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Chapter 7

Chapter 7. Sexuality . Objectives. Identify structures of the female & male sexual anatomy Identify methods and their effectiveness in the prevention of sexually transmitted infections and pregnancy Name and describe the stages of the menstrual cycle

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Chapter 7

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  1. Chapter 7 Sexuality

  2. Objectives • Identify structures of the female & male sexual anatomy • Identify methods and their effectiveness in the prevention of sexually transmitted infections and pregnancy • Name and describe the stages of the menstrual cycle • Explain the female and male reproductive process • Identify options in the case of an unplanned pregnancy

  3. Female Anatomy

  4. Male Anatomy

  5. Reproduction • Menstrual cycle • Ovarian cycle • Endometrial cycle • Pregnancy

  6. Menstrual Cycle • Typically 28 days (range of 20 – 40 days) • Day one of the cycle is the first day of menstruation • Follicular phase • Begins with menstruation • Ends when ovulation occurs • Luteal Phase • Begins with ovulation • Ends when the next menstrual cycle begins

  7. Ovarian Cycle • Immature eggs move toward the surface of the ovary • An egg is released from the ovary and swept into fallopian tubes • Fertilized egg attaches to the uterine wall • Non-fertilized egg will disintegrate

  8. Endometrial Cycle Three phases: 1. Menstrual phase: • 4 to 7 days • The lining of the uterus is sloughed off and flows out of the uterus through the vagina 2. Proliferative phase • Begins with the completion of menstruation • Ends when ovulation occurs 3. Secretory phase • When ovulation occurs, the endometrial lining of the uterus becomes twice as thick

  9. Pregnancy Fertilization:Occurs in the fallopian tubes • Cell  begins immediately • Fertilized egg implanted within the first week 1st Trimester: • First signs pregnancy: missed period, nausea, fatigue • All major organs develop - Prenatal Care is Crucial! 2nd & 3rd Trimesters: • Continued Growth & Development

  10. Prenatal Development 1st week: Implantation 6th week: Heart Beat Detectable / Sex determined 8th week: Limbs, Eyes, & Ears are formed 12th week: Vital Organs formed and functioning 16th week: Mother can feel baby kicking 33 weeks: Considered Viable if premature 37th week: “Full Term” 40th week: Typical Delivery

  11. Sexually Transmitted Infections and Pregnancy • STIs can be passed from a pregnant woman to the baby before, during, or after the baby’s birth. • HIV can cross the placenta during pregnancy, during delivery, and can infect the baby through breast milk. • Syphilis can cross the placenta and infect the baby while it is in the uterus. • Chlamydia, gonorrhea, genital herpes, and hepatitis B can be transmitted from the mother to the baby during delivery.

  12. Sexually Transmitted Infections and Pregnancy • STI transmission can result in: • still-birth and low birth weight • conjunctivitis • pneumonia • infection of the baby’s blood stream • neurological damage • Blindness and deafness • acute hepatitis • meningitis • chronic liver disease and cirrhosis

  13. Sexually Transmitted Infections and Pregnancy cont… • It can be prevented if the mother receives routine prenatal care. • The CDC recommends women be screened on their first prenatal visit for STIs.

  14. Abstinence Withdrawal Method FAM Male Condom Female Condom The Pill NuvaRing Ortho Evra Depo-Provera Diaphragm Cervical Cap Spermicide IUD Sterilization Pregnancy Prevention

  15. Abstinence from Penile/Vaginal Intercourse Effectiveness: • Pregnancy and STI prevention = 100% Advantages: • No worries or risks Problems: • Forgetting protection / not being prepared if one stops abstaining.

  16. Withdrawal Method • Effectiveness: • Pregnancy prevention – 73-96% • STI prevention – NONE • Advantages: • Can be used when no other method is available • Disadvantages: • Requires great self-control, experience, and trust

  17. Fertility Awareness-Based Methods How does it work? • Basic Idea: identify “safe” and “unsafe” days • Requires: • Woman must chart her menstrual cycle (regular/irregular cycle and to detect physical signs to predict “unsafe”days) • Abstain or use barrier contraceptives during nine or more “unsafe” days each menstrual cycle • Check temperature daily • Check cervical mucus daily • Sperm can live up to 96 hours

  18. FAM cont… Effectiveness: • Pregnancy prevention – 75-99% • STI prevention – NONE Advantages: • No medical or hormonal side effects • Calendar, thermometers, charts easy to obtain

  19. FAM cont… Problems: • Requires expert training before effective use • Taking risks during “unsafe” days • Poor record keeping • Illness & lack of sleep affect body temperature • Vaginal infections and douches change mucus • Cannot use with irregular periods or temperature patterns

  20. Male Condom Effectiveness: • 85-97% for STI and pregnancy prevention • why only 85-97% effective???? Advantages: • Most effective to prevent STIs besides abstinence • Easy to buy (inexpensive) • Easy to carry • Only way for male to protect himself from unplanned pregnancy • Can help relieve premature ejaculation

  21. Male Condom cont… • Problems: • Possible allergies to latex • Less sensation • Condom breakage • Sometimes interrupts “the mood” • Human error

  22. The Pill (Oral Contraceptive) How does it work? • The sperm is unable to penetrate the egg, and/or the fertilized egg is prevented from implanting in the uterus • The hormones estrogen and progestin: • Prevent the release of an egg • Thicken the cervical mucus • Reduce the buildup of the endometrial lining w/in the uterus

  23. The Pill (Oral Contraceptive) cont… Effectiveness: • Pregnancy prevention – 92-99.7% • STI prevention - NONE Advantages: • Regular and shorter periods • Decreased chance of developing ovarian and endometrial cancers, non-cancerous breast tumors, ovarian cysts, pelvic inflammatory disease, and osteoporosis • Decreased incidence of tubal pregnancies • Ability to become pregnant occurs quickly when use is stopped

  24. The Pill (Oral Contraceptive) cont… • Disadvantages: • Must be taken daily (within the same 2 hr period) • Risk of blood clots, heart attack, and stroke. This risk increases as women age, smoke, and use hormonal contraceptive methods. • Side effects can include temporary irregular bleeding, weight gain, breast tenderness, and nausea.

  25. NuvaRing How does it work? • A thin, flexible ring that’s inserted into the vagina, usually around the cervix • The ring is left in the vagina for 3 weeks, followed by a week off which triggers menstruation • Works the same way as oral contraceptive pills Effectiveness: • Pregnancy prevention – 92-99.7% • STI prevention - NONE

  26. NuvaRing cont… Advantages: • No pill to take daily • Does not require a “fitting” by a clinician • Does not require the use of spermicide • Nothing to put in place before intercourse • Same advantages as the oral contraceptive pills Disadvantages: • Increased vaginal discharge • Vaginal irritation or infection • Cannot use a diaphragm or cap for a backup method of birth control • Same disadvantages as the oral contraceptive pills

  27. Ortho Evra “The Patch” How Does it Work? • A thin plastic patch can be placed on the following areas: buttocks, abdomen, upper outer arm, or upper torso (front & back, excluding the breasts) • It’s replaced on the same day of the week for 3 consecutive weeks & the 4th week is patch free • Works the same way as the oral contraceptive pill Effectiveness • Pregnancy prevention – 99.7% • STI prevention - NONE

  28. Ortho Evra “The Patch” cont… Advantages: • No pill to take daily • Nothing to put in place before intercourse • Same advantages as the oral contraceptive pill Disadvantages: • Skin reaction at the site of application • Menstrual cramps • May not be effective for women who weigh more than 198 pounds • Same disadvantages as the oral contraceptive pill

  29. Depo-Provera What is it? • Hormone injection given every 3 months • Works the same way as the Oral Contraceptive Pill Effectiveness: • Pregnancy prevention – 97-99.7% • STI prevention – NONE Advantages: • No daily pill • Nothing to put in place before intercourse

  30. Depo-Provera • Can be used by some women who cannot take the pill • Decreases incidence of cancer in the lining of the uterus as well as iron deficiency anemia • Can be used while breast feeding Disadvantages: • Side effects include irregular bleeding, headaches, depression, nausea, loss of monthly period, weight gain, nervousness, and dizziness • Side effects cannot be reversed until medication wears off

  31. Depo-Provera cont… • May cause a delay in getting pregnant after shots are stopped (up to 12-18 months) • Should not be used continuously for more than 2 years

  32. Diaphragm & Cervical Cap How does it work? • Prevents the sperm from reaching the egg • Used in conjunction with spermicide Effectiveness: • Pregnancy prevention with spermicide • Diaphragm (84-94%) • Cervical Cap (71-86%) • STI prevention - NONE

  33. Diaphragm & Cervical Cap cont… Advantages: • No major health concerns • Can last several years Disadvantages: • Can be messy • Possible allergies to latex, silicone, or spermicide • Cannot use with vaginal bleeding or an infection • Diaphragm – can only be left in place for up to 24 hrs. • Diaphragm – increased risk of bladder infection

  34. Diaphragm & Cervical Cap cont… • Fem Cap – difficult for some women to use • Fem Cap – can only be left in place for up to 48 hrs.

  35. Spermicides, Foam, Jelly, or Cream How Does it Work? • Inserted deep into the vagina prior to intercourse Effectiveness: • Pregnancy prevention: 71-85% • STI prevention - NONE

  36. Female Condom How Does it Work? • Inserted into the vaginal pouch deep into the vagina prior to intercourse Effectiveness: • 79-95% for STI and pregnancy prevention In Preventing STIs: • Female condom is similar to the male condom, but not quite as effective, due to possible folding

  37. Female Condom cont… Advantages: • Easy to buy • Increased sensation compared to the male condom • Erection not necessary to keep female condom in place Disadvantages: • Outer ring of female condom may slip into vagina during intercourse • Possible difficulty inserting the pouch • Possible allergies to spermicide

  38. Intrauterine Device What is it? • A small plastic device implanted in the uterus • It contains copper or hormones that prevent conception and in rare cases prevents the implantation of a fertilized egg Effectiveness: • Pregnancy prevention – 99.4-99.9% • STI prevention - NONE

  39. Intrauterine Device cont… Advantages: • Para Guard (Copper IUD) may be left in place for up to 12 years; Mirena (hormone IUD) may be left in place for up to 5 yrs. • Ability to become pregnant returns quickly when use is stopped Problems: • May cause cramping (copper IUD) • Spotting between periods • Heavier and longer periods • Increased risk of tubal infection, in rare cases the wal of the uterus may be punctured

  40. Sterilization What is it? • Tubal Ligation (women) / Vasectomy (males) Effectiveness: • Pregnancy prevention – 99.5-99.9% • STI prevention - NONE Advantages: • Permanent protection against pregnancy • No lasting side effects • No effects on sexual pleasure • Protects woman whose health would be seriously threatened by a pregnancy

  41. Sterilization cont… Problems: • Mild bleeding or infection after the surgery • Some regret being unable to have children later • Reaction to anesthetic • Not usually reversible if you change your mind • Rare cases, tubes reopen, allowing pregnancy to occur • Rare complications with tubal ligation include bleeding and injury to the bowel • Vasectomy – infection or blood clot can occur in or near the testicles; often there is temporary bruising, swelling, or tenderness

  42. Emergency Contraception“The Morning After Pill” • Emergency contraception pills are different from medication abortion (RU-486) • Pregnancy begins when a pre-embryo completes implantation into the lining of the uterus • ECPs prevent pregnancy by inhibiting ovulation and fertilization • ECPs help prevent pregnancy, whereas medication abortion terminates a pregnancy

  43. Emergency Contraception cont… • Take within 120 hours of unprotected sexual intercourse – the quicker it is taken – the higher the effectiveness rate • Typically used in cases of unanticipated sexual intercourse, contraceptive failure, or sexual assault • 2 Types of Emergency Contraception: • Combination pills (estrogen & progestin) – Taken within 72 hours, it’s 75% effective • Progestin only – Taken within 24 hours, it’s 95% effective

  44. Unplanned Pregnancy THREE OPTIONS • Parenthood • Adoption • Abortion • Best to fully consider all options before making a decision

  45. Parenthood • Rewarding but very demanding • Requires lifestyle changes for the parent • Child is dependent for attention, love, shelter, clothing, and food 24 hrs/day • Life long commitment

  46. Adoption • Difficult decision • Done in the best interest of child • Parent desires to provide the child with improved opportunities • Adoption agencies exist to help make this option as painless as possible • Some allow biological parents to remain involved • Can provide means for children to obtain information about their birth parents

  47. Abortion • Reasons may be personal or medical • The decision is reached for various reasons

  48. Summary • Fertilization occurs in the fallopian tube and cell division begins immediately • All major organs are developed by the 1st trimester – prenatal care is crucial • Abstinence from penile/vaginal intercourse is the only 100% effective method of pregnancy prevention • The 3 options of unplanned pregnancy include parenthood, adoption, and abortion

  49. Local Contacts and Websites: • Texas A&M University • Health Center 847-9242 • Women’s Clinic 845-1576 • Health Services 845-6111 • AIDS Services of Brazos Valley • 260-2437 • Texas Dept of Health: • http://www.tdh.texas.gov/hivstd • Hope Pregnancy Center of Brazos County - 846-1097 • Good Samaritan Pregnancy Services - 846-2909 • Planned Parenthood - 846-1744 • Project Rachel - 888-456-4673

  50. Contacts and Websites cont… • Center for Disease Control • www.cdc.gov • CDC National STI Hotline • 1-800-227-8922 • www.sunsite.unc.edu/ASHA • www.unspeakable.com • Risk Profile • STD Quiz • http://www.acha.org/info_resources/stis_on_campus.cfm • Other STI slides

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