Reproductive Health
Methods of Fertility Management
• Conception
▫ Occurs when a viable ovum is fertilized by a viable
sperm
• The following conditions are necessary for
conception
▫ A viable egg (ovum)
▫ A viable sperm
▫ Access to the egg by the sperm
Methods of Fertility Management
• Contraception (birth control)
▫ Refers to methods used to prevent conception
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Barrier methods
Hormonal methods
Surgical methods
Other methods
 Abstinence
 Fertility patterns
Barrier Methods
• Physical or Chemical barriers
▫ Physical barriers- condoms (male and female),
diaphragm, cervical cap, sponge
▫ Chemical barriers- creams, foams, jellies,
spermicides, films
Barrier Methods
• The Male Condom
▫ A thin sheath that covers the penis to catch semen
before it enters the vagina
▫ Available in latex, polyurethane, or lambskin
▫ Must be used for vaginal, oral, or anal intercourse
▫ Never use
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Baby oil
Cold cream
Petroleum jelly
Vaginal yeast infection meds
Hand or body lotion with a condom
▫ Can be up to 98% effective with proper use
Barrier Methods
• The Female Condom
▫ Meant for internal use
▫ Provides protection against conception,
contraction of HIV and STIs
▫ Can be up to 95% effective with proper use
▫ Can be used by either gender for anal intercourse
▫ As with the male condom, there is always
potential for user error including possible
breaking, slipping, or leaking
Barrier Methods
• Jellies, Creams, Foams, Suppositories, and Film
▫ Spermicides
 Substances designed to kill sperm
 Do not require a prescription
 Jellies, creams, and foams have tubes designed to
insert into the vagina, and must be inserted far
enough to cover the cervix
 Suppositories and vaginal film are other available
methods
 Generally not effective in preventing contraction of
STIs
 Recommended as a secondary form of contraception
for use with another product, generally a condom
Hormonal Methods
• Hormonal Contraception
▫ Contains synthetic estrogen and/or progestin
▫ Introduced into a woman's system to prevent
ovulation or fertilized egg from implanting
▫ Does not protect against STIs
▫ Available in transdermal, injection, and oral
forms
▫ Requires a prescription
▫ Antibiotics diminish the contraceptive's
effectiveness
Hormonal Methods
• Oral Contraceptives
▫ Prevents ovulation
▫ Combination of synthetic estrogen and
progesterone
▫ Must be taken daily
▫ May help lessen menstrual difficulties
▫ Possible health problems
 Blood clots, stroke, heart attack, high blood pressure
▫ 99.7% effective with perfect use and 92% effective
with typical use.
Hormonal Methods
• Progestin-Only Pills
▫ Contains small doses of synthetic progesterone
and no estrogen
▫ Taken continuously (no placebo pills)
▫ Good choice for women who are at high risk for
estrogen-related side effects or have diabetes,
high blood pressure, or cardiovascular conditions;
are older than age 35; or are breast-feeding
▫ Side effects include irregular menstrual bleeding
or spotting, mood changes, changes in sex drive,
and headaches.
▫ Important they be taken at the same time each
day
Hormonal Methods
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Ortho Evra (the patch)
NuvaRing
Depo-Provera
Implanon and other Implants
Intrauterine Contraceptives
• Women have been using IUDs since 1909
• Small plastic, flexible devices that are placed in
the uterus and left there for up to 10 years
• Exact mechanism not clearly understood
• ParaGard
• Mirena
Emergency Contraception
• The use of contraceptive to prevent pregnancy
after unprotected intercourse
• Most effective up to 72 hours after a condom
breaks, sexual assault, or unprotected sex
• 2006, FDA approved Plan B, without a
prescription
• 14% of sexually active college students reported
using it within the past school year
Behavioral Methods
• Withdrawal (coitus interruptus)
▫ “Pull out and pray”
 Removing the penis from the vagina just prior to
ejaculation
 Highly unreliable, offers no protection against STIs
▫ Abstinence and “Outercourse”
 Deliberately avoiding intercourse
 Massaging, kissing, solitary masturbation
 Only method that is 100% effective against pregnancy
and STIs
Behavioral Methods
• “Outercourse”
▫ Includes oral/genital sex and mutual
masturbation
▫ Can be 100% effective against pregnancy if male
does not ejaculate near the vaginal opening
▫ Not effective against STIs because of possible
oral/genital contact
▫ Can be made safer through use of male and
female condoms
Behavioral Methods
• Fertility Awareness Methods
▫ Cervical Mucus Method
 Check color and consistency to determine fertile
times
 Avoid sexual activity when mucus is present and for
several days afterward
▫ Body Temperature Method
 Basal body temperature rises between .4 and .8
degrees after ovulation
 Abstain from sexual activity before the temperature
rise until several days after the temp rise is observed
▫ Calendar Method
 Assumes that ovulation occurs during the midpoint of
the cycle
The Fertility Cycle
Surgical Methods
• Female Sterilization
▫ Permanent fertility control
 Tubal ligation
 Hysterectomy
▫ Rare side effects
• Male Sterilization
▫ Vasectomy
▫ Can be reversed in most cases
▫ Rare side effects
Female and Male Sterilization
Choosing a Method of Contraception
• How comfortable would I be using a particular
method?
• Will this method be convenient for me and my
partner?
• Am I at risk for the transmission of STIs?
• Do I want to have biological child in the future?
• How would an unplanned pregnancy affect my
life?
Video
• Cost of birth control
• Should state or government money be used to
subsidize birth control for college student? For
people on welfare? For people without
insurance?
Planning a Pregnancy
• Emotional Health
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Why have a child?
Ready to make sacrifices?
Can you be loving and nurturing?
If yes, start preparations: read about parenting,
take classes, talk to parents, or join a support
group
• Maternal Health
▫ Preconception care
• Paternal Health
Planning a Pregnancy
• Financial Evaluation
▫ Can you afford the life you'd like for yourself and
your child?
▫ USDA estimate it can cost as much as $250,000
for a married, middle-class couple to raise a child
to age 17 (does not include college tuition)
▫ Cost and availability of child care
Pregnancy
• Prenatal Care
▫ Nutrition and Exercise
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Additional protein, calories, vitamins and minerals
Recommended normal weight gain is 25 to 35 lbs
Obese women to gain 15 to 25 lbs
Underweight women to gain 28 to 40 lbs
▫ Drugs and Alcohol
 First trimester fetus vulnerable to teratogenic effects
of drugs, chemicals, X rays, and diseases
 Fetal alcohol syndromes include mental retardation,
slowed nerve reflexes, and small head size
Pregnancy
• Smoking
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Premature birth
Low birth weight
Stillbirth
Infant mortality
Cleft lip and palate
• Other Teratogens
▫ Avoid Xrays, toxic chemicals, heavy metals,
pesticides, and gases
▫ Do not clean cat litter boxes
 Toxoplasmosis
Pregnancy
• Maternal Age
▫ A decline in both the quality and viability of eggs
after age 35
▫ Increases the incidence of Down syndrome
• Prenatal Testing and Screening
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Ultrasonography or ultrasound
The triple marker screen (TMS)
Amniocentesis
Chorionic villus sampling (CVS)
• Pregnancy Testing
▫ Psitive test for pregnancy is based on the
secretion of human chorionic gonadortropin
(HCG)
Fertilization
Pregnancy
• The process of Pregnancy
▫ Early signs of pregnancy
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Missed period, although spotting may occur
Breast tenderness
Emotional upset
Extreme fatigue
Nausea and vomiting (morning sickness)
Sleeplessness
Changes in a Woman's Body during
Pregnancy
The Process of Pregnancy
• First Trimester
▫ Few noticeable changes in woman's body
▫ May urinate more often and morning sickness
▫ Embryo differentiates and develops organ
systems
▫ At the start of third month the embryo is called a
fetus indicating all organ systems are in place
• Second Trimester
▫ Placenta- the network of blood vessels connected
to umbilical cord that carries oxygen and
nutrients from mother to fetus and fetal waste
products to mother becomes well established.
The Process of Pregnancy
• Third Trimester
▫ Greatest fetal growth, gains most of its weight
▫ Fetus must get large amounts of calcium, iron,
and nitrogen from mother's food intake
▫ Fat layer develops in eighth month
▫ Respiratory and digestive organs need further
development to avoid complications
The Birth Process
Childbirth
• The Postpartum Period
▫ 4-6 weeks after delivery
▫ Women experience fluctuating emotions
▫ Postpartum depression
 Affects about 10% of new mothers
 Disabling mood swings, no energy, crying, guilt,
depression
 Should seek professional help
Childbirth
• Breast-Feeding
▫ Colostrum
 Secreted first few days before milk “come in”
 Contains vital antibodies necessary to help baby fight
potential infections
▫ American Academy of Pediatrics recommends
breast-feeding for 6 to 12 months
▫ Advantages of breast-feeding
 Babies have fewer illnesses and recover more
quickly when ill
 Children less likely to be obese
 Children have fewer allergies throughout
their life
Sexually Transmitted Infections
• Also called STDs, once called venereal diseases
VD
• More than 20 known types of STIs
• Can be eliminated through education,
responsible action, simple preventive strategies,
and prompt treatment
• What's your risk?
▫ Moral and social stigma can keep infected people
from seeking treatment
▫ Casual attitude toward sex
▫ Ignorance about infections/symptoms
STIs
• Routes of Transmission
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Sexual intercourse
Oral-genital contact
Hand-genital contact
Anal
Mouth-to-mouth contact
Contact with fluids from body sores
STIs
• Chlamydia
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2.2 million infected annually in the US
Many people display no symptoms
Secondary damage can lead to sterility
Chlamydia may be responsible for one type of
conjunctivitis, an eye infection
 If you play with yourself, you'll go blind
▫ If detected early, it is easily treatable with
antibiotics
STIs
• Gonorrhea
▫ One of the most common STIs in the US
▫ CDC estimates over 700,000 cases per year
▫ Caused by bacterial pathogen Neisseria
gonorrhoeae
▫ If detected early, it is easily treatable with
antibiotics
STIs
• Syphilis
▫ Caused by a bacterial organism
▫ Spirochete known as Treponema pallidum
▫ “Great Imitator;” symptoms often resemble other
STIs
▫ Stages
 Primary, seondary, latent, tertiary/late
▫ Easily treated with antibiotics except in the late
stage
STIs
• Herpes
▫ Herpes simplex type 1 and 2
▫ Especially serious in pregnant women; possible to
transfer infection to baby during birth
▫ Women with herpes have a greater risk for
cervical cancer
• Preventing Herpes
▫ Awareness
▫ Extreme caution in casual sexual affairs
▫ Seek medical help
STIs
• Human Papillomavirus (HPV) and Genital
Warts
▫ Over 100 types of HPV
▫ Infect over 6.2 million Americans each year
▫ Certain types of HPV can cause genital warts
• HPV vaccination
▫ Recommended for girls and women aged 9 to 26
STIs
• Candidiasis (Moniliasis)
▫ Yeastlike fungus caused by Candida albicans
▫ Symptoms include severe itching, burning, and
swelling
▫ Antifungal drugs can cure candidiasis in just a few
days
• Trichomoniasis
▫ Caused by a protozoan
▫ Half of all American men and women carry this
organism
▫ Many remain symptom free
STIs
• Pubic Lice
▫ Informally called “crabs”
▫ Symptoms include itchiness in the pubic hair,
bluish gray skin color, and sores in the genital
area
▫ Treatment includes thorough washing on
clothing, furniture, and linens
▫ Takes 2-3 weeks to kill all larval forms
HIV/AIDS
• Acquired Immunodeficiency Syndrome (AIDS)
• Human Immunodeficiency Virus (HIV)
▫ At the end of 2008, there were approximately
33.4 million people worldwide living with HIV
▫ 95% of people with HIV worldwide live in
developing nations
HIV/AIDS
• How HIV is Transmitted
▫ Engaging in high risk behaviors
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Exchanging of body fluids
Injecting drugs
Having received a blood transfusion prior to 1985
Mother-to-child (perinatal) transmission
Gender and Health
• Women and AIDS
▫ Women are twice as likely than men to contract
HIV through unprotected sexual intercourse
▫ Underrepresented in clinical trials for treatment
and prevention
▫ Cultural barriers can prevent women from being
involved in decision making related to sexual
matters
HIV/AIDS
• Symptoms of HIV/AIDS
▫ Incubation time varies greatly
▫ For HIV + adults who receive no medical
treatment, AIDS will develop in 8 to 10 years
▫ Opportunistic infections are characteristic of the
disease
 Karposi's Sarcoma
HIV/AIDS
• Testing for HIV Antibodies
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Blood test known as ELISA
Wsetern blot test follows 2 positive ELISA tests
These tests detect antibodies
Whether a person with HIV develops AIDS
depends to some extent on the strength of that
person's immune system
▫ A cure does not exist