1015 (1)

• The final exam is cumulative and covers concepts from the entire course.
• The exam is out of 100 points.
• The exam includes 70 multiple-choice questions worth 1 point each.
• There are 5 multiple-select questions worth a total of 10 marks.
• There are 8 matching questions which are worth 0.25 marks each.
• There are 8 fill-in-the-blank questions which are worth 1 mark each.
• There are 2 short answer questions worth 5 marks each.
• Finally, there are 2 bonus questions worth 1 mark each.

Interpersonal Violence (IPV)

• Violence is the intentional use of physical force or power, whether threatened or actual, against oneself, another person, or a group/community.
• Violence can result or have a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.
• Interpersonal violence occurs when a violent act occurs between persons.
• IPV is not just physical threats/force but emotional abuse and neglect.

Examples of IPV

• Child abuse and neglect
• Elder abuse and neglect
• Youth violence
• Bullying
• Sexual violence

Results of IPV

• Physical consequences like injury, pregnancy, death, and chronic health issues
• Psychosocial consequences like PTSD, depression, learning, social, and cognitive function delays, behavioral issues, and aggression/violence and criminal behavior

Risk Factors for IPV

• Everyone is at risk for IPV
• Populations at risk include infants and children, older adults, and members of the LGBTQ community.
• Individual risk factors include substance use, mental health conditions, neurobiology and genetics, childhood exposure to violence, and sociocultural factors.

Sexuality

• Sexuality is central to being human throughout life.
• Sexuality includes sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction.
• Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles, and relationships.
• Sexuality does not always have to be experienced or expressed.
• Sexuality is influenced by biological, psychological, social, economic, political, cultural, legal, historical, religious, and spiritual factors

Sexual Health

• Sexual health is a state of well-being related to sexuality across the lifespan that involves physical, emotional, mental, social, and spiritual dimensions.
• An intrinsic element of human health is sexual health and it is based on a positive, equitable, and respectful approach to sexuality, relationships, and reproduction, free of coercion, fear, discrimination, stigma, shame, and violence.

Primary Prevention of Sexual Health

• Patient education
• Condom use
• Safe-sex practices
• HPV vaccine

Secondary Prevention (Screening) of Sexual Health

• Screening for sexually transmitted and blood-borne infections (STBBIs)
• Screening for intimate partner violence
• Cervical cytologic screening (Pap test)
• HIV screening

Reproduction

• Reproduction is the total process by which organisms produce offspring

Primary Prevention of Optimal Reproduction

• Health education
• Safe sex
• Contraception
• Avoidance of smoking, alcohol, and drug use
• Nutrition
• Exercise

Secondary Prevention/Screening of Optimal Reproduction

• Prenatal care monitors the pregnancy's progress and allows early detection of problems.
• Procedures include monitoring weight gain, blood pressure, fundal height, edema, and fetal heart sounds.
• Laboratory screening includes urine for protein, Rh factor, rubella titer, and blood glucose levels.

Human Papillomavirus (HPV)

• HPV is a prevalent viral STI seen in ambulatory health care settings
• HPV was previously called genital or venereal warts.
• Pre-existing lesions from HPV may enlarge during pregnancy.
• Most HPV infections, nine out of ten, go away on their own within two years.
• Sometimes HPV infections can cause cancers of the cervix, vagina, and vulva in women, penis in men, and anus and back of the throat in both women and men

HPV Infections

• HPV infections are very common.
• Nearly all men and women get at least one type of HPV in their lives.
• About 14 million Americans, including teens, become infected each year.
• HPV spreads through intimate skin-to-skin contact, including vaginal, anal, and oral sex with someone who has the virus.

HPV Vaccine

• The CDC recommends all boys and girls get two doses of the HPV vaccine at ages 11-12, starting as early as age 9, ideally before exposure to HPV.
• HPV vaccination is recommended through age 26 for those not already vaccinated.
• Vaccination is not recommended for everyone older than 26, as it provides less benefit due to prior exposure.
• Some adults aged 27-45 who are not already vaccinated may decide to speak with their doctor about the risk.
• Common side effects are usually mild include like mild pain, redness, or swelling in the arm where the shot was given, dizziness or fainting, nausea, and headache
• The benefits outweigh the potential risk of side effects

Pap Tests

• A Pap test is a simple test that removes a small sample of cells from the surface of the cervix.
• The cells are examined to see if the cells look normal.
• The Pap test can find abnormal changes in cells early, before cancer develops.
• Pap tests can find cell changes at an early stage.
• Pap tests can find most cell changes, but no screening test is perfect, so repeat tests ensure accuracy.
• Approximately one in ten women may have an abnormal result.
• If a Pap test is abnormal, it does not mean that the person has cancer.
• A doctor or nurse should follow every person with an abnormal Pap result.

Contraception

• Contraception is a mechanism to prevent unwanted pregnancies
• Methods necessitate healthcare intervention/prescription
• Nonprescription/over the counter contraceptive methods are available

Hormonal Contraception

• Oral contraceptive pill
• Contraceptive patch
• Vaginal ring
• Intrauterine contraception (IUC)
• Injectable contraception

Non-Hormonal Contraception

• Male condom
• Female condom
• Sponge
• Cervical cap
• Diaphragm
• Spermicides
• Vasectomy
• Tubal ligation and tubal occlusion
• Intrauterine contraception (IUC)

Natural Methods for Contraception

• Fertility-awareness based methods
• Lactational amenorrhea method
• Withdrawal
• Abstinence

Emergency Contraception

• Emergency contraception may be considered if a birth control pill was missed, patch or injection, no contraception was used, there was non-consensual sexual intercourse (sexual assault, rape), the condom slipped, broke, or leaked, or if there was an error in the calculation of the fertility period
• In Canada, there are two types of emergency contraception pill (ECP): progestin ECP (e.g., Plan B), taken within 72 hours of sexual activity, and ulipristal acetate ECP (e.g., Ella), with the later more effective than progestin if it has been >72 hours
• ECPs are intended for occasional use only, and they are not a regular method of birth control.
• A copper IUD can be inserted up to 7 days post-sexual activity

Abortion

• There are no legal restrictions on abortion in Canada
• Abortion is a fully funded procedure in some provinces.
• 60% of abortions are performed in abortion clinics, while the remainder occur in hospitals, with the exception of Prince Edward Island, where they are offered through Sexual Health, Options & Reproductive Services (SHORS)
• Abortion is influenced by personal values

Sexually Transmitted Infections (STIs)

• STIs include more than 25 infectious organisms that are sexually transmitted
• Prevention includes changing behaviors, identifying risk factors, and using techniques for effective counseling

Safer Sex Practices for STIs:

• Safer sex practices
• Abstinence from activities with fluid exchange
• Avoid anal-oral, anal-genital intercourse, anal-digital activities, practices that increase tissue damage, and direct contact with lesions
• Knowledge of partner's STI status and appropriate follow-up after sex
• Condom use requiring male adherence, negotiation of use, and female condom

General STIs Include

• Chlamydia
• Gonorrhea
• Syphilis
• Human papillomavirus (HPV)
• Human immunodeficiency virus (HIV)

Chlamydia

• Most common and fastest spreading STI
• Infections often silent and highly destructive.
• Difficult to diagnose, females have two times the rate of males
• Screening includes asymptomatic and pregnant women
• Comparisons of diagnostic procedures

Gonorrhea

• Gonorrhea is aka "the clap" or "the drip"
• Incidence on the rise in Canada
• Symptoms in women are often asymptomatic, leading to menstrual irregularities and rectal complications
• Gonorrhea is caused by Neisseria gonorrhoeae
• Transmission can be genital to genital, oral to genital, or anal to genital
• Treatment includes antibiotic therapy

Syphilis

• Caused by Treponema pallidum, a motile spirochete
• Transmission is by entry in subcutaneous tissue through microscopic abrasions that can occur during sexual intercourse, including vaginal, oral, or anal sexual contact
• Transplacental transmission may occur at any time during pregnancy
• Syphilis can lead to serious systemic disease and even death.
• The primary stage of syphilis occurs within 3 to 90 days, with painless sores near where syphilis enters the body
• The secondary stage occurs within 2 to 6 months, with sores spreading and becoming rash-like
• The latent stage may have no visible symptoms
• The tertiary stage occurs 10-30 years after infection, resulting in internal organ damage and potentially death
• Screening and diagnosis should be done in pregnant women using serological tests
• False positives are possible
• Management includes penicillin
• Sexual abstinence during treatment

Human Immunodeficiency Virus (HIV)

• HIV is a sexually transmitted viral infection
• HIV is a retrovirus found in blood, semen, rectal fluid, vaginal secretions, and breast milk
• Perinatal/vertical transmission: HIV infected pregnant people pass the infection to their children
• Horizontal Transmission: Through intimate sexual contact or parenteral exposure to blood or body fluids containing visible blood
• Diagnosis: ELISA (HIV enzyme-linked immunosorbent assay & Western blot immunoassay)
• Management: Includes nutritional support and symptomatic treatment, as well as slowing the growth of the virus, preventing and treating opportunistic infections,
• Treatment: Antiretroviral medications