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NURS 330 November 7, 2011 Abortion Spontaneous abortion aka miscarriage Loss of baby before 20 weeks of pregnancy Induced abortion Surgical Drug-based Surgical Method Vacuum Aspiration First trimester method Dilation and Extraction (D & X) Late surgical method Drug-Based Methods Mifepristone (RU 486) –Injection, 0rally An anti-progesterone Approved by FDA in September 2000 for abortion 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) Methotrexate –Injection; orally (rarely) Prevents cell division and multiplication Can be used to induce an abortion 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 Legal Drug used in conjunction with above drugs The second drug used to complete the abortion procedure 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 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 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 Surgical 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) Drug-based most providers do charge more for this method Abortion and the Law Roe v. Wade 1973 Supreme Court decision stating 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 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 Anti-abortion (Pro-life) position Pro-choice position What is Sexuality? 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 The Senses and Sexuality Touch Smell Sound Sight 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 Sound Sound Auditory stimuli Your partner’s voice Romantic or sexy music Love-making sounds Not all sounds are conducive to sexual arousal 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 Which sense is this? Does not appear to play a significant role in sexuality. Female Ejaculation Does it exist? Terms to know Erogenous zones Kegel Exercises Aphrodisiacs Pheremones Definition Erogenous Zones parts of the body that, when stimulated, elicit sexual arousal Kegel Exercise Recommended to reduce urinary incontinence and possibly increase sexual pleasure Identify the muscle by stopping urination in midstream Definition Aphrodisiacs Agents that show any ability to enhance sexual functioning Pheromones Substances that when secreted have a particular smell found to be sexually arousing. 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 FACT A person’s emotional and mental states also help determine whether that person experiences arousal Models of Human Sexual Response Master’s and Johnson Proposed their four-stage model of human sexual response cycle 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 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 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 Prevalence 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 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 Orgasmic Disorders Female orgasmic disorder (anorgasmia) Male orgasmic disorder Recurrent problem with reaching orgasm despite adequate erotic stimulation Delay or inability to reach orgasm during sexual activity Premature ejaculation Persistent or recurrent ejaculation following minimal stimulation and before the person wishes it Sexual Pain Disorders Dyspareunia Recurrent genital pain during sexual intercourse Vaginismus 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 Physiological/Biological Psychological/Emotional Anxiety Negative beliefs Sexual trauma Interpersonal/Social Medication and illicit drugs Relationship problems Environmental Cultural factors Treatment of Sexual Dysfunctions • • Medical treatment of sexual dysfunctions Sex therapy Medical Treatment Viagra FDA approval in March 1998 Prescription only Lasts about four hours Side effects Short duration 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 Sexual Orientation Sexual orientation Erotic and romantic attraction to one or both sexes Asexual No erotic or romantic interest Sexual Orientation Homosexual Heterosexual Same sex Opposite sex Bisexual Both sexes Defining Terms Sex Gender Gender Roles What Is Sexual Harassment? Sexual harassment Sexual advances that are unwelcome and/or other sexually related behaviors that are hostile, offensive, or degrading 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 Sexual Harassment can occur at…….. Schools College campuses Workplace Family member’s home Public places 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 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 - http://www.calstatela.edu/univ/police/ - (323) 343-3700 Other resources Rape Drugs What is a Rape Drug? A rape drug is one that is used in a drug facilitated sexual assault. Rape Drugs (cont) The most common rape drugs: Rohypnol GHB Other common rape drugs Ecstasy Ketamine Odorless, colorless Easily dissolved into drinks Effects of Rape Drugs Drowsiness Disorientation Disinhibition Amnesia 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 Causes of infertility Both men and women contribute to infertility 90% of cases, cause will be known Remaining 10% of cases, cause remains unknown Males Each gender contributes 40% Both contribute 10% Usually due to sperm defect Females More complex Risk Factors Some common risk factors Age Weight Lifestyle Occupational and Environmental risks Stress and Emotional factors Genetic conditions?? 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 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 Common causes Blocked Fallopian Tubes Pelvic Inflammatory Disease Endometriosis Ovulation disorders Others 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). 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 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 Symptoms Eventually causes scarring and inflammation Often causes no symptoms Painful periods, painful sex, painful bowel movements Cause is unknown Possible defects in immune system Endometriosis and infertility Endometrial cysts in the fallopian tubes may cause blockage Scar tissue between uterus, ovaries and fallopian tubes Poor egg implantation Female InfertilityOther 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 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 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 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 Varicocele Other causes of sperm defect Testosterone Deficiencies Autoantibodies Retrograde Ejaculation Physical and Structural abnormalities Cancer and its treatments Infections Other medical conditions Medications Testing for Infertility - males Sperm evaluation Hormone tests Ultrasound Testing for Infertility – females Ovulation Assessment Body temperature Cervical mucus assessment Hormone Analysis Laparascopy Check vagina for naturally occurring sperm antibodies Infertility Treatment Artificial Insemination Drug therapy Clomid In Vitro Fertilization (IVF) Infertility Treatment Gamete Intrafallopian Transfer (GIFT) Zygote Intrafallopian Transfer (ZIFT) Both egg and sperm inserted into Fallopian tube Fertilized outside body and inserted into Fallopian tube Intracytoplasmic Sperm Injection (ICSI) Direct injection of sperm into egg in lab In-Class Assignment