|g Tanssexuality- a transsexual or transgender is an individual who, although of one big biologic | gender, fecls as if he or she is of the opposite gender. They may undergo cosmetic surgery to | change the gender they feel they are. FAMILY PLANNING AND CONTRACEPTION CHAPTER THREE ‘A conscious process by, which a.couple decides on the number and spacing of children and the timing of births. © Objectives of family planning include: A. avoiding unwanted pregnancies through contraception B. regulating intervals between pregnancies. C. deciding on the number of children that will be in the family. D. controlling the time at which the birth occurs. E. preventing pregnancy for women with serious illness in whom pregnancy would pose a health risk. F. providing the option of avoiding pregnancy to women who are carriers of genetic diseases. ‘Bs CONTRACEPTION © - The voluntary prevention of pregnancy. The decision to practice contraception has individual and social implications. © When choosing an appropriate contraceptive method, the client must consider many factors including: A. religious orientationB, social and cultural values C, medical contraindications D. psychological contraindications E, individual sexual expression F. cost G. availability of bathroom facilities and Privacy h.partner’s support and willingness to cooperate. I. personal lifestyle C. NURSING RESPONSIBILITIES: 1, Assisting the couple in selecting and using an effective contraceptive method is an important part of the nurse’s role. 2. Understanding one’s own philosophy, beliefs, and standards isimportant. 3. Educating the individual or couple about the complete ‘range. of» contraceptive . possibilities. . 4. Understanding and teaching about available contraceptive methods and their use, effectiveness, advantages, disadvantages and side effects. 5. Providing a comfortable, factual nonjudgmental attitude when discussing contraception and sexuality. 6. Compiling a thorough health history and assessment data. CONTRACEPTIVE METHODS: A, Natural Fertility Awareness Methods: © It teaches familiarity with body in order to recognize signs of fertility pregnancy, as well as monitor gynecological health. © To prevent pregnancy, couples abstain during recognized period of fertility. relations has a theoretical 0% failure rate and also is the © It is useful to avoid or achieve 1, Abstinence- or refraining form sexual Most effective way to prevent STI. 2. Calendar method- requires couple to ab: when the woman is most likely to conceive (3 0 stain from coitus on the days of the menstrual cycle 1 4 days before or 3 or 4 days after ovulation)To calculate for ‘safe days,’ subtract 18 from the shortest menstrual cycle. This represents her first fertile day. Then she subtracts 11 from her longest cycle, then this represents her last fertile day 3. Basal body temperature-monitoring the body temperature daily before rising. Prior to ovulation, BBT decreases slightly in Tesponse to estrogen. After ovulation, a surge of progesterone increases BBT by 0.5-1.0 degree Fahrenheit 4, Cervical mucous method- the amount and character of the cervical mucous changes throughout the menstrual cycle in response to hormone. Following menses, cervical mucous is Scant, thick and cloudy. At ovulation, cervical mucous becomes more abundant, slippery, clear> and stretchable in response to: cstrogeri known as\‘spinnb promoting sperm motility, increased likelihood of pregnancy with unprotected intercourse. (Feming test- when high levels of estrogen are present in the body as they are just before ovulation, the cervical mucus forms fefilike palicra caused by erystallization of sodium chloride (cytofix) on mucous fibers when it is placed on a glass slide and allowed to dry. 5,Symptothermal method- a combination of BBT and cervical mucus method 6. Mittelschmerz B. Coitus Interruptus- oldest known methods of contraception. The couples proceed with coitus until the moment of ejaculation. Then the man withdraws his penis and spermatozoa are emitted outside the vagina. GC LAM (lactation Amenorrhea Method)-prolactin suppresses FSH, and therefore suppresses ovulation. Postpartum women who ‘exclusively’ breastfeed. during the ‘first6-month> after childbirth, including at least one night feeding may postpone ovulation. D. Barrier Methods 1. Female condoni (vaginal pouch) - prelubricated polyurethane sheath with two flexible tings, The inner ring helps with insertion and covers the cervix, while the outer ring rests on vulva. 2..Male condoms thin latex sheath that covers the erect penis during sexual intercourse. 3. Cervical can- made of soft rubber, are shaped like a thimble with a thin rim, and fit snugly over the uterine cervix. 4. Diaphragm- domed-shape rubber cup with a flexible ring that fits over the cervixE, Intrauterine Device (IUD) - inhibits feritization by altering the fallopian tube transport of sperm and ova. Signs of IUD complications: P- Period late (pregnancy) A-abdominal pain (infection) J-Infection N-Not feeling well (infection) S- String missing (IUD expelled) F. Pharmacologic Method 1. Oral contraceptives- are composed of varying amounts of synthetic estrogen with a small amount of synthetic progesterone. Mostly administered daily for 21 days, followed by 7 hormone-free days (either no pills taken or placebos taken for 7 days). © Alterations in menstrual cycle common with progestin-only methods. 6 Side offects includenveight gain, menstrual irregularities and depression. 2. Jinipills- back-up method of birth control needed with missed or late pills © Important to take at the same time cach day. 3. Subdermal implants 4, Subcutancous injections 5. Transdermal patch and the vaginal ring G. Sterilization © Vasectomy — surgical ligation of the vas deferens Tubal ligation---surgical ligation or cauterized of the fallopian tubes through ° minilaparotomy or laparoscopy.J- Overview: A. FERTILITY 1. The reproductive potential of men and women depends on multiple factors, included age, sex, and overall health status. 2. Under optimal condition, about 50% of couples who try to conceive will do so within 6 months. B, SUBFERTILITY 1. Description: © The inability to conceive after at least 1 year of sexual intercourse at least 4 times per week without contraception. © Two types of infertility: 1.:Primary infertility refers to no. piévious history, of elther partner conceiving or impregnating. 2. Secondary infertility is the inability to conceiverafier-a previoussuccessful pregnancy. STERILITY- inability to conceive because of a known condition, such as the absence of the uterus: 2, Etiology: 'A. Factors contributing to female infertility include: © Anovulation-absence of ovulation, the most common cause of infertility among women. It maybe due to hormonal imbalance caused by a condition such as hypothyroidism. The most frequent cause however is due to PCOS, a condition in which the ovaries produces excessive testosterone. © Tubal transport problem Pelvic inflammatory disease is the infection of the pelvic organ: which include the uterus, fallopian tubes, ovaries and their supportive structure.© “Uterine probles Bee umes Such as fibromas may be a rare cause of sub infertility if ,! block the ¢ i vt -ntrance of the fallopian tubes into the uterus or limit the space available on the uterine wall for effective implantation, “ Endometriosis: the implaricis ule sis- the implantation of the uterine endometrium or nodules that have spread from the interior of the uterus to locations outside the uterus, Common sites of endometriosis: 1° Douglas’s cul-de-sac’ 2. Ovaries 3: Uterine ligaments! 4. Outer surface of the uterus and bowel ° Cervical Problems. a stenotic cervical os or obstruction of the os by a polyp may further compromise sperm penetration. A woman who undergone several Procedures of dilatation and curettage (D&C) should be evaluated further for the Possibility of the tightening of the cervical os, © Vaginal Problems: infections of the vagina can cause the pH of the vaginal secretions to become acidotic, limiting or destroying the motility of the sperm. B. Factors contributing to male infertility include: 1, Inadequate sperm count- it is the number of the sperm in a single ejaculation or in a milliliter of semen. © Normal sperm count-20 million/ ml” © 50 million of sperm- per ejaculation © 50% should be motile and 30% morphologically normal. Cryptorchidism (undescended testes)- may lead to lowered sperm production ° Varicocele (varicosities in the spermatic cord), increasing the temperature —_—_ ° disrupting the spermatogenesis. — 2. Obstruction or impaired sperm motility- inability of the sperm to travel because of an obstruction at any point along the pathway. ©. Orchitis- inflammation of the testicles and scarring because of the,stlumps virus 7 © Epididymitis- inflammation of the epididymis - gpm houre, © Tubal infection and gonorthea or ascending urethral infection.© Lhpospidias 3 isvadias: can cause the sperm to be deposited too far from the sexual partner's cervix to allot 3. Ejaculation problems:_ e Erectile dysfunction also called as impotence © Premature ejaculation C. Interactive Problems- eee nomems WV optimal cervical penetration. Tesulting from causes specific to teach people, include: -®7 Insufficient frequency of sexual intercourse # Poor timing of sexual intercourse — Development of antibodies against a partner’s sperm 9 Use of potentially spermicidal lubricants, such as petroleum jelly, and some water- soluble lubricants 27 Inability of the sperm to penetrate the egg cell. Il- FERTLITY TESTING: _ 1/Semen analysis- the number of sperm will be counted and examined. 2. Cervical mucous assessment ° Spinnbarkei it test 3, Posteoital Test - 4, Basal temperature recordings 5, Hormonal assessment of ovulatory function 6. Endometrial Biopsy - y ingography - tA ysterosalpin ont PN 8. Teyiwapinal ultrasound imagery - 9. Hysteroscopy