Reproductive Systems

1. Reproductive Systems Sexual and Reproductive Health

2. Sexual Health • Appreciation for one’s body • Appropriate and respectful interaction • Appropriate expressions of love and intimacy • Avoiding exploitative relationships • Identification of values • Responsibility for one’s own behaviour • Enjoying sexual feelings without necessarily acting on them

3. Sexual Health Continued… • Understand consequences of sexual activity (talk with partner about sexual activity, limits, contraception, and meaning of relationship, prior to sexual activity) • Practice proactive health behaviours (go for regular check-ups – paps, testicular exams) • Understanding the impact of media messages • Seek information about sexuality as needed • Able to negotiate and communicate sexual limits

4. Reproductive Health • Anything pertaining to, or affecting reproduction • The physical ability to produce offspring • Awareness of what is normal and abnormal in regards to reproductive organs • Pre-conceptual health • Prenatal health

5. Reproductive Health - Sexuality • Sexuality and reproductive health are interdependent • Sexuality is a natural and healthy part of living • Sexuality involves more than sex and sex involves more than sexual intercourse • Sexual feelings and sexual behaviour are integral aspects of reproductive health

6. Why Promote Reproductive Health? • The promotion of reproductive health contributes to the health of women and men and can impact the health of future pregnancies. • Maintaining a healthy lifestyle throughout the reproductive years helps to prevent infant death, premature birth, low birth weight, and many birth defects. • Over 50% of pregnancies in Canada are “unplanned” • A fetus can be subjected to a number of risk factors in the crucial two to eight weeks after conception, which is often before a woman realizes that she is pregnant

7. Why Promote Reproductive Health? • Most people require 3 exposures to new information before they really hear it. Therefore, it is important • to offer reproductive health messages early and to repeat them often. • Benefits of reproductive health messages: • Improved health through the life span • Fewer infant deaths • Decreased incidence of premature birth, low birth weight (LBW) and birth defects • Decreased health care costs

8. Reproductive Health - Fertility Requirements for Male Fertility • normal sperm production, which includes a normal count, mobility, biological structure and functioning of sperm • transmit sperm to female vagina through: • an adequate sexual drive • the ability to maintain an erection • the ability to achieve a normal ejaculation • the placement of ejaculate in vagina

9. Reproductive Health - Fertility Requirements for Female Fertility • adequate sexual drive and sexual function to permit coitus • functioning reproductive anatomy and physiology that include: • vagina capable of receiving sperm • normal cervical mucus to allow passage of sperm to the upper genital tract • ovulatory cycles • fallopian tubes that will function to permit the sperm and ovum to meet • uterus capable of developing and sustaining the product of conception to maturity • adequate hormonal status to maintain pregnancy • normal immunological responses to accommodate sperm, product of conception (fertilized ovum) and fetal survival • adequate nutritional, chemical and health status to maintain nutrition and oxygenation of placenta and fetus

10. Reproductive Health - Infertility • The most common causes of infertility include: • the woman not ovulating • the man not producing a sufficient amount of healthy sperm • some barrier to the transport of sperm or ovum through the womanÕs fallopian tube (e.g., scar tissue in the fallopian tubes)

11. Reproductive Health - Infertility What is infertility? • Infertility is the malfunctioning of a man or a woman’s reproductive system. Male infertility is responsible for 40% of infertile couples and female infertility is responsible for 40%, 10% combined and 10% unexplained. It is estimated that 10-15% of couples are not able to conceive within one year of trying. However, the majority of couples do conceive whether or not they are treated for infertility. Types of Infertility • Primary Infertility • A couple has never conceived despite unprotected intercourse for at least 12 months. • Secondary Infertility • A couple has previously conceived but is subsequently unable to conceive within 12 months despite having unprotected intercourse. • Third Type of Infertility (Pregnancy wastage) • A woman has conceived but unable to produce a live birth.

12. Reproductive Health – Preconceptual Health • Pre-conceptual health is the general health status of a person prior to conception. • Pre-conceptual health is the single most important determinant of male and female fertility. • Good health care prior to conception reduces unplanned pregnancy, promotes healthier pregnancies and healthier births, reduces the risk of low birth weight, birth defects and premature deliveries. • Most birth defects occur 2-8 weeks after conception, often before a woman knows she is pregnant. • Research now shows that an increased intake of folic acid (a B vitamin) by women before she becomes pregnant reduces the risk of birth defects called Neural Tube Defects (NTDÕs). These are birth defects affecting the brain and spinal cord (e.g., Spina Bifida). • Good sources of folic acid or folate are fruits and vegetables. The critical time to have enough folate is before conception occurs. 50% of all pregnancies are not planned.

13. Factors that Affect Reproductive Health • Environmental • Hormonal • Sexual History • General Health • Physiological Response to Stress

14. Environmental Factors • i) Smoking • Females who smoke: • are at risk for lowering folic acid, vitamin C and beta-carotene levels. These reduced levels are all associated with infertility, delay in conception, ectopic pregnancy and menstrual disorders • have an increased risk of spontaneous abortion, fetal and neonatal death • will have a child lower in birth weight due to reduced nutrients and oxygen to the fetus in utero • Males who smoke: • may have the quality of their sperm affected • marijuana may have the quality of the their sperm reduced

15. Environmental Factors ii) Alcohol • The use of alcohol: • · reduces sperm quality in males • · affects ability to achieve and/or maintain an erection iii) Chemical Exposure • A teratogen can be a drug, a chemical or an infection that results in the permanent • damage to the developing fetus. There are approximately 25 chemicals known to be teratogenic. • The following can result in low birth weight, still birth and birth defects: • carbon monoxide in car exhaust • kerosene heaters • lead and paint strippers • Preventative measures include: • leaving the work area to eat • avoiding noxious substances • using gloves • washing hands • adequate ventilation • determining the status of hazardous substances at place of employment

16. Environmental Factors iv) Medications • narcotics (e.g., Percodan), tranquilizers (e.g., Valium), anti-depressants (e.g., Prozac) and anti-hypertensives (e.g., blood pressure medications) may cause erectile dysfunction in males • other drugs may affect sperm production and/or ovulation • some drugs may cause fetal defects (e.g., tetracycline, accutane treatment for acne, anti-coagulants, steroids) • chemotherapy may affect sperm quality and ovulation and indirectly affect fertility due to nutritional status • some herbs contain drug-like ingredients and can have harmful effects during pregnancy and while breastfeeding (e.g., can stimulate the uterus or cause uterine contractions, act as a diuretic, produce toxic effects in the developing baby, cause birth defects, infant deaths or be passed onto infant through breast milk and harm the baby) • healthy eating ensures the proper nutrients required pre-conceptually and prenatally

17. Hormonal • can affect sperm quality, production and ovulation (e.g., failure to ovulate regularly, or irregular menstrual cycle, may be caused by problems with the hypothalamus and pituitary gland) • congenital factors may impede ability to conceive (e.g., born without uterus)

18. Sexual History • a lack of understanding of oneÕs own reproductive biology and a lack of awareness of fertility methods can impact fertility • multiple sexual partners increase the risk for STIÕs (sexually transmitted infections), Pelvic Inflammatory Disease (PID) and cervical cancer • some women develop antibodies to sperm, a condition some clinicians believe more common in women with multiple sexual partners • sexually transmitted infections (e.g., chlamydia, gonorrhea) and pelvic conditions if left untreated can cause conditions in both males and females which can impair fertility

19. Sexual History Note: • genital chlamydia infection is the leading cause of preventable infertility and ectopic pregnancy • 80% of women and 25% of men with chlamydia have no symptoms • 50% of women and 25% of men with gonnorhea have no symptoms • Pelvic Inflammatory Disease (PID) can cause tubal damage in women and increase risk of ectopic pregnancy • inflammatory effects of infection in male reproductive organs (e.g., epididymitis) can cause scarring • Human Papilloma Virus (HPV) is often a precursor to cervical dysplasia • cervical treatments may reduce fertility by causing scarring or damage to cervical mucous-producing cells • lifestyle choices that affect nutrition, physical activity and healthy sexual practices effect overall health and fertility status • infectious diseases such as mumps after puberty can cause sterility • issues relating to same sex couples wishing to parent

20. General Health • endometriosis can cause scarring, tubal blockage and possible immune responses (Note: 25-30% of infertile women have endometriosis) • there is conflicting evidence that tight clothing may affect sperm production • Sickle Cell disease can cause possible impotence due to nerve and tissue damage and may increase the incidence of miscarriage in women

21. Physiological Response to Stress • psychological stress (e.g., depression, difficulty sleeping, anxiety) and physiological stress (increased muscle tension, lack of energy, nervousness) affect libido • stress affects the ability to make healthy lifestyle choices (e.g., alcohol and other substance use, smoking, decrease in physical activity or sedentary living, poor • nutrition) which in turn also affects fertility