Download Abortion

NURS 330
November 7, 2011
Abortion
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Spontaneous abortion
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aka miscarriage
Loss of baby before 20 weeks of pregnancy
Induced abortion
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Surgical
Drug-based
Surgical Method
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Vacuum Aspiration
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First trimester method
Dilation and Extraction (D & X)
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Late surgical method
Drug-Based Methods
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Mifepristone (RU 486) –Injection, 0rally
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An anti-progesterone
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Approved by FDA in September 2000 for abortion
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prevents progesterone from making uterine lining hospitable for
implantation
If fetus is already implanted, causes the uterus to shed its lining
and, along with it, the fertilized fetus
As an alternative to surgical procedure
Effectiveness is increased if used with another drug,
Misoprostol (95-98%)
Most effective within 7 weeks of fertilization
Drug-Based Methods (cont)
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Methotrexate –Injection; orally (rarely)
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Prevents cell division and multiplication
Can be used to induce an abortion
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Effectiveness is increased if used with another drug, Misoprostol (95%)
Approved by FDA for treatment of cancer, arthritis and psoriasis
Most effective within 7 weeks of fertilization
Misoprostol – orally or vaginally
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Legal Drug used in conjunction with above drugs
The second drug used to complete the abortion procedure
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Taken a day or two after administration of the first drug
Causes the uterus to contract and expel its contents
Approved in the US for coating the stomach of people who take
stomach-irritating anti-inflammatory drugs.
Abortifacient
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A method or substance that causes a
fertilized egg that has implanted in the
uterine wall or fetus to be expelled.
Which of the drug-based methods is an
abortifacient?
Incidence of Abortions
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Nearly half of pregnancies among American women are
unintended, and four in 10 of these are terminated by
abortion.
Twenty-two percent of all pregnancies (excluding
miscarriages) end in abortion.
In 2005, 1.21 million abortions were performed, down from
1.31 million in 2000. From 1973 through 2005, more than
45 million legal abortions occurred.
Each year, about two percent of women aged 15-44 have
an abortion; 47% of them have had at least one previous
abortion.
Source: Perspectives on Sexual
and Reproductive Health
Cost
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Surgical
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In 2005, the cost of a non-hospital abortion
with local anesthesia at 10 weeks’ gestation
ranged from $90 to $1,800; the average
amount paid was $413
(Source: Perspectives on Sexual and Reproductive Health)
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Drug-based
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most providers do charge more for this method
Abortion and the Law
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Roe v. Wade
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1973 Supreme Court decision stating
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1st trimester abortions cannot be regulated by
states and the decision to abort is between woman
and physician
2nd trimester abortions permitted when mental or
physical health of mother at risk
3rd trimester abortions allowed when life of mother
at risk
California Law
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California does not have any of the major
types of abortion restrictions – such as
waiting period, mandated parental
involvement or limitations on publicly funded
abortions – often found in other states.
Source: Alan Guttmacher Institute
The Pro-Life and Pro-Choice
Controversy
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Anti-abortion (Pro-life) position
Pro-choice position
What is Sexuality?
What factors influence
Sexuality?
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Values
Attitudes
Behaviors
Physical Appearance
Beliefs
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Emotions
Personality
Likes/Dislikes
Spirituality
Other
Source:http://www.engenderhealth.org/res/onc/sexuality/introduction/index.html
The Senses and Sexuality
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Touch
Smell
Sound
Sight
Smell
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Smell
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Odors play a role in sexual arousal
Pheremones
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Perfumes
Colognes
Debate about its existence
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i.e. menstrual synchrony
Not all odors are conducive to sexual arousal
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Offensive odors
Sound
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Sound
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Auditory stimuli
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Your partner’s voice
Romantic or sexy music
Love-making sounds
Not all sounds are conducive to sexual
arousal
Sight
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Sight
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Allows us to experience many images that can
trigger feelings of sexual arousal
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Viewing an “attractive” person
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Subject to social and cultural influences
Erotic images
Sometimes even parts of one’s genitals
Which sense is this?
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Does not appear to play a significant role
in sexuality.
Female Ejaculation
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Does it exist?
Terms to know
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Erogenous zones
Kegel Exercises
Aphrodisiacs
Pheremones
Definition
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Erogenous Zones
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parts of the body that, when stimulated,
elicit sexual arousal
Kegel Exercise
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Recommended to reduce urinary
incontinence and possibly increase sexual
pleasure
Identify the muscle by stopping urination
in midstream
Definition
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Aphrodisiacs
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Agents that show any ability to enhance sexual
functioning
Pheromones
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Substances that when secreted have a
particular smell found to be sexually arousing.
Sex Hormone
Testosterone
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“Male” hormone
Found in small amounts in women
Affects sexual response in men and women
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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
FACT
A person’s emotional and mental states
also help determine whether that
person experiences arousal
Models of Human Sexual
Response
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Master’s and Johnson
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Proposed their four-stage model of human
sexual response cycle
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Stage
Stage
Stage
Stage
I - Excitement
II - Plateau
III - Orgasm
IV - Resolution
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 – Respiratory Rate; BP – Blood Pressure; HR – Heart Rate
PLATEAU – 2ND STAGE
FEMALE
MALE
Orgasmic Platform
Tenting Effect
Seminal Pool
Erection is maintained
(if there is enough
stimulation)
Cowper’s Gland
secretes fluid
ORGASM – 3RD STAGE
FEMALE
MALE
Muscle spasms
Involuntary
Collection of semen in the
urethral bulb
Ejaculatory Invariability
-bulbocavernosus muscle
Expulsion of semen
RESOLUTION – 4TH STAGE
FEMALE
MALE
Return to non-aroused
state
Refractory Period
Comparing male and female
sexual response
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Key difference
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Male has a refractory period
There’s a potential for multiple orgasms in
women
Controversies in understanding the female
orgasm
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Freud
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vaginal orgasm is true orgasm
Master’s and Johnson
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only one kind no matter how achieved
Sexual Dysfunctions
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Recurrent or persistent sexual problems that
interfere with normal performance and cause
distress
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Nine types of sexual disorders
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Four categories
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Sexual Desire Disorders
Sexual Arousal Disorders
Orgasmic Disorders
Sexual Pain Disorders
Prevalence
Sexual Desire Disorders
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Hypoactive sexual desire disorder
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Persistent deficit in sexual fantasies and desire for
sex
Sexual aversion disorder
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Extreme aversion to any form of sexual contact
with a partner
Sexual Arousal Disorders
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Female sexual arousal disorder
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Difficulties becoming sexually aroused
Deficient vaginal lubrication
Male erectile disorder
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Recurrent problems in achieving or sustaining penile
erection in a sexual situation
Aka Impotence
Orgasmic Disorders
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Female orgasmic disorder (anorgasmia)
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Male orgasmic disorder
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Recurrent problem with reaching orgasm despite
adequate erotic stimulation
Delay or inability to reach orgasm during sexual activity
Premature ejaculation
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Persistent or recurrent ejaculation following minimal
stimulation and before the person wishes it
Sexual Pain Disorders
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Dyspareunia
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Recurrent genital pain during sexual intercourse
Vaginismus
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Persistent involuntary spasms of vaginal muscles, which
interfere with sexual intercourse
Sexual Dysfunctions -
Differences in Men and Women
Female
Male
Sexual Aversion Disorder
Sexual Aversion Disorder
Dyspareunia
Dyspareunia (rare in men)
Vaginismus
Premature Ejaculation
Female Orgasmic Disorder
Male Orgasmic Disorder
Hypoactive Sexual Desire
Disorder
Hypoactive Sexual Desire
Disorder
Female Sexual Arousal
Disorder
Male Erectile Disorder
General Causes
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Physiological/Biological
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Psychological/Emotional
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Anxiety
Negative beliefs
Sexual trauma
Interpersonal/Social
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Medication and illicit drugs
Relationship problems
Environmental
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Cultural factors
Treatment of Sexual Dysfunctions
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Medical treatment of sexual
dysfunctions
Sex therapy
Medical Treatment
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Viagra
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FDA approval in March 1998
Prescription only
Lasts about four hours
Side effects
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Short duration
Sex Therapy
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Principles of sex therapy
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Mutual responsibility is emphasized
Information and education are integral
components
Attitudes, expectations, and sexual scripts
usually must be modified
Sexual Orientation
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Sexual orientation
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Erotic and romantic attraction to one or
both sexes
Asexual
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No erotic or romantic interest
Sexual Orientation
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Homosexual
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Heterosexual
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Same sex
Opposite sex
Bisexual
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Both sexes
Defining Terms
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Sex
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Gender
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Gender Roles
What Is Sexual Harassment?
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Sexual harassment
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Sexual advances that are unwelcome
and/or other sexually related behaviors
that are hostile, offensive, or degrading
Two types of
Sexual Harassment
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Quid pro quo harassment
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Employee is expected to exchange sexual
favors in return for keeping job or getting
promotion
Hostile environment harassment
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Unwanted behavior of a sexual nature
creates a hostile or offensive work
atmosphere
Sexual Harassment can occur
at……..
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Schools
College campuses
Workplace
Family member’s home
Public places
Examples of Harassment
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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
What to do if you feel you are
being sexually harassed
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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
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At school/on campus:
- 1 & 2 above
- Notify appropriate individuals on campus
- Contact the public safety office on campus
- http://www.calstatela.edu/univ/police/
- (323) 343-3700
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Other resources
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)
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The most common rape drugs:
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Rohypnol
GHB
Other common rape drugs
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Ecstasy
Ketamine
Odorless, colorless
Easily dissolved into drinks
Effects of Rape Drugs
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Drowsiness
Disorientation
Disinhibition
Amnesia
Infertility
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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
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Both men and women contribute to infertility
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90% of cases, cause will be known
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Remaining 10% of cases, cause remains unknown
Males
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Each gender contributes 40%
Both contribute 10%
Usually due to sperm defect
Females
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More complex
Risk Factors
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Some common risk factors
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Age
Weight
Lifestyle
Occupational and Environmental risks
Stress and Emotional factors
Genetic conditions??
Age and Infertility
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Females
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As a woman gets older, her chances of fertility declines
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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
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High risk of miscarriage
Males
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Not very clear on its impact of age and fertility in men
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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
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Common causes
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Blocked Fallopian Tubes
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Pelvic Inflammatory Disease
Endometriosis
Ovulation disorders
Others
Pelvic Inflammatory Disease (PID)
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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).
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Infection of one or both fallopian tubes is known as
Salpingitis
Symptoms
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Mostly asymptomatic
Fever, chills, pelvic pain (indicating inflammation of the
entire pelvic area).
PID (cont)
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Causes of PID
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Untreated/uncured bacterial infection
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Most common chlamydia (about 75% of cases)
Second most common cause is gonorrhea.
Other Causes
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Non-sterile abortions
Cervicitis (usually from genital herpes infection)
Other vaginal infections (bacterial vaginosis, trich)
Ruptured appendix
Childbirth
Endometriosis
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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
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Symptoms
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Eventually causes scarring and inflammation
Often causes no symptoms
Painful periods, painful sex, painful bowel movements
Cause is unknown
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Possible defects in immune system
Endometriosis and infertility
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Endometrial cysts in the fallopian tubes
may cause blockage
Scar tissue between uterus, ovaries and
fallopian tubes
Poor egg implantation
Female InfertilityOther possible causes
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Ovulation Disorders
Hormone Disorders
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Hypothalamic-Pituitary Disorders
Polycystic Ovarian Disease/Syndrome
Thyroid
Other
Ovarian Cysts
Benign Uterine Fibroids
Ectopic pregnancies, medical conditions, medications
Male Infertility
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Over 90% of cases are due to:
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Low sperm count
Poor sperm quality
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Motility
Morphology
Both
30 - 40% of cases have an unknown cause
What affects sperm count and
quality?
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Environmental and Biologic Factors
Lifestyle
-Emotional
-Smoking
-Sexual Issues/Infection
-Malnutrition
-Substance Abuse
-Obesity
-Testicular Exposure to overheating
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Genetic Factors
Varicocele
Varicocele
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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
Varicocele
Other causes of sperm defect
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Testosterone Deficiencies
Autoantibodies
Retrograde Ejaculation
Physical and Structural abnormalities
Cancer and its treatments
Infections
Other medical conditions
Medications
Testing for Infertility - males
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Sperm evaluation
Hormone tests
Ultrasound
Testing for Infertility – females
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Ovulation Assessment
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Body temperature
Cervical mucus assessment
Hormone Analysis
Laparascopy
Check vagina for naturally occurring
sperm antibodies
Infertility Treatment
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Artificial Insemination
Drug therapy
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Clomid
In Vitro Fertilization (IVF)
Infertility Treatment
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Gamete Intrafallopian Transfer (GIFT)
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Zygote Intrafallopian Transfer (ZIFT)
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Both egg and sperm inserted into Fallopian
tube
Fertilized outside body and inserted into
Fallopian tube
Intracytoplasmic Sperm Injection (ICSI)
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Direct injection of sperm into egg in lab
In-Class Assignment