November 18, 2013

Human Reproductive Health

NURS 330

Week of 11/18/13 Reading for this week has been

updated. Refer to the course website for more

information.

You are responsible for reading all assigned readings.

What is Sexuality?“The integration of the physical,

emotional, intellectual and social aspects of sexual being in ways that are positively enriching and that enhance personality, communication, and love. Every person has a right to receive sexual information and to consider sexual relationships for pleasure as well as for procreation. “-WHO

What factors influence Sexuality?

Sex HormoneTestosterone “Male” hormone Found in small amounts in women Affects sexual response in men and women

Men – produced by the seminiferous tubules Women - produced by the ovaries

Increase energy, sex drive (libido), aggression, appetite, muscle mass Increases libido in both men and women

A person’s emotional and mental states also help determine whether

that person experiences arousal

FACT

Sexual Response Cycle

Models of Human Sexual Response

Master’s and Johnson Proposed their four-stage model of

human sexual response cycle Stage I - Excitement Stage II - Plateau Stage III - Orgasm Stage IV - Resolution

EXCITEMENT- 1ST STAGE:

FEMALE MALE

TransudationVasocongestionTenting EffectHR, BP, RRMyotonia

Penile ErectionVasocongestionTestis enlarge HR, BP, RRMyotonia

•Response to stimuli

RR – Respiratory Rate; BP – Blood Pressure; HR – Heart Rate

PLATEAU – 2ND STAGE

FEMALE MALE

Orgasmic PlatformTenting Effect Seminal Pool

Erection is maintained (if there is enough stimulation)Cowper’s Gland secretes fluid

ORGASM – 3RD STAGE

FEMALE MALE

Muscle spasmsInvoluntary

Collection of semen in the urethral bulbEjaculatory Invariability -bulbocavernosus muscleExpulsion of semen

RESOLUTION – 4TH STAGE

FEMALE MALE

Return to non-aroused state

Refractory Period

Comparing male and female sexual response

Key difference Male has a refractory period There’s a potential for multiple orgasms in

women Controversies in understanding the

female orgasm Freud

vaginal orgasm is true orgasm Master’s and Johnson

only one kind no matter how achieved

Sexual Dysfunctions

Sexual Dysfunctions

The persistent impairment of the normal patterns of sexual interest or response. (WHO)

Four categories Sexual Desire Disorders Sexual Arousal Disorders Orgasmic Disorders Sexual Pain Disorders

Prevalence

Sexual Desire Disorders Hypoactive sexual desire disorder

Persistent deficit in sexual fantasies and desire for sex

Sexual aversion disorder Extreme aversion to any form of sexual

contact with a partner

Sexual Arousal Disorders Female sexual arousal disorder

Difficulties becoming sexually aroused Deficient vaginal lubrication

Male erectile disorder Recurrent problems in achieving or sustaining

penile erection in a sexual situation Aka Impotence

Orgasmic Disorders Female orgasmic disorder (anorgasmia)

Recurrent problem with reaching orgasm despite adequate erotic stimulation

Male orgasmic disorder Delay or inability to reach orgasm during sexual

activity

Premature ejaculation Persistent or recurrent ejaculation following minimal

stimulation and before the person wishes it

Sexual Pain Disorders Dyspareunia

Recurrent genital pain during sexual intercourse

Vaginismus Persistent involuntary spasms of vaginal

muscles, which interfere with sexual intercourse

Sexual Dysfunctions - Differences in Men and Women

Female MaleSexual Aversion Disorder Sexual Aversion DisorderDyspareunia Dyspareunia (rare in men)

Vaginismus Premature EjaculationFemale Orgasmic Disorder Male Orgasmic Disorder

Hypoactive Sexual Desire Disorder

Hypoactive Sexual Desire Disorder

Female Sexual Arousal Disorder

Male Erectile Disorder

General Causes Physiological/Biological

Medication and illicit drugs Psychological/Emotional

Anxiety Negative beliefs Sexual trauma

Interpersonal/Social Relationship problems

Environmental Cultural factors

Treatment of Sexual Dysfunctions

• Medical treatment of sexual dysfunctions

• Sex therapy

Rape Drugs What is a Rape Drug?A rape drug is one that is used in a

drug-facilitated sexual assault.

Rape Drugs (cont) The most common rape drugs:

Rohypnol GHB Ketamine

Odorless, colorless Easily dissolved into drinks

Effects of Rape Drugs Drowsiness Disorientation Disinhibition Amnesia

INFERTILITY

Infertility

Definition: number of couples who have unprotected intercourse for one year and do not experience a pregnancy

10-15% of American couples are infertile

Causes of infertility Both men and women contribute to infertility

90% of cases, cause will be known Each gender contributes 40% Both contribute 10%

Remaining 10% of cases, cause remains unknown Males

Usually due to sperm defect Females

More complex

Risk Factors Some common risk factors

Age Weight Lifestyle Occupational and Environmental risks Stress and Emotional factors Genetic conditions??

Age and Infertility Females

As a woman gets older, her chances of fertility declines Menopause Higher risk of chromosomal abnormalities that occur in her eggs More likely to have health problems that may interfere with

fertility However, if fertilization occurs, can carry to full term

High risk of miscarriage Males

Not very clear on its impact of age and fertility in men Age does not appear to impact fertility in males as it does in

females. More likely to have health problems that may interfere with

fertility

Chances of Pregnancy by Age

Age Fertility %

Up until 34 90%

By age 40 Declining to 67%

By age 45 Declining to 15%

Causes of Female Infertility

Aging Disorders of Ovulation Damage of the Fallopian Tubes Uterine Fibroids Endometriosis

Aging Fertility begins to decline when a

woman is in her mid-30s About 10 years before menopause Decrease in ovarian function Reduction in ovaries Increased chromosomal abnormalities Increase in miscarriages

Ovulation Disorders Responsible for approx. 25% of

female infertility problems Anovulation Oligoovulation

Damage to Fallopian Tubes

Pelvic Inflammatory Disease (PID) Most common cause

Pelvic Inflammatory Disease (PID)

Pelvic Inflammatory Disease, or PID, is the major cause of infertility worldwide. It is an infection of a woman's pelvic organs (uterus, fallopian tubes, and ovaries). Infection of one or both fallopian tubes is known

as Salpingitis

Symptoms Mostly asymptomatic Fever, chills, pelvic pain (indicating inflammation

of the entire pelvic area).

PID (cont) Causes of PID

Untreated/uncured bacterial infection Most common chlamydia (about 75% of cases) Second most common cause is gonorrhea.

Uterine Fibroids Occurs in one in every four or five

American women Benign tumors Can cause excessive uterine bleeding

and pain Interferes with ovum implantation Compresses the opening of the

fallopian tubes

Endometriosis Uterine lining grows outside the uterine cavity

Lining of the uterus, instead of being expelled into the vagina, is expelled out into the fallopian tubes and implanted in other areas of the pelvis.

These implants respond to hormonal changes, slowly increasing in number and size with each menstrual cycle

Eventually causes scarring and inflammation

Symptoms Some have no symptoms Pain before , during and after the menstrual period Pain during sexual intercourse Spotting (bleeding between periods)

Cause is unknown Possible defects in immune system

Endometriosis and infertility

Endometrial cysts in the fallopian tubes may cause blockage

Scar tissue between uterus, ovaries and fallopian tubes

Poor egg implantation

Female Infertility-Other possible causes

Hormone Disorders Hypothalamic-Pituitary Disorders Polycystic Ovarian Disease/Syndrome Thyroid Other

Ovarian Cysts Ectopic pregnancies, medical conditions,

medications

Male Infertility Affect sperm quality and quantity Includes problems with:

Sperm production Blockage of sperm-delivery system Presence of antibodies against sperm Testicular injury Anatomic abnormalities Varicocele

Male Infertility Over 90% of cases are due to:

Low sperm count Poor sperm quality

Motility Morphology

Both 30 - 40% of cases have an unknown

cause

What affects sperm count and quality?

Environmental and Biologic Factors Lifestyle

-Emotional -Smoking-Sexual Issues/Infection -Malnutrition-Substance Abuse -Obesity-Testicular Exposure to overheating

Genetic Factors Varicocele

Varicocele Varicose vein in the cord that

connects to the testicle. Found in 10-15% of all men Found in 25% - 40% of infertile

men Only varicoceles large enough to

be felt are reported to affect fertility

Other causes of sperm defect

Testosterone Deficiencies Retrograde Ejaculation Physical and Structural abnormalities Cancer and its treatments Infections Other medical conditions Medications

Testing for Infertility – females Ovulation Assessment

Body temperature Cervical mucus assessment

Hormone Analysis Laparascopy Check vagina for naturally

occurring sperm antibodies

Infertility Treatment

Artificial Insemination Drug therapy

Clomid In Vitro Fertilization (IVF)

Infertility Treatment Gamete Intrafallopian Transfer (GIFT)

Both egg and sperm inserted into Fallopian tube

Zygote Intrafallopian Transfer (ZIFT) Fertilized outside body and inserted into

Fallopian tube Intracytoplasmic Sperm Injection (ICSI)

Direct injection of sperm into egg in lab

Video

In-Class Assignment