Pills (OCP):** These are generally **contraindicated** in heart disease, especially those involving valvular issues or arrhythmias, due to the estrogen component. Estrogen increases the risk of thromboembolism and can cause fluid retention, worsening heart failure. * **IUCD:** While highly effective, IUCDs carry a risk of **vasovagal syncope** during insertion, which can be dangerous for patients with fixed cardiac output (e.g., valvular stenosis). There is also a theoretical risk of pelvic infection leading to subacute bacterial endocarditis (SBE), though routine antibiotic prophylaxis is no longer universally mandated. * **Norplant/Progestogen-only implants:** While safer than OCPs regarding thromboembolism, they have higher failure rates than sterilization and may cause irregular bleeding. **Clinical Pearls for NEET-PG:** * **Barrier methods:** Have the highest failure rate and are generally not recommended as the sole method for cardiac patients. * **Injectable Progestogens (DMPA):** Should be used with caution as they can cause fluid retention. * **Most Dangerous Time:** For a cardiac patient, the immediate postpartum period (third stage of labor) is the most critical due to the sudden "autotransfusion" of blood from the involuting uterus.
Question 8: What is the most common side effect of IUD insertion?
- A. Bleeding (Correct Answer)
- B. Pain
- C. Pelvic inflammatory disease
- D. Ectopic pregnancy
Explanation: **Explanation:** The most common side effect of Intrauterine Device (IUD) insertion is **Bleeding** (specifically menorrhagia or intermenstrual spotting). This occurs due to a local inflammatory response in the endometrium, increased vascularity, and the release of prostaglandins and enzymes that interfere with local clotting mechanisms. In the case of Copper-T, it typically manifests as heavier or prolonged menstrual periods. **Analysis of Options:** * **A. Bleeding (Correct):** It is the #1 reason for the discontinuation of IUDs. * **B. Pain:** This is the **second most common** side effect. It usually presents as low-backache or pelvic cramping, often occurring during insertion or during the first few menstrual cycles post-insertion. * **C. Pelvic Inflammatory Disease (PID):** While there is a slight risk of infection within the first 20 days of insertion (due to the introduction of vaginal flora into the uterus), it is a **rare complication**, not a common side effect. * **D. Ectopic Pregnancy:** IUDs actually reduce the absolute risk of ectopic pregnancy because they are highly effective contraceptives. However, if a woman *does* become pregnant with an IUD in situ, the **relative risk** (proportion) of that pregnancy being ectopic is higher. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect:** Bleeding. * **Second most common side effect:** Pain. * **Most common cause of removal:** Bleeding. * **Most common complication:** Expulsion (most likely to occur in the first year, particularly during the first 3 months). * **Ideal time for insertion:** Within 10 days of the beginning of menstruation (to ensure the patient is not pregnant and the cervix is slightly dilated).
Question 9: Low dose progestational contraceptives primarily act on which of the following?
- A. Oviductal motility
- B. Uterine endometrium
- C. Cervix (Correct Answer)
- D. Pituitary
Explanation: **Explanation:** The primary mechanism of action for **low-dose progestational contraceptives** (such as Progestogen-Only Pills or POPs) is the alteration of **cervical mucus**. 1. **Why Option C is Correct:** Low doses of progesterone make the cervical mucus thick, viscous, and scanty. This creates a "hostile" environment that acts as a physical barrier, preventing sperm penetration into the upper reproductive tract. This is the most consistent and immediate effect of low-dose formulations. 2. **Why Other Options are Incorrect:** * **Option D (Pituitary):** While high-dose progesterone (like DMPA) or Combined Oral Contraceptives (COCs) reliably suppress the hypothalamic-pituitary-ovarian axis to inhibit ovulation, low-dose POPs do **not** consistently suppress ovulation (ovulation occurs in about 60% of cycles). * **Option B (Uterine Endometrium):** Progesterone does cause endometrial atrophy (making it out of sync for implantation), but this is considered a secondary/backup mechanism rather than the primary one for low-dose formulations. * **Option A (Oviductal Motility):** Progesterone can decrease the motility and ciliary activity of the fallopian tubes, but this is a minor contributory factor compared to the cervical effect. **High-Yield Clinical Pearls for NEET-PG:** * **POPs (Minipill):** Must be taken at the same time every day (3-hour window). If a dose is missed by >3 hours, backup contraception is needed for 48 hours. * **Drug of Choice:** POPs are the contraceptive of choice for **lactating mothers** as they do not suppress milk production (unlike estrogens). * **Primary MOA Summary:** * **COCs:** Inhibition of Ovulation (Primary). * **POPs:** Cervical mucus thickening (Primary). * **IUCD (Cu-T):** Sterile inflammatory response/Spermicidal (Primary). * **LNG-IUS (Mirena):** Endometrial atrophy (Primary).
Question 10: Which of the following contraceptives provides complete protection against sexually transmitted diseases?
- A. Intrauterine contraceptive device (IUCD)
- B. Barrier method (Correct Answer)
- C. Oral contraceptive pill (OCP)
- D. Minipill
Explanation: **Explanation:** The **Barrier method** (specifically male and female condoms) is the only contraceptive method that provides dual protection: preventing unintended pregnancy and significantly reducing the transmission of **Sexually Transmitted Diseases (STDs)**, including HIV, Hepatitis B, Syphilis, and Gonorrhea. This is because they act as a physical mechanical barrier that prevents the exchange of infectious genital secretions and reduces contact with mucosal surfaces or lesions. **Analysis of Incorrect Options:** * **Intrauterine Contraceptive Device (IUCD):** While highly effective for long-term contraception, IUCDs offer **no protection** against STDs. In fact, if a patient has a pre-existing cervical infection (like Chlamydia) at the time of insertion, it may increase the risk of Pelvic Inflammatory Disease (PID). * **Oral Contraceptive Pill (OCP) & Minipill:** These are hormonal methods that prevent pregnancy by inhibiting ovulation or thickening cervical mucus. They do not provide any physical barrier to pathogens and thus offer **zero protection** against STDs. **High-Yield Clinical Pearls for NEET-PG:** * **Dual Protection:** This term refers to the simultaneous use of a highly effective contraceptive (like an IUCD or OCP) along with a barrier method (condom) to ensure both pregnancy prevention and STD protection. * **Nonoxynol-9:** Previously used in spermicidal barriers, it is now discouraged as it can cause vaginal irritation, potentially *increasing* the risk of HIV transmission. * **PID Risk:** Barrier methods are considered protective against PID, whereas IUCDs are contraindicated in patients with active purulent cervicitis or known PID.
Practice by Chapter
Natural Family Planning Methods
Practice Questions
Barrier Methods
Practice Questions
Hormonal Contraceptives
Practice Questions
Intrauterine Devices
Practice Questions
Emergency Contraception
Practice Questions
Permanent Contraception Methods
Practice Questions
Contraception in Special Populations
Practice Questions
Contraceptive Counseling
Practice Questions
Side Effects and Complications of Contraceptives
Practice Questions
Future Contraceptive Technologies
Practice Questions
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free