Sexual Development/ Human Sexuality/ Contraception

Sexual Development/ Human Sexuality/ Contraception
Prepared by:Teresa Fisher, PBT, RN, BSN Revised & Presented by: Judy Carlyle, MSN, RN

Family Planning Goal: to assist clients with reproductive decision making, enabling the client to have control in preventing pregnancy, limiting the number of children, spacing the time between children, and voluntarily interrupting pregnancy as desired.

So Many options; which one to choose?????
Safe Easily available Economical Available Simple to use Promptly reversible

Nurses Role in Contraception
Foster safe environment for consultation Provide correct education Distinguish myth from fact Clarify misinformation Fill in gaps of knowledge Provide visual samples Gain a complete history

History should include
Menstrual history Contraceptive history Contraceptive goal Obstetric history Medical history Familial history Nursing Process on Page 170 – Excellent – Look it over B – Benefits R – Risks A – Alternatives I – Inquires/questions D – Decisions E- Explanations D - Documentation

Methods of Contraception
Natural Methods 1) Abstinence 2) Coitus interruptus Fertility awareness methods 1) Calendar method 2) Basal body temperature method 3) Cervical mucus method 4) Symptothermal method

Methods of Contraception
Spermicides & barrier methods * condoms * diaphragm * cervical cap * cervical sponge Hormonal methods Emergency contraception Intrauterine devices Sterilization

Abstinence The practice of avoiding sexual intercourse

Advantages Safe Free Available to all
100% effective in preventing pregnancy & STIs Can be initiated at any time Encourages communication between partners

Disadvantages Both participants must practice self-control

Nursing Education Teach alternative methods of obtaining sexual pleasure Provide positive feedback to clients who desire and maintain abstinence

Coitus Interruptus AKA withdrawal
Male partner withdraws penis prior to ejaculation Effectiveness depends on man’s ability to withdraw prior to ejaculation

Advantages Can be practiced at any time during the menstrual cycle
Free

Disadvantages One of the least reliable contraceptive methods
Only 80% effective Does not protect from STIs Some pre-ejaculatory fluid, which may contain sperm, may escape from the penis during the excitement phase prior to ejaculation At the peak of sexual excitement, exercising self-control may be difficult

Nursing Education Before engaging in sexual intercourse, the male should urinate and wipe off the tip of the penis to decrease the potential of introducing sperm into the vagina Conception may occur if pre-ejaculatory fluid containing sperm enters the vagina A spermicide or post-coital contraceptive may be needed if the female partner is exposed to sperm

Fertility Awareness Methods
Calendar based methods Symptoms based method Biologic marker methods

Advantages Free Safe Acceptable to couples whose religious beliefs prohibit other methods, such as Roman Catholics Increases awareness of the woman’s body Encourages couple communication Can be used to prevent or plan a pregnancy Our President saw first hand how resistant the Catholic religion was on this issue when he tired to pass contraception law. Major resistance from the Catholic church.

Disadvantages Requires extensive initial counseling and education
May interfere with sexual spontaneity May be difficult or impossible for women with irregular menstrual cycles Used alone, they offer no protection against sexually transmitted infection Less effective in actual use

Calendar Rhythm Method
Based on assumption that ovulation occurs 14 days prior to the next menses, sperm are viable for 5 days, and the ovum is capable of being fertilized for 24 hours 91% effective if used perfectly

Calendar rhythm method
Based on number of days in each cycle, counting from first day of menses Beginning of fertile period is estimated by subtracting 18 days from length of shortest cycle in last 6 months End of fertile period is determined by subtracting 11 days from length of longest cycle

Example of Calendar Rhythm Method
Shortest cycle 24 days 24-18 = 6th day Longest cycle 30 days = 19th day To avoid conception the couple would abstain during the fertile period days 6-19

Lets Try One You are educating a client on the contraceptive calendar rhythm method. When you ask her how long her cycles have been for the last 6 months, she explains that her cycle is consistently 28 days. What days should you tell her to abstain from sexual intercourse???

Let’s Work This Together
Shortest cycle 28 days = 10th day Longest cycle 28 days 28 – 11 = 17th day To avoid pregnancy the couple abstains from day

Disadvantage To Calendar Rhythm Method
Attempting to predict future events with past data

Standard Days Method A modified form of calendar rhythm method
Has fixed number of days of fertility for each cycle Day 8 – 19 Cycle Beads (bracelet) Is useful for women who have day cycle Unreliable for others 12% failure rate Red bead – 1st of menses. White beads – fertile days Brown beads – pregnancy unlikely Not recommended for women with irregular cycles Two day method – Monitors cervical secretions for 2 consecutive days. Cervical secretion yes, no sex. IF no, then should be safe. Failure rate 14%.

Cervical Mucus Method Based on monitoring and recording of cervical secretions Cervical mucus changes occur in response to levels of estrogen and progesterone Spinnbarkeit – Watery thin, clear mucus becomes more abundant and thick. Feels similar to a lubricant and can be stretched 5+ cm between the thumb and forefinger Sounds like fun!!!

Spinnbarkeit Presence indicates period of maximal fertility
Sperm deposited in this type of mucus can survive until ovulation occurs

Cervical Mucus in Relation to Conception
Cervical mucus that accompanies ovulation is necessary for viability & motility of sperm Mucus alters pH by neutralizing acid

Barriers to Assessing Mucus
Contraceptive gels or foams Vaginal infection Douches Vaginal deodorant Medications (antihistamines dry up mucus) Sexually aroused state thins mucus Uncomfortable touching genitals

Education Assess cervical mucus daily
Avoid intercourse when first notices cervical mucus becoming more clear, elastic, and slippery and then for 4 days Instruct women on barriers to cervical mucus assessment Can be highly accurate. If female is breastfeeding – lets couples know when ovulation has returned and risk for pregnancy is high Also, can determine if woman is perimenopausal.

Basal Body Temperature Method
BBT is lowest body temperature of a healthy person taken immediately after waking and before getting out of bed BBT varies from during menses and days after At time of ovulation there is a slight decrease in temperature (fertile period) After ovulation the BBT increases slightly and remains until 2-4 days prior to menstruation 36.2 C = 97 F Thermal shift

Fertile period is day of first temp drop or first elevation through 3 days of elevated temp Abstinence begins the first day of menstrual bleeding and lasts through 3 consecutive days of sustained temp rise

Temps are recorded on graph 97% effective if performed correctly

Alterations in BBT Accuracy
Infection Fatigue Less than 3 hours sleep per night Awakening late Anxiety New thermometer Jet lag Alcohol Antipyretic medications Heated waterbed Electric blanket

Combination contraception
Calendar rhythm method Two day method BBT

Urine Ovulation Predictor Test
Detects the sudden surge of luteinizing hormone (LH) that occurs hours before ovulation Test is not affected by illness, emotional upset, or physical activity (+) = LH surge detected and easy to read color change

Mechanical Methods of Contraception
Spermicide Male condom Female condom Diaphragm Cervical cap Contraceptive sponge Intrauterine device (IUD)

Spermicides Serve as chemical barriers against the sperm
Nonoxynol-9 (N-9) work by reducing the sperm’s mobility Attacks sperm flagella and body so they cannot reach the cervical os Use of N-9 too often could increase transmission of HIV by disrupting vaginal mucosa N-9 can also be found in lubricated condoms, diaphragm, and cervical caps Prostitutes and highly sexually active females are at high risk

Intravaginal spermicides
Foams Tablets Suppositories Creams Films Gels Preloaded single-dose applicators Inserted high in vagina to reach cervix Inserted 15 min – 1 hr before sexual intercourse When used alone 94% effective Must be use consistently and accurately Failure rate when used alone 29%

Advantages No prescription required
May be used alone or with a diaphragm or condom May add additional lubrication and moisture Penis can remain in vagina following ejaculation Safe for breast-feeding women Several choices

Disadvantages The spermicide may be irritating to one or both clients
Some forms may be perceived as messy May interfere with spontaneity

Nursing Education Apply spermicide inside vagina & close to the cervix prior to inserting penis Spermicides must be applied with each act of sexual intercourse Onset of spermicidal action varies When used alone effectiveness lasts no longer than 1 hour Foams, creams, & gels are effective immediately Vaginal contraceptive film & suppositories become effective 15 minutes after insertion into vagina

Male Condoms Are made of latex, polyurethane, or animal tissue
Polyurethane is thinner and stronger than latex Protects against pregnancy and some STIs Latex condoms will break down with oil-based lubricants Only water-based or silicone lubricants should be used Polyurethane - Researching effectiveness with STIs STIs – gonorrhea, chlamydia, trich, and HIV Condoms with N-9 are not recommended for preventing STIs or HIV

Advantages Males are able to participate in contraception
Sexual intercourse may be prolonged Condoms are available in a variety of sizes & styles at low cost or free Partners can participate in placing the condom to enhance enjoyment All condoms except those made of natural skins offer protection against pregnancy

Natural Skin Male Condoms
Natural skin condoms (lamb cecum) does not provide same protection against STIs & HIV Contain small pores that could allow passage of viruses such as hepatitis B, HSV, & HIV Correct condom placement: Page 177 Box 8-3

Disadvantages Penis must be erect before placing the condom on
To prevent spillage of semen, the male must withdraw after ejaculating, while the penis is still erect Condoms can rupture or leak Oil-based lubricants can decrease effectiveness of condom

Use of the Male Condom Make sure to educate on proper use and fit
Condom should be in place prior to any penile penetration

Client Education Check expiration date on package
Avoid using oil-based lubricants Put on condom by placing condom on the tip of the erect penis, leaving enough room at tip to collect sperm, then unroll condom from tip of erect penis to base After intercourse erect penis should be withdrawn from vagina while holding rim of condom to prevent leakage Inspect used condom for tears or holes Discard used condom in disposable waste container Do not flush in toilet

Female Condom Thin, polyurethane sheath with flexible rings at each end, which covers cervix, lines vagina, and partially shields perineum 95% effective with perfect use

Female Condom

Insertion of Female Condom

Advantages May be inserted up to 8 hours prior to intercourse
Not made of latex Both partners are protected against STIs Available without prescription Use of lubricants will not decrease effectiveness Breast-feeding women can safely use

Disadvantages May twist or slip during intercourse
Improper removal results in risk of ejaculate leaking Outer ring may irritate external genitalia High cost Noise produced with intercourse Altered sensation Initial insertion may be awkward Noise – may use oil or lubricant to help

Client Education Insert closed end of condom into vagina so ring fits loosely against cervix After intercourse, condom should be removed before standing up by squeezing and twisting outer ring to close sheath while gently pulling out of vagina Other end covers the labia 1 size fits all Avoid using male and female condoms together – friction may cause tearing.

Diaphragms A shallow dome-shaped latex or silicone device with a flexible rim that covers cervix.

Advantages Gives woman control
Partner may insert diaphragm as part of foreplay Diaphragm contains no hormones and is safe for breast-feeding client Penis can remain inside vagina after ejaculation

Disadvantages Must be fitted by healthcare provider
Must be replaced every 2 years Refitting & replacement may be needed following pregnancy or a 15 pound weight gain or loss (20% weight fluctuation) Difficulty with learning how to place correctly Should not be used if client has UTI or TSS or history of either

Diaphragms Available in many sizes
Should be largest size woman can wear without her being aware of its presence Most effective when used with spermicide Annual gynecologic exam to assess fit Inspect device prior to each use 4 different types – coil spring, arcing spring, flat spring, and wide seal rim. Refer to individual insertion instructions because each one is different. Women at high of HIV should avoid N-9 spermicides and diaphragms.

Inspecting Diaphragm Hold diaphragm up to light source
Carefully stretch at area of the rim, on all sides Make sure there are no holes Sharp fingernails can puncture diaphragm Can fill diaphragm with water to assess for holes If diaphragm is puckered do not use Puckering could mean this spots

Insertion of a Diaphragm
Can be inserted up to 6 hours prior to intercourse Hold diaphragm between thumb and fingers Dome can be up or down Insert inward and downward as far as it will go Do not use oil based products such as vaginal lubricants b/c they weaken the rubber BE sure to rinse off cornstarch prior to insertion Instruct client to empty her bladder prior to insertion and again immediately after intercourse.

Disadvantages of Diaphragms
Diaphragms are contraindicated for women with pelvic relaxation, uterine prolapse, or large cystocele. Not a good option for women with poor vaginal muscle tone or recurrent UTIs Toxic shock syndrome TSS can occur

Toxic Shock Syndrome Remove diaphragm within 6-8 hours after intercourse Do not use diaphragm or cervical cap during menses Watch for danger signs of TSS * Sunburn type rash * diarrhea * dizziness * faintness * sudden high fever * vomiting * weakness * sore throat * aching muscles and joints

Client Education Should be inserted 6 hours prior to sexual intercourse Should remain 6 hours after sexual intercourse Removal – forefinger to top of rim, break the suction. Pull down and out. Do not attempt to pull from bottom rim = possible spillage Care – no oil based products. Wash with mild soap and warm H2O. Dry thoroughly. Dust with cornstarch.

Cervical Cap Small thimble-shaped device Made of soft rubber
Fits over cervix Held in place by suction Acts as barrier b/t sperm & cervix Effectiveness determined by childbearing hx Nulliparous – 91% effective Parous = 74% effective

Cervical Cap Three types Advantages & disadvantages same as diaphragm
Should remain in place for at least 6 hours and no more than 48 hours after intercourse Provides a physical barrier to sperm Spermicide is inside the cap 2 in varying sizes and 1 – one size fits all

Cervical Cap Fits the same way as a diaphragm
Requires less spermicide than the diaphragm Can be inserted hours before sexual intercourse without need for additional spermicide Repeated acts of intercourse are possible There is a potential risk of TSS Should teach that during the menstrual cycle, should use other contraceptive method. Also during the postpartum period.

Cervical Cap

Contraceptive Sponge Small, round polyurethane sponge that contains N-9 spermicide Designed to fit over cervix One size fits all One side is concave Other side has woven polyester loop to be used for removal of sponge Before insertion, sponge must be moistened with water

Contraceptive Sponge Provides protection for 24 hours
Should be left in place for at least 6 hours after last intercourse Wearing longer than 24 hours places women at risk for TSS

Contraceptive Sponge

Hormonal Methods More than 30 different formulations Oral Transdermal
Vaginal Injectable Emergency Intrauterine

Combined oral contraceptives (estrogen – progestin)
AKA COCs Suppress the action of the hypothalamus & anterior pituitary which leads to insufficient secretion of FSH & LH Follicles do not mature Ovulation is inhibited Should be taken at the same time each day

COC Available in 21 day, 28 day, 91 day packages
99.1% effective if used perfectly

COC Regimen Is initiated on the first Sunday after day one of the menstrual cycle or after childbirth or abortion Another form of contraception should be used throughout the first week Taken the same time each day Almost 100% effective Almost all failures are a result of omission of one or more pills during regimen

COCs From 1-4 days after last COC, the endometrium soughs and bleeds
Due to hormone withdrawal Bleeding is less profuse than normal menstruation May only last 2-3 days

What to do if COC is Missed
If one pill is missed: * take pill immediately * begin regimen with time new pill taken * no alternate forms of contraception is necessary

What to do if COC is Missed
If two pills are missed * Take one pill every day until Sunday * Begin new pack on Sunday * Do not take 2 pills at same time * Use backup contraception for one week

Advantages of COCs Does not effect sexual act
Improvement in sexual response may occur once possibility of pregnancy is not an issue Convenience of knowing when next menstrual flow will occur Decreased menstrual blood loss Decreased iron-deficiency anemia Regulation of irregular cycles Reduced incidence of dysmenorrhea & PMS Return to fertility happens quickly

Disadvantages No protection against STIs
Clients need to remember to take a pill at the same time each day Clients with preexisting medical problems may not be candidates for this method Effectiveness may be decreased with certain medications May decrease effectiveness of insulin or warfarin (coumadin) Medications – certain antibx, St. John’s wort,

Contraindications include HX. Of:
thromboembolic disorders cerebrovascular or coronary artery disease breast cancer Estrogen dependent neoplasms Currently pregnant, lactation <6 weeks postpartum Smokes >35 years old Hypertension DM with vascular disease Surgery on legs gallbladder disease

Common Side Effects Nausea Breast tenderness Fluid retention
Chloasma (klo – as-mah) Increased appetite Tiredness Depression Hirsutism Bleeding irregularities Chloasma – AKA melasma – AKA – Mask of pregnancy Tan/Dark skin discoloration usually seen on face of pregnant woman

Serious Adverse Effects
Attributable to estrogen, progestin, or both Stroke MI Thromboembolism Hypertension Gallbladder disease Liver tumors

Finding the Right COC The right product for a woman contains the lowest dose or hormones that prevents ovulation and that has the fewest and least harmful side effects You may have to try different ones in order to find the right one for you.

Effectiveness is Altered When Women also Take:
phenytoin (Dilantin) topirimate (Topamax) ampicillin (Omnipen) tetracycline (Achromycin) penobarbital rifampin (Rifadin) Anti-HIV inhibitors St. John’s wort

Nursing Considerations
A drop of blood or small brown smear counts as a period All women taking oral contraceptives should be aware of alternate methods of contraception Assure woman knows that oral contraceptives will not protect them from STIs or HIV

Oral Contraceptive 91-Day Regimen
Some women take COCs in 3 month cycles Have fewer menstrual periods Seasonale Take 3 months of active pills followed by 1 week of inactive pills Menstrual period occur during 13th week If 13th week period does not occur, woman should consider pregnancy

Transdermal Contraceptive System
Small continuous levels of progesterone and estrogen are released to suppress ovulation Applied to intact skin of upper outer arms, upper torso, lower abdomen & buttocks

Advantages Patch requires only weekly application
Patch stays on even when showering and swimming

Disadvantages No protection against sexually transmitted infections
Not recommended for obese women, or women with skin disorders Clients with preexisting medical diseases may not be candidates for this method Medication precautions are same as oral contraceptives

Client Education Do not apply to breasts
Apply same day once a week for 3 weeks Followed by week without patch Failure rate < 8% in women weighing less than 198 pounds Menses occurs on off week.

Vaginal Contraceptive Ring
Available only with a prescription Flexible ring made of ethylene vinyl Worn in the vagina to deliver continuous levels of progesterone & estrogen Worn for 3 weeks Followed by 1 week without ring Bleeding occurs during ring free week

Advantages Requires application only once every 4 weeks
Requires no special fitting Can safely be left in place during exercise or intercourse

Disadvantages Offers no protection against sexually transmitted infections Clients with marked vaginal prolapse should be cautioned to check for expulsion Med precautions are same as taking oral contraceptives

Vaginal ring insertion
Ring is inserted by woman Does not have to be fitted If woman or partner notices discomfort during coitus, ring can be removed and still be effective up to 3 hours Failure rate is < 8 %

Progestin-Only Contraceptives
Impair fertility by inhibiting ovulation, thickening and decreasing the amount of cervical mucus, thinning the endometrium, and altering cilia in the uterine tubes Oral Injectable Implantable

Advantages 95.5% effective May be used by: * lactating women
* women with mild hypertension

Oral Progestin (Minipill)
Failure rate 1-10% Must be taken correctly to increase effectiveness Must be taken at same time every day

Oral Progestin (minipill)
If client misses one pill * missed pill should be taken immediately * next pill taken at regular time * Additional method of contraception through end of that cycle Use additional method to be on the safe side

Injectable Progestin Depo-provera
Given IM or subcutaneously 4 times a year Should be initiated during first 5 days of menstrual cycle Administered every weeks 97.7% effective Usual dose is 150 mg every 3 months. Do not massage injection site = speeds up the absorption and decreases period of effectiveness

Depo-provera Blocks the luteinizing hormone surge Suppresses ovulation
Thickens cervical mucus to prevent penetration of sperm Disadvantage: Lose bone density – is reversible though. These clients need a calcium supplement and to exercise.

Important Education Subsequent dose must be given days after previous dose for continuous contraceptive protection Return of fertility may be delayed up to 1 year after stopping this method

Implantable Progestins
Norplant 6 Implants are inserted under the skin of the woman’s arm Effective up to 3 years Prevent ovulatory cycles, thicken cervical mucus I believe Norplant has been taken off the market in U.S. Implanon – uses single rod implant, regulated in U.S. Protection lasts for 3 years.

Side Effects of Implantable Progestins
Irregular menstrual bleeding HA Nervousness Nausea Skin changes Vertigo

Advantages Not user-dependent for effectiveness 99.95% effective
Does not contain estrogen Effective within 24 hours Lasts up to 5 years Progestins only

Disadvantages Minor surgery for insertion & removal
May be visible under skin Irregular or prolonged menses No protection against STI Slightly higher failure rates in women >154 pounds in fifth year of use

Emergency Contraception
Plan B Available without a prescription Is available in 1 or 2 dose regimens Should be taken by women as soon as possible within 120 hours of unprotected intercourse, or birth control mishap Risk of pregnancy is reduced by 75% - 89%

Emergency Contraception
If taken before ovulation emergency contraception prevents ovulation by inhibiting follicular development If taken after ovulation there is little effect on ovarian hormone production or endometrium If woman does not begin menstruation within 21 days, she should be evaluated for pregnancy Is ineffective if the woman is pregnant because the pills do not disturb an implanted pregnancy

Intrauterine Device A small T-shaped device with bendable arms for insertion through the cervix into the uterus Mirena – releases levonorgestrel gradually from a reservoir Impairs sperm motility, thickens cervical mucus, decreases lining of uterus Uterine cramping & bleeding is decreased Effective for 5 years Two on market : Mirena and Copper T Copper T – radiopaque polyethylene and fine solid copper. Good for 10 years. Copper serves as a spermicide because it causes endometrium inflammation which prevents fertilization

Mirena Provider inserts against uterine fundus
Arms open near fallopian tubes Adversely affect sperm motility & irritate lining of uterus Failure rate < 1%

Mirena 2 strings hang from base of stem through cervix & protrude into vagina Woman must have negative pregnancy test, cervical cultures to rule out STIs & consent form signed

Advantages to IUD (Mirena)
Long-term protection Highly effective Continuous protection Good option for women who cannot use hormone contraception, breastfeeding, >35, or smoke Immediate return to fertility when removed

Disadvantages to IUD Has to be inserted by healthcare provider
Risk of PID Unintentional expulsion of device Infection Possible uterine perforation No protection against HIV or STIs

Nursing Considerations
Teach woman to check for strings once a week for first month then once a month after menstruation If strings are shorter = dislodgement No strings = may have come out

Signs of Potential Complications with IUD
P – period late, abnormal A – abdominal pain; pain with intercourse I – Infection exposure, abnormal vag d/c N – not feeling well, fever, chills S - string missing, shorter, longer Page 186

Sterilization Refers to surgical procedures intended to render a person infertile Involves the occlusion of the passageways for the ova & sperm Woman – uterine tubes are occluded Men – vas deferens are occluded Only a hysterectomy or oopherectomy guarantees absolute sterility in women

Tubal Ligation Fallopian tubes are accessed through two small incisions into the abdomen and visualized using a laparoscope They are cut, tied, cauterized, or banded to block passage of sperm & prevent ovum from becoming fertilized 96-99% effective Bands/clips = possible removal and return to tubal patency.

Tubal ligation Takes 20-30 minutes
Performed under general or local anesthesia Pain for several days Avoid tub baths for 48 hours Avoid driving, lifting, & strenuous activity for 1 week

Tubal Ligation Health care provider must be certain woman is not pregnant ½ are performed immediately after pregnancy

Advantages Permanent and effective in preventing pregnancy
May be performed at any time Immediately after childbirth is optimal b/c uterus is enlarged and fallopian tubes are easily identifiable Sexual function and spontaneity are not affected

Disadvantages Requires outpatient surgery
Potential complications such as infection & bleeding If pregnancy does occur risk for ectopic pregnancy is increased Reversal of procedure is not always possible Sterilization offers no protection from STIs May feel pain at ovulation The ovum disintegrates within the abdominal cavity

Male Sterilization AKA vasectomy
Sealing, tying, or cutting vas deferens Sperm cannot travel from testes to penis Done on outpatient basis Permanent method of sterilization Reversal is generally unsuccessful

Advantages 99.85% effective Recovery time is short
Simpler, safer, and more effective than female sterilization Complications are rare Sexual function is not affected Cost effective Convenient

Disadvantages Very unlikely that it can be reversed
Potential complications include adverse infection, bleeding, sperm granuloma or spontaneous re-anastomosis of vas deferens Anastomosis- it is either reconnected by surgery or on its own.

Vasectomy Ice packs applied to scrotum intermittently for a few hours after surgery Scrotal support Moderate inactivity for 2 days Suture removed 5-7 days postop Sexual intercourse resumed as desired Scrotal support – rolled up towel Do not go hunting!!!

Considerations Sterility is not immediate
Some sperm remain in proximal portions of sperm ducts Takes 1 week to several months to clear ducts of sperm Alternate contraception should be utilized until 2 sperm counts come back as zero

Vasectomy

Sexual Function Explain to male that ability to achieve and maintain erection or volume of ejaculate is not altered Sperm production continues but are unable to leave epididymis Many men fear this – Sperm in the epididymis is taken care of by the immune system

Laws & Regulations Informed consent Always!!!
Voluntary sterilization of any mature, rational woman without reference to marital or pregnancy status Partner’s consent is not required Partners are encouraged to discuss situation with each other Health care provider may request consent Sterilization of minors is restricted I had to come with Ed for counseling and had to sign a consent form along with Ed. We had 2 consultation visits before the actual procedure, so 3 weeks total.

Laws & Regualtions if Using Federal Funds
Person must be 21 years old Irreversible method of birth control and a statement that mandates a 30-day waiting period between giving consent and the sterilization Please read Legal Tip: Sterilization on Page 188

Induced Abortion Purposeful interruption of pregnancy before 20 weeks of gestation Elective abortion - is done at woman’s request Therapeutic abortion – performed for reasons of maternal or fetal health or disease

Indications for woman’s decision to have an abortion
Preservation of life & health of mother Genetic disorders of fetus Rape or incest Pregnant woman’s request

Rowe VS Wade Abortion is now regulated Prior to 1970 was not legal
January 1973 Supreme court legalized abortion

Trimester approach First trimester abortion is permissible
Different states have different laws regarding second trimester abortions Third trimester abortions are limited & may be prohibited by state regulations unless it interferes with life or health or pregnant woman

Attempted Abortion Bans
In 2006 several states introduced bills to ban abortions US supreme court will decide the future of abortions Hospitals maintained by Roman Catholics forbid abortion & sterilization Be sure to know your state’s law related abortion before any counseling given

Incidence of Abortions
In 2006 there were 846,181 abortions Most are unmarried Caucasian women b/t years Text breaks percentages down in trimesters. If interested can read on your own We should never impose our beliefs and values on our clients. Our job is to deliver the options and make appropriate referrals.

Nurses Right Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN, 200) supports a nurse’s right to chose to participate or not in abortion procedures in keeping with his or her “personal, moral, ethical, or religious beliefs. Nurse have a professional obligation to inform their employers at time of employment of attitudes & beliefs that may interfere with job function Make sure you know what your facility’s policies are. If no policy in place, strongly encourage the adoption of one to protect you from Abandonment.

Sexual Development/ Human Sexuality/ Contraception

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