2. May 4, 2015 NURS 330 Human Reproductive Health

3. Agenda for 5/4/15 §Grades §Review mid-term §Review In-Class Assignments (4/13/15 & 4/27/15) §Lecture l Sexually Transmitted Diseases (STDs) l Sexuality §Group Time §Distribute Quiz Study Guide §5/4/15 In-Class Assignment

4. Grades DateAssignmentPossible Points 4/6/15In-Class #110 4/13/15In-Class #210 4/20/15Mid-term100 4/27/15In Class #310 Total Possible Points (through 4/27/15)130 5/4/15Quiz25 5/11/15In Class #410 5/18/15Group Project25 6/1/15In-Class #510 6/8/15Final Exam200

5. What Are STDs? §Sexually – relating to having sex, personal intimate contact (e.g., rubbing of genitals, masturbating a partner), etc. §Transmitted – passed by means of, spread by §Disease – being sick (with or without symptoms), body not working properly So, an STD = a disease/infection you can get from or give to someone else by having oral, vaginal, or anal sex or other intimate contact with him/her. Source: County of Los Angeles STD Program

6. Health Consequences of STDs §Various Cancers §Infertility §Ectopic pregnancy §Miscarriage §Persistent pain §Death §Other chronic conditions or illnesses Source: County of Los Angeles STD Program

7. STDs in the United States The CDC estimates that there are approximately 19 million new cases each year in the US 1 There are an estimated 65 million people in the US living with a viral STD 2 More than half of all people will have an STD/STI at some point in their lifetime. 2 One in two sexually active persons will contact an STD/STI by age 25. 2 The cost of STDs to the U.S. health care system is estimated to be as much as $15.9 billion annually 1 1 Source: Centers for Disease Control and Prevention, cdc.gov 2 Source: American Social Health Association, www.ashastd.org

8. BACTERIAL STDs ChlamydiaGonorrheaSyphilis Transmission Pre-cum, semen, vaginal secretions Perinatal Pre-cum, semen, vaginal secretions Perinatal Skin-to-skin; genital to genital rubbing Symptoms NOTHING or Discharge from penis, vagina NOTHING or Discharge from penis, vagina 1-chancre 2-skin, genital rash 3- organ damage Complications PID in females Epidimytis in males PID in females Epidimytis in males Blindness, paralysis, heart problems, etc Diagnosis Urine sample Urethral, cervical swab Urine sample Urethral, cervical swab Blood sample Treatment Curable with antibiotics

9. Source: County of Los Angeles STD Program

10. CHLAMYDIA Risk factors: Unprotected oral, vaginal or anal sex

11. GONORRHEA Risk factors: Unprotected oral, vaginal or anal sex

12. SYPHILIS Oral, vaginal or anal sex (protected or unprotected)

13. VIRAL STDS HPVHERPESHEP B Transmission Skin-to-skin; genital to genital rubbing Skin-to-skin; genital to genital rubbing; social kissing Blood, pre-cum, semen, vaginal secretions Symptoms NOTHING –or- High Risk: Cervical changes Low Risk: Warts in, on around genitals NOTHING –or- Blisters in, on around genitals (HSVII) or mouth (HSV I) NOTHING –or- Fatigue, flu-like symptoms, jaundice Complications Cervical Cancer Psychosocial Complications of the liver Diagnosis HPV test Pap smear screening Blood test, blister sample Blood sample Treatment Not curable Vaccine available Not curable Vaccine available

14. Human Papilloma Virus (HPV) Vaginal or anal sex (protected or unprotected)

15. Pap Smears §Screens for pre-cancerous cells in cervix §When to start l 3 years after sexual debut or at age 21, whichever comes first l Remember, you do NOT have to be sexually active to get a pap smear §Does not necessarily test for STDs l You have to ask for specific STD tests l It is important to be your own health advocate §How often should I get pap smears? l It varies, depending on your pap results l Your doctor or nurse will let you know

16. HPV Vaccine §Vaccine l Gardasil® by Merck approved in 2006 Provides protection against four HPV types which together cause 70% of cervical cancers and 90% of genital warts Three shots over six-month period Licensed for use in girls/women 9-26 years old In October 2009, FDA approved for use in boys/men 9-26 years old l Another HPV vaccine by GSK currently in final stages of development Would provide protection against two HPV types that cause most (70%) cervical cancers Source: County of Los Angeles STD Program

17. HERPES Risk Factors: Oral, vaginal or anal sex (protected or unprotected)

18. HEPATITIS B Risk factors: Unprotected sex, sharing needles, tattoos, sharing household items such as razors, toothbrushes

19. OTHER YeastBacterial Vaginosis (BV ) Trichomoniasis CauseNot an STD. Caused by an overgrowth of yeast. Sexual transmission possible.Overgrowth of bacteria. STD SymptomsWomen - Thick, cloudy discharge from vagina, itching Men – rash on penis White or yellow discharge, fishy odor Bubbly, frothy discharge. Irritation upon urination ComplicationsNo major complications Excessive scratching can cause irritation in genital area Increases chance of HIV infection; If pregnant, a woman runs the risk of pregnancy complications Increased risk of getting HIV Can cause Complications during pregnancy DiagnosisVaginal cultureWhiff testVaginal culture TreatmentAnti-fungal creamPrescription Drugs

20. STD Prevention Review §Abstinence §Use latex or polyurethane condoms (male or female) and barriers as much as possible §Water-based lubricants l Reduces friction §Get tested regularly §Reduce number of sex partners §Reduce frequency of risky situations §Spectrum of sexual risk, depending on the STD l e.g., oral sex may be considered low risk for HIV but not for syphilis §Talk to partners §Vaccines - Hepatitis B, HPV §Get to know your bodies!

21. 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

22. What factors influence Sexuality? §Values §Attitudes §Behaviors §Physical Appearance §Beliefs §Emotions §Personality §Likes/Dislikes §Spirituality §Other Source:http://www.engenderhealth.org/res/onc/sexuality/introduction/index.html

23. Sex Hormone Testosterone l “Male” hormone l Found in small amounts in women l Affects sexual response in men and women Men – produced by the seminiferous tubules Women - produced by the ovaries l Increase energy, sex drive (libido), aggression, appetite, muscle mass Increases libido in both men and women

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

25. Sexual Response Cycle

26. Models of Human Sexual Response §Master’s and Johnson l Proposed their four-stage model of human sexual response cycle Stage I - Excitement Stage II - Plateau Stage III - Orgasm Stage IV - Resolution

27. EXCITEMENT- 1 ST STAGE: FEMALEMALE Transudation Vasocongestion Tenting Effect  HR, BP, RR Myotonia Penile Erection Vasocongestion Testis enlarge  HR, BP, RR Myotonia Response to stimuli RR – Respiratory Rate; BP – Blood Pressure; HR – Heart Rate

28. PLATEAU – 2 ND STAGE FEMALEMALE Orgasmic Platform  Tenting Effect Seminal Pool Erection is maintained ( if there is enough stimulation ) Cowper’s Gland secretes fluid

29. ORGASM – 3 RD STAGE FEMALEMALE Muscle spasms Involuntary Collection of semen in the urethral bulb Ejaculatory Invariability -bulbocavernosus muscle Expulsion of semen

30. RESOLUTION – 4 TH STAGE FEMALEMALE Return to non-aroused state Refractory Period

31. Comparing male and female sexual response §Key difference l Male has a refractory period l There’s a potential for multiple orgasms in women §Controversies in understanding the female orgasm l Freud vaginal orgasm is true orgasm l Master’s and Johnson only one kind no matter how achieved

32. Sexual Dysfunctions

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

34. Prevalence

35. Sexual Dysfunctions - Differences in Men and Women FemaleMale Sexual Aversion Disorder Dyspareunia Dyspareunia (rare in men) VaginismusPremature Ejaculation Female Orgasmic DisorderMale Orgasmic Disorder Hypoactive Sexual Desire Disorder Female Sexual Arousal Disorder Male Erectile Disorder

36. General Causes §Physiological/Biological l Medication and illicit drugs §Psychological/Emotional l Anxiety l Negative beliefs l Sexual trauma §Interpersonal/Social l Relationship problems §Environmental l Cultural factors

37. Treatment of Sexual Dysfunctions Medical treatment of sexual dysfunctions Sex therapy

38. Medical Treatment §Viagra l FDA approval in March 1998 l Prescription only l Lasts about four hours l Side effects Short duration

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

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

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

42. Effects of Rape Drugs §Drowsiness §Disorientation §Disinhibition §Amnesia

43. Is alcohol a rape drug?