november 18, 2013 human reproductive health nurs 330
DESCRIPTION
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. “-WHOTRANSCRIPT
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November 18, 2013
Human Reproductive Health
NURS 330
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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.
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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
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What factors influence Sexuality?
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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
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A person’s emotional and mental states also help determine whether
that person experiences arousal
FACT
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Sexual Response Cycle
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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
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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
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PLATEAU – 2ND STAGE
FEMALE MALE
Orgasmic PlatformTenting Effect Seminal Pool
Erection is maintained (if there is enough stimulation)Cowper’s Gland secretes fluid
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ORGASM – 3RD STAGE
FEMALE MALE
Muscle spasmsInvoluntary
Collection of semen in the urethral bulbEjaculatory Invariability -bulbocavernosus muscleExpulsion of semen
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RESOLUTION – 4TH STAGE
FEMALE MALE
Return to non-aroused state
Refractory Period
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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
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Sexual Dysfunctions
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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
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Prevalence
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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
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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
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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
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Sexual Pain Disorders Dyspareunia
Recurrent genital pain during sexual intercourse
Vaginismus Persistent involuntary spasms of vaginal
muscles, which interfere with sexual intercourse
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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
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General Causes Physiological/Biological
Medication and illicit drugs Psychological/Emotional
Anxiety Negative beliefs Sexual trauma
Interpersonal/Social Relationship problems
Environmental Cultural factors
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Treatment of Sexual Dysfunctions
• Medical treatment of sexual dysfunctions
• Sex therapy
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Rape Drugs What is a Rape Drug?A rape drug is one that is used in a
drug-facilitated sexual assault.
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Rape Drugs (cont) The most common rape drugs:
Rohypnol GHB Ketamine
Odorless, colorless Easily dissolved into drinks
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Effects of Rape Drugs Drowsiness Disorientation Disinhibition Amnesia
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INFERTILITY
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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
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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
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Risk Factors Some common risk factors
Age Weight Lifestyle Occupational and Environmental risks Stress and Emotional factors Genetic conditions??
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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
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Chances of Pregnancy by Age
Age Fertility %
Up until 34 90%
By age 40 Declining to 67%
By age 45 Declining to 15%
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Causes of Female Infertility
Aging Disorders of Ovulation Damage of the Fallopian Tubes Uterine Fibroids Endometriosis
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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
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Ovulation Disorders Responsible for approx. 25% of
female infertility problems Anovulation Oligoovulation
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Damage to Fallopian Tubes
Pelvic Inflammatory Disease (PID) Most common cause
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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).
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PID (cont) Causes of PID
Untreated/uncured bacterial infection Most common chlamydia (about 75% of cases) Second most common cause is gonorrhea.
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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
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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
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Endometriosis and infertility
Endometrial cysts in the fallopian tubes may cause blockage
Scar tissue between uterus, ovaries and fallopian tubes
Poor egg implantation
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Female Infertility-Other possible causes
Hormone Disorders Hypothalamic-Pituitary Disorders Polycystic Ovarian Disease/Syndrome Thyroid Other
Ovarian Cysts Ectopic pregnancies, medical conditions,
medications
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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
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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
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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
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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
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Other causes of sperm defect
Testosterone Deficiencies Retrograde Ejaculation Physical and Structural abnormalities Cancer and its treatments Infections Other medical conditions Medications
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Testing for Infertility – females Ovulation Assessment
Body temperature Cervical mucus assessment
Hormone Analysis Laparascopy Check vagina for naturally
occurring sperm antibodies
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Infertility Treatment
Artificial Insemination Drug therapy
Clomid In Vitro Fertilization (IVF)
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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
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Video
In-Class Assignment