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NURS 330 Human Reproductive Health

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1 NURS 330 Human Reproductive Health
February 7, 2011 NURS 330 Human Reproductive Health

2 Today’s Schedule 6:15pm - 7pm Mid-term 7:00pm – 7:15pm BREAK
7:15pm - 10pm Lecture & In-Class Assignment

3 Announcements 2/14/11 Electronic submission of essay to turnitin.com BY MIDNIGHT. No lecture 2/21/11 Submit hard copy of essay in class (must attach article) Lecture on Contraception Last day to submit extra credit* (*to make up for the missed lecture, you may submit two extra credit assignments on 2/7/11 -OR- 2/21/11.)

4 Disclaimer This lecture as well as preceding and proceeding
ones are to enhance your knowledge on Reproductive Health NOT to promote self diagnosis. If conditions, pictures, etc sound or look familiar, please do not diagnose yourself or loved ones. The only way to know if you have a condition discussed in class is to seek medical treatment and be diagnosed by a medical professional. –Fredua, E.

5 What is Sexuality?

6 What factors influence Sexuality?
Source:http://www.engenderhealth.org/res/onc/sexuality/introduction/index.html

7 The Senses and Sexuality
Touch Smell Sound Sight

8 Smell Smell Odors play a role in sexual arousal Pheremones
Perfumes Colognes Debate about its existence i.e. menstrual synchrony Not all odors are conducive to sexual arousal Offensive odors

9 Sound Sound Auditory stimuli
Your partner’s voice Romantic or sexy music Love-making sounds Not all sounds are conducive to sexual arousal

10 Sight Sight Allows us to experience many images that can trigger feelings of sexual arousal Viewing an “attractive” person Subject to social and cultural influences Erotic images Sometimes even parts of one’s genitals

11 Which sense is this? Do not appear to play a significant role in sexual arousal

12 Female Ejaculation Does it exist?

13 Terms to know Erogenous zones Kegel Exercises Aphrodisiacs Pheremones

14 Definition Erogenous Zones Kegel Exercise

15 Definition Aphrodisiacs Pheromones

16 Sex Hormone Testosterone “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

17 FACT A person’s emotional and mental states also help determine whether that person experiences arousal

18 Sexual Response Cycle

19 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

20 EXCITEMENT- 1ST STAGE: Response to stimuli
FEMALE MALE Transudation Vasocongestion Tenting Effect HR, BP, RR Myotonia Penile Erection Vasocongestion Testis enlarge HR, BP, RR Myotonia RR – Respitory Rate; BP – Blood Pressure; HR – Heart Rate

21 PLATEAU – 2ND STAGE Orgasmic Platform Tenting Effect Seminal Pool
FEMALE MALE Orgasmic Platform Tenting Effect Seminal Pool Erection is maintained (if there is enough stimulation) Cowper’s Gland secretes fluid

22 ORGASM – 3RD STAGE Muscle spasms Involuntary
FEMALE MALE Muscle spasms Involuntary Collection of semen in the urethral bulb Ejaculatory Invariability -bulbocavernosus muscle Expulsion of semen

23 RESOLUTION – 4TH STAGE Return to non-aroused state Refractory Period
FEMALE MALE Return to non-aroused state Refractory Period

24 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

25 Sexual Dysfunctions

26 Sexual Dysfunctions Recurrent or persistent sexual problems that interfere with normal performance and cause distress Nine types of sexual disorders Four categories Sexual Desire Disorders Sexual Arousal Disorders Orgasmic Disorders Sexual Pain Disorders

27 Prevalence

28 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

29 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

30 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

31 Sexual Pain Disorders Dyspareunia Vaginismus
Recurrent genital pain during sexual intercourse Vaginismus Persistent involuntary spasms of vaginal muscles, which interfere with sexual intercourse

32 Sexual Dysfunctions - Differences in Men and Women
Female Male Sexual Aversion Disorder Dyspareunia Dyspareunia (rare in men) Vaginismus Premature Ejaculation Female Orgasmic Disorder Male Orgasmic Disorder Hypoactive Sexual Desire Disorder Female Sexual Arousal Disorder Male Erectile Disorder

33 General Causes Physiological/Biological Psychological/Emotional
Interpersonal/Social Environmental

34 Treatment of Sexual Dysfunctions
Medical treatment of sexual dysfunctions Sex therapy

35 Medical Treatment Viagra FDA approval in March 1998 Prescription only
Lasts about four hours Side effects Short duration

36 Sex Therapy Principles of sex therapy
Mutual responsibility is emphasized Information and education are integral components Attitudes, expectations, and sexual scripts usually must be modified

37 Sexual Orientation

38 Sexual Orientation Sexual orientation Asexual
Erotic and romantic attraction to one or both sexes Asexual No erotic or romantic interest

39 Sexual Orientation Homosexual Heterosexual Bisexual Same sex
Opposite sex Bisexual Both sexes

40 Defining Terms Sex Gender Gender Roles

41 Rape Drugs What is a Rape Drug?
A rape drug is one that is used in a drug facilitated sexual assault.

42 Rape Drugs (cont) The most common rape drugs: Odorless, colorless
Rohypnol GHB Other common rape drugs Ecstasy Ketamine Odorless, colorless Easily dissolved into drinks

43 Effects of Rape Drugs Drowsiness Disorientation Disinhibition Amnesia

44 Is alcohol a rape drug?

45 What Is Sexual Harassment?
Sexual advances that are unwelcome and/or other sexually related behaviors that are hostile, offensive, or degrading

46 Two types of Sexual Harassment
Quid pro quo harassment Employee is expected to exchange sexual favors in return for keeping job or getting promotion Hostile environment harassment Unwanted behavior of a sexual nature creates a hostile or offensive work atmosphere

47 Sexual Harassment can occur at……..

48 Examples of Harassment
Uninvited or deliberate touching Uninvited sexually suggestive looks or gestures Cornering or pinching Unwelcome sexual advances Demands for sexual favors Degrading sexual remarks Groups of one sex making jokes about the opposite sex Persons in positions of leadership taking advantage of their position with sexual threats Inquiries about sexuality

49 Group Question:

50 What to do if you feel you are being sexually harassed
At work: 1. Let the person know that their behavior is inappropriate and ask them to stop 2. Keep a written record of events 3. Notify your supervisor immediately 4. Follow the complaint process/policy At school/on campus: - 1 & 2 above - Notify appropriate individuals on campus - Contact the public safety office on campus - - (323) Other resources

51 INFERTILITY

52 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

53 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

54 Risk Factors Some common risk factors Age Weight Lifestyle
Occupational and Environmental risks Stress and Emotional factors Genetic conditions??

55 Age and Infertility Females Males
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.

56 Chances of Pregnancy by Age
Fertility % Up until 34 90% By age 40 Declining to 67% By age 45 Declining to 15%

57 Causes of Female Infertility
Common causes Blocked Fallopian Tubes Pelvic Inflammatory Disease Endometriosis Ovulation disorders Others

58 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).

59 PID (cont) Causes of PID Untreated/uncured bacterial infection
Most common chlamydia (about 75% of cases) Second most common cause is gonorrhea. Other Causes Non-sterile abortions Cervicitis (usually from genital herpes infection) Other vaginal infections (bacterial vaginosis, trich) Ruptured appendix Childbirth

60 Endometriosis 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 Often causes no symptoms Painful periods, painful sex, painful bowel movements Cause is unknown Possible defects in immune system

61 Endometriosis and infertility
Endometrial cysts in the fallopian tubes may cause blockage Scar tissue between uterus, ovaries and fallopian tubes Poor egg implantation

62 Female Infertility- Other possible causes
Ovulation Disorders Hormone Disorders Hypothalamic-Pituitary Disorders Polycystic Ovarian Disease/Syndrome Thyroid Other Ovarian Cysts Benign Uterine Fibroids Ectopic pregnancies, medical conditions, medications

63 Male Infertility Over 90% of cases are due to:
Low sperm count Poor sperm quality Motility Morphology Both % of cases have an unknown cause

64 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

65 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

66 Other causes of sperm defect
Testosterone Deficiencies Autoantibodies Retrograde Ejaculation Physical and Structural abnormalities Cancer and its treatments Infections Other medical conditions Medications

67 Testing for Infertility - males
Sperm evaluation Hormone tests Ultrasound

68 Testing for Infertility – females
Ovulation Assessment Body temperature Cervical mucus assessment Hormone Analysis Laparascopy Check vagina for naturally occurring sperm antibodies

69 Infertility Treatment
Artificial Insemination Drug therapy Clomid In Vitro Fertilization (IVF)

70 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

71 In-Class Assignment


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