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MODULE 5 - Reproductive Health, Issues and Concerns
MODULE 5 - Reproductive Health, Issues and Concerns
I. Introduction
The chapter presents several issues and concerns of reproductive health. The module
covers topics on mate selection, sexual and non-sexual risk behaviors, premarital sex, teenage
pregnancy, abortion, responsible planned- parenthood, same sex marriage and sex change.
Learning activities of the module include writing your analyses on cases of teenage pregnancy,
unsafe abortion, and discrimination against workers with HIV. As Gender and Development
(GAD) is mainstreamed in instruction, research and extension in all programs and activities of
CHMSC, the lesson encourages students‟ support in HIV/AIDS awareness campaign to further
educate the youth, stop the stigma, and promote prevention and risks among Filipinos. This
chapter covers 9 hours per week.
Mate Selection
- is the process of choosing a partner with whom to
form a long‐term relationship or a marriage bond. Personal preference is a key component in
the
selection process through structural influences. Sociological literature studies have emphasized
life course factors and variations by gender, race, class, culture, and specific personal traits are
among the explanations for mate choice selection.
Teenagers who feel incomplete, inadequate and unappreciated are more likely to seek
comfort in a sexual relationship. But those with a life rich in relationships, family
traditions, activities, interests and most of all consistent love and affirmation are less likely
to embark on a desperate search for fulfillment that could lead to unwise sexual decisions.
Those who have a healthy, productive faith in God are more likely to have deeply rooted
reasons to respect and preserve the gift of sex and to respect rather than exploit others. The
following are the specific risk factors for teen sex:
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Risk for STDs (Sexually Transmitted Diseases) – A study has revealed that time
spent single after sexual debut was significantly associated with HIV and other
STIs. The study found higher odds of HIV-1, HSV-2 and other STIs among women
with longer duration of premarital sex. Moreover, women with longer duration of
premarital sex were more likely to report multiple sexual partners (Finkelman, 2013).
The number of new cases in the Philippines of HIV, which causes AIDS, jumped
from only four a day in 2010 to 31 a day as of November 2017. From just 117 cases
a decade ago, the total number of HIV cases as of November 2017 is 49,733, an
overwhelming majority of which – 41,369, or 83 percent – were reported in the past
five years alone. Most new infections, up to 83 percent according to the Philippine
government, occur among men or transgender women who have sex with men. The
increase prompted the government to declare a “national emergency” in August
2017. The epidemic is fueled by an environment hostile to policies and programs
proven to help prevent HIV transmission. Government policies create obstacles to
access to condoms and HIV testing and limit educational efforts on HIV
prevention.
3.3 Abortion
choosing to give birth, will leave an everlasting impact on her life. While an abortion may
seem to be the only way out for pregnant teenagers who do not have financial and family
support, the fact remains that an abortion can leave them emotionally unstable for a long
time, sometimes for life.
Abortions are safe if they are done with
a method recommended by World Health
Organization (WHO) that is appropriate to
the pregnancy duration and if the person
providing or supporting the abortion is
trained. Such abortions can be done using
tablets (medical abortion) or a simple
outpatient procedure. However, unsafe abortion occurs when a pregnancy is terminated
either by persons lacking the necessary skills or in an environment that does not conform
to minimal medical standards or both. Women, including adolescents, with unwanted
pregnancies, often resort to unsafe abortion when they cannot access safe abortion.
Abstinence
- This natural method involves abstaining from sexual intercourse and is the most
effective natural birth control method with ideally 0% fail rate. It is also the most effective
way to avoid STIs. However, most people find it difficult to comply with abstinence, so
only a few of them use this method.
Calendar Method
- Also called as the rhythm method, this natural
method of family planning involves refraining from
coitus during the days that the woman is fertile.
According to the menstrual cycle, 3 or 4 days before
and 3 or 4 days after ovulation, the woman is likely
to conceive. The process in calculating for the
woman‟s safe days is achieved when the woman
records her menstrual cycle for six months. It has an
ideal fail rate of 5%, but when used it has a typical
fail rate
of 25%
Basal Body Temperature
- The basal body temperature is the woman‟s temperature at rest. BBT falls at 0.5⁰F
before the day of ovulation and during ovulation, it rises to a full degree because of
progesterone and maintains its level throughout the menstrual cycle, and this is the basis for
the method. The woman must take her temperature early every morning before any
activity, and if she notices that there is a slight decrease and then an increase in her
temperature, this is a sign that she has ovulated. The woman must abstain from coitus for
the next 3 days.
The BBT method has an ideal fail rate of 9% and has a typical use fail rate of 25%.
Ovulation Detection
- The ovulation detection method is an over-the-counter kit that can predict ovulation
through the surge of luteinizing hormone that happens 12 to 24 hours before ovulation.
The kit requires the urine specimen of the woman to detect the LH. The kit is 98% to 99%
accurate and is fast becoming the method of
choice by women.
Coitus Interruptus
- This is one of the oldest methods of contraception. The couple still proceeds with the
coitus, but the man withdraws the moment he ejaculates to emit the spermatozoa outside
of the vagina. The disadvantage of this method is the pre-ejaculation fluid that contains a
few spermatozoa that may cause fertilization. Coitus interruptus is only 75% effective
because of this.
Hormonal Contraception
These hormonal contraceptives are effective through manipulation of the hormones that
directly affect the normal menstrual cycle so that ovulation would not occur.
Oral contraceptives
- Also known as the pill, oral contraceptives contain synthetic estrogen and progesterone.
Estrogen suppresses the FSH and LH to suppress ovulation, while progesterone decreases
the
Transdermal Patch
- The transdermal patch has a combination of both estrogen and progesterone in a form of a
patch. For three weeks, the woman should apply one patch every week on the following
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Vaginal Ring
- The vaginal ring releases a combination of estrogen and progesterone and surrounds the
cervix. This silicon ring is inserted vaginally and remains there for 3 weeks, then removed
on the fourth week as menstrual flow would occur. The woman becomes fertile as soon as
the ring is removed. The vaginal ring has the same effectivity rate as the oral
contraceptives. The subdermal implants are two rod-like implants embedded under the skin
of the woman during her menses or on the 7 th day of her menstruation to make sure that she
is not pregnant. It contains etonogestrel, desogestrel, and progestin. It is effective for 3 to 5
years. Subdermal implants have a fail rate of 1%.
Hormonal injection
- A hormonal injection consists of
medroxyprogesterone, a progesterone, and given
once every 12 weeks intramuscularly. The injection
inhibits ovulation and causes changes in the
endometrium and the cervical mucus. After
administration the site should not be massaged so it
could absorb slowly. It has an effectiveness of almost 100%, making it one of the most
popular choices for birth control. Advise the woman to ingest an adequate amount of
calcium in her diet as there is a risk for decreased of bone mineral density and to engage
in weight-bearing exercises.
Chemical Barriers
- Chemical barriers such as spermicides, vaginal gels and creams, and glycerin films are
also used to cause the death of sperms before they can enter the cervix and also lower the
pH level of the vagina so it will not become conducive for the sperm. These chemical
barriers cannot prevent sexually transmitted infections; however, they can be bought without
any prescription. The ideal fail rate of chemical barriers is 80%.
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Male Condoms
- The male condom is a latex or synthetic rubber sheath
that is placed on the erect penis before vaginal
penetration to trap the sperm during ejaculation. It can
prevent STIs and can be bought over-the-counter. Male
condoms have an ideal fail rate of 2% and a typical fail
rate of 15% due to a break in the sheath‟s integrity or spilling. After sexual intercourse,
the condom is removed to be disposed.
Female Condoms
- These are also latex rubber sheaths that are specially designed
for females and pre-lubricated with spermicide. It has an inner ring
that covers the cervix and an outer, open ring that is placed against
the vaginal opening. These are disposable and require no
prescription.
The fail rate of female condoms is 12% to 22%.
Vasectomoy
- Males undergo vasectomy, which is executed through a small incision made on each
side of the scrotum. The vas deferens is then tied, cauterized, cut, or plugged to block
the passage of the sperm. This procedure is done with local anesthesia, so advise the
patient that mild local pain can be felt after the procedure. There is a 99.5% accuracy
rate for vasectomy and has a few
complications.
Tubal Ligation
- In women, tubal ligation is performed by
occluding the fallopian tubes through cutting,
cauterizing, or blocking to inhibit the passage
of the both the sperm and the ova. After
menstruation and before ovulation, the procedure is done through a small incision under
the woman‟s umbilicus. The woman may return to her sexual activities after 2 to 3 days of
the operation. The effectiveness of this method is at 99.5%.
enables a trans person to alter their physical appearance and the existing sexual
characteristic into the one of their identified gender.
This procedure has become popular, so much so that
many of the public and commercial health insurance
plans in countries abroad provide defined benefits
covering such surgeries. The reassignment primarily
includes Genital Reconstruction Surgery (MTF and
FTM), Chest Reconstruction (FTM), Breast
Augmentation (MTF) and Hysterectomy (FTM). Here
MTF means Male to Female and FTM means
Female to Male.
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community by 2030
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building)
leizl.tortogo@chmsc.edu.ph (63-34) 712-0420 loca
l 116
Pros:
Pros and cons of Sex Change
Surgery:
✔ A patient who undergoes a sex reassignment procedure is able to enjoy her
sexual life in the future as s/he does not have to deal with the mental stress of
being in the wrong body.
✔ Finding the right doctor and getting the desired treatment can lead to
psychological happiness for the patient.
✔ After the gender reassignment surgery, the patients are usually found to be less
gender dysphoric. There have less anxiety levels, depression levels than
before.
Cons:
o The patient who has undergone the surgery from male to female or vice versa,
will be unable to reproduce.
o The patient will not only have to face physical changes but also
psychological changes which may be hard to deal with.
o Postoperative complications can include hematoma. Small hematoma can be
cured through puncture and the larger one needs the patient to undergo surgical
treatment.
References:
Book:
Aguilar,et.al. (2006).Teaching Gender, Sexuality and Reproductive Health (Modules for Integration in the
Social Sciences, Humanities and the National Service Training Program
Amper, Zona S. et.al., Teaching Gender, Sexuality and Reproductive Health. Academe Component of the
Visayas Reproductive Health Initiative. 2006.)
Finkelman, Matthew D. and Ghebremichael, Musie S. (2013) The Effect of Premarital Sex on Sexually
Transmitted Infections (STIs) and High Risk Behaviors in Women. US National Library of Medicine
National Institute of Health. HHS Access Author Manuscript Peer Review and Accepted for Publication.
Electronic resources:
https://www.doh.gov.ph/faqs/What-is-meant-by-Responsible-Parenthood
https://schoolworkhelper.net/understanding-the-theories-of-attraction-and-mate-
selection/
Sex, Love or Infatuation, How Can I Really Know?, Ray E. Short, Kadena Books, 1991, pp . 186-
187. http://www.heraldopenaccess.us/openaccess/premarital-sex-safer-sex-and-factors-influencing-
premarital-sex-practices-among-senior-secondary-school-students-in-ebonyi-local-government-
area- of-ebonyi-state-nigeria
https://www.who.int/health-topics/abortion#tab=tab_1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3634578/
https://nurseslabs.com/family-planning-methods/#natural_family_planning
https://www.freedomofresearch.org/abortion-in-the-philippines-a-true-story/
https://www.hrw.org/news/2018/02/09/philippines-discrimination-against-workers-
hiv