2022-02-08
Chapter 5 Part 1:
Sex Hormones and Human Sexuality
Copyright © A. Brown, MUN, 2021
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2022-02-08
What are Hormones?
Hormones are chemical messengers that are
released by endocrine organs and carried
throughout the body via the circulatory
system
– They provide the connections within and between
the nervous system (the brain, the spinal cord,
and the peripheral nerves and muscles) and the
reproductive system (the ovaries, the testes, and
the genitals).
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What are Hormones?
• Hormones are released into the bloodstream
by endocrine organs such as the gonads `
• Small amounts of hormones produce strong
and lasting effects.
• Hormones are regulated by feedback signals
from every organ affected, especially the
brain.
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What Are Sex Hormones?
• Sex hormones are hormones that regulate
sexual maturity and reproduction.
• Main sex hormones:
– Androgens
– Estrogens
– Progestogens
• Oxytocin and vasopressin can also be
considered sex hormones.
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The HPG Axis and the Regulation
of Sex Hormones
• The brain regulates sex hormone production
through the HPG axis:
– Hypothalamic-pituitary-gonadal axis
– It’s a communication system between areas of the
brain (the hypothalamus and pituitary gland) and
the gonads that affects the production and release
of sex hormones.
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The HPG Axis and the Regulation
of Sex Hormones
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The HPG Axis and the Regulation
of Sex Hormones
Terms:
Hypothalamic hormone:
– GnRH = gonadotropin releasing hormone
Pituitary hormones:
– FSH = follicle stimulating hormone
– LH = leutenizing hormone
Gonadal hormones
– Testosterone (testes)
– Estrogen/Progesterone (ovaries)
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Male Reproduction
• In biological males, LH binds to cells inside the
testes and causes them to secrete
testosterone.
• Levels of LH, FSH and testosterone remain
relatively constant in males after puberty.
– Testosterone production operates in a negative
feedback loop
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Male Reproduction
Negative feedback loop for testosterone:
– Hypothalamus directly monitors testosterone
levels
– This influences gonadotropin-releasing hormone
(GnRH) levels
– LH production (from pituitary) is regulated by the
hypothalmus via GnRH
• EG: Low T > hypothalamus increases GnRH >
pituitary increases LH > T rises
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Male Reproduction
There is also a negative feedback loop for FSH
and sperm production
– Low Inhibin -> Hypothalamus secretes GnRH ->
Pituitary secretes FSH -> Testes manufacture
sperm
– Inhibin secreted by testes regulates the negative
feedback loop for FSH
– Operates in a different area of the hypothalamus
than testosterone production
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Female Reproduction
• The interaction of the different components of the HPG
axis regulates the female menstrual cycle.
• The menstrual cycle’s purpose is reproduction.
– Phase 1: Follicular (proliferative) phase
• ovarian follicle matures; growth of endometrium
– Phase 2: Ovulation
• mature egg released
– Phase 3: Luteal (secretory) phase
• increased complexity of endometrium
– Phase 4: Menstruation
• shedding of the endometrium if conception does not occur
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Female Reproduction
1. The Follicular (proliferative) Phase
– Pituitary secretes high levels of FSH
– Stimulates a follicle in the ovary to bring an egg to
the final stage of maturity
– The follicle also secretes estrogen at this time
• Affecting the endometrium
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Female Reproduction
2. Ovulation
– Estrogen has risen to a high level, so FSH levels fall
– The high estrogen levels also stimulates the
hypothalamus to produce GnRH, which stimulates
the pituitary to produce LH
• This LH surge triggers ovulation
• Note: this is a positive feedback loop
• So High E -> Produce GnRH -> Produce LH
– The follicle ruptures open and releases a mature
egg
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Female Reproduction
3. The luteal (secretory) phase
– After releasing an egg, LH levels cause the follicle
in the ovary to turn into a glandular mass of cells
called the corpus luteum
– Corpus luteum secretes progesterone
– The progesterone from corpus luteum stimulates
glands of the endometrium (uterus) to start
secreting a nourishing substance
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Female Reproduction
3. The luteal (secretory) phase (cont’d)
– Corpus luteum will only produce progesterone for
about 10-12 days (if no pregnancy)
– If no pregnancy, the corpus luteum withers and
the uterine lining cannot be maintained due to the
decline in progesterone
– Sharp decline in both Estrogen and Progesterone
levels at end of luteal phase
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Female Reproduction
4. Menstruation
– Shedding of the inner lining (endometrium) of the
uterus
– Discharged through cervix and vagina
– Triggered by the sharp decline of Estrogen and
Progesterone at end of luteal phase
– FSH levels are now starting to rise again
– Menstrual fluid is a mixture of blood from the
endometrium, degenerated cells, and mucus from
the cervix and vagina
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Female Reproduction
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Female Reproduction
Cycle is typically between 20-36 days, with 28
being an average
– In a 28 day cycle:
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•
•
Day 1 to 4/5 = menstruation
Day 5 to 13 = follicular phase
Day 14 = ovulation
Day 15 to 28 = luteal phase
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Female Reproduction
Issues associated with menstruation:
1.
2.
3.
4.
Dysmenorrhea
Endometriosis
Amenorrhea
Mood fluctuations
– PMS
– PMDD
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The Role of Hormones in the Development
of Secondary Sex Characteristics
The development of secondary sex
characteristics is triggered by the activation of
the HPG axis during puberty.
– Males: Increased muscle mass, facial hair, growth
of the testes, lowering of the voice
– Females: Widening of hips and pelvis, growth of
breasts, increased fat tissue in the arms, thighs,
mons pubis, and buttocks
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Menstrual cycle video
Youtube (copy and paste link):
https://www.youtube.com/watch?v=WGJsrGm
WeKE
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Chapter 5 Part 2:
Sex Hormones and Human Sexuality
2022-02-10
Copyright © A. Brown, MUN, 2021
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The Sexual Brain
The Hypothalamus
– highly responsive to hormones
– produces sex hormones and influences sexual acts
and the individual’s perception of sexuality
Prenatally, the human brain is very sensitive to
androgens and estrogens.
– May affect gender identity and sexual attraction
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The Sexual Brain
The sexual brain is connected to brain regions
that play a role in our thinking, perceptions, and
self-control
– Sexuality, attraction, desire, and a sexual sense of
self cannot be uncoupled from life experience.
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How Hormones Affect Sexuality
• There is strong evidence that sex hormones
may directly affect sexual attraction, desire,
and performance.
• Androgens and estrogens play a direct role in
genital and subjective arousal.
– For example, administration of testosterone can
increase genital sexual arousal in both women and
men.
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How Sexual Activity and Other Life
Factors Affect Hormone Levels
• The relationship between sex and sex
hormones is reciprocal.
– Sexual activity increases testosterone in men and
women.
– Intimate physical contact (even of a non-sexual
nature) can increase testosterone in women.
– Sexual arousal decreases the stress hormone
cortisol and increases estradiol in women.
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How Sexual Activity and Other Life
Factors Affect Hormone Levels
– Viewing erotica appears to increase testosterone
levels in men and estradiol levels in females.
– Imagining sexual interactions (fantasy) increased
testosterone levels in women.
– There is a bidirectional relationship between
testosterone levels and relationship status in
women
• low when entering relationship, but higher when in one
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Oxytocin and Vasopressin:
Pleasure and Bonding
• Together, these hormones play a role in sexual as
well as in other reproductive behaviours.
• Oxytocin is associated with childbirth, lactation,
and maternal behaviour and bonding.
– It is considered the “cuddle” or “ love” hormone
• Vasopressin is involved with multiple aspects of
human social and sexual functions, such as
increased heart rate and fluid balances.
– It is considered the “relationship bonding” hormone
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Does the Act of Smelling Sex
Hormones Lead to Sexual Behaviour?
• Smells can activate areas in our emotional
brain (limbic system) outside of conscious
awareness.
• Pheromones in males and females are
produced in the apocrine glands (armpit and
pubic areas).
– Synthesis is controlled by androgens in males and
females.
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Does the Act of Smelling Sex
Hormones Lead to Sexual Behaviour?
• Four types of pheromones have been
identified in humans:
– Territorial, menstrual/fertile, sexual, and
maternal-infant
• Major histocompatibility complex (MHC)
compounds are found in vaginal pheromones
and may communicate genetic information to
sexual partners
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Sex Hormones, Sexuality and Aging:
Menopause
• Perimenopause occurs usually for women in
their late 40s and signals a decline in fertility.
• When a woman has not had a menstrual
period in 12 months or more, she is said to be
menopausal.
– Menopausal women may experience a decline in
their libido due to declining estradiol levels.
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Sex Hormones, Sexuality and Aging:
Women, Aging, and Androgens
• The most common sexual disorder among
women of all ages is low desire.
– affects 34–43% of women in Western countries
• Levels of circulating testosterone in women
decline gradually from young adulthood
through menopause.
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Sex Hormones, Sexuality and Aging:
Andropause
• As men age, their levels of testosterone fall.
• Some men over 50 experience “andropause”:
– low libido
– decreased strength, energy, and/or stamina
– increased irritability
– decreased enjoyment of life
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Sex Hormones, Sexuality and Aging:
Andropause
• Aging men may experience bone and muscle
mass loss, increased body fat, breast
development, and changes in cognitive
functions.
• Low libido seems to be caused principally by
hypogonadism in older men.
– can cause erectile dysfunction
– can be treated with androgen therapy
2022-02-10
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Chapter 6 Part 1:
Pregnancy and Childbirth
2022-02-15
Copyright © A. Brown, MUN, 2021
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Conception
Conception requires several systems to work
together:
– Ovulation occurs (egg released from ovary).
– Egg is picked up by fimbriae and enters the
fallopian tube.
– 200–400 million sperm start out to fertilize the
egg.
– Sperm travel through the cervix and uterus to one
of the two fallopian tubes.
– Only 200 to 300 sperm make it as far as the egg.
2022-02-15
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Conception
Conception requires several systems to work
together:
– Sperm work together to dissolve the zona
pellucida (sperm secrete hyaluronidase).
– One (sometimes more) sperm enters the egg, and
fertilization occurs in the fallopian tube.
– Now a zygote, it continues to move down the
fallopian tube to the uterus.
– Zygote implants in the uterus.
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Pregnancy Detection
• The absence of menstruation is not a definite
indication of pregnancy.
• Basal body temperature that stays high for two
weeks after ovulation indicates the probability that
conception has occurred.
• Chemical tests are designed to detect human
chorionic gonadotropin (HCG) in the woman’s urine.
• Delivery date is calculated using Nägele’s Rule.
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Fetal Development: First Trimester
• First 8 weeks of pregnancy:
– Embryonic stage
– Placenta and amniotic sac develop.
– Most of the major organs and systems develop.
• After 8 weeks = fetal stage
• Effects of pregnancy:
– Tingling and fullness in breasts
– Nausea, tiredness, and change in appetite
• “Morning sickness”
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Fetal Development: First Trimester
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Fetal Development: Second Trimester
• Fetal movements can be detected as early as
13–16 weeks or as late as 18–20 weeks.
• By the fifth month, fetal heartbeat can be
heard with a stethoscope.
• By the sixth month, the fetus is sensitive to
light and sound.
• Considerable further development occurs
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Fetal Development: Second Trimester
• Effects of pregnancy:
– Indigestion and constipation is common.
– Breasts enlarge with breast milk and the nipples
darken.
– Stretch marks may develop on breasts and
stomach.
– Most women report feeling well during this time
as the nausea and vomiting have disappeared
after the first trimester.
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Fetal Development: Second Trimester
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Fetal Development: Third Trimester
• By the end of seventh month, the brain and nervous
system are complete.
– Fetus usually turns to the head-down position to prepare
for delivery.
• Effects of pregnancy:
– Balance becomes an issue.
– Backache, leg cramps, frequent urination, or swelling in
the hands and feet is common.
– Healthy weight gain is 25–35 pounds (less if woman starts
pregnancy already overweight).
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Fetal Development: Third Trimester
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Sexuality during Pregnancy
• A person can safely continue to have sex during
their pregnancy until the start of labour.
– The male’s penis will not harm the fetus; it is
protected by the amniotic sac and mucous plug in
cervix.
• Women with a history of miscarriage or who have
cramping or spotting may be advised to abstain
from having orgasms.
– The contractions from an orgasm could trigger labour.
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Nutrition during Pregnancy
• Diet during pregnancy is extremely important
• Adequate diet
– Woman is at lesser risk for complications and
disease
– Baby has a better chance of a normal birth weight
• Important for pregnant woman to get enough
protein, folic acid, calcium, magnesium, iron and
vitamin A
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Choice of Caregiver for
Uncomplicated Births
• Many women have an obstetrician deliver their baby.
• In industrialized countries, healthy women cared for
by midwives have better maternal and neonatal
outcomes:
– lower perinatal mortality rates
– lower Caesarean-section (C-section) rates
– In Canada, women also expressed far greater satisfaction with their
labour and birth if they were assisted by a midwife rather than an
obstetrician or a family doctor.
• Childbirth practices vary considerably from culture to
culture and from country to country.
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Delivery Options
Vaginal birth
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Caesarean-section (C-section)
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Delivery Options – Vaginal Birth
• A few weeks before labour begins, the fetus
turns so that the widest part of its head is
against the woman’s pelvic bones.
• Effacement (thinning of the cervix) occurs.
– Dilation (stretching/opening) also occurs.
• In some women the amniotic sac ruptures
(“water breaking”).
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Delivery Options – Vaginal Birth:
Stage 1
• Average labour lasts 8.6 hours in a first
pregnancy.
– Average is about half that time for subsequent
pregnancies.
• Contractions help efface and dilate the cervix.
– Early phase: dilates to 4cm
– Active phase: dilates to 8cm
– Transition: dilates fully to 10 cm
• This allows the baby to pass through.
• Short (about 30mins), but most difficult phase.
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Delivery Options – Vaginal Birth:
Stage 2
• It begins when the cervix is fully dilated, and the
baby’s head begins to move into the vagina.
– It ends with the birth of the baby.
• In this stage, the birthing parent pushes to help
the baby move down the vagina.
• Once the baby’s head is delivered (“crowned”),
blood and mucus are cleared from the baby’s
nose and mouth to induce breathing.
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Delivery Options – Vaginal Birth:
Stage 3
• The final stage may last from a few minutes to
over an hour.
• It is sometimes called the “placental phase.”
• Placenta detaches from the uterine walls and
is expelled with other material called
“afterbirth.”
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Delivery Options – Vaginal Birth:
Pain Management
• Childbirth preparation classes encourage the
use of non-pharmacological techniques.
– E.g. birthing balls, controlled breathing, soaking in
a tub, walking around, using massage or
distraction techniques, TENS machine use,
hypnosis
• Pharmacological analgesics and anesthetics
may be used.
– tranquilizers and narcotics
– epidurals or spinal blocks
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C-Section
• The baby is delivered through an incision made
through the abdomen and wall of the uterus.
• There are many reasons for a C-section delivery:
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–
–
–
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Baby is too large.
Mother’s pelvis is too narrow.
Baby is in a breech or transverse position.
Umbilical cord will pass through the cervix before the
baby (prolapses).
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Chapter 6 Part 2:
Pregnancy and Childbirth
2022-02-17
Immediately after the Baby is Born
• The umbilical cord is clamped and cut.
• Parent and baby engage in skin-to-skin contact
and baby should begin to breastfeed soon
after.
• Drops of an antibiotic or silver nitrate placed
in eyes
• Infant receives an injection of vitamin K to
ensure that blood will clot normally.
2022-02-17
Postpartum Emotional Issues
• Birthing parent may experience psychological
and physiological changes after birth as levels
of estrogen and progesterone slowly return to
pre-pregnancy levels.
• Three major categories of postpartum
conditions:
– Postpartum blues: 80% of women
– Postpartum depression: 10%–20%
– Postpartum psychosis: 0.2%
2022-02-17
Sexuality During the Postpartum Period
• Traditionally women were advised to wait a
minimum of six weeks postpartum to resume
sex.
– In recent times, this recommendation has
changed to support the couple having intercourse
as soon as the couple is ready.
• British study:
– Out of 484 women, 89% resumed sex at six
months postpartum.
2022-02-17
Breastfeeding
• Canadian health organizations recommend
exclusive breastfeeding for the first six
months after birth to optimize infant growth,
immunity, and cognitive development.
– After six months, complementary foods should be
given.
– Breastfeeding may continue up to two years of
age and beyond.
2022-02-17
Physiology of Breastfeeding
• The breasts first produce colostrum that is high in
nutrients as well as antibodies that protect the
baby from infection.
• Milk production begins 2 to 3 days after delivery.
– Prolactin is released to stimulate milk production.
– Oxytocin is produced, which is needed to eject the
milk from the breasts.
• Exclusive breastfeeding delays the resumption of
regular menstrual cycles (lactational
anovulation)
2022-02-17
Breastfeeding and Sexuality
• Masters and Johnson:
– Women who breastfed their babies had higher levels
of sexual interest in the months after delivery.
• Other studies showed opposite effects:
– decreased desire
– increased sexual functioning problems
• Breastfeeding helps the uterus return to its prepregnancy size and shape (due to oxytocin).
2022-02-17
Complicated Pregnancies
•
•
•
•
•
•
•
•
•
Ectopic Pregnancy
Miscarriage (Spontaneous Abortion)
Rh Incompatibility
Pregnancy-Induced Hypertension
Congenital Anomalies
Preterm Birth/Low Birth Weight
Anoxia
Stillbirth
Maternal Mortality and Morbidity
2022-02-17
Ectopic Pregnancy
• Fertilized egg implants somewhere other than
uterine lining
• Most common cause: obstructed fallopian
tube
• If an ectopic pregnancy grows and ruptures,
seek medical treatment immediately.
2022-02-17
Miscarriage (Spontaneous Abortion)
• Most miscarriages occur within first 20 weeks
of gestation.
• The most common reason for miscarriage is a
defect in the embryo or fetus.
• Mothers may experience significant
psychological consequences including
elevated levels of anxiety, depression, and
grief.
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Rh Incompatibility
• Antibodies from the pregnant woman’s blood
destroy red blood cells in the fetus.
• Occurs when the woman has Rh-negative blood
and the fetus has Rh-positive blood.
• The risk is low in the first pregnancy but very high
in subsequent ones.
– Anti-bodies will have formed by then and attack the
fetus’s red blood cells.
– Can lead to fetal anemia, intellectual disability, or
death.
2022-02-17
Pregnancy-Induced Hypertension
• There are three types of hypertension (high
blood pressure) related to pregnancy:
1. Pregnancy-induced hypertension is simply high
blood pressure associated with the pregnancy.
2. Pre-eclampsia includes edema (fluid retention
and swelling) and proteinuria (protein in the
urine).
• increased risk of fetal death
3. Eclampsia may result if uncontrolled and may
lead to convulsions, coma, and even death.
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Congenital Anomalies
• Congenital anomalies may result from
– genetics (e.g. Down’s syndrome)
– maternal illness or infection (e.g. diabetes, STI)
– use of drugs or alcohol (e.g. fetal alcohol syndrome)
• Folic acid supplements in the three months before
conception and in the first trimester can reduce the
incidence of congenital abnormalities from neural
tube defects.
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Congenital Anomalies
• Screening for elevated levels of the glycoprotein alphafetoprotein (AFP) in the mother’s blood is one way to
detect congenital anomalies early in the pregnancy.
– Sonographic examination helps rule out three of the
common causes of AFP elevation:
• underestimation of gestational age
• multifetal gestation
• fetal death
• Amniocentesis and chorionic villus sampling are more
invasive methods of detecting congenital anomalies.
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Preterm Birth/Low Birth Weight
• A preterm baby is born before 37 weeks of
gestation,
– 60–80% of infant deaths (with no congenital
anomalies) are due to preterm birth.
– Preterm births have been linked to low birth
weight.
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Anoxia
• The umbilical cord can be compressed as the
baby passes through birth canal, especially if
the baby is born in the breech position.
– Anoxia (oxygen deprivation) can occur.
– The physician may order a C-section.
• Prolonged anoxia can lead to cerebral palsy,
brain damage, intellectual disability, and even
death.
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Stillbirth
• Stillbirth occurs when a baby is born dead any
time after 28 weeks gestation and weighs at least
500 grams.
• Global stillbirth rate is 18.4 per 1000 births
(2015).
– Most (98%) occurred in low- to middle-income
countries.
• Stillbirth often leads to increased psychological
difficulties in the birthing parent:
– anxiety, depression, and post-traumatic stress
disorder (PTSD)
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Maternal Mortality and Morbidity
• Maternal mortality in Canada is relatively rare,
but it is unacceptably high in many other parts
of the world.
– 830 women die from pregnancy- or childbirthrelated complications around the world every day.
– Almost all of these deaths (99 per cent) occurred
in low-resource settings.
– Most deaths could have been prevented.
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Infertility and Reproductive
Technologies
• 1 in 8 couples in Canada has infertility issues.
– primary and secondary infertility
• Of all infertility cases:
– 40 per cent result from male infertility
– 40 per cent result from female infertility
– 20 per cent result from infertility in both partners
or unknown causes
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Infertility and Reproductive
Technologies
• Male infertility is believed to affect about 1 in 10
men.
– Most common problem is low sperm count
– Other factors include sperm shape and motility,
disease, injury, autoimmune responses, and pituitary
imbalance.
• Female infertility affects approximately 1 in 12
women between 15 and 45 years of age.
– Most common issue is irregular ovulation.
– Other factors include obstructions, endometriosis,
hormone levels, PCOS, advancing age
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Psychological Impact of Infertility
• The psychological and social consequences of infertility
are considerable:
– Anger, confusion, sadness, anxiety, shame, depression,
insecurity, inadequacy, sense of failure, jealousy,
resentment, low-self esteem, etc.
• Infertility issues can lead to increased conflict and
decreases in sexual satisfaction.
• Psychological distress due to infertility often affects the
woman more than their partner.
– Infertility can challenge a man’s sense of masculinity and virility
2022-02-17
Treatment of Infertility
• Several different treatment options are
available.
– Likelihood of an assisted reproductive technology
(ART) procedure resulting in pregnancy and a livebirth delivery is approximately 30 per cent.
• The first step in fertility treatments is often
the use of “fertility drugs.”
• All methods are regulated by The Assisted
Human Reproduction Act in Canada.
2022-02-17
Treatment of Infertility
• Artificial insemination (AI)
– A thin, flexible catheter inserts sperm directly into
vagina or uterus.
• In vitro fertilization (IVF)
– Eggs are surgically removed from the ovaries.
– Eggs are then fertilized with sperm in the laboratory.
– The fertilized egg is injected into the birthing parent’s
uterus (intrauterine) or cervix (intracervical).
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Treatment of Infertility
• Gamete intrafallopian transfer (GIFT):
– Eggs and sperm are collected and deposited directly
into woman’s fallopian tubes.
• Zygote intrafallopian transfer (ZIFT):
– A fertilized egg is transferred directly to a fallopian
tube to allow for natural implantation.
• Surrogacy:
– A woman outside of the couple will become pregnant
through any of the procedures mentioned above and
deliver a baby to term for the parent(s)-to-be.
2022-02-17
SGD Families and Assisted Human
Reproductive Technologies
• Many SGD people choose to parent.
– They often rely on assisted reproduction services
to create their families.
– SGD individuals make up about 30% of AHR
service users.
2022-02-17
Chapter 7 Part 1:
Contraception and Pregnancy
Options
2022-02-28
Copyright © A. Brown, MUN, 2021
1
Ancient Forms of Birth Control
Silphium in ancient Greece
Poisons like mercury and arsenic
Barrier methods were used in ancient Egypt.
Seclusion of menstruating females
Intra-crural intercourse instead of penilevaginal intercourse
• Infanticide was widely used
•
•
•
•
•
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A Brief History of Birth Control in Canada
• Canada’s Criminal Code of 1892 made the use
and sale of contraceptives illegal.
• The first formal contraceptive advocacy
organization was formed in 1923 in Vancouver.
– 1930s: The Parents Information Bureau in
southern Ontario distributed contraceptives to
low-income families.
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A Brief History of Birth Control in Canada
• 1960s: The “Baby boom” and global concerns
about population control made birth control
more acceptable.
– 1963: International Planned Parenthood
Federation is formed.
– 1968: The United Nations recognizes family
planning as a human right.
– 1969: The Trudeau government removes birth
control from the Canadian Criminal Code.
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Modern Methods of Birth Control
• The first reusable linen condoms were
developed by Gabriello Fallopio in the 16th
century.
• Religious (Catholic Church) and political
agendas (repopulating Europe after several
plagues) reduced contraceptive use
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Modern Methods of Birth Control
• The effectiveness of birth control methods is
much improved with perfect use as opposed
to typical use.
• The probability of getting pregnant in one year
with no birth control is 85%.
• Many forms of contraception are available.
– Consult a health-care provider to decide which
method is the right one for you.
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Methods of Contraception
•
•
•
•
•
•
Hormonal contraceptives
Non-hormonal IUD
Barrier Methods
Surgical Methods
Natural Methods
Abstinence
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Hormonal Contraceptives
• Hormonal contraceptives work by
– inhibiting ovulation;
– altering the endometrium; and/or
– altering the consistency of the cervical mucus.
• They’re typically more effective in preventing
pregnancy than non-hormonal methods.
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Hormonal Contraceptives
• Options for hormonal contraceptives include:
Combination:
• the pill
• NuvaRing
• transdermal patch
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Progestin only:
• mini-pill
• Depo-Provera
• LNG-IUS
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Hormonal Contraceptives
• Pros:
– highly effective
– do not need to think
about usage (for some)
– regulates menstrual
cycle
– reduces menstrual flow
– reversible
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• Cons:
– must be taken (used)
regularly to be effective
– do not protect against
STIs
– several side effects
including weight gain,
cancer risks, mood
change, etc.
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Non-hormonal Intra-uterine Devices
• IUDs (intra-uterine devices; Cu-IUD) must be
inserted by a doctor.
– makes uterine environment inhospitable to sperm
and inhibits implantation
– lasts for 5 years
– reversible
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Barrier Methods
• Barrier-type contraceptives such as
contraceptive sponges or cervical caps can by
inserted by the individual.
– Users can improve effectiveness by combining
them with spermicides
• They do not offer protection against STIs.
• They have higher failure rates than other
methods.
– Failure rates increase for parous women.
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Barrier Methods
• Male (external condoms) and female (internal
condoms) are the only barrier methods that
also provide STI protection.
– They’re the most effective form of HIV protection.
– Female condoms offer some protection against
external genital contact, which can reduce
infection from some STIs.
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Surgical Methods
• Female sterilization is called a tubal ligation.
– It is more than 99% effective.
• Male sterilization is called a vasectomy.
– 0.05% failure rate.
• Surgical methods are generally not reversible.
• Patients must make informed decisions before
committing to these operations.
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Natural Methods
• Natural methods involve no human-made
barriers or hormones.
– They are reversible, chemical free, and supported
by some religious groups.
• Fertility awareness methods rely on a woman
understanding and tracking her menstrual
cycle.
– They require restricting intercourse at certain
times in order to avoid pregnancy.
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Natural Methods
• The Sympto-thermal Approach
– A woman charts her basal body temperature,
cervical position, and cervical mucus to determine
when she is fertile and could get pregnant.
– The user must track these changes for months
consistently and correctly in order for this method
to be effective
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Natural Methods
• The rhythm method is a calendar-based method.
– The fertile time is calculated based on the length of
the previous 12 cycles.
– The standard-days method is another (often more
accurate) variation of the rhythm method.
– Cons:
• The timing of a woman’s fertile window can be
unpredictable.
• Many women and couples find these methods overly
restrictive and difficult to follow in practice.
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Natural Methods
• Lactational Amenorrhea
– Breastfeeding hormonally suppresses ovulation.
– It is 98% effective as long as menstruation has not
returned, the baby is being nursed exclusively
with breastmilk, and the baby is less than six
months of age.
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Natural Methods
• The Withdrawal Method
– The method involves pulling the penis out from
the vagina before ejaculating.
• Must have self control and recognize that ejaculation is
imminent.
– It has been used throughout history.
– Perfect use is estimated at 96% effectiveness.
– Pregnancy can still result from pre-ejaculate.
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Natural Methods
• Abstinence
– may mean avoiding all sexual activity including
masturbation and other sex acts, or simply
avoiding penile–vaginal intercourse
– 100% effective while in use
• A backup method should be available if a couple
changes their minds in the heat of the moment
– may be frustrating and too restrictive for some
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Chapter 7 Part 2:
Contraception and Pregnancy
Options
2022-03-02
Copyright © A. Brown, MUN, 2021
1
Birth Control Use around the World
• The most common contraceptive methods
worldwide according to UN:
1.
2.
3.
4.
Female sterilization = 19%
IUD = 14%
Pills = 9%
Condoms = 8%
• Female-controlled methods accounted for
79% of contraceptive use.
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Birth Control Use around the World
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3
Birth Control Use in Canada Today
• 2006 Canadian Contraception Study (N=3253
women):
– The most frequently used methods included
condoms (54.3%), oral contraceptives (43.7%),
and withdrawal (11.6%).
• Only 65.2% of sexually active individuals who
were trying not to conceive endorsed always
using contraception.
– 14.9% of respondents used no contraception
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Why Use Birth Control?
The Bigger Picture
• In Canada, teenage pregnancy rates have been
declining since 1974.
• The world’s population is projected to reach
9.9 billion by 2050.
– The majority will live in the world’s poorest
countries.
– The number of children in a family affects the
overall education level, health, and family income.
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Choosing Not to Use Birth Control:
Sexual Risk-Taking in Canada
• 74% of 15- to 19-year-old women who were
sexually active in the previous six months said that
they always used contraception.
• Reasons for sexual risk- • Reducing sexual risktaking:
taking:
– Personality factors
– Situational factors
– Relationship factors
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– IMB model
• Information
• Motivation
• Behavioural skills
6
Emergency Contraception
• Emergency contraception is used after
intercourse and before a zygote can implant
• Emergency contraceptive pill:
–
–
–
–
available without a prescription since 2005
Plan B or Yuzpe
taken within 72 hours post coitus
75-89% effective
• Post-coital IUD:
– inserted within 7 days post coitus
– almost 100% effective
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Unwanted Pregnancies
• Two choices for an unwanted pregnancy:
1. abortion
2. continue pregnancy – adoption or parenting
choices
• An abortion can be considered either
therapeutic or elective.
• Many reasons people consider to have an
elective abortion
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A Brief History of Abortion in Canada
• 1869: Abortion is made illegal in Canada.
• 1969: Legal abortions can be performed under
very strict guidelines.
• 1988: Abortion in Canada is made legal,
largely due to Dr. Henry Morgentaler
• Access to abortion varies widely across
Canada
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The Pro-choice–Pro-life Debate
• Pro-choice supporters believe women should
have the choices of
– having the baby,
– giving it up for adoption, or
– terminating the pregnancy.
• Pro-life supporters believe that abortion
should never (or almost never) be an available
choice.
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Types of Abortions:
Medical (non-surgical)
• Medical abortions are performed up to the 7
weeks following the last menstrual period.
– They can be performed up to the 10th week gestation.
• Options available in Canada:
– administration of drugs methotrexate and misoprostol
– administration of mifepristone (RU-486)
• These drugs cause the fetus to stop growing
and/or the uterine lining to be expelled.
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Types of Abortions:
Surgical Abortions
• Manual vacuum aspiration:
– It is only an option in the first 7 weeks of pregnancy.
– Contents of uterus are removed by inserting a tube
and creating suction.
– It is considered safe and effective.
• Vacuum suction curettage
– It can be performed from 6th to 14th week of gestation.
• They are performed up to 20 weeks in some clinics.
– They are safe and have little risk.
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Types of Abortions:
Surgical Abortions
• Dilation and evacuation
– It is performed between 13th and 16th weeks (up to 24
weeks).
– They must be done in hospital under general
anaesthetic.
• Second- and third-trimester abortions
– Late pregnancy abortions are rare and are most often
performed because of diagnosed fetal anomalies.
– They involve an injection to stop the fetal heartbeat.
• Fetus is removed by forceps or labour is induced.
• In some cases, a C-section is performed.
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13
The Psychological Effects of Abortion
• Studies of the psychological consequences of
abortion are often controversial.
• Post-abortion syndrome (PAS) was debunked
by the American Psychological Association
(APA).
– Panel concluded that severe negative reactions
after abortions are rare and that most negative
reactions (if present) are mild.
– Other research shows that the most
overwhelming responses are relief and happiness.
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Adoption
• No statistics are available on how many
women in Canada put their babies up for
adoption.
– The estimate is in the hundreds per year.
– The decision is usually difficult to make.
• Most unplanned pregnancies end in either
abortion or in the woman raising the child
herself.
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Surrogacy
• Provides an alternative to adoption and is
available and legal in many countries.
• A person cannot directly pay a surrogate for
their services, but they can reimburse for
reasonable expenses incurred.
• A surrogacy agreement must be drafted and
negotiated, setting out the legal obligations
and rights of each party.
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Chapter 8:
Sexually Transmitted Infections:
At the Junction of Biology
and Behaviour
2022-03-02
Copyright © A. Brown, MUN, 2021
1
Sexually Transmitted Infections
• Public Health Agency of Canada (PHAC)
recommends the use of sexually transmitted
Infections (STIs) over sexually transmitted
diseases (STDs)
– STD is reserved for infections that cause symptoms
– STIs can be asymptomatic
• Some STIs are caused by bacteria (cured with
antibiotics), some caused by viruses (no cure, but
can often manage symptoms)
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Bacterial STIs: Chlamydia
• Chlamydia is the most common (highest
prevalence) bacterial STI in Canada.
• Young heterosexual females and males aged
20–24 have the highest incidence in Canada.
– often asymptomatic
– may be mild discharge from vagina, penis, or anus
• Chlamydia can lead to pelvic inflammatory
disease (PID).
• Chlamydia can be treated with antibiotics.
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Bacterial STIs:
Gonorrhea
• Highest prevalence is in men who have sex with
men (MSM) and travelers who had sex abroad.
• Symptoms include
– yellow-greenish discharge from the vagina, urethra,
or anus
– throat pain in cases of oral gonorrhea
• It may cause pelvic inflammatory disease (PID)
in women and impede fertility.
• Gonorrhea can be cured by antibiotics.
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Bacterial STIs:
Syphilis
• Highest prevalence is in men who have sex with
men, travelers who had sex abroad, and those
that visit outbreak areas.
• Different stages of progression
– Primary syphilis: painless ulcers
– Secondary syphilis: rash on palms of hands, soles
of feet, and trunk
– Tertiary syphilis: affects blood vessels, heart, eyes
and brain
• Syphilis can be cured with injected antibiotics.
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Viral STIs: Herpes
• Herpes can be caused by two different but
closely related types of the herpes simplex
virus:
– HSV type 1 is found in orolabial and anogenital
areas.
– HSV type 2 is found in anogenital area.
• It is not a reportable disease in Canada.
– An estimated 13.6% of Canadians (2.9 million)
tested positive for HSV type 2.
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Viral STIs: Herpes
• A person can transmit the virus even if they are
asymptomatic.
– Symptoms include painful blisters.
– The virus remains in the body for life.
• Being infected may increase the risk of
contracting HIV and other STIs.
• Antiviral drugs can prevent or shorten outbreaks.
• Condoms can help with prevention but aren’t
100% effective.
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Viral STIs: Human Papillomavirus (HPV)
• More than 120 types of HPV have been
identified.
– More than 40 subtypes can be transmitted sexually.
• HPV is transmitted by skin-to-skin contact.
• HPV is not a reportable disease.
– Estimated to be the most prevalent STI in Canada.
– It is very common amongst university-aged people.
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Viral STIs: HPV
• “Low-risk” types of HPV can lead to genital
warts and low-grade genital diseases.
• “High-risk” types of HPV can lead to
precancerous lesions or cancers of the genitals,
mouth, or respiratory track.
• Three vaccines are approved for the prevention
of HPV infection in Canada.
– They prevent against high and low risk strains.
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Viral STIs: Human Immunodeficiency Virus
(HIV)
• It is most prevalent in men who have sex with
men, injection drug users, and persons from
countries where HIV is endemic.
• More than 63,000 Canadians are living with HIV
infection today, and approximately 2,400 new HIV
infections were reported in Canada in 2017.
– More than 28.7% of new infections in Canada occur in
heterosexual populations.
– 24.7% occur among women.
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Viral STIs: HIV
• HIV is transmitted when blood and bodily fluids
of an infected person come into contact with
the mucosa/bloodstream of an uninfected
individual.
• The virus can be transmitted by both sexual
and non-sexual means:
– Penile-vaginal and penile-anal intercourse are highrisk behaviours.
– Needle sharing, breastfeeding, occupational
exposure are other means of transmittal.
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Viral STIs: HIV
• Initial symptoms may be flu-like.
– If left untreated, immune function will become
compromised over time.
– If left further untreated, HIV will progress to AIDS
that could lead to death.
• Diagnosed by blood tests for antibodies to HIV.
– It may take up to three months to produce enough
antibodies to be identified
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Viral STIs: HIV
• ARV drugs must be taken with rigorous
consistency in order to be effective.
• ARV therapy can make the HIV-infected
individual’s viral load drop to such a low level
that she or he may become less infectious or
even non-infectious.
– It is not a cure for HIV, as the virus will return if
ARV is stopped.
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Viral STIs: HIV
• Treating HIV-infected mothers can prevent
mother-to-infant transmission.
• Post-exposure prophylaxis is available to
professionals (such as nurses or police officers)
who have been accidentally exposed to
contaminated blood or needles.
– administer ARV meds for prevention
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Viral STIs: Viral Hepatitis
• Hepatitis A:
– epidemic levels in “closed” communities such as prisons;
and contaminated food served in residential settings
• Hepatitis B:
– widespread among men who have sex with men;
injection drug users; and among people from countries
where the disease is prevalent or blood products are not
screened
• Hepatitis C:
– IV drug users; healthcare settings with poor infection
control and where blood products are not screened;
among HIV-positive men who have sex with men
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Viral STIs: Viral Hepatitis, cont’d
• Transmision
– Hep A: fecal-oral routes
– Hep B: sexual contact; IV drug use
– Hep C: blood contact
• Symptoms include jaundice and flu-like symptoms.
• Treatment/prevention
– Hep A: symptom specific treatments; vaccine available
– Hep B: antiviral drugs; vaccine available; safer IV use
– Hep C: antiviral drugs; safer IV use
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Other Genital Concerns:
Trichomoniasis
• It is a protozoan infection commonly spread
through sexual contact.
• It is uncommon in Canada.
– It is more common in parts of Africa.
• Symptoms include a yellowish discharge in
women. Many are asymptomatic.
– It can lead to infertility if left untreated.
• It is treated with an oral drug: metronidazole.
• Male and female condoms can help prevention.
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Other Genital Concerns: Pubic Lice and
Scabies
• Scabies and pubic lice are infestations of small
parasites.
• Infestations are uncommon in Canada.
• Transmission
– Direct sexual contact with infected people.
– Non-direct contact with contaminated sheets and
towels.
• Ointments and shampoos can treat the
parasites.
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Other Genital Concerns: Moniliasis
• Commonly referred to as candidiasis or thrush
is a vaginal yeast infection caused by the
overgrowth of naturally occurring vaginal
organisms.
• Symptoms include itchiness, odour, and
discharge.
• Oral or topical drugs are used to treat this
condition.
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Other Genital Concerns: Bacterial
Vaginosis (BV)
• BV is an overgrowth of bacteria that normally
live in the vagina.
– It is fairly common in pregnant women.
• It is not generally considered an STI.
– If left untreated, it could raise susceptibility to
other STIs.
• Treatment is oral drugs and/or nightly vaginal
insertion of drugs.
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STI Screening and STI Testing
• Screening means you test for an STI even in
the absence of symptoms.
– A couple might decide to be screened before
becoming sexually active together.
• Being tested for an STI means that you have a
reason to suspect you may have been exposed
to an infection.
• Some STIs cannot be detected by screening.
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Think about Sex
• Think in advance if you
want to be active with a
partner and to what
degree.
• Think about consent.
• Think about safer sex
practices.
• Think about sexual
pleasure and what that
means to you.
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• Think about the knowledge
that you need:
contraception, sexual
communication, etc.
• Use condoms!
• Get vaccinated!
• Take secondary prevention
measures such as
screening and testing.
• Check your partner’s
history.
22