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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