Download through 2/17/14

February 24, 2014
Human Reproductive Health
NURS 330
Agenda

Return & Review




Mid-term & Extra Credit
2/17/14 In-class Assignment
Mid-Quarter Grades
Quiz #2
Grades
Date
Assignment
Possible Points
1/13/14
In-Class #1
10
1/27/14
Quiz #1
25
2/3/14
In-Class #2
10
2/10/14
Mid-term
100
2/17/14
In-Class #3
10
Total Possible Points (through
2/17/14)
155
2/24/14
Quiz #2
25
3/3/14
In-Class #4
10
3/10/14
In-Class #5
10
3/17/14
Final Exam
200
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
What factors influence
Sexuality?
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
Sexual Response Cycle
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
Sexual Dysfunctions

The persistent impairment of the normal patterns
of sexual interest or response. (WHO)

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
Rape Drugs
What is a Rape Drug?
A rape drug is one that is used in a drugfacilitated sexual assault.

Rape Drugs (cont)

The most common rape drugs:





Rohypnol
GHB
Ketamine
Odorless, colorless
Easily dissolved into drinks
Effects of Rape Drugs




Drowsiness
Disorientation
Disinhibition
Amnesia
INFERTILITY
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





Aging
Disorders of Ovulation
Damage of the Fallopian Tubes
Uterine Fibroids
Endometriosis
Aging

Fertility begins to decline when a
woman is in her mid-30s





About 10 years before menopause
Decrease in ovarian function
Reduction in ovaries
Increased chromosomal abnormalities
Increase in miscarriages
Ovulation Disorders



Responsible for approx. 25% of female
infertility problems
Anovulation
Oligoovulation
Damage to Fallopian Tubes

Pelvic Inflammatory Disease (PID)

Most common cause
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.
Uterine Fibroids





Occurs in one in every four or five
American women
Benign tumors
Can cause excessive uterine bleeding
and pain
Interferes with ovum implantation
Compresses the opening of the fallopian
tubes
Endometriosis

Uterine lining grows outside the uterine cavity


These implants respond to hormonal changes, slowly increasing in
number and size with each menstrual cycle


Eventually causes scarring and inflammation
Symptoms





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.
Some have no symptoms
Pain before , during and after the menstrual period
Pain during sexual intercourse
Spotting (bleeding between periods)
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

Hormone Disorders






Hypothalamic-Pituitary Disorders
Polycystic Ovarian Disease/Syndrome
Thyroid
Other
Ovarian Cysts
Ectopic pregnancies, medical conditions, medications
Male Infertility


Affect sperm quality and quantity
Includes problems with:






Sperm production
Blockage of sperm-delivery system
Presence of antibodies against sperm
Testicular injury
Anatomic abnormalities
Varicocele
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
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 – 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
March 3, 2014



Last Day to submit make-up quiz or
in-class assignment
Need a doctor’s note
Will not be accepted after this date
Quiz #2



25 Points
Short Answer
Closed-book