1. November 18, 2013 Human Reproductive Health NURS 330

2. Week of 11/18/13 Reading for this week has been updated. Refer to the course website for more information. You are responsible for reading all assigned readings.

3. What is Sexuality? “The integration of the physical, emotional, intellectual and social aspects of sexual being in ways that are positively enriching and that enhance personality, communication, and love. Every person has a right to receive sexual information and to consider sexual relationships for pleasure as well as for procreation. “-WHO

4. What factors influence Sexuality?

5. 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

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

7. Sexual Response Cycle

8. 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

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

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

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

12. RESOLUTION – 4 TH STAGE FEMALEMALE Return to non-aroused state Refractory Period

13. 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

14. Sexual Dysfunctions

15. The persistent impairment of the normal patterns of sexual interest or response. (WHO) Four categories Sexual Desire Disorders Sexual Arousal Disorders Orgasmic Disorders Sexual Pain Disorders

16. Prevalence

17. 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

18. 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

19. 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

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

21. Sexual Dysfunctions - Differences in Men and Women FemaleMale Sexual Aversion Disorder Dyspareunia Dyspareunia (rare in men) VaginismusPremature Ejaculation Female Orgasmic DisorderMale Orgasmic Disorder Hypoactive Sexual Desire Disorder Female Sexual Arousal Disorder Male Erectile Disorder

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

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

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

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

26. Effects of Rape Drugs Drowsiness Disorientation Disinhibition Amnesia

27. INFERTILITY

28. 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

29. 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

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

31. Age and Infertility Females 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. More likely to have health problems that may interfere with fertility

32. Chances of Pregnancy by Age AgeFertility % Up until 3490% By age 40Declining to 67% By age 45Declining to 15%

33. Causes of Female Infertility Aging Disorders of Ovulation Damage of the Fallopian Tubes Uterine Fibroids Endometriosis

34. Aging Fertility begins to decline when a woman is in her mid-30s About 10 years before menopause Decrease in ovarian function Reduction in ovaries Increased chromosomal abnormalities Increase in miscarriages

35. Ovulation Disorders Responsible for approx. 25% of female infertility problems Anovulation Oligoovulation

36. Damage to Fallopian Tubes Pelvic Inflammatory Disease (PID) Most common cause

37. 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).

38. PID (cont) Causes of PID Untreated/uncured bacterial infection Most common chlamydia (about 75% of cases) Second most common cause is gonorrhea.

39. Uterine Fibroids Occurs in one in every four or five American women Benign tumors Can cause excessive uterine bleeding and pain Interferes with ovum implantation Compresses the opening of the fallopian tubes

40. Endometriosis Uterine lining grows outside the uterine cavity 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 Some have no symptoms Pain before, during and after the menstrual period Pain during sexual intercourse Spotting (bleeding between periods) Cause is unknown Possible defects in immune system

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

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

43. Male Infertility Affect sperm quality and quantity Includes problems with: Sperm production Blockage of sperm-delivery system Presence of antibodies against sperm Testicular injury Anatomic abnormalities Varicocele

44. Male Infertility Over 90% of cases are due to: Low sperm count Poor sperm quality Motility Morphology Both 30 - 40% of cases have an unknown cause

45. 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

46. 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

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

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

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

50. 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

51. Video In-Class Assignment