The Diploma of the Faculty of Sexual and Reproductive Healthcare (DFSRH) is the standard credential for UK clinicians providing contraceptive care — and for GPs in particular, it's increasingly expected rather than optional. Yet the revision landscape is surprisingly sparse.
The DFSRH certifies competence in contraception, pregnancy choices, common gynaecological conditions, and sexual health as it relates to primary care. It's awarded by the FSRH (part of the RCOG) and requires both theoretical assessment and documented practical competencies. If you prescribe contraception, fit IUDs/implants, or advise on pregnancy choices as part of your clinical work, this is the diploma that formally validates that practice.
The exam format
The DFSRH has two components:
Theoretical assessment: A computer-based exam with 64 Single Best Answer (SBA) questions, delivered at Pearson VUE centres across the UK. Time: 2 hours. The questions draw from the FSRH Clinical Effectiveness Unit (CEU) guidelines, NICE, and BASHH guidance. Topics include: all methods of contraception (mechanism, efficacy, contraindications, drug interactions), emergency contraception, pregnancy choices, STI screening and management, medical eligibility criteria (UKMEC), and special populations (adolescents, postpartum, perimenopausal).
Competency portfolio: Documented practical assessments covering counselling, IUD/IUS fitting, implant insertion/removal, and injectable contraception. These are signed off in clinical practice and don't involve a formal exam — but they take time to complete and require supervised sessions.
The theoretical exam is the part that requires structured revision. The competency portfolio is about accumulating clinical experience.
What study resources exist
The essentials
FSRH Clinical Effectiveness Unit guidelines — these are the primary reference and the basis for exam questions. They're freely available on the FSRH website and cover every contraceptive method in detail: indications, contraindications, UKMEC categories, drug interactions, and management of complications. If you read nothing else, read these. They're updated regularly and the examiners expect current guideline knowledge.
UKMEC (UK Medical Eligibility Criteria for Contraceptive Use) — the single most tested document. Know the UKMEC categories (1–4) cold, particularly for: combined hormonal contraception with migraine/BMI/age/smoking, IUD/IUS with PID history, and special scenarios (breastfeeding, immediate postpartum, liver disease). This is where most marks are won or lost.
FSRH e-Learning and webinars — the Faculty offers online learning modules mapped to the diploma curriculum. Variable in depth but useful as structured revision alongside the guidelines.
Question banks
PasSRH is the main dedicated qbank. It offers SBA questions mapped to the DFSRH curriculum with explanations referencing FSRH guidelines. It's the most commonly recommended resource in FSRH trainee forums. Quality is generally good — focused, guideline-aligned, and format-appropriate. If you're buying one thing, buy this.
Beyond PasSRH, there is no other significant dedicated qbank. No PassMedicine module, no AMBOSS section. Some MRCOG Part 1 question banks include relevant contraception/SRH content, but the focus and guideline framework differ (MRCOG questions test at a different depth and context).
Textbooks
Contraception: Your Questions Answered (Guillebaud & MacGregor) — the classic reference. Excellent for understanding the reasoning behind guidelines and for scenarios where the FSRH guidance alone doesn't give you enough clinical context.
FSRH "Quick Starting" and other key documents — the Faculty publishes specific guidance on quick-starting contraception, bridging between methods, and managing missed pills/patches/rings. These are frequently tested and should be read in full.
What's missing
Volume question practice is the gap. A 64-question SBA exam with a broad curriculum ideally needs 300–500 practice questions for adequate preparation. PasSRH covers this to a reasonable extent, but beyond it, you're limited. The DFSRH is also unusual in that the content is highly guideline-specific — general obstetrics/gynaecology questions don't substitute well because the DFSRH tests primary care SRH decision-making, not secondary care gynaecology.
Using AI tools effectively
Sexual and reproductive health is one of the areas where AI clinical search tools can genuinely help — because the answers are almost entirely guideline-defined.
Queries like "UKMEC category for combined pill in a 38-year-old smoker with BMI 32" or "can you start desogestrel immediately after stopping rigevidon?" have clear, guideline-based answers. iatroX's clinical search covers NICE guidance and can reference the FSRH framework for contraception queries. The guidelines section includes relevant NICE-aligned summaries for women's health topics.
For generating practice: ask an AI tool to produce SBA questions on UKMEC categories, emergency contraception timing, or LARC counselling — then verify every answer against the CEU guidelines. The DFSRH is one of the exams where AI-generated practice is most reliable because the content is so tightly guideline-defined.
Practical revision strategy
Week 1: Read the UKMEC summary table cover-to-cover. Highlight every Category 3 and Category 4 entry. These are the exam's bread and butter.
Weeks 2–3: Work through each FSRH CEU guideline: combined hormonal, progestogen-only pill, injectable, implant, IUD, IUS, emergency contraception, quick starting. For each method, know: mechanism, efficacy (Pearl index and typical use), absolute contraindications, drug interactions (especially enzyme-inducing drugs), and what to do when things go wrong (bleeding, expulsion, missed pills).
Weeks 4–5: PasSRH question practice. Do all available questions in timed blocks. Review every wrong answer against the guideline. The most common reason candidates get questions wrong is applying general knowledge rather than FSRH-specific guidance — the exam rewards guideline-faithfulness over clinical intuition.
Week 6: Focused revision on the topics that catch people out: drug interactions (rifampicin, enzyme inducers, ulipristal acetate timing with hormonal contraception), bridging and switching between methods, and safeguarding/Fraser competence in under-16s.
The bottom line
The DFSRH is a well-designed, clinically relevant exam with a clearly defined knowledge base. The revision challenge isn't complexity — it's that the resource ecosystem is small. PasSRH plus FSRH guidelines plus focused question practice gets most candidates through. The danger is overconfidence from clinical experience: you may have fitted 200 IUDs, but if you can't recall the UKMEC category for IUD insertion with current PID, the exam doesn't care how skilled your hands are.
iatroX offers AI clinical search covering UK contraception and women's health guidelines, plus a UK qbank for primary care and general medicine. UKCA-marked medical device built by a practising NHS GP.