1. NURS 330 November 7, 2011

2. Abortion Spontaneous abortion Induced abortion aka miscarriage
Loss of baby before 20 weeks of pregnancy
Induced abortion
Surgical
Drug-based

3. Surgical Method Vacuum Aspiration Dilation and Extraction (D & X)
First trimester method
Dilation and Extraction (D & X)
Late surgical method

4. Drug-Based Methods Mifepristone (RU 486) –Injection, 0rally
An anti-progesterone
prevents progesterone from making uterine lining hospitable for implantation
If fetus is already implanted, causes the uterus to shed its lining and, along with it, the fertilized fetus
Approved by FDA in September 2000 for abortion
As an alternative to surgical procedure
Effectiveness is increased if used with another drug, Misoprostol (95-98%)
Most effective within 7 weeks of fertilization

5. Drug-Based Methods (cont)
Methotrexate –Injection; orally (rarely)
Prevents cell division and multiplication
Can be used to induce an abortion
Effectiveness is increased if used with another drug, Misoprostol (95%)
Approved by FDA for treatment of cancer, arthritis and psoriasis
Most effective within 7 weeks of fertilization
Misoprostol – orally or vaginally
Legal Drug used in conjunction with above drugs
The second drug used to complete the abortion procedure
Taken a day or two after administration of the first drug
Causes the uterus to contract and expel its contents
Approved in the US for coating the stomach of people who take stomach-irritating anti-inflammatory drugs.

6. Abortifacient
A method or substance that causes a fertilized egg that has implanted in the uterine wall or fetus to be expelled.
Which of the drug-based methods is an abortifacient?

7. Incidence of Abortions
Nearly half of pregnancies among American women are unintended, and four in 10 of these are terminated by abortion.
Twenty-two percent of all pregnancies (excluding miscarriages) end in abortion.
In 2005, 1.21 million abortions were performed, down from 1.31 million in From 1973 through 2005, more than 45 million legal abortions occurred.
Each year, about two percent of women aged have an abortion; 47% of them have had at least one previous abortion.
Source: Perspectives on Sexual and Reproductive Health

8. Cost Surgical Drug-based
In 2005, the cost of a non-hospital abortion with local anesthesia at 10 weeks’ gestation ranged from $90 to $1,800; the average amount paid was $413
(Source: Perspectives on Sexual and Reproductive Health)
Drug-based
most providers do charge more for this method

9. Abortion and the Law Roe v. Wade 1973 Supreme Court decision stating
1st trimester abortions cannot be regulated by states and the decision to abort is between woman and physician
2nd trimester abortions permitted when mental or physical health of mother at risk
3rd trimester abortions allowed when life of mother at risk

10. Source: Alan Guttmacher Institute
California Law
California does not have any of the major types of abortion restrictions – such as waiting period, mandated parental involvement or limitations on publicly funded abortions – often found in other states.
Source: Alan Guttmacher Institute

11. The Pro-Life and Pro-Choice Controversy
Anti-abortion (Pro-life) position
Pro-choice position

12. What is Sexuality?

13. What factors influence Sexuality?
Values
Attitudes
Behaviors
Physical Appearance
Beliefs
Emotions
Personality
Likes/Dislikes
Spirituality
Other
Source:

14. The Senses and Sexuality
Touch
Smell
Sound
Sight

15. Smell Smell Odors play a role in sexual arousal Pheremones
Perfumes
Colognes
Debate about its existence
i.e. menstrual synchrony
Not all odors are conducive to sexual arousal
Offensive odors

16. Sound Sound Auditory stimuli
Your partner’s voice
Romantic or sexy music
Love-making sounds
Not all sounds are conducive to sexual arousal

17. Sight
Sight
Allows us to experience many images that can trigger feelings of sexual arousal
Viewing an “attractive” person
Subject to social and cultural influences
Erotic images
Sometimes even parts of one’s genitals

18. Which sense is this?
Does not appear to play a significant role in sexuality.

19. Female Ejaculation
Does it exist?

20. Terms to know
Erogenous zones
Kegel Exercises
Aphrodisiacs
Pheremones

21. Definition Erogenous Zones Kegel Exercise
parts of the body that, when stimulated, elicit sexual arousal
Kegel Exercise
Recommended to reduce urinary incontinence and possibly increase sexual pleasure
Identify the muscle by stopping urination in midstream

22. Definition Aphrodisiacs Pheromones
Agents that show any ability to enhance sexual functioning
Pheromones
Substances that when secreted have a particular smell found to be sexually arousing.

23. 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

24. FACT
A person’s emotional and mental states also help determine whether that person experiences arousal

25. Models of Human Sexual Response
Master’s and Johnson
Proposed their four-stage model of human sexual response cycle
Stage I - Excitement
Stage II - Plateau
Stage III - Orgasm
Stage IV - Resolution

26. EXCITEMENT- 1ST STAGE: Response to stimuli Transudation Vasocongestion
FEMALE
MALE
Transudation
Vasocongestion
Tenting Effect
HR, BP, RR
Myotonia
Penile Erection
Testis enlarge
RR – Respiratory Rate; BP – Blood Pressure; HR – Heart Rate

27. PLATEAU – 2ND STAGE Orgasmic Platform Tenting Effect Seminal Pool
FEMALE
MALE
Orgasmic Platform
Tenting Effect
Seminal Pool
Erection is maintained (if there is enough stimulation)
Cowper’s Gland secretes fluid

28. ORGASM – 3RD STAGE Muscle spasms Involuntary
FEMALE
MALE
Muscle spasms
Involuntary
Collection of semen in the urethral bulb
Ejaculatory Invariability
-bulbocavernosus muscle
Expulsion of semen

29. RESOLUTION – 4TH STAGE Return to non-aroused state Refractory Period
FEMALE
MALE
Return to non-aroused state
Refractory Period

30. 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

31. Sexual Dysfunctions
Recurrent or persistent sexual problems that interfere with normal performance and cause distress
Nine types of sexual disorders
Four categories
Sexual Desire Disorders
Sexual Arousal Disorders
Orgasmic Disorders
Sexual Pain Disorders

32. Prevalence

33. 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

34. 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

35. Orgasmic Disorders Female orgasmic disorder (anorgasmia)
Recurrent problem with reaching orgasm despite adequate erotic stimulation
Male orgasmic disorder
Delay or inability to reach orgasm during sexual activity
Premature ejaculation
Persistent or recurrent ejaculation following minimal stimulation and before the person wishes it

36. Sexual Pain Disorders Dyspareunia Vaginismus
Recurrent genital pain during sexual intercourse
Vaginismus
Persistent involuntary spasms of vaginal muscles, which interfere with sexual intercourse

37. Sexual Dysfunctions - Differences in Men and Women
Female
Male
Sexual Aversion Disorder
Dyspareunia
Dyspareunia (rare in men)
Vaginismus
Premature Ejaculation
Female Orgasmic Disorder
Male Orgasmic Disorder
Hypoactive Sexual Desire Disorder
Female Sexual Arousal Disorder
Male Erectile Disorder

38. General Causes Physiological/Biological Psychological/Emotional
Medication and illicit drugs
Psychological/Emotional
Anxiety
Negative beliefs
Sexual trauma
Interpersonal/Social
Relationship problems
Environmental
Cultural factors

39. Treatment of Sexual Dysfunctions
Medical treatment of sexual dysfunctions
Sex therapy

40. Medical Treatment Viagra FDA approval in March 1998 Prescription only
Lasts about four hours
Side effects
Short duration

41. Sex Therapy Principles of sex therapy
Mutual responsibility is emphasized
Information and education are integral components
Attitudes, expectations, and sexual scripts usually must be modified

42. Sexual Orientation Sexual orientation Asexual
Erotic and romantic attraction to one or both sexes
Asexual
No erotic or romantic interest

43. Sexual Orientation Homosexual Heterosexual Bisexual Same sex
Opposite sex
Bisexual
Both sexes

44. Defining Terms
Sex
Gender
Gender Roles

45. What Is Sexual Harassment?
Sexual advances that are unwelcome and/or other sexually related behaviors that are hostile, offensive, or degrading

46. Two types of Sexual Harassment
Quid pro quo harassment
Employee is expected to exchange sexual favors in return for keeping job or getting promotion
Hostile environment harassment
Unwanted behavior of a sexual nature creates a hostile or offensive work atmosphere

47. Sexual Harassment can occur at……..
Schools
College campuses
Workplace
Family member’s home
Public places

48. Examples of Harassment
Uninvited or deliberate touching
Uninvited sexually suggestive looks or gestures
Cornering or pinching
Unwelcome sexual advances
Demands for sexual favors
Degrading sexual remarks
Groups of one sex making jokes about the opposite sex
Persons in positions of leadership taking advantage of their position with sexual threats
Inquiries about sexuality

49. What to do if you feel you are being sexually harassed
At work:
1. Let the person know that their behavior is inappropriate and ask them to stop
2. Keep a written record of events
3. Notify your supervisor immediately
4. Follow the complaint process/policy
At school/on campus:
- 1 & 2 above
- Notify appropriate individuals on campus
- Contact the public safety office on campus -
- (323)
Other resources

50. Rape Drugs What is a Rape Drug?
A rape drug is one that is used in a drug
facilitated sexual assault.

51. Rape Drugs (cont) The most common rape drugs: Odorless, colorless
Rohypnol
GHB
Other common rape drugs
Ecstasy
Ketamine
Odorless, colorless
Easily dissolved into drinks

52. Effects of Rape Drugs
Drowsiness
Disorientation
Disinhibition
Amnesia

53. 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

54. Causes of infertility Both men and women contribute to infertility
90% of cases, cause will be known
Each gender contributes 40%
Both contribute 10%
Remaining 10% of cases, cause remains unknown
Males
Usually due to sperm defect
Females
More complex

55. Risk Factors Some common risk factors Age Weight Lifestyle
Occupational and Environmental risks
Stress and Emotional factors
Genetic conditions??

56. Age and Infertility Females Males
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.

57. Chances of Pregnancy by Age
Fertility %
Up until 34
90%
By age 40
Declining to 67%
By age 45
Declining to 15%

58. Causes of Female Infertility
Common causes
Blocked Fallopian Tubes
Pelvic Inflammatory Disease
Endometriosis
Ovulation disorders
Others

59. 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).

60. PID (cont) Causes of PID Untreated/uncured bacterial infection
Most common chlamydia (about 75% of cases)
Second most common cause is gonorrhea.
Other Causes
Non-sterile abortions
Cervicitis (usually from genital herpes infection)
Other vaginal infections (bacterial vaginosis, trich)
Ruptured appendix
Childbirth

61. Endometriosis
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.
These implants respond to hormonal changes, slowly increasing in number and size with each menstrual cycle
Eventually causes scarring and inflammation
Symptoms
Often causes no symptoms
Painful periods, painful sex, painful bowel movements
Cause is unknown
Possible defects in immune system

62. Endometriosis and infertility
Endometrial cysts in the fallopian tubes may cause blockage
Scar tissue between uterus, ovaries and fallopian tubes
Poor egg implantation

63. Female Infertility- Other possible causes
Ovulation Disorders
Hormone Disorders
Hypothalamic-Pituitary Disorders
Polycystic Ovarian Disease/Syndrome
Thyroid
Other
Ovarian Cysts
Benign Uterine Fibroids
Ectopic pregnancies, medical conditions, medications

64. Male Infertility Over 90% of cases are due to:
Low sperm count
Poor sperm quality
Motility
Morphology
Both
% of cases have an unknown cause

65. 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

66. 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

67. Varicocele

68. Other causes of sperm defect
Testosterone Deficiencies
Autoantibodies
Retrograde Ejaculation
Physical and Structural abnormalities
Cancer and its treatments
Infections
Other medical conditions
Medications

69. Testing for Infertility - males
Sperm evaluation
Hormone tests
Ultrasound

70. Testing for Infertility – females
Ovulation Assessment
Body temperature
Cervical mucus assessment
Hormone Analysis
Laparascopy
Check vagina for naturally occurring sperm antibodies

71. Infertility Treatment
Artificial Insemination
Drug therapy
Clomid
In Vitro Fertilization (IVF)

72. Infertility Treatment
Gamete Intrafallopian Transfer (GIFT)
Both egg and sperm inserted into Fallopian tube
Zygote Intrafallopian Transfer (ZIFT)
Fertilized outside body and inserted into Fallopian tube
Intracytoplasmic Sperm Injection (ICSI)
Direct injection of sperm into egg in lab

73. In-Class Assignment