Reproductive Health.pptx

 Reproductive Health It is defined as the total well-being in all aspects of reproduction, i.e, physical, emotional, social and behavioural. Thus, a reproductively healthy society consists of people having physically and functionally normal reproductive organs, and normal emo...

 Reproductive Health It is defined as the total well-being in all aspects of reproduction, i.e, physical, emotional, social and behavioural. Thus, a reproductively healthy society consists of people having physically and functionally normal reproductive organs, and normal emotional and behavioural interactions in all sex related aspects. India as a country ensures reproductive health to all, and since 1951, successive governments have introduced a number of programmes to ensure this, e.g., family planning and RCH (Reproductive and Child Healthcare) programmes. The major tasks of RCH are: – To create awareness among people about the various reproduction related aspects. – To provide facilities and support for building up a reproductively healthy society. Several audio-visual aids and pamphlets have been developed by both governmental and non-governmental organisations. Awareness is being created among school children by introducing sex education in schools. It is essential to provide medical assistance to people with problems related to STDs, pregnancy, contraception and infertility, especially in villages.  Population Explosion The tremendous increase in size and growth rate of population is called population explosion. Improvement in the quality of life due to all-round development (better health facilities and improved conditions of living) has lead to a large increase in the world population (around 1 billion in the year 2000). The causes of population explosion are: – Decline in death rate (including maternal mortality rate and infant mortality rate). – Increase in the number of people in the reproducible age. Population explosion causes a scarcity of every basic need. Therefore, it has become essential to check this increase in population. Role of government in controlling the population One-child norm Increasing the marriageable age (21 years for boys and 18 years for girls) Incentives given to couples with small families Promoting contraception (temporary or permanent measure to prevent pregnancy). Government is motivating young couples through mass media such as television, radio, newspapers, magazines, hoardings, etc., for this purpose.  Birth Control It is essential to ensure birth control to check population explosion. Successive governments have come out with various programmes that encourage smaller families by means of various contraceptive methods. Contraceptive methods are of two types: – Natural means of contraception – Artificial means of contraception  Natural Methods These methods work on the principle of avoiding chances of ovum and sperm meeting. These methods do not have any device, medicine or religious sanction. These include: – Periodic abstinence: Avoiding coitus from days 10 to 17 of the menstrual cycle, a few days before and after ovulation. Since the chances of fertilisation are very high during this period, it is called the fertile period. This method is based on the following facts.  Ovulation takes place on about the 14th day of menstruation in a 28-day menstrual cycle.  Ovum remains alive for one to two days only.  Sperm survives for about 3 days in the female genital tract. Since only a few women have regular menstrual cycle and the actual time of ovulation cannot be predicted, the effectiveness of this method is limited. Contd… – Withdrawal or Coitus interruptus: Withdrawal of penis from the vagina before ejaculation to avoid insemination in the female’s vagina. This method is also not fully effective since there is every possibility of some sperm passing into the vagina. – Lactational amenorrhoea: Just after parturition there is absence of menstruation. It is called amenorrhoea. It is the phase of intense lactation. Breast feeding the child fully prevents conception. This method is effective only for 6 months after parturition.  Artificial Methods Physically preventing the coming together of ovum and sperm by mechanical methods. Barriers: Include condoms, fem shields, diaphragms, cervical caps and vaults.  Condom – It is a tubular latex sheath which fits over the penis and traps ejaculated sperm during coitus. The common condom provided by family welfare centers is NIRODH. This device also protects from AIDS and STDs.  Fem shield – It is a female condom which is a polyurethane pouch with a ring at both the ends. The inner ring is smaller and closed at the inner end. This device covers the genitalia and also the vagina. It also provides protection against STDs.  Diaphragm - It is a vaginal barrier. It is a dome-shaped rubber device with a flexible steel spring enclosed in the rim. It is inserted into the vagina and fitted over the cervix to prevent sperm from entering the uterus.  Cervical cap – It is a rubber nipple which is fitted over the cervix. It prevents the entry of sperm into the uterus. Condom Fem shield Diaphrag s m Cervical Vault cap caps Barrier methods Contd… Intra uterine devices (IUDs): These are special devices, inserted into the uterus by specific techniques by expert doctors and nurses. Various types of IUDs are:  Non-medical IUDs like Lippes loop  Copper-releasing IUDs like Cu T (Copper T), Cu 7 (Copper 7), Multiload 375, etc.  Hormone-releasing IUDs like Progestasert, LNG-20, etc.  IUDs increase the phagocytosis of sperms within the uterus and the copper ions are released to suppress sperm motility. This reduces the fertilising capacity of sperms and also makes the uterus unsuitable for implantation.  IUDs are ideal contraceptives for females with a very good success rate and are ideal to space children.  Cu T Lippes loop Progestase Multiload 375 rt IUD  Oral contraceptive pills Females often use pills that contain small doses of either progestogens or progesterone-estrogen combinations to avoid pregnancy. Pills are normally taken after a gap of 7 days from menstruation for 21 days continuously as one pill a day without any break. Pills inhibit or prevent ovulation and also inhibit implantation. Pills have also been found to have a high success rate and are taken by a large number of females. A pill called Saheli is a new contraceptive pill with non- steroidal preparation. It has very few side effects and a high contraceptive advantage.  Implants This is the most convenient and reliable method and is needed once after every 5 years. The implant has 6 capsules similar to matchstick in appearance. Each capsule is filled with synthetic progesterone. The implant is inserted under the skin in upper arm. Hormone implant capsule  Surgical methods These are also called sterilisation techniques. They are normally irreversible and are employed as a terminal method to prevent any more pregnancies. These methods block the transport of gamete, thereby prevent conception. i. In males, the sterilisation procedure is called vasectomy. In vasectomy, a small part of the vas deferens is tied up or removed through a small incision on the scrotum. ii. In females, the procedure is called tubectomy. In tubectomy, a small part of the fallopian tube is removed or tied up through a small incision in the abdomen or through the vagina.  Tubectomy Vasectomy  Medical Termination of Pregnancy (MTP) Intentional or voluntary termination of pregnancy before the foetus becomes viable is called MTP or induced abortion. In India, MTP is legal, but with certain strict conditions so as to prevent female foeticide. But in some places, MTP is used with amniocentesis, and when the foetus is female, it is aborted. Such practices can prove to be fatal to the mother as well. Period or Safe Time for MTP: First trimester (i.e., up to 12 weeks of pregnancy). It is riskier in second trimester of pregnancy because foetus becomes intimately associated with the maternal tissue. Why is MTP done? (Reasons): It is done to avoid birth of unwanted child conceived due to: 1. Casual unprotected intercourse. 2. Failure of contraceptive device during intercourse. 3. Pregnancy due to rape. 4. In such cases where continuation of pregnancy may pose threat to the foetus, mother or both.  Amniocentesis Amniocentesis is a technique by which a small amount, about 10mL, of amniotic fluid is withdrawn at a very early stage of foetal development and analyzed for certain metabolites. It aims at detecting any possible chromosomal abnormalities or metabolic disorders. The amniotic fluid that surrounds the foetus in the uterus acts as a shock absorber. A little amount of this fluid is taken out from the mother’s womb with the help of a surgical needle without causing any damage to the foetus. This fluid contains the foetal cells which are cultured and analyzed for any possible abnormalities. In case of any serious congenital defect, termination of pregnancy is advised. Amniocentesis is often misused to determine the sex of the child so as to abort the female foetus.  Role of amniocentesis in detecting genetic defects From the foetal cells taken, an analysis of the karyotype can be done. Karyotype helps to identify if there is any chromosomal aberration or defect like, extra or missing chromosome, for example Down’s syndrome which is trisomy of 21st chromosome. Any high-risk genetic defects can be identified for which counselling of the parents is done. Amniocentesis is usually done by the 12th week of pregnancy to diagnose the genetic state of early embryos. Mothers who are more than 35 years old, have a high frequency of showing Down’s syndrome in foetus. Genetic counselling helps in identifying genetic defects and counselling parents accordingly.  Infertility It is the inability to conceive or produce children in spite of unprotected sexual intercourse. Causes: could be physical, congenital diseases, drugs, immunological or even psychological. Infertility in males A fertile male ejaculates on an average 2.75mL (3-4mL) semen per ejaculation, which contains over 200 million normal, motile sperms. A man is infertile if the semen has low sperm count (20 million) or abnormal sperm structure or poor sperm motility. The various causes of male infertility may include cryptorchidism (failure of testes to descend into scrotum), hyperthermia (higher temperature in scrotal sac due to tight undergarments), blockage of vas deferens, alcoholism (inhibits spermatogenesis), infection with mumps virus after puberty, deficiency of gonadotropins, ejaculation defect, exposure to radiations, etc. Contd… Infertility in females It may be due to irregular ovulation or no ovulation or defect in the genital tract like impaired motility of fallopian tube, defective uterine endometrium, defects in the cervix, defective vaginal growth or deficiency of sex hormones. Assisted Reproductive Technologies (ARTs) ARTs include a number of special techniques which assist infertile couples to solve their infertility problems. These technologies include- In Vitro Fertilisation (IVF) or test tube babies – It is a technique in which the ovum is fertilised using a donor sperm outside the body and the fertilised ovum is implanted in the female body (uterus) for further development. It enables a woman who is not able to conceive to give birth to a normal baby. Test tube fertilisation is a delicate surgery where the ova from a woman are removed under aseptic conditions and fertilised externally with the sperm in the laboratory. IUT − It stands for Intra-Uterine Transfer. In this technique, embryo at 32-blastomere stage is transferred into the uterus. ZIFT − It stands for Zygote Intra-Fallopian Transfer. In ZIFT, the sperm from a donor male and the ova from a donor female are fused in the laboratory. The zygote so formed is transferred into the fallopian tube at the 8-blastomere stage. ICSI − It stands for Intra-Cytoplasmic Sperm Injection. In this method, a single healthy sperm is directly injected into the cytoplasm of the ovum in case the sperm count is very low. IVF IUI Contd… GIFT − It stands for Gamete Intra-Fallopian Transfer. In GIFT, washed sperm and two retrieved ova are transferred into fallopian tube with the help of a laparoscope. Therefore, fertilisation occurs in the fallopian tube. It is used in those cases where the husband has very low sperm count. (Sperm washing is the process in which individual sperms are separated from the semen) Artificial insemination (AI) − In this technique, the semen collected from the husband or a donor is injected into the vagina or cervix. This cures the infertility arising from the inability of the male partner to ejaculate, or due to low sperm count. Intrauterine Insemination (IUI) – Semen collected from the husband or donor is artificially introduced into the uterus. In couples with unexplained infertility, it increases chances of pregnancy many fold.  Sexually Transmitted Diseases (STDs) Diseases or infections which are transmitted through sexual intercourse with infected persons are collectively called STDs or Venereal Diseases (VDs) or Reproductive Tract Infections (RTIs).  Gonorrhoea  Cause – Diplococcus bacterium, Neisseria gonorrhoeae  Symptoms – The bacterium lives in genital ducts producing a pus-containing discharge, pain over genitalia and burning during urination. It may lead to arthritis and eye infection.  Prevention - Avoiding sex with unknown/multiple partners, use of condoms, to check with a doctor when in doubt, avoiding common toilets and undergarments. Neisseria gonorrhoeae Contd…  Syphilis  Cause – Spirochaete bacterium, Treponema pallidum  Symptoms – Syphilis progresses through 3 stages. o In the primary or first stage, painless ulcer or chancre appears around vaginal opening, penis, mouth or anus with swelling of local lymph glands. o In the secondary or second stage, lesions on the lips, mouth and genitalia appear. Other symptoms include skin lesions, rashes, hair loss and swollen joints. o In the tertiary or third stage, chronic ulcers appear on palate, nose and lower legs. o In case of chronic infection, there can be paralysis, brain damage, blindness, heart trouble and aortic impairment.  Prevention - Avoiding sex with unknown/multiple partners, use of condoms, to check with a doctor when in doubt. Treponema pallidum A- Lesion on mouth, B- Lesions on hand, C and D- Chronic ulcers on lower leg. Contd…  Genital herpes  Cause – Virus called Herpes simplex  Symptoms – There are vesiculopustular lesions (mixed eruptions or rashes in the form of vesicles and pustules) and then clusters of reddish ulcers over genitalia and perianal areas, swelling of inguinal lymph nodes, pain, vaginal and urethral discharge, dysuria (painful or difficulty in urination), headache and malaise (general discomfort and uneasiness). (Inguinal lymph nodes are lymph nodes in the human groin.)  Prevention - Avoiding sex with unknown/multiple partners, use of condoms, to check with a doctor when in doubt.  Herpes Vesiculopustular simplex virus lesions Contd…  Chlamydiasis  Cause – Bacterium, Chlamydia trachomatis found in semen and vaginal fluid. It infects cervix and urethra and can live in rectum or even in throat.  Symptoms – Causes trachoma (roughening of the inner surface of the eyelids) and perinatal infection. The bacterium is an obligate intracellular pathogen that causes urethritis, epididymitis, mucopurulent (with yellowish mucus and pus) cervicitis, inflammation of fallopian tubes, rectal pain with mucus and occasional bleeding. It also causes severe pelvic inflammatory disease and increases the risk of cervical cancer. Often there are no symptoms at initial stage but at later stages: o Symptoms in men include red sore tip of penis, itching and burning of testicles, burning sensation during urination and white, watery discharge from penis. o Symptoms in women are mucus-like discharge from vagina, pain and burning sensation during urination and abdominal pain. (An infection caused by a bacteria or virus that can be passed from a mother to her baby during pregnancy or delivery is called a perinatal infection.)  Prevention - Avoiding sex with unknown/multiple partners, use of condoms, to check with a doctor when in doubt.  Trachoma Normal cervix Mucopurulent cervicitis Contd…  Genital warts  Cause – Human Papilloma virus (HPV)  Symptoms – Mostly asymptomatic but by some infections, genital warts appear as clusters of skin- coloured very small outgrowths on the penis, scrotum, groin, thighs, inside and around anus. In women, these warts appear inside or outside vagina or anus or in cervix. Genital warts cause itching, bleeding or burning and vaginal discharge. Warts may also appear on hands, lips, mouth, tongue or throat.  Prevention - Avoiding sex with unknown/multiple partners, use of condoms, to check with a doctor when in doubt. HPV Warts Contd…  Trichomoniasis  Cause – Protozoan, Trichomonas vaginalis  Symptoms – In males, it causes urethritis, epididymitis and prostatitis resulting in pain and burning sensation. In females, it causes vaginitis with foul smelling, yellow vaginal discharge and burning sensation.  Prevention - Avoiding sex with unknown/multiple partners, use of condoms, to check with a doctor when in doubt. Contd…  Hepatitis- B  Cause – Hepatitis B virus  Symptoms – After an incubation period of 1 to 6 months, the infected person shows onset of symptoms for several weeks. The symptoms include headache, fever and jaundice-like yellowing of skin and eyes, dark urine, extreme fatigue, nausea, vomiting and abdominal pain. In acute hepatitis, the infection may lead to liver cirrhosis or liver cancer.  Prevention - Avoiding sex with unknown/multiple partners, use of condoms, to check with a doctor when in doubt, injection needles and syringes should not be reused. o Hepatitis B vaccine to be given to the infant within 24 hrs after birth, followed by 3-dose schedule of hepatitis B vaccine. Hepatitis B virus AIDS (Acquired Immuno Deficiency Syndrome) Caused by HIV (Human Immunodeficiency Virus) [HIV is a retrovirus (RNA virus)] Transmission of HIV occurs through: – Sexual contact with infected person. – Sharing infected needles (as in case of intravenous drug abusers). – Transfusion of contaminated blood. – Infected mother to child through placenta and breastfeeding. – By organ transplant and artificial insemination. Time lag between infection and appearance of symptoms − Few months to many years (5-10 years). Contd… Symptoms: HIV causes tremendous damage to the defence mechanisms of the body against diseases. Symptoms begin with simple fever, cough, slight but recurring diarrhoea, rashes on the skin and weight loss. Some suffer from a rare lung infection, or may develop a cancer that affects the skin and lining of blood vessels and spread throughout the body. Patients are also susceptible to unusual bacterial and fungal infections. Herpes, diarrhoea, ulcerating infections of the mouth, genital openings or anus are also common among patients. Contd… Prevention of AIDS – People should be educated about AIDS. – Ensuring use of disposable needles and syringes. – Routine screening may be done of blood donors, organ donors, donors of semen and growth hormone, and of females in high risk group who are pregnant or contemplating pregnancy. – Sexual habits should be changed immediately. – Strict monogamy. – Insist on the use of thoroughly sterilized equipments by the dentist or the doctor. – Before receiving blood, it must be screened for HIV. – Do not share razor, toothbrush and other articles that can become contaminated with blood.