Week 11 - Healthy Sexuality PDF

CHAPTER 8 Healthy Sexuality Preventing Unintended Pregnancy and STDs Zak Callaway PhD, MPHTM Science Division, MUIC Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. Learning Objectives (1 of 3)  List five reasons f...

CHAPTER 8 Healthy Sexuality Preventing Unintended Pregnancy and STDs Zak Callaway PhD, MPHTM Science Division, MUIC Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. Learning Objectives (1 of 3)  List five reasons for using fertility control. Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Define typical and lowest observed failure rate for several fertility-control methods.  List and describe four methods of combination hormonal contraception.  Describe two types of progestin-only contraception.  Explain how an intrauterine device (IUD) is used to prevent pregnancy. Learning Objectives (2 of 3)  List and describe five barrier methods of contraception. Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Describe four fertility-awareness methods of contraception.  Explain why many people do not use fertility-control methods.  List the five most common sexually transmitted infections in North America. Learning Objectives (3 of 3)  List the nine risk factors for acquiring a sexually Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com transmitted disease (STD).  Describe how to practice safer sex and some common barriers to practicing it.  Identify the causative agents, symptoms, and treatments for the following STDs: trichomoniasis, gonorrhea, chlamydia, genital herpes, and anogenital warts.  Sexuality  WHO definition of healthy sexuality:  State of physical, mental, and social well-being in relation to sexuality Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Not merely absence of disease, dysfunction, or infirmity  Requires positive and respectful approach and possibility of having pleasurable and safe sexual experiences free of coercion, discrimination, and violence  Must respect, protect, and fulfill sexual rights of all persons  Personal health perspective:  Represents aspects of life over which individuals have considerable control hy, responsible sexuality is as important to health and well-being as maintaining a hea g adequate exercise, and being tobacco and drug free.  Preventing Unintended Pregnancy  Examples of ancient methods:  Ball of wool dipped into paste of acacia bark, dates, & honey in vagina Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Douching with water, vinegar, or mixtures of plant and animal substances  Having woman jump or sneeze after intercourse  Ancient methods still used today:  Man not ejaculating at all (coitus reservatus) or not ejaculating in vagina (coitus interruptus) aka “pulling out”  Prayer  About 65 million women in most fertile stage of life in U.S.  ~65% of them sexually active & take steps to avoid pregnancy  How Pregnancy Occurs  Begins with fertilization How Do You Get Pregnant? https://youtu.be/n04NPtZI4QQ?si=72GEinFLx7mY  Sperm continually produced in testes Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Takes about 73 days for immature sperm cell to mature  Mix with seminal fluids prior to ejaculation  Female produces fertilizable ovum and provides structure (fallopian tube) in which fertilization takes place  Fertilizable ova produced in ovaries  One ovum (sometimes both) matures about every 28 days and leaves ovum (Can survive about 24 hours after release)  Uterus connects to fallopian tubes  Site where fertilized ovum develops into fetus  How Pregnancy Occurs  Cervix  Opening in lower part of uterus Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Passageway for sperm to enter from vagina and for fetus to exit at birth  Covered by thick mucus that acts as barrier to sperm & microorganisms  Becomes more fluid near time of ovulation and organizes into channels that orient sperm movement toward uterus  Some ejaculated sperm moves through cervix and uterus into fallopian tubes  Majority becomes trapped in coagulated semen in upper part of vagina  Liquefies after ~20 minutes & move into microscopic folds in cervix  Healthy, motile sperm released into uterus continuously over next 48h  Only one sperm penetrates ovum’s outer covering and fertilizes egg  Fertilization & Early Development of Embryo  Embryo  Moves along fallopian tube Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com toward uterus within first 3 days after fertilization  Arrives in uterus about fourth day after fertilization  Attaches to inner lining of uterus 2 days later  Implants in uterus by Figure 8.1 Fertilization and Early Development of the Embryo. A mature ovum is released from the ovary about every 28 days and survives for about eroding uterine lining 1 day. Should ejaculation take place in the vagina within a week prior to egg release (ovulation), some sperm will have made their way to the fallopian  Fetus develops over next tubes, one of which will contain the recently released egg. The fusion of a sperm and the ovum is fertilization. After fertilization, the fertilized egg 9 months until birth (called a zygote) travels down the fallopian to the uterus, where fetal development and pregnancy take place.  The Menstrual Cycle  Menstruation  Process of uterine lining and some blood vessels sloughing off and exiting via the Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com vagina if fertilization does not occur  Initiates another 28-day process begins to produce a fertilizable ovum and ready uterus for pregnancy  Menstrual cycle  Near-monthly periods of ovum production  Cycle lengths between 24 and 35 days most common  Irregular cycles common in menarche (1st cycle) & perimenopause (cycles stop)  May be accompanied by symptoms such as:  Cramps, headache, & backache  Fatigue, Feeling bloated, Breast tenderness  Depression, Irritability, Unusual aggressive feelings, Social withdrawal The Menstrual Cycle (3 of 3) Figure 8.2 The Menstrual Cycle. Menstrual phase (days 1–5): Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com The beginning of a cycle is marked by the first day of menstrual bleeding. Proliferative phase (days 6–14): Hormones from the hypothalamus trigger the release of follicle-stimulating hormone from the pituitary gland, which circulates through the blood to the ovaries and stimulates the production of estrogen and the maturation of an egg. Estrogen stimulates the proliferation of the lining of the uterus and uterine blood vessels. Ovulation phase (days 14–15): The egg is released from the ovary. Secretory phase (days 16–25): Hormones from the hypothalamus trigger the release of luteinizing hormone (LH) from the pituitary gland, which circulates through the blood to the ovaries and stimulates the production of progesterone from a structure called the corpus luteum. Progesterone stimulates the development of nutrient- producing glands in the lining of the uterus. Next menstrual phase: If pregnancy does not occur, hormone levels drop, the uterine lining breaks down, and menstruation ensues.  Methods for Preventing Unintended Pregnancy  Choosing a method to prevent unintended pregnancy requires:  Weighing benefits and drawbacks of each method Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Selecting one or more that both partners are comfortable with using properly each time sexual activity takes place  Failure rate  % of women likely to become pregnant during 1st yr of using method  Lowest user failure rate  How well a method performs when used as intended & consistently  Typical user failure rate (TFR)  Estimates how well a method performs when all errors and problems people typically encounter with a method are taken into account  Ineffective Methods: Not Recommended  85% typical failure rate (TFR) when using no method  Vaginal douching (cleansing) soon afterwards Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Rinsing vagina with fluid after sexual intercourse  Ineffective because 1000s of ejaculated sperm move through cervix and enter uterus within a few seconds  No time to flush sperm from vagina before significant number enter uterus  Force of spray of douche may propel sperm into uterus, aiding conception  Minimally Effective Methods (17-23% TFR)  Fertility awareness methods  Also called natural family planning, rhythm method, calendar method Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Attempts to determine days in woman’s menstrual cycle when ovulation most likely to occur  Unsafe days  Days in menstrual cycle not to have unprotected sexual intercourse  Safe days  Days woman is least likely to be fertile  Fertilization still possible due to natural variations in reproductive processes  Only acceptable pregnancy prevention methods for many with religious convictions  Minimally Effective Methods  Barrier methods  Block movement of sperm in female reproductive tract or bring sperm Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com into contact with spermicide  Common methods:  Male condom  Female condom  Diaphragm  Cervical cap  Contraceptive sponge  Spermicidal contraceptives (foams, gels, and creams)  Highly Effective Methods (7-10% TFR)  Hormonal contraceptives  Convenient, low cost, reversible, tolerable side effects, and effective Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Combination estrogen-progesterone methods:  Birth control pill, skin patch, and vaginal ring  Progestin-only methods: Minipill, injectables, and implants  Unpleasant side effects of hormonal contraceptives:  Nausea, breast tenderness and swelling, fluid retention, headaches, weight gain, depression, decreased sex drive, and acne or oily skin  Beneficial side effects of hormonal contraceptives:  Disappearance of menstrual cramps, reduction in bleeding days & blood loss  Lower risk of pelvic inflammatory disease (PID), benign breast disease, ovarian cysts, ectopic pregnancy, and anemia  Extremely Effective  Failure rate less than 1%  Intrauterine device (IUD) Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Small T-shaped plastic object placed inside cavity of uterus to prevent pregnancy by:  Killing or weakening sperm  Altering timing of ovum’s or embryo’s movement through fallopian tube  Inhibiting implantation of embryo in uterine lining  Remains in place for as long as woman desires  Extremely Effective  Disadvantages of IUD:  May cause heavier menstrual flow or menstrual cramps Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Increases risk of pelvic inflammatory disease, uterine perforations, and ectopic pregnancy  Injectable hormonal implant (“the shot” or Depo-Provera)  Injection of 3-month supply of synthetic progestin hormone  Released into body at steady rate  Replacement injection every 12 weeks  Reversible by ceasing use  Extremely Effective  Surgical sterilization  Makes person virtually Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com permanently unable to have children  No effect on ability to engage in or enjoy sex  Applies to both males and females  Methods:  Tubal ligation and hysterectomy (removes uterus) (females)  Vasectomy (males)  Reversal sometimes possible Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Emergency Contraception  Used for situations such as unprotected intercourse, misusing a contraceptive, and sexual assault Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Not intended as primary method of contraception  Hormonal emergency contraception  Estrogen and progestin type taken in two large doses 12 hours apart within 72 hours of unprotected intercourse  Progestin-only types:  Plan B (levonorgesteral) taken within 72 hours  EllaOne (ulipristal) taken up to 5 days after intercourse  Reduce pregnancy risk by 90% by blocking ovulation  Abortion  Intentional, premature termination of pregnancy  3 safe, medically administered methods: Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Medication abortion or chemical abortion  Used to stop pregnancy prior to 7th week  Induces contractions to remove uterine components  Vacuum or aspiration abortion  Used between 6th and 14th weeks of pregnancy  Dilatation and evacuation  Removes uterine contents after 15th week of pregnancy  In Thailand (as of 2020): legal up to 20 wks if physical/mental well-being is threatened, if pregnancy is result of rape or incest, or if fetus has serious deformities  Up to 12 wks, no condition is required  Aftereffects of Abortion  Time between confirmation of pregnancy and receiving abortion generally emotionally trying Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Anxiety and some depression common  Symptoms of anxiety or depression less prevalent  May experience anger or disappointment  Predominant feeling of most women is relief  Several months after abortion:  Some continue to be troubled by experience or consider it too upsetting to think about  Preventing Sexually Transmitted Diseases (STDs)  11 common STDs in North America:  HIV/AIDS, chlamydia, genital warts, gonorrhea, hepatitis B, genital Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com herpes, pubic lice, scabies, syphilis, and trichomoniasis  About half occur in people younger than 25  Have been afflicting humans for thousands of years  Noted in writings from ancient China and ancient Egypt  Mentioned in Old Testament and Talmudic writings  The Definition of STD/STI  Infection usually transmitted by vaginal, oral, or anal sexual contact Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Caused by viruses, bacteria, protozoa, worms, and insects  STD-causing agents can enter body through:  Breaks in skin  Wet surface layers (mucous membranes) of body’s orifices  Blood, either by injection or during sexual activity through microscopic abrasions  STD Risk Factors  Several factors increase risk of contracting an STD: Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Multiple sexual partners  False sense of safety  Absence of signs and symptoms  Untreated conditions  Impaired judgment  Lack of immunity  Body piercing  Value judgments  Denial  Preventing STDs  Vaccines for hepatitis B (HBV) and human papillomavirus (HPV)  Other STDs prevented by consistent public health programs and Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com services for STD education, prevention, and treatment  Infected individuals must:  Seek treatment and take responsibility for not infecting others  Practicing “safer sex” reduces risk of infection  Abstaining from STD-risky sexual activity  Using latex condoms  Being selective about sexual partners  Postponing sexual interaction until level of trust established  Disclosing any prior exposure to STD to new sexual partner  Trichomoniasis  Caused by protozoan Trichomonas vaginalis Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Symptoms tend to occur in women  Can survive in urethra and under foreskin  Several million new cases diagnosed in U.S. annually  Diagnosed by collecting vaginal fluid & testing for trichomonas microorgs  Treated with medication  Male should also undergo testing and Tx  Bacterial Vaginosis (BV)  Caused by overgrowth of certain types of bacteria Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Generally Gardnerella vaginalis  Can be transmitted via sexual intercourse  Characterized by vaginal discharge which may have a “fishy” smell, especially after intercourse  May have no Sxs  Treated with metronidazole (Flagyl)  Chlamydia  Caused by bacterium Chlamydia trachomatis  Infects certain cells that line MM of genitals, mouth, anus, rectum, Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com conjunctiva of eyes, and occasionally lungs  “Steals” biochemical materials from host cell, ultimately destroying it  ~2 million reported cases/yr in U.S. - only 1/3 of cases that actually occur  Occurs simultaneously with gonorrhea in about half of all cases  Can be transmitted from infected mother to newborn at time of birth - Common complications are conjunctivitis & pneumonia  75% of infected women & 50% of infected men have mild/no Sxs  May unknowingly transmit infection to new sex partners  Chlamydia  Symptoms generally appear w/in 7-21 days. Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Include pain on urination and whitish discharge from penis or vagina  Tx with antibiotics  Causes inflammation and damage to reproductive organs if untreated (PID)  Males  Causes pain, swelling, and tenderness in scrotum  Damages tissues in epididymis  Chlamydia  Females  Causes infections of cervix, uterus, Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com fallopian tubes, and peritoneum  May cause chronic pelvic pain, vaginal discharge, vaginal bleeding, and dyspareunia (painful intercourse)  Can cause scarring in fallopian tubes that damages lining or blocks tube  Induces immune response, but host does not build immunity  Gonorrhea  Also known as “the clap”  Caused by bacterium Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Neisseria gonorrhea, which infects mucous membranes  Transmission almost always through genital, oral, or anal sexual contact  Symptoms similar to chlamydia  Can be treated with antibiotics  Syphilis  Caused by bacteria called Treponema pallidum  Transmitted through microscopic breaks in skin with genital, oral, and Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com anal contact and direct transfer into blood  Can also be transmitted to fetus as early as ninth week of pregnancy  First noticeable sign is chancre (painless open sore)  Appears between first week and third month after infection  Heals if not treated, and disease enters “secondary stage” characterized by skin rash, loss of hair, and round, flat-topped growths on most areas of body  Syphilis  Latency period occurs if secondary stage untreated Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  No obvious signs as bacteria reproduce in many regions of body  Eventually damages vital organs and causes severe illness or death  Treated with antibiotics at any stage of infection  Herpes Simplex Virus-2  Two strains:  HSV-1 Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Assoc. w/ cold sores on mouth (“fever blisters”)  HSV-2  Assoc. w/ lesions on penis, vagina, vaginal labia, rectum, and skin of genital, pelvic, and anal regions  Organism cannot be eliminated from body  Genital lesions appear w/in 2 to 20 days  Major Sx is presence of 1 or more blisters  Herpes Simplex Virus-2  Virus remains dormant in certain nerve cells, permitting periodic recurrences Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com (flare-ups)  Thought to be triggered by stress, anxiety, poor nutrition, sunlight, and skin irritation  May / may not cause visible lesions  Extremely contagious when sore is present  Transmission less likely when no sore present  Both strains can cause genital and oral infections  Can also infect eyes  Herpes Simplex Virus-2  Can be transmitted to newborn in birth canal Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Often results in brain damage and abnormal development  Two-thirds of infected babies die if untreated  Pregnant women who have had herpes should tell health providers to take steps to help prevent possible transmission to newborns  No cure  Several drugs available to minimize severity and duration of symptoms  Human Papillomaviruses & Anogenital Warts  HPVs include more than 100 types of similar viruses - ~40 transmitted through sexual contact Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Most infections symptomless and resolve on their own  Persistent infections can cause cervical cancer  Some types may cause visible anogenital warts  Cauliflower shaped, soft, moist, pink, or flesh-colored  Can appear on vulva, in or around vagina or anus, on cervix, and on penis, scrotum, groin, or thigh  Contagious  Human Papillomaviruses & Anogenital Warts  Tx  Can be removed with self-applied Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com medications or by healthcare provider  Clinician-applied treatments include:  Applying 10% to 25% podophyllum resin, trichloroacetic acid, or bichloroacetic acid  Physically excising wart  Cryosurgery (freezing), electrocautery (burning), or exposure to laser  Treatments remove warts, but not HPV in cells  Human Papillomaviruses and Anogenital Warts  Vaccines available for:  Two types of HPV that cause 70% of cervical cancers Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Two types of HPV that cause 90% of genital warts  Highly effective in preventing infection in young women not yet exposed to HPV  Can also prevent infection by avoiding skin-to-skin contact and using latex condoms  Hepatitis B Virus (HBV)  Transmitted most often thru sex & blood Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  ~150,000 sexually transmitted HBV infections in US/yr  Sxs:  fever, fatigue, headache, loss of appetite, nausea, dark urine, and jaundice  Flulike Sxs 14-100 days after infection  Signs of liver disease appear later  No Sxs in ~30% of infected persons  Vaccine recommended for everyone  Acquired Immune Deficiency Syndrome (AIDS)  Caused by human immunodeficiency virus (HIV)  Infection causes diseases b/c of body’s immune cells destruction Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  If untreated, multiplies in immune system cells, immune system weakens, and individual eventually becomes sick and dies  Course of infection varies greatly  Full-blown AIDS and death w/in months OR no Sxs for 10 years or more  First signs of AIDS:  Mononucleosis-like symptoms, headache, and impaired mental functioning  Sxs progress to weight loss, shingles or thrush, lung infections, cancer  HIV transmission  Adults: transmitted by blood, semen, or vaginal fluids  Fetus/newborn: transmitted during pregnancy and childbirth, and via breast milk  Acquired Immune Deficiency Syndrome (AIDS)  ~1 million persons currently infected with HIV in U.S. Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Most common routes of infection:  Men having sex with men  Injection drug use  Sex with infected other-sexed individuals  Not acquired from getting a blood test or donating blood  Transmission through blood transfusion highly unlikely with modern screening  HIV Testing  Should seek testing if potentially exposed to HIV by:  Injecting drugs or steroids using shared equipment Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Unprotected sex with men who have sex with men, multiple partners, or anonymous partners  Exchanging sex for drugs or money  Diagnosed with or treated for hepatitis, tuberculosis, or a sexually transmitted disease (STD)  Sex with someone whose history is unknown  Having sex with several partners  Having sex with someone while drunk  Pubic Lice  Phthirus pubis or “crabs”  Barely visible Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Feed on blood and live on hair shafts primarily in genital-rectal region  Occasionally found on hair in armpits, beard, and eyelashes  Signs of infection:  Itching from bites and presence of nits attached to hair shafts  Pubic Lice  Transferred by body-to-body contact Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Can also be transmitted via contact with objects on which lice eggs might have been laid, such as towels, bed linens, and clothes  Can eliminate infestation by washing with lice-killing liquids or shampoos  Must also wash infected person’s clothes, towels, and linens in hot water  Scabies  Infestation by extremely small mites called Sarcoptes scabiei  Burrow into skin, where they live and lay eggs Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Signs of infection:  Intense itching from tiny lesions  Tiny burrows across skin lines  May produce small round nodules  Tend to live:  In webs between fingers, on sides of fingers  On wrists, elbows, breasts, abs, penis, & buttocks  Transmitted sexually and nonsexually  May take several weeks for signs of infection to appear  Treated with topical agents that also kill mites and their eggs