Reproductive Health Book 3rd Level 2024-2025 PDF

**Tanta University** **Faculty of Nursing** **Third level** **Reproductive Health** ![](media/image3.jpeg) **By** **Prof. Dr\\ Samia Ebrahim Khaton** **Assistant prof. Dr\\ Ekbal** **2024\\2025** **[Content]** I. **Introduction to Reproductive health& woman life stage approach** II. **Basic elements of reproductive health during mature stage** III. **Menstruation & Menopause** IV. **Contraception and reproductive life planning** V. **Pelvic inflammatory diseases** VI. **Violence against woman** VII. **Male involvement in reproductive health** **[Introduction to Reproductive health& woman lifestage approch]** **General objective:** **At the end of this lecture the student will able to** discuss overview on Reproductive health. **Specific objectives:** **At the end of this seminar, the student will be able to:** - Define reproductive health. - Illustrate importance of reproductive health. - Discuss Factors affecting reproductive health. - List Components of reproductive health - Discuss life cycle approach of reproductive health - Identify needs of childhood stage - Mention the common problems during childhood stage - List strategy to improve girl childhood stage. - Identify the needs of adolescence period - Discuss harmful practice of adolescence stage - identify the Needs of adulthood period of mature women; - mention the Common problems during reproductive stage **Outlines** - **Introduction.** - **Definition of Reproductive health.** - **Importance of reproductive health.** - **Factors affecting reproductive health.** - **Component of reproductive health:** - **Life cycle approach in reproductive health** - - - - - **Needs of adulthood period of mature women;** - **Common problems during reproductive stage** - **Male involvement in reproductive health.** - **Top Barriers to Reproductive Health Care in the Developing WorldSexual and Reproductive Health Care** - **Role of maternity nurse in reproductive health.** - **References.[\ ]** **[Introduction]** Reproductive health addresses the human sexuality and reproductive processes, functions and system at all stages of life. Every individual has the right to make their own choices about their sexual and reproductive health. To maintain one's sexual and reproductive health, people need access to accurate information and the safe, effective, affordable and acceptable contraception method of their choice. They must be informed and empowered to protect themselves from sexually transmitted infections. And when they decide to have children, women must have access to skilled health care providers and services that can help them have a fit pregnancy, safe birth and healthy baby. Reproductive disorders affect millions of people each year. The WHO assessed in 2018 that reproductive disorders accounts for 20% of the global burden of ill-health for women, and 14% for men. **[Definition of reproductive health ]** Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. **[Importance of reproductive health:]** 1. Good reproductive health is important for women's general health and wellbeing during childhood, adolescence and adulthood and affects health of next generation. 2. The reproductive organs are one of the most sensitive organs of the human body and proper care of them is needed to protect oneself from any reproductive disorders. 3. It helps in the prevention of sexually transmitted infections such as AIDS or HIV. 4. Taking proper reproductive health is needed in order to have a safe and satisfying sexual life. It is also a necessity for having healthy children. 5. Reproductive health problems are the leading cause morbidity, mortality for women of childbearing age worldwide, and even for infant mortality. **[Factors affecting the reproductive health:]** **[Economic factors:]** - **level of income** low income lead to decrease access to health and medical care which result in increased risk for poor health, particularly poor reproductive status. - **Lack of personal resources and opportunities:** if women, who are economically dependent upon men, are left entirely without resources of their own, this would have a negative effect on their health and nutrition. **[Social factors:]** **Denying the following rights would affect women**\'s health**:-** - Right to be informed about reproductive health. - Right of getting services. - Right to go safely through pregnancy and child birth. **[Cultural factors:]** **Gender issue:** The high value placed on sons in some regions and gender inequality leads to serious physical and psychological consequences for girls and women as it means that [men](https://en.wikipedia.org/wiki/Men) and [women](https://en.wikipedia.org/wiki/Women) are not equal and that [gender](https://en.wikipedia.org/wiki/Gender) affects an individual\'s lived experience. - **Traditional harmful practices** - **Poverty, iilliteracy** - **Lack of Nutrition Due to:** - Lack of knowledge about dietary pattern and imbalanced diet or bad eating habits might cause women to develop chronic disease as diabetes, hypertension and cardiac disease and anaemia. - Women and girls are typically the last to eat in a family; thus, if there is not enough food, they are the ones to suffer most resulting in medical conditions like anemia, malnourishment. **[Health factors:]** - Lack of health services especially in the developing countries. - Lack of trained personnel. [Age:] ------------------ Women at different ages and different stages of reproductive health have different health needs and problems. Teenage pregnancy affects the women\'s health. **[Life style and bad habits:]** - Smoking and alcohol abuse may lead to reproductive health problem like irregular ovulation and amenorrhea. **[Environmental factors:]** - Exposure to chemical substance and radiation. - Poor environmental sanitation (poor housing, poor food and water sanitation). **[Violence against women:]** - Physical violence (involve using physical force to harm or injury body). - Sexual violence. - Psychological violence includes isolating the women and humiliating or embarrassing her. **Life cycle approach in reproductive health:** - **[During childhood stage:]** - Childhood (being a child) is a broad term usually applied to the phase of development in humans between infancy and adulthood. - \- Infancy (birth to 2 years old). - \- Early childhood (3 to 8 years old). - \- Middle childhood (9 to 11 years old). - **(Adolescence period) teenaged women (11-19):** - **[During adulthood stage(Maturation):]** **[Needs of girl child (birth-10yrs):]** **1- Psychological wellness** **-** The child needs a warm, caring environment to develop trust, self-esteem and self-confidence. \- Emotional support, encouragement and listening play important role in child development. **2- Nutrition\ -** It is important to meet needs of the child for growth and development. **3- Vaccination:** protect children against diseases **4- Need for health promotion and disease prevention** **5-Environmental safety:** - Children should be supervised at all times - Keep floors free of toys and obstructions that can be tripped over - Never leave babies unattended on raised surfaces **7**- **Hygiene needs** **[Problems in this period ]** - **[The risk for accident:]** - Because children are often absorbed in their own immediate interests, they can be oblivious to their surroundings. They only have a limited perception of the environment because of their lack of experience or development. They are not aware of the consequences of the many new situations that they encounter daily. - **delayed growth and development** - growth delay occurs when a child isn't growing at the normal rate for their age. The delay may be caused by an underlying health condition, such as growth hormone deficiency or hypothyroidism. In some cases, early treatment can help a child reach a normal or near-normal height. - **The risk for child abuse and neglecting:** - - **Harmful traditional practices and their effects on girl child:** **Female genital mutilation**: have health and psychological consequences such as depression anxiety bleeding infection - **[Strategies to improve girl child health :]** - The child needs a warm, caring environment to develop trust, self-esteem and self-confidence. - Emotional support, encouragement and listening play important role in child development. - It is important to meet needs of the child for growth and development. - The child Need for health promotion and disease prevention **[During adolescence stage:]** **(Adolescence period) teenaged women (11-19):** **[Needs of adolescence (young adulthood) period\ 1-Nutritional needs:]** - **[2- Education needs:]** - The increase in the education of girls contributes to greater empowerment of women. **[3- Needs for sexual and reproductive health information: ]** \- Risks and consequence of sexual activity \- Contraceptives and STIs \- Fertility issues for men and women **[4- Need for hygiene during menstruation:]** - **path regularly** take your bath at least twice a day when you are on your period. Having regular baths during your periods will help clean your private parts as well as relieve your mood. - **Change your pads regularly** change it every six hours - **Avoid soaps or vaginal hygiene products** Washing it with soap can kill the good bacteria making way for infections. - **Avoid tight-fitting clothing** This will ensure airflow around the sensitive areas as well as prevent sweating to a large extent. **[Adolescence girl problems:]** **[1-Menarche:]** Menarche usually occurs between ages 12 and 13 but may occur as early as age 9 or as late as age 18. An adolescent also may need psychological preparation for this development. Some cultures celebrate menarche, giving the adolescent special attention. **[2-Menstruation:]** The adolescent women may need information about the physiology of menstruation and external factors that may affect it, such as diet, exercise, sleep, climate changes, drug use, and stress. [**3-Early marriage**:] Early marriage increases the risk for operative delivery, low weight and malnutrition resulting from frequent pregnancies and lactation, Denial of personal development and education., Girl children undergo severe health problems like pregnancy and childbirth. **4- [Anemia:]** **5-[Violent against women]**: **6[-Depression]** Equal rates of depression between male and female pre-adolescence (11-13yrs). **[During adulthood stage (Maturation):]** - This period cover the age between 15-44. - **Needs of adulthood period of mature women;** - **Reproductive health care:** Health promotion of mother; satisfying requirements of normal pregnancy and labor, for fetal health and favorable outcome Prevention of health hazards to which the mother may be exposed during pregnancy, labor, and the postpartum period. - **Common problems during reproductive stage:** **1 --STDs :**Sexually transmitted diseases (STDs) are a major public health problem. **2-Un safe abortion :** are a leading cause of maternal mortality and can result in permanent injuries. 3**- Infertility** :is the inability to conceive a child after 12 months with regular sexual relation- without using of any contraceptive method. 4-**Contraception:** Some contraceptive methods affect women health. E.g., long-term use of oral contraceptives may increase the risk of cardiovascular disease; use of an IUD increases the risk of pelvic inflammatory disease, ectopic pregnancy. **5-Depression** \- Biological difference (reproductive, hormonal, genetic). \- Psychosocial factors (stress from working, family responsibilities and societal roles, increased rates of poverty and sexual abuse; chronic illness). **[Basic elements of reproductive health during mature stage:]** **Specific objectives:** **At the end of this seminar, the student will be able to:** - Explain components of reproductive health - Discuss Basic elements of reproductive health during mature stage - Discuss Reproductive Health Services - Discuss Reproductive Health rights - Discuss Equality in reproductive health - Discuss Role of maternity nurse in reproductive health **Outlines** - 1. 2. 3. 4. 5. - **Reproductive health services.** - **Reproductive health rights.** - **Equality in reproductive health** **[Component of reproductive health:]** 1. Maternal health: is only one aspect of women's health. Further, it is prevalent not only to women in their reproductive or fertile years ( between the age of 15and 49 years ) but encompasses the entire life cycle of a women , from an infant girl to an elderly women , and it includes a range of issues related to sexual and reproductive health 2. Mental health: evidence suggests that women are more prone than men to experience anxiety, depression and somatic complaint --physical symptoms that cannot be explained medically. depression is the most common mental health problem for women and suicide is a leading cause of death for women 3. Gender based violence : women experience a range of different forms of violence but physical and sexual violence by a partner or someone else is particularly prevalent 4. Sexually transmitted infections: **[5-Family Planning ]** **[Basic elements of reproductive health during mature stage:]** **[1- Preconception care: ]** - Preconception care is the promotion of the health and well-being of a woman and her partner before pregnancy to identify any areas such as health problems, lifestyle habits.. - **Preconception care involves:** - screening for Hereditary blood diseases, especially sickle cell disease and thalassemia. - Early detection of health problems and early treatment - Providing guidance, preparation for marriage, family education, training in the art of child rearing and family planning. - Prevention of health problems for the couple and their future children. - medical conditions, such as cardiovascular or respiratory problems and genetic disorders. **2- [Antenatal or prenatal care:- ]** It is preventive obstetric program including group of observation, medical care, investigations and advice aiming to get pregnancy, labor and postpartum as near to normal as possible. - **Objectives of antenatal care:** To reduce maternal and prenatal morbidity and mortality rates. Through: - Ensure a healthy mother and newborn. - Estimation of gestational age and expected date of delivery. - Early detection and prevention of any disease that may occur during pregnancy. - To prepare woman for labor, lactation and care of her infant. **3- [Natal care:- ]** \- It is the care that women receive during labor including: - Assessing and monitoring women during labor using the partograph. - Providing emotional and physical support through labor and childbirth. - Recognizing complications and providing appropriate management. **4- [Postnatal care:- ]** It's a comprehensive care of mother and baby start immediately after labor and extend over a period of 6 -8 week which genital organs return nearly to their pre-pregnant condition. - **Objectives of Postnatal care:** - - - Follow up and re-examination - Encourage breast feeding and proper nutrition for infants **5- [Family planning:-]** It is a program to regulate the number and spacing of children in a family through the practice of birth control. - **Objectives of family planning:** - To helps women protect themselves from unwanted pregnancies. - choose a suitable FP method, proper spacing of birth & addressing the right number of children - To improve the quality of family planning, counseling, and services. - To increase the participation and sharing of responsibility of men in family planning **Reproductive Health Services** The primary health care department provides preventive services in order to improve the health of the women through: - - Delivering reproductive health information through awareness and education programs - Providing equipment that enables early detection of reproductive system diseases (early detection of breast cancer, cervical cancer). - Encouraging pregnant women to receive a minimum of 4 visits during pregnancy and one postnatal visit. - Preparing governmental hospitals to receive emergency obstetric cases. - Equipping governmental hospitals to receive high-risk pregnancies. **The health services can be summarized in the following categories:** - - - - REPRODUCTIVE health RIGHTS ========================== - The right for Sexual and reproductive health, prevention and treatment services - The right for the ability to choose whether and when to get pregnant - The right for services for sexually transmitted infections and reproductive tract illnesses, - The right for access to basic health care and contraception. - The right for sexual and reproductive autonomy **Equality in reproductive health** includes access, without discrimination, to affordable, quality contraception, including emergency contraception. as The right of a woman or girl to make autonomous decisions about her own body and reproductive functions **[Reproductive health and gender equity and equality:]** Reproductive health services are important tools in promoting the well-being of women as well as in contributing to their empowerment. Providing family-planning, counseling, information and education to women can help in the achievement of gender equality and equity. **[Male involvement in reproductive health:]** -It is the participation and involvement of men in reproductive health programs, reproductive rights and reproductive behavior. Also it can define as: A complex process of social and behavioral changes that needed for men to play a responsible role in reproductive health. -Safe guarding women\'s health during pregnancy, child birth and post-partum. **[Top Barriers to Sexual and Reproductive Health Care in the Developing World:]** 1-Gender inequality:- Women often can't access reproductive health care because of systemic gender inequality. For instance, a woman in need of emergency obstetric care, must have her husband's permission to go to a clinic. 2-Lack of funding:- Global reproductive health is significantly underfunded. More than 200 million women want, but lack access to contraceptives. 3-Lack of skilled service providers:- In many areas, the number of service providers like doctors, nurses, and midwives is limited, and often undertrained. 4-Distance to health service point:- In rural communities, health centers, clinics, and hospitals can be far away or too difficult to reach. **[Role of the maternity nurse in Reproductive health:]** **1-Administrative role** **2-Supervisory role** **3-Educational role** **4-Research and evaluation role** **5- Sexual and Genetic counseling role** **6-Counseling role** **1-Administrative role:** Formation of policies about reproductive health. Planning of surveys of needs for information about reproductive health. Preparation in budget. Data collection. In-services education and training of nursing staff. **2-Supervisory role:** Supervision for nurses and midwifery personal. **3-Educational role:** Nurses must have knowledge about human biology of reproduction, education for family life and concept of reproductive health. The nurse must be able to transmit this knowledge effectively. **4-Role in research and evaluation:** Nurses are essential members of the research team studies. Keep careful records and reports relating to their nursing activities used in research studies. Provide valuable data upon which research may be based. Evaluation of reproductive health services. **5-Genetic and sexual counseling role:** a\) Genetic counseling may include: Provided for a client of reproductive age before conception, after conception and after birth. Genetic screening is analyzed to detect the presence of disease or case finding for couples at potential risk based on medical/family histories. b\) Sex education: Sex education may include: Risks and consequences of sexual activity. Contraceptive and sexual transmitted diseases STD\'s. **6-Counsling role:** Counseling has six elements you can remember them with the English word (GATHER): 1-(G) Great clients. 2-(A) Ask clients about themselves. 3-(T) Tel the clients about reproductive health. 4-(H) Help clients. 5- (E) Explain information. 6- (R ) Return for follow up. **Menstruation and Menopause** **General objectives:** At the end of lecturer the master student able to understand Women's Health across Life Span (Menstruation and Menopause) **Specific objectives :** The student at the end of lecture able to : - Define meaning of health - Define meaning of women health - Identify meaning of menstruation - Know the menstrual cycle - Identify menstrual cycle problems - Discuss health education for women during menstruation - Define menopause - List symptoms of menopause - Identify what happen during menopause - Discuss menopause complications - List nursing management **Out line:** - Definition of health - Definition of women health - meaning of menstruation - the menstrual cycle - menstrual cycle problems - health education for women during menstruation - Define menopause - symptoms of menopause - what happen during menopause - menopause complications - nursing management - Role of nurse **Introduction:** Attitudes toward menstruation and menopause are shaped by both cultural and individual characteristics. Menstruation and menopause are not celebrated in western cultures, where they are depicted by the mass media and the health-care profession as something to be managed or remedied, and as something less than feminine Conversely, menstruation has been viewed historically and cross-culturally as a natural phenomenon In fact, a recent study found that the majority of women regarded menstruation as natural; only a small minority thought of it as a nuisance or a curse. Prompting much of the current research about women's attitudes toward cyclical bleeding.Menopause has also been medicalized, recently gaining media attention highlighting the findings of risks associated with hormone therapy and women's and health-care practitioners' responses. Because most research on menopause has focused on the undesirable aspects, such as hot flashes and night sweats, this has inadvertently contributed to the negative social construction of menopause. in some cases, menopausal symptoms can be problematic and affect women's quality of life but perceptions and attitudes toward menopause are also influenced by culture, education, and geography **Definition of health:** Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." **Women\'s health:** Women\'s health refers to the branch of medicine that focuses on the treatment and diagnosis of diseases and conditions that affect a woman\'s physical and emotional well-being. **Definition of menstruation** Menstruation is a woman's monthly bleeding, often called "period." When menstruate, the body discards the monthly buildup of the lining of uterus. Menstrual blood and tissue flow from uterus through the small opening in cervix and pass out of body through vagina. estrogen and progesterone hormone levels begin falling Very low levels of estrogen and progesterone tell body to begin menstruation. **Signs &symptoms :** - Abdominal cramps. Abdominal, or menstrual, cramps are also called primary dysmenorrhea. \.... - Tender breasts. \... - Fatigue. \... - Bloating. As(abdominal bloating ) - Bowel issues. \... - Headache. \... - Mood swings. PMS Symptoms. Female Stress, Abdominal Pain, Acne and Moody. Woman Period Problems. Isolated Menstrual Syndrome, Panty Stock Vector - Illustration of belly, human: 169844969 ***Menstrual cycle:*** - Menstrual cycle is counted from the first day of period up to the first day of next period. hormone levels (estrogen and progesterone) usually change throughout the menstrual cycle and can cause menstrual symptoms. - The typical menstrual cycle is 28 days long, but each woman is different. a woman's menstrual cycle length might be different from month-to-month. periods are still "regular" if they usually come every 24 to 38 days. - This means that the time from the first day of last period up to the start of next period is at least 24 days but not more than 38 days. ***Phases of the menstrual cycle*** menstrual cycle is the series of hormone-driven events that prepares your body to get pregnant and carry a baby. This cycle follows a process that's divided into four distinct phases: ![C:\\Users\\intel\\Desktop\\menstrual-cycle.jpg](media/image5.jpeg) **Menstruation** This is the first, but also in some ways the last, phase of your menstrual cycle. It's when the thickened lining of your uterus sheds during your monthly period. Menstruation can last from three to seven days, depending on the length of your cycle. **Follicular phase** This starts on the first day of menstrual period and ends when you start to ovulate. During this phase, the egg-containing pods called follicles ripen and one of the eggs matures. **Ovulation** This phase happens when the ovary releases that mature egg down the fallopian tube on its way to fertilization. This is the [shortest phase of the cycle](https://www.healthline.com/health/womens-health/what-is-ovulation), lasting just 24 hours. **Luteal phase** In this phase, the follicle that released the egg produces hormones that thicken and ripen the uterus to ready it for pregnancy. Every woman's menstrual cycle is unique. The length of each cycle and its phases can vary based on your age and other factor. **Menstrual cycle problems** Women may at times experience problems or irregularities in menstrual cycle. **Common problems include**: - **[Amenorrhea]**: This refers to the absence of a menstrual cycle for at least 90 days. Contributing factors amenorrhea period include pregnancy, breastfeeding, eating disorders, excessive exercising, and stress. - **[Dysmenorrhea]**: This is sometimes severe menstrual pain. Possible causes include uterine fibroids, endometriosis, and excessive levels of a hormone called prostaglandin. - **[Abnormal uterine bleeding]**: This term includes any vaginal bleeding not considered normal for a menstrual period. This might include bleeding between periods or after sex, any vaginal spotting, unusually heavy or prolonged menstrual bleeding, and postmenopausal bleeding. **Health education for women during menstruation:** - It's normal. Menstruation is a normal process that should happen to every girl once reaches puberty -- usually somewhere between the ages of 9 and 16. - Menstruation is not a sickness. women can live their normal life during menses &perform all activity. - Women can have irregular cycles in their first few years of menstruation. But each women can learn to understand how own body works by watching the small changes that happen each month. It may take a few years to settle into a regular monthly pattern. - women experience many changes around the time they get first period. women's breasts grow, grows hair on her body, and her hips widen. Sometimes hormones make both women more emotional than usual. - Menstruation does not have to be a secret. There is a big difference between being discreet and keeping something secret because are scared or ashamed. - Sometimes menstruation can be painful! The amount of pain can differ a lot from women to women and from month to month. - Diet makes a difference to well-being. The girls in community might be told by their families and communities to avoid certain food and drinks when they have their period. she can eat and drink anything that's included in a well-balanced diet. If women do not eat lots of different foods, especially foods rich in iron and folic acid, they may face feel tired and depressed. - Exercise is really good for women, no matter which time of the month. There are many benefits to exercise, including the mental boost get from feeling fit. Exercise is a good way to help prevent cramps, and gentle exercise like a walk can also help relieve pain. - A women's body will be healthy if she practices good hygiene during her period. - women must continue to wash normally during menses. Not being clean can leave women at risk of infections. - A women should wash outside her genital area at least once a day. If she does not have access to a shower or bath, she use a small amount of plain water, soap and a soft cloth - She should always wash her hands with soap after she uses the toilet or changes a pad or cloth. - Disposable pads need to be changed regularly, at least every six hours **Definition of Menopause**. **The menopause**: is defined as a physiological event thus: ovarian failure due to loss of ovarian follicular function accompanied by oestrogen deficiency resulting in permanent cessation of menstruation and loss of reproductive function. **NICE define menopause as:** "Menopause is when a woman stops having periods as she reaches the end of her natural reproductive life. This is not usually abrupt, but a gradual process during which women experience perimenopause before reaching post-menopause. **Symptoms of pre menopause:** - Irregular periods, absent periods, heavy bleeding. - Hot flushes. - Night sweats leading to poor sleep. - Tiredness. - Mood changes/low mood/anxiety/irritability. - Poor self esteem. - Vaginal dryness. - Decreased sex drive. - Poor sleeping. - Bladder issues. - Vaginal problems including increase in infections. - Changes in skin and hair. - Joint pains. - Bloating. - Longer-term problems such as osteoporosis and - increase in cardiovascular disease (CVD). The Complete List of Menopause Symptoms - All 35 of Them! **What Happens During Menopause?** Natural menopause isn't caused by any type of medical or surgical treatment. It's slow and has three stages: This phase usually begins several years before menopause, when ovaries slowly make less estrogen. Per menopause lasts until menopause, the point at which ovaries stop releasing ovum. In the last 1 to 2 years of this stage, estrogen levels fall faster. Many women have menopause symptoms. - **[Menopause]** This is when it\'s been a year since you had a period. ovaries have stopped releasing ovum and making most of their estrogen. - ### [Post menopause.] These are the years after menopause. Menopausal symptoms such as hot flashes usually ease. But health risks related to the loss of estrogen increase as get older. **Menopause Complications** The loss of estrogen linked with menopause is tied to a number of health problems that become more common as women age. After menopause, women are more likely to have: - Bone loss (osteoporosis) - Heart disease - Bladder and bowels that don't work like they should - Higher risk of Alzheimer\'s disease - More wrinkles - Poor muscle power and tone - Weaker vision, such as from cataracts and macular degeneration - sexual changes that come along with menopause, like vaginal dryness and a loss of sex drive. don't enjoy sex as much and have trouble reaching orgasm. **Managing menopause symptoms:** **1-Keeping cool and staying comfortable** Dress in loose, layered clothing, especially during the nighttime and during warm or unpredictable weather. This can help manage hot flashes. Keeping bedroom cool and avoiding heavy blankets at night can also help reduce chances of night sweats. If regularly have night sweats, consider using a waterproof sheet under bedding to protect mattress. can also carry a portable fan to help cool down if feeling flushed. **2-Exercising and managing your weight** Reduce daily calorie intake by 400 to 600 calories to help manage weight. It's also important to exercise moderately for 20 to 30 minutes a day. This can help: increase energy promote a better night's sleep improve mood promote your general well-being **3-Communicating your needs** Talk to a therapist or psychologist about any feelings of depression, anxiety, sadness, isolation, insomnia, and identity changes. **4-Supplementing your diet** Take calcium, vitamin D, and magnesium supplements to help reduce risk for osteoporosis and improve energy levels and sleep. **5-Practicing relaxation techniques** Practice relaxation and breathing techniques, such as: yoga box breathing meditation **6-Taking care of skin** Apply moisturizers daily to reduce skin dryness. should also avoid excessive bathing or swimming, which can dry out or irritate skin. **7-Managing sleeping issues** Use sleep medications to temporarily manage insomnia or consider discussing natural sleep aids with doctor. Talk to doctor if regularly have trouble sleeping so they can help manage it and get a better night's rest. **8-smoking and** **alcohol limiting use** Stop smoking and avoid exposure to secondhand smoke. Exposure to cigarettes may make symptoms worse. should also limit your alcohol intake to reduce worsening symptoms. Role as a nurse\...**\ ** think about menopause or hormone-related issues in women you see\ when you meet a woman with menopause symptoms suggest they see their GP, practice nurse or specialist -- use the BMS specialist finder\ be skilled and confident to ask questions relating to wellbeing, mood, symptoms, vaginal dryness, sexual issues in a compassionate and supportive way\ think about how menopause could have an impact on existing expression or mental health and understand the differences in hormonal low mood and depression and the different treatment pathways\ assess whether a presentation is related to menopause and holistic support - do not assume it is depression\ be aware of the common menopausal treatments and any interactions with medication\ be aware of evidence in side effects and myths around HRT\ make a diagnosis from history and not blood tests\ think menopause and its treatment not depression and anti-depressants\ women with a strong history of reproductive depression respond well to oestrogens Menopause and Mental Health \< Contents**\ ** think not only about symptoms but long-term health, think bones and cardiovascular disease and what can you do to optimise health\ be aware of diagnostic overshadowing for women with menopause\ be aware of the common treatments and interactions\ be positive - menopause is natural **[Contraception and reproductive life planning]** - Introduction - Definition of the Reproductive Life Plan (RLP) - Factors contributing the Reproductive Life Plan (RLP) - Role of nurse during the Reproductive Life Plan - Definition of Family Planning services. - Objectives of family planning methods. - Types of Family Planning Methods. Access to safe, voluntary family planning is a human right. Family planning it is a key factor in reducing poverty. Yet, globally at least 222 million women who want to use safe and effective family planning methods are unable to do so because they lack access to information, services, the support of their partners or communities. Most of the women with an unmet need for family planning live in 69 of the poorest countries on earth. Egypt is the most populous country in the Middle East and the third most populous country in Africa. The 2018 fertility rate is at 3.1, according to a study prepared by UNFPA, with data collected from the birth and mortality registration system implemented in collaboration between with the Ministry of Planning, Monitoring and Administrative Reform and the Ministry of Health and Population. **Egypt\'s Situation:** The 2014 DHS indicates that fertility rate significantly has increased after more than 20 years of decline. Between 1980 and 2008, Fertility dropped from 5.3 children per woman to 3.0 children per woman. But since2008, fertility has risen (by half a child) to 3.5 births after experiencing a plateau of 3 births for years (3.8 in rural areas, 2.9 in urban areas). In 2020, Egypt launched a two-year initiative called \"Two Is Enough\" to encourage families to have fewer children. In 2021, fertility rate for Egypt was 2.9 births per woman. Fertility rate of Egypt fell gradually from 6 births per woman in 1972 to 2.9 births per woman in 2021. In 2021, birth rate for Egypt was 22.6 per 1,000 people. Birth rate of Egypt fell gradually from 41.2 per 1,000 people in 1972 to 22.6 per 1,000 people in 2021. **Definition of fertility rate** Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with current age-specific fertility rates. **Definition of Birth rate** Crude birth rate indicates the number of live births occurring during the year, per 1,000 population estimated at midyear. **Definition of the Reproductive Life Plan (RLP)** the CDC defines the RLP as "a set of personal goals about having (or not having) children. It also states how to achieve those goals **[Factors contributing the Reproductive Life Plan (RLP)]** - **Health Literacy** Is defined as "the degree to which individuals have information about future intentions for pregnancy, number of children desired and optimal time for childbearing. - **Social and Cultural Dimensions of RLPs** Considerations should include the woman's Religion, Ethnic culture, Available social support including family relationship, and available sources of information. - **Policy Issues** Unemployment rates and living below the poverty level is challenging for nurses to introduce the RLP. - **[benefits of Reproductive Life Planning]** - **Patient Empowerment** - Increase people's sense of empowerment, encouraging exploration of their own values and resources to formulate goals about whether or when to be parents. - Facilitate matching contraceptive choices to short and long term reproductive goals, resulting in increased satisfaction and adherence to a specific method. - Increase understanding about the benefits of optimal preconception - Increase healthy behaviors - **Supporting Fertility Preferences** - Offers the opportunity to support all women's fertility desires, independent of social norms. **[Role of nurse during the Reproductive Life Plan]** 1-nurses discuss the concept of a RLP during a well-baby visit. The dialogue begins with a few broad questions including desire to have children, the number of planned children, and the timing of each pregnancy (Table 2). 2-After these data are gathered the nurse can then tailor the intervention in response to the woman's plan and questions. 3-Development of educational materials will be essential to support patient learning and help with time management. Some Sample Questions for a RLP 1-Do you plan to have children (even if this plan is in the future)? 2-When do you plan to have your first baby? Or next baby (if you already have children)? 3- How many children do you want to have? How many years apart do you plan to have your children? 4-How do you plan to prevent pregnancy when you do not want to have children? 5-What will you do if you have an unplanned pregnancy? What can I do to help you with your plan? What information can I share with you to have a healthy pregnancy? ***[Contraception and reproductive planning during the COVID-19 pandemic]*** *On 30 January 2020, the World Health Organization (WHO) Emergency Committee declared the corona virus disease (COVID-19) a global health emergency. Infectious outbreaks have the potential to devastate family planning programs;* *recent evidence suggests that despite some concentrated declines in April and May 2020 many countries were able to maintain or restore access to essential health services, including family planning. However, the impact of COVID-19 on access to health services has varied across countries and is ongoing. ƒ* ***[Recommendations for using contraceptive method during COVID-19 pandemic]*** For policymakers, WHO advises that innovative strategies are developed to ensure as many eligible people as possible can access information and contraception during this period, including: - - Increase use of mobile phones and digital technologies to help people make decisions about which contraceptive methods to use, and how they can be accessed. - Managing some contraceptive side effects can be done through various communication methods that do not require in-person contact (SMS, WhatsApp, video calls, or telephone calls). - Always offer long-acting reversible contraception (LARC) to every patient seeking contraception - If a woman is well adapted to her current method, she should keep using it. Although it may be difficult to access all the contraceptive methods, due to restrictions on movement, lack of supply, and increased demands on health providers and services during the COVID-19 pandemic. **types of Contraception methods.** 1**. Natural Contraception.** **2. Mechanical Contraception.** **3. Hormonal Contraception.** **4. Surgical Contraception.** **1) Natural Family Planning Methods** 1. **[Rhythm method :]** - Also known as the calendar method. - The rhythm method involves avoiding unprotected intercourse during the fertile period. - This fertile period ( it is a certain days in menstrual cycle in which woman is more likely to conceive , usually lasts from 3 to 4 days before until 3 to 4 days after ovulation). - woman should record the length of menstrual cycle for at least 6 cycles to identify the shortest and longest cycle length. - The beginning of fertile period is estimated by subtracting 18 days from the shortest cycle. - The end of fertile period is estimated by subtracting 11 days from the longest cycle. - The first day of menstruation is the first day of the cycle. - Increased reliability can obtained with 8 to 12 months of menstrual cycle. 2)**[body temperature]** - The basal body temperature method involves observing a woman's temperature every morning. Because a woman's temperature drops about half degree 12 to 24 hours before her ovary releases an egg, and one degree at day of ovulation this indicates a period of high fertility. should avoid intercourse during this time to avoid pregnancy. This period lasts from temperature drop until 48 to 72 hours after it returns to normal. 3. **[Cervical mucus (ovulation or Billings )method: ]** - The normal stretchable amount of cervical mucus is 8 to 10 cm. - Before and after ovulation the mucus is scant, thick, sticky and whitish. It stretches less than 6 cm. - Just before ovulation and for 2 to 3 days after: the cervical mucus becomes thin, watery, transparent and increase in amount. During the peak of ovulation the cervical mucus becomes slippery and stretches at least 6 cm or more before the strand breaks. - The fertile period consist of all the days that cervical mucus is watery and the 3 days after the peak date. - During these days the woman and her husband should abstain from intercourse to avoid conception.. It is a natural birth control technique based on the fact is that lactation (milk breastfeeding) causes amenorrhea (absence of menstruation). LAM to be fully effective, the following criteria must be met: 1\. The woman's menstrual period mustn't have returned. 2\. Exclusive breast feeding : which means that the infant receives no food or fluid other than breast milk. 3\. The baby must be less than 6-months Old. **[2) Mechanical Family Planning Methods ]** **Definition of Mechanical (barriers):** Mechanical barriers are devices that placed inside uterus, over the cervix or the penis to physically obstruct passage of sperm through cervix. So it prevents sperm from entering uterus and fallopian tubes. **Types of mechanical barriers:** **A- Intrauterine contraceptive device(IUDs).** **B- Female Condom.** **C- Cervical Cap.** **A. Intrauterine contraceptive device(IUDs)** **Definition of intrauterine device** IUDs is a small, plastic \"T-shaped\" device with bendable arms inserted into the uterus through the cervical canal attached with two strings/ threads protrude into the vagina so that woman can check for placement of IUDs. **Types of (IUDs):-** 1\. None-medicated: It is first generation as lippes loop not availablenow. 2\. Medicated (has two types): Less pain, bleeding & better protection than non-medicated. - ParaGard (Copper IUD) Made of plastic and fine solid copper wrapped around its vertical stem and arm with strings attached through a hole in the stem. The most common used and used for 10 years. - Hormonal containing (IUDs) Are device that release progesterone hormone and they're Expensive - **[Contraindications of (IUDs):-]** 1. Suspected pregnancy. 2. Cancers of the reproductive organs. 3. Allergy to copper (suspected or proven). 4. Infection or inflammation of the genitaltract. 5. liability of bleeding. 6. Anatomic uterine deformities/malformation as bicornuate uterus. 7. A History of ectopic pregnancy and a history of problems with IUDS. 8. Severe Anemia. Anemia is relative complication on account of possible menorrhagia that IUDS induce. 9. Cardiac disease -- diabetes, for the risk of infection. - Tell the woman about warning signs which needs to seek the doctor immediately: - [P] Period late, abnormal spotting orbleeding. - [A] Abdominal pain, pain with intercourse. - [I] Infection exposure, abnormal vaginal discharge. - [N] Not feeling well, fever, and chills. - [S] Strings missing , shorter or longer than normal. - Follow-up examination is suggested 4 to 8 weeks after insertion THEN after 3 months THEN after 5 years. - Diet rich in iron and vitamin c. - Personal hygiene ( keep perineal area clean and dry \_ wear cotton underwear, avoid vaginal douching \_ change perineal pad every 2 hours ) **[B- Female Condom. ]** **[Definition of female condom: ]** **[C.Cervicalcap]** **[Definition of cervical cap: ]** **3) Hormonal Family Planning Methods** **[Definition o f hormonal F.P methods: ]** Are methods consist of synthetic hormones, called (estrogen and progesterone) used to prevent unwanted pregnancy. There are several different types of hormonal contraceptive methods. The difference among them involve; ▪ The type of hormone. ▪ The amount of hormone. ▪ The way hormone enters a woman\'s body. The hormones Formulations are administered orally, trans dermally, vaginally, by implantation into body tissue, or by injection. **A) Oral Contraceptive Pills.** Types of Oral contraceptives pills include two types:-  Combined Oral Contraceptive Pills (COCs) contain both estrogen and progestin.  Progestin only pills (POCs, also known as mini-pill does not contains estrogen, contains less progestin than combination pills and may be used by lactating women. **1) Combined Oral Contraceptive Pills (COCS):** Effectiveness of COCS pills:- - COCS is the most effective method available to women today. - effectiveness rate is almost 100%. - Failures rate( i.e., pregnancy occurs) are caused by omission of one or more pills during the regimen 9%. **[Method of Use for COCS:- ]** Three regimens are available : 1- The 21 day system pack: In this case the woman will have the pill for 21 days consecutively, and then take a 7 day break to allow the monthly menses to occur.. 2- The 28 day system pack: User take 21 pills first contain estrogen and progesterone then the 7 remaining pills dose contains no active drug they only iron pills or placebo. **Initiations of pills: (Methods of beginning COCS use )** In the 1st day of menses- Sure that the women not pregnant- After child birth: Non-breastfed women: delay until 6 weeks\# Breastfed women: can delay until 6 months in complete, exclusive breastfeeding\# **After abortion :**The pills can be taken in the first **7-10 days** after abortion **Schedule** One pill per day until the pack is finished (21 pills- -7days break between packs -Start another pack in day 7.. **Advantage of COCS ** - Highly effective in providing contraception - Don't interfere with sexual intercourse. - Client can stop use any time they want to get pregnant. - Reduction on incidence of ectopic pregnancy through inhibition of ovulation. - Eliminate premenstrual cramps. - Increase menstrual cycle regularity. **Disadvantages of COCS** - They don\'t protect the woman or her partner from sexual transmitted disease (STDS). - Not used with breastfeeding woman. - Illness that cause vomiting may reduce their effectiveness. - Some anticonvulsant and antibiotics reduce their effectiveness. **Contraindications of COCS:** Presence or a history of deep venous thrombosis or pulmonary embolism. Diabetes Benign or malignant Liver tumor, severe cirrhosis/hepatitis. Uncontrolled Hypertension. Gall bladder disease. Suspected or known pregnancy and lactation. Absolute breastfeeding \< 6 months. **Side Effects of COCS**  Nausea, vomiting and headache.  Increase in appetite.  Weight gain.  Depression.  menorrhea, amenorrhea or dysmenorrhea. **2) The Progestin-Only Oral Contraceptive pills (POP):** **Definition of minipill Progestin-only pills (mini-pill)** it' s a type of oral contraceptive pills that contain a synthetic form of progestin hormone only **-Progestin-only pill** a small dose of progesterone is taken daily without any break. Mode of action:- 1-Cause thickening of the cervical mucus to prevent penetration by sperm 2-they are also making endometrial lining unfavorable for implantation **[Initiation]** \- In the 1st day of menses- \- After child birth: \#Non-breastfed women: can start immediately Breastfed women: can delay until 6 weeks\# Schedule: \- One pill per day at the same time daily until the pack is finished (28 pills). \- No breaks between packs. **Advantages of POCS** Minipill is considered to be more than 99%effective used properly. has a low dose of progesterone may cause less side effects can be used by women who are breastfeeding does not affect fertility Decrease painful menses and menstrual blood loss. **Disadvantages of POCS**  does not protect against sexually transmissible infections (STIs)  can be less effective than some other methods of contraception  must remember to take it at exactly the same time every day  may make periods change -as: (some bleeding between periods ,irregular bleeding pattern )  can have hormonal side-effects including:( headaches, acne andmood changes) **Client education for combined and progestin-only contraceptive Pills (Nursing role).** 1\) Reinforce the need to take pills every day at the same time 2)The woman should know that pills don\'t offer protection against sexually transmitted disease,.she or her partner should use a condom in combination with the pill for this type protection. 3\) Instruct the woman to use additional form of contraception for the first 7 days after starting pills because it does not take effect for 7 days. 4\) When the woman missed one pill: less than 12 hours, take the pill immediately when she remembers. 5\) When the woman missed one pill: more than 12 hours or more than one pill, there is the possibility of escape ovulation. Take pills as soon as remembered and continue rest of pack/ pills at usual time. Use a back-up method along with pills for the next 7 days or refrain from intercourse for the remainder of the cycle.  if two pills missed, two pills taken immediately once remember, then two tablets are taken at the usual time + Using a backup method for 7days or the remainder of the cycle ). 6\) The woman should be aware with signs of potential complications associated with the use of oral contraceptives that warn her to discontinue/stop taking the pill **(ACHES).** - **A**:-**Abdominal pain**or yellowing of skin may indicate problem with the liver or gallbladder. - **C:-Chest pain**or shortness of breath may indicate possible clot problem within the lungs or heart. - **H:-Headaches (sudden or persistent),** weakness, or numbness of extremities may be caused by cardiovascular accident or hypertension - **E:-Eye problems**(complete or partial loss of vision), speech problems may indicate vascular accident or hypertension. - **S:-Severe leg pain (calf or thigh)**may indicate thromboembolic process. **B) Hormonal Injectable contraceptives:** **Definition of hormonal injectable contraceptives** 1. progesterone alone As depo provera injected every 3 months or 2. estrogen and progesterone injected every month **Post use instructions.** **C) Subdermal implantable contraceptive (Implanon):** **Definition and Description:** **Post use instructions.** **[4.Surgical Family Planning Methods]** A. **Tubal ligation** **Advantage** **Disadvantage** B. **Vasoectomy** It\'s a surgical contraceptive method performed on males in which vas deferens (tubes that carry sperm from testicles to seminal vesicles) are cut tied or interrupted and called permanent sterilization. **Advantage** 1\) It\'s safe and effective 99.6%. 2\) It\'s a permanent method of birth control. 3\) It can be done as an outpatient procedure, with little anesthesia and minimal pain (causes fewer complications than tubal ligation In female) 4\) No decrease in the production of male hormone (testosterone) or the amount of ejaculate. 5\) It does not affect man\'s physical ability to have intercourse , the male still produce seminal fluid, it just doesn\'t contain sperm. **Disadvantage** 1\) Misconception about the procedure may lead some men to resist it. 2\) Infertility does not occur immediately after procedure is finished i.e. (the vasectomy is not immediately effective). 3\) No protection against sexually transmitted diseases. **Family Planning Counseling** Definition of family planning counseling: It is a face-to-face, personal communication between two persons in which one person (counselor) has information helping another to choose a family planning method and make decisions on them and the other receives this information (client or / mother). **Principles of family planning counseling:** Show clients that you are care about them by 3 qualities: Understanding: put yourself in client place and try to understand how the client feels. Respect: be friendly and polite. Honesty (build trust): tell the truth do not try to hold back information that client wants. Give client clear, useful and accurate information so client understands. Confidentiality must be ensured, both in the process of counseling & the handling of client records. Voluntary voice. Informed consent. Empowerment. Client or woman\'s rights. **Elements / Steps of family planning counseling:-** Counseling about family planning has six elements or steps which can be remembered as acronym (GATHER): 1\. \"G\" refers to (Greet clients in friendly respectful manner, give them full attention and introduce yourself.). 2\. \"A\" refers to (Ask clients about themselves.Ask about age, marital status, number of pregnancies, number of births, number of living children, family planning methods used now or in the past and their medical history. 3\. \"T\" refers to (Tell about family planning methods). 4\. \"H\" refers to (Help clients Choose a method). 5\. \"E\" refers to (Explain how to use the chosen method). 6\. \"R\" refers to (Return for Follow-Up). **[Pelvic Inflammatory Disease]** **[Out lines]** - Introduction. - Definition of Pelvic Inflammatory Diseases (PIDs). - Risk Factors of Pelvic Inflammatory Diseases. - Sign &Symptoms of Pelvic Inflammatory diseases. - Sites of Infection. - Complication of Pelvic Inflammatory Diseases. - Diagnosis of Pelvic Inflammatory Diseases - Medical management of Pelvic Inflammatory Diseases. - Nursing care plan of Pelvic Inflammatory Diseases. **[Introduction]** Pelvic inflammatory disease (PID) is an infection of a woman\'s pelvic organs including the uterus, fallopian tubes, ovaries, and cervix. PID begins with a cervical infection that spreads by surface invasion along the uterine endometrium & then out to the fallopian tubes and ovaries. The diagnosis of pelvic inflammatory disease (PID) can include any combination of endometritis, salpingitis, tubo-ovarian abscess, or pelvic peritonitis. Each of these disease processes is characterized by ascending spread of organisms from the vagina or cervix to the structures of the upper female genital tract. Although PID is most notable for the associated risk of severe, the infections may be asymptomatic (\"silent\") or overt with mild to severe symptoms. It is most likely to occur at the end of a menstrual period, because menstrual blood provides an excellent growth medium for bacteria & there is loss of normal barrier of cervical mucus during this time. **[Definition of pelvic inflammatory Diseases (PIDs):]** Pelvic inflammatory diseases (PIDs) is infection and inflammation of the genital tract in women. It occurs when a bacteria or organism enters the cervix and spreads upward. It can affect the uterus, fallopian tubes, ovaries, and other organs related to reproduction. **[Incidence of PIDs]:** in 2020the annual incidence of PIDs in 2020 20 to 39 years of age was 10 to 15per 1,000 women **[Risk Factors of PID:]** - Women at greater risk for PID include those at risk for sexually transmitted infections (STIs). - Women under age 25 are at risk because the cervix of teenage girls and young women is not fully matured. - Other potential risk factors include douching removes the natural, protective mucous from the cervix. - Using an intrauterine device (IUD) to prevent pregnancy can also cause PID. - Multiple sexual partner &frequent intercourse. - Smoking. - D&C: (Dilation and curettage): is a procedure to remove tissue from inside the uterus to diagnose and treat certain uterine conditions such as heavy bleeding or to clear the uterine lining after a miscarriage or abortion. - Termination of pregnancy. - HSG: (Hysterosalpingogram) is an important test of female fertility in which a radiographic contrast (dye) is injected into the uterine cavity to show whether the fallopian tubes are open or blocked. **[Micro-organism of PID:]** 1. Chlamydia trichomonis , Neisseria gonorrhea. 2. E-coli, Mycoplasm. 3. Staphylococci, Streptococci. 4. **[Sign and Symptoms of PID:]** - Pain in lower abdomen. - Fever up to 38 degree. - Rapid pulse. - Chills. - Vaginal discharge that may have an odor. - Painful intercourse. - Painful urination. - Back pain. - Irregular menstrual bleeding. **[Sites of infection:]** - The vulva. - The vagina. - The cervix. - The uterus. - The fallopian tubes. **[1.The vulva]** - **[Vulvitis : ]** It is inflammation of the vulva in which the vulva is swollen, red ,burning sensation, hotness, and tenderness. **[Causes:]** 6. Excessive vaginal discharge. 7. Stress incontinence which irritates the skin. 8. Allergy to any used chemicals such as; soap, contraceptive creams 9. Diabetes: sugar content of the urine and vaginal discharge which favors media for growth of Candida albicans 10. Tight underclothing or sanitary pads 11. Poor personal hygiene, incorrect wiping of the anus, lacks of washing, excessive discharge. **[Signs and symptoms:]** - Extreme itching. - A burning sensation in the vulvar area. - Vaginal discharge. - Redness and swelling on the vulva and labia. - Blisters on the vulva (a small bubble on the skin filled with serum and caused by friction, burning, or other damage). - Thick whitish patches on the vulva. **[2.The vagina ]** - **[Vaginitis:]** Inflammation of vagina can occur at any age. [**Types of vaginitis**:] 1. **Senile vaginitis:** After menopause the vaginal epithelium becomes thin and dry, no longer protected by the acid virginal secretions. This will lead to senile vaginitis. 2. **Gonococal Vaginitis:** Caused by gonococcus. 3. **Allergic vaginitis :** It is due to allergic reaction to chemicals such as contraceptives, foreign bodies such as forgotten tampons. 4. **Trichomonal vaginitis:** Caused by trichomonis virginals 5. **Monilial vaginitis :** Infection by fungus called Candida albicans **[Signs & Symptoms of vaginitis:]** 1. Redness and soreness of vaginal wall. 2. Bleeding & dyspareunia. 3. Burning sensation of micturation. 4. Slight gray discharge with unpleasant odor. **[3.The Cervix]** - **[Cervicitis:]** It is Inflammation of the endocervix may be acute or chronic. **[a. Acute Cervicitis:]** Occur commonly during puerperium, cervix is red, swollen, and tender. A yellow mucoid discharge (does not cause irritation or soreness). The treatment is to correct the infection. **[b. Chronic Cervicitis and Cervical Erosion (endocervicitis)]** It is usually followed acute cervicitis, or after cervical laceration due to childbirth. It occurs in about 20% of parous women. Treatment: is usually cauterization. [**C**. **Cervical Ectropion**] It is a condition in which laceration or dilatation of the external os causes the edges to evert, the columnar epithelium is exposed and become infected. Squamous cells grow over the area **[4.The Uterus]** - **[Endometritis]** It is inflammation of the lining of the uterus. - **[Acute Endometritis ]** May be caused by infection after childbirth, gonorrhea, or during uterine operations. - **[Chronic Endometritis]** May be due to malignancy, infected polyps or lack of resistance because of senile atrophy. **[Sign & symptoms:]** - - - - - - **[5.The fallopian tubes:]** - **[Salpingitis :]** -It is inflammation of the fallopian tubes. may be unilateral or bilateral. -This condition is a common cause of female infertility because the inflammation can damage the fallopian tubes. **[Causes: - ]** -Septic abortion, puerperal sepsis, tuberculosis and appendicitis. **[Symptoms:]** - - - [**Complications of PID**:] - Ectopic pregnancy. - Obstructed labor. - Premature rupture of membrane. - Sepsis. - Infertility. - Carcinoma. - Chronic pelvic pain. - **Tubo-ovarian abscess.** **[Diagnosis of PIDs:]** **I- History:** 6. **[Symptoms]** : - [Abdominal pain](http://www.emedicinehealth.com/script/main/art.asp?articlekey=58648) (especially lower abdominal pain) or tenderness. - [Back pain](http://www.emedicinehealth.com/script/main/art.asp?articlekey=59170). - [Abnormal uterine bleeding](http://www.emedicinehealth.com/script/main/art.asp?articlekey=58758). - [Unusual or heavy vaginal discharge](http://www.emedicinehealth.com/script/main/art.asp?articlekey=105575). - Painful urination. - [Painful sexual intercourse](http://www.emedicinehealth.com/script/main/art.asp?articlekey=59329). **II- Physical examinations:** 7. **[General examination:]** There is fever 38^0^C and above. - **[Pelvic examination:]** - - **III-Investigations**: - **[Laboratory tests:]** **Blood and urine tests.** These tests may be used to test for pregnancy, HIV or other sexually transmitted infections, or to measure white blood cell counts or other markers of infection or inflammation. **[Cervical swab:]** Used to diagnose Chlamydia& gonorrhea. - **[Ultrasound & Laparoscopy:]** If the disease process is unclear, these techniques are ultimate way to establish the diagnosis. **[Medical management of PIDs:]** ***[Outpatient]*** PID treatment should be early, aggressive and last for 14 days prospectrum antibiotics. PID treatment regimens should provide empiric, broad-spectrum coverage of likely pathogens. Multiple parenteral and oral antimicrobial regimens have been effective in achieving clinical and microbiologic cure in randomized clinical trials with short-term follow-up - - - - - ***[Inpatient]*** The decision of whether hospitalization is necessary should be based on provider judgment and whether the woman meets any of the following criteria: - - - - - - **Pregnancy** Pregnant women suspected of having PIDs are at high risk for maternal morbidity and preterm delivery. These women should be hospitalized and treated with IV antimicrobials in consultation with an infectious disease specialist. **HIV Infection** women with HIV infection and PIDs were more likely to require surgical intervention. they are more likely to have a tubo-ovarian abscess. An abscess may require surgical removal, and the procedure is typically followed by oral (by mouth) or IV antibiotics. **Principles of treatment of PIDs:** - Early and aggressive treatment for 14 days. - Used combined and broad-spectrum antibiotic. - Re-evaluation in48-72 hours. - Encourage barrier contraceptive method. - Screening and treatment of sexual partner. **Recommended Parenteral Regimens for Pelvic Inflammatory Disease** - - - - +-----------------------------------------------------------------------+ | **Nursing Intervention for PID** | | | | - After establishing that the patient has no drug allergies, | | administer an antibiotic | | | | - Monitor vital signs for fever and fluid intake and output for | | signs of dehydration. | | | | - Watch for abdominal rigidity and distention, possible signs of | | developing peritonitis | | | | - Provide frequent perineal care if vaginal drainage occurs. or | | chronic infection | | | | - Use meticulous hand-washing technique; institute wound and skin | | precautions, | | | | - Encourage the patient to discuss her feelings. Also, offer | | emotional support, | | | | - To prevent recurrence, encourage compliance with treatment and | | explain the disease (endometritis), | | | | - Stress the need for the patient\'s sexual partner to be examined | | | | - Discuss the use of condoms to prevent the spread of sexually | | transmitted diseases. | | | | - Because PID may cause dyspareunia, advise the patient to check | | with her physician broad ligaments about sexual activity. | | (Parametritis). | | | | - To prevent infection after minor gynecologic procedures, such as | | dilatation and curettage, tell the patient to immediately report | | fever, increased vaginal discharge, or pain. After such | | procedures, | | | | - Instruct her to avoid douching or having intercourse for at least | | 7 days. | +-----------------------------------------------------------------------+ **[Violence against woman]** **Outlines** - Introduction - Definition of terms - Health consequences or impact of violence against women\\ - Risk factors for both intimate partner and sexual violence - Types of violence against women - - Prevention of violence against women - Ethical and safety standards for research on violence against women (VAW) - Role of the nurse **\ Introduction** Violence against women is the most pervasive yet under recognized human rights violation in the world. It is also a profound health problem that saps women's energy, compromises their physical and mental health, and erodes their self-esteem. In addition to causing injury, violence increases women's long-term risk of a number of other health problems, including chronic pain, physical disability, drug and alcohol abuse, and depression. Women with a history of physical or sexual abuse are also at increased risk for unintended pregnancy, sexually transmitted infections, and miscarriages. Despite the high costs of violence against women, social institutions in almost every society in the world legitimize, obscure, and deny abuse. The same acts that would be punished if directed at an employer, a neighbor, or an acquaintance often go unchallenged when men direct them at women, especially within the family. [ ] **[Definition of terms]** **Violence against women** any act of gender-based violence that results in physical, sexual, or mental harm or suffering to women, including threats of such acts, coercion, or deprivation of liberty, whether occurring in public or private life". **Intimate partner violence** refers to behaviour by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, and psychological abuse and controlling behaviours. **Sexual violence** ** **is \"any sexual act, attempt to obtain a sexual act, or other act directed against a person\'s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting. [ **Health consequences or impact of violence against women**] Violence -- in all its forms -- can have an impact on a woman's health and well-being throughout the rest of her life -- even long after the violence may have ended. - It is associated with increased risk of injuries, depression, anxiety disorders, unplanned pregnancies, sexually-transmitted infections including HIV and many other health problems. It has impacts on society as a whole and comes with tremendous costs, impacting national budgets and overall development. - Intimate partner (physical, sexual and psychological) and sexual violence cause serious short- and long-term physical, mental, sexual and reproductive health problems for women. - They also affect their children's health and wellbeing. This violence leads to high social and economic costs for women, their families and societies. 8. 9. **Impact on children** - - [Types of violence against women] --------------------------------------------- **1)Domestic violence** - Domestic violence, also called domestic abuse or intimate partner violence, is any pattern of behavior that is used to gain or maintain power and control over an intimate partner. - This is one of the most common forms of violence experienced by women globally. **[Domestic violence can include the following.]** - **Economic violence** - Economic violence involves making or attempting to make a person financially dependent by maintaining total control over financial resources, withholding access to money. - **Psychological violence** - Psychological violence involves causing fear by intimidation; threatening physical harm to self, partner or children. **Emotional violence** - Emotional violence includes undermining a person\'s sense of self-worth through constant criticism; belittling one\'s abilities; name-calling or other verbal abuse; damaging a partner\'s relationship with the children; or not letting a partner see friends and family. - **Physical violence** - Physical violence involves hurting or trying to hurt a partner by hitting, kicking, burning, grabbing, pinching, shoving, slapping, hair-pulling, biting, denying medical care or forcing alcohol and/or drug use, or using other physical force. It may include property damage. - **Sexual violence** - Sexual violence involves forcing a partner to take part in a sex act when the partner does not consent. See more about sexual violence below. **2)Femicide** Femicide refers to the intentional murder of women because they are women, but may be defined more broadly to include any killings of women or girls. Femicide differs from male homicide in specific ways. For example, most cases of femicide are committed by partners or ex-partners **3)Sexual violence** Sexual violence is any sexual act committed against the will of another person, either when this person does not give consent or when consent cannot be given because the person is a child, has a mental disability, or is severely intoxicated or unconscious as a result of alcohol or drugs. Sexual violence can include the following. - **Sexual harassment** - Sexual harassment encompasses non-consensual physical contact, like grabbing, pinching, slapping, or rubbing against another person in a sexual way. It also includes non-physical forms, such as catcalls, sexual comments about a person's body or appearance. - **Rape** - Rape is any non-consensual vaginal, anal or oral penetration of another person with any bodily part or object. This can be by any person known or unknown to the survivor, within marriage and relationships, and during armed conflict. - **Corrective rape** - Corrective rape is a form of rape of perpetrated against someone on the basis of their sexual orientation or gender identity. It is intended to force the victim to conform to heterosexuality or normative gender identity. - **Rape culture** - Rape culture is the social environment that allows sexual violence to be normalized and justified. It is rooted in patriarchy and fueled by persistent gender inequalities and biases about gender and sexuality. - **Human trafficking** - Human trafficking is the acquisition and exploitation of people, through means such as force, coercion, or deception. This crime ensnares millions of women and girls worldwide, many of whom are sexually exploited. **4)Female genital mutilation** Female genital mutilation (FGM) includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. It is classified into four major types, and both the practice and the motivations behind it vary from place to place. FGM is a social norm, often considered a necessary step in preparing girls for adulthood and marriage and typically driven by beliefs about gender and its relation to appropriate sexual expression. **5)Child marriage** Child marriage refers to any marriage where one or both of the spouses are below the age of 18. It is a violation of the Universal Declaration of Human Rights, which states that "marriage shall be entered into only with the free and full consent of the intending spouses." Girls are more likely to be child brides, and consequently drop out of school and experience other forms of violence. **6)Online or digital violence** Online or digital violence against women refers to any act of violence that is committed, assisted or aggravated by the use of information and communication technology (mobile phones, the Internet, social media, computer games, text messaging, email, etc) against a woman because she is a woman. **[Risk factors for both intimate partner and sexual violence include:]** - - - - - - - - - - - - - [Prevention of violence against women ] --------------------------------------------------- - RESPECT also highlights that successful interventions are those that prioritize safety of women; whose core elements involve challenging unequal gender power relationships; that are participatory; address multiple risk factors through combined programming and that start early in the life course. - To achieve lasting change, it is important to enact and enforce legislation and develop and implement policies that promote gender equality; allocate resources to prevention and response; and invest in women's rights organizations. **[Role of the health sector]** While preventing and responding to violence against women requires a multi-sectoral approach, the health sector has an important role to play. The health sector can: - - - - - **[WHO response]** WHO, in collaboration with partners: - - - - - - Identifying Abuse - Taking Care of the Physical Health Needs of Patients - Attending to Women's Safety - Making Referrals - Providing Support) psychological, informational, instrumental, and financial( - Providing Advice ***[Male involvement in reproductive health]*** Out lines - Introduction - Definition of (male reproductive health, Male involvement , Sexual and reproductive health) - Objectives of male involvement in reproductive health - Factors influencing male participation in reproductive health - Barriers of male involvement in reproductive health - Principles for engaging men in reproductive health - Men as reproductive health clients/users of RH services - Reproductive health care guidance - Male involvement and responsibility in reproductive health - Approaches for involving men in reproductive health; creating awareness, male friendly RH clinics, male RH life-cycle approach Introduction Although the data in maternal death show declining trend over the last three decades in developing countries, it still accounts for 99% of global maternal mortality in low- and middle-income countries, which approximates to 287,000 per year. Many international communities are putting their optimum efforts in reducing maternal mortality. Institutional delivery, universal access to antenatal care, presence of skilled health personnel during delivery and provision of essential equipment, drugs, and supplies are some of the important strategies that are being put forward. However, in recent years along with these potential drivers, male involvement in reproductive health is recommended as one of the basic interventions to improve the maternal health and outcomes. The 1994 International Conference on Population and Development (ICPD) held in Cairo, Egypt called for male involvement in reproductive health programs to overcome gender inequities and improve the health of both men and women. Male involvement in reproductive health is an essential component in promoting maternal and family health. In Nepal, men are not actively engaged in most maternal and child health (MCH) services nor in other reproductive health programs. There is a need to know about the understanding of key professionals in such practices. This study explores gendered perspectives among teachers and health professionals to understand the factors contributing to male involvement in reproductive health. Male involvement in reproductive health: The word \"Reproductive Health\" implies both men and women. Men are partners in reproduction and sexuality. Men\'s reproductive health and their behaviors impact on women\'s reproductive health and children\'s well-being and society as well. And encouraging men to become more involved and supportive of women\'s needs, choices, needs and rights in reproductive health. Reproductive health The ability of people to have a responsible, satisfying and safer sex life, to be able to have children and to have the freedom to choose when and how to do so. It also includes that men and women know about safe, effective, affordable and acceptable birth control methods; As well as obtaining appropriate health care services for sexual and reproductive medicine, and implementing health education programs to ensure that having a safe pregnancy and childbirth provides couples with the best chance of having a healthy child. Reproductive health is a state of physical, emotional, mental, and social well-being in relation to all aspects of reproduction, not merely the absence of disease, dysfunction, or infirmity. Therefore, a positive approach to reproduction should recognize the part played by pleasurable relationships, trust, and communication in the promotion of self-esteem and overall well-being. **Objectives of male involvement in reproductive health:** 1\. Provide guidance on how men can actively participate in all aspects of reproductive health as a way to attain women's empowerment and gender equality. 2\. Identify capacity building needs to equip national agencies, local government units to implement the program. 3\. Provide suggestions for moving forward on the previous recommendations for encouraging male involvement in RH. **Factors Affecting the Reproductive** **Health Needs of Young Adults** - Age. - Marital status. - Gender norms. - Sexual activity. - School status. - Childbearing status. - Economic/social status. - Rural/urban. **Barriers to male participation in reproductive health** **Individual** - Personality - Socialization - Ego **Family barriers** - Taboos made against mammal interaction with small children. - Cultural norms about family planning being women problem. - Lack of role models for involved fathering. - Cultural assummption that any thing domestic is women work. - Fear of being viewed as not man enough by peer if caught doing housework or child care - Family planning service are geared towards womens needs and are not welcoming to men e.g( MCH) - Traditional male female roles reinforced in mass media - Sepration law are not favourable to male or joint custody of children. - No legal paternity leave. - Inadquate family life education in school to help change gender strereotypes. - Hospital clinic regulation not supportive of father involvement in birth and post partum care. - Lack of specific interventions to address them. - **Principles for Engaging Men in Sexual and Reproductive Health** - Take a human rights-based approach, incorporating sexual and reproductive rights, and amplifying the voices of men who already advocate for SRHR. - Uphold women's rights and autonomy, including women's right to choose if, and how, their partners are involved in their sexual and reproductive health (SRH) decisions and services. - Take a positive approach to men's engagement that supports men to be more healthy, caring, and gender equitable and that acknowledges the positive role they can, and already do, play in their own SRH and that of their families. - Acknowledge men's own vulnerabilities, including their specific needs, experiences, and challenges in relation to SRH - Provide high-quality, male-friendly, and client-centered services using accessible entry points for men, boys, and couples, including a healthcare model that is not solely biomedical, that incorporates rights and gender equity, and that provides privacy and confidentiality, dignity, and respect. - ensure the meaningful involvement of communities in designing responses to men needs. Men as reproductive health clients/users of RH services SRH Clinical Services for Men and Adolescent Boys 1\. Assessment Questions on Client History - Take a standard medical history - Take a detailed sexual health assessment (including sexual function and satisfaction) - Assess for fertility intentions - Take a cancer evaluation (as appropriate) - Assess for experience of sexual and gender-based violence, including intimate partner violence (initial assessment questions) - Assess for alcohol, tobacco, and other substance use - Assess for mental health, including depression - Assess for nutrition, food availability, diet, and exercise - Assess for immunizations/vaccinations 2\. Physical Exam - Measure height and weight, and calculate body mass index (BMI) - Measure blood pressure - Conduct external genital and perianal exam - Conduct other physical exam(s) relevant from history using clinical judgment 3\. Contraception - Counsel client (if not undertaking couple counseling) and provide information on all available contraceptive options, his role in contraception, and how to be supportive and communicate with his partner in choosing the contraceptive option that works for them both - Counsel the couple (if partner agrees) and provide information on all available methods of contraception, including promotion of dual protection - Provide condoms and condom-compatible lubricant, as well as other contraceptive methods, including emergency contraception 4\. Sexually Transmitted Infections (STIs) - Counsel client and provide information on STIs, including couple counseling (if partner agrees) - Provide etiological diagnosis of STIs (diagnostic testing; i.e., laboratory and microscopy) - Provide HPV and hepatitis B vaccinations - Provide viral hepatitis services, including prevention, screening, and treatment 5.Disorders of the Male Reproductive System, Including Sexual Dysfunction - Diagnose sexual dysfunctions (erectile dysfunction, delayed ejaculation, premature ejaculation), counsel client, and provide referral - Treat (or refer) for sexual dysfunctions (erectile dysfunction, delayed ejaculation, premature ejaculation) - Treat (or refer) for other disorders of the male reproductive system (warts, varicoceles, urological disease, etc.) 6\. Fertility and Infertility - Counsel client on basic fertility awareness, including preconception health - Counsel couples for conception (if the partner agrees) - Counsel client on infertility - Provide basic infertility care for men, including semen analysis - Provide vasectomy reversal (recanalization) services (or refer) 7.Sexual and Gender-Based Violence (SGBV) Support) - Screen for experience of SGBV, including intimate partner violence - Counsel and support clients affected by violence and refer for clinical, psychosocial, and protection services - Refer clients who have a history of perpetrating violence against women to a relevant program/support group Reproductive health care guidance The QFP makes recommendations for core family planning and SRH services to deliver to reproduction-age persons, and, for the first time, delineates preventive SRH care services to deliver specifically to men. The QFP makes comprehensive recommendations that reproductive- age men 1.receive family planning services - contraception and counseling - information on achieving pregnancy; - basic infertility care; - preconception healthcare; - STI diagnosis and treatment 2.family planning-related preventive services - genital examination to assess progress of healthy sexual development) 3.other preventive services - lipid screening - quality family planning delivery be monitored for women as well as for men **Male Involvement and Responsibility in Reproductive Health** - Filipino males play a dominant role in decision making in relationship and family matters. Many sectors recognize that involving males in women's reproductive health significantly increases the chances of improved reproductive health and well-being of women and children. - It has been pointed out that among the major weaknesses of family planning program in the country is its focus on women and corresponding lack of male contraceptive responsibility for the broader RH program, there is a need for men's shared responsibility and involvement in : - Maternal care and Child Health and Nutrition, - Preventing and Management of Abortion and its Complications - Violence Against Women and Children - Education and Counseling on Sexually Transmitted Diseases, - Adolescent Reproductive Health. Approaches for involving men in reproductive health; creating awareness, male friendly RH clinics, male RH life-cycle approach The approach considers males in the following stages: 5. Early adolescents (10--14 years old) 6. Older adolescents (15--21 years old) 7. Single adults (who may have casual sexual partners or only male partners) 8. Newly married/cohabiting men and couples (of all sexual orientations) with no children 9. Pregnancy and postpartum for men and couples (of all sexual orientations) with children 10. Parenting stage for couples with children 11. Older stage for men and couples who no longer desire to have children and in older age - Important areas to consider for assessments of knowledge and attitudes include: - Knowledge of puberty and reproduction across the life cycle, for example: - Boys' knowledge of physical, social, and emotional changes during puberty - Young men's knowledge of reproduction, women's menstruation, and related issues - Knowledge of the fertile period - Knowledge, beliefs, and attitudes toward family planning and contraceptive methods, particularly as they relate to sexual functioning and gendered social roles, for example: - Knowledge of individual methods, how they work, and their side effects - Ideal family size - Beliefs about how contraception affects health, work, and future fertility - Knowledge of, preferences for, and perceptions of family planning services, for example: - Men's and boys' knowledge of family planning service availability - Men's and boys' preferred characteristics for contraceptive services, service providers, and health facilities Semester work (20 Marks) Give short account on:- I. Causes and risk factors for early marriage in Egypt II. Egypt strategies for preventing early marriage

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