Physical and Sexual

self
REPRODUCTIVE
SYSTEM
Why do we need to
produce?
• To ensure survival of the species.
• To produce egg and sperm cell.
• To transport and sustain these sperm
• To nurture the developing offspring.
• To produce harmones
MALE + FEMALE =

FERTILIZATION
 Diseases associated with reproductive
system,
• Reproductive tract infection (RTI) are infections that affect
the reproductive tract, which is part of the Reproductive System. For
females, reproductive tract infections can affect the upper
reproductive tract (fallopian tubes, ovary and uterus) and the lower
reproductive tract (vagina, cervix and vulvaiatrogenic infections and
the more commonly known sexually transmitted infections.[1]Each has
its own specific causes and symptomsby a bacterium, virus, fungus
or other organism. Some infections are easily treatable and can be
cured, some are more difficult, and some are non curable such
as AIDS and herpes.[2]); for males these infections affect
the penis, testicles, urethra or the vas deferen. The three types of
reproductive tract infections are endogenous infections, 
• Prostate cancer - Cancer of the prostate gland
• Breast cancer - Cancer of the mammary gland.
• Ovarian cancer - Cancer of the ovary.
• Penile cancer - Cancer of the penis.
• Uterine cancer - Cancer of the uterus.
• Testicular cancer - Cancer of the
testicle/(plural:testes).
• Cervical cancer - Cancer of the cervix
 Sexually transmitted diseases
• Sexually transmitted diseases (STDs) are infections
that pass from one person to another through sexual
contact.They are also known as sexually transmitted
infections (STIs) or venereal diseases (VD).
• Some STDs can spread through the use of unsterilized
drug needles, from mother to infant during childbirth
or breast-feeding, and blood transfusions.
• The genital areas are generally moist and warm
environments, ideal for the growth of yeasts, viruses,
and bacteria.
 Chlamydia

• What is chlamydia?
• Chlamydia is a common sexually transmitted disease. It
is caused by bacteria called Chlamydia trachomatis. It can
infect both men and women. Women can get chlamydia
in the cervix, rectum, or throat. Men can get chlamydia in
the urethra (inside the penis), rectum, or throat.
• How do you get chlamydia?
• You can get chlamydia during oral, vaginal, or anal sex
with someone who has the infection. A woman can also
pass chlamydia to her baby during childbirth.
Chlamydia
 Gonorrhea
• Gonorrhea: A bacterial infection that is
transmitted by sexual contact. Gonorrhea is
one of the oldest known sexually transmitted
diseases (STDs), and it is caused by the
Neisseria gonorrhoeae bacteria. Men
with gonorrheamay have a yellowish
discharge from the penis accompanied by
itching and burning.
Gonorrhea
 Syphilis
• Syphilis is a sexually transmitted disease (STD)
caused by an infection with bacteria known as
Treponema pallidum. Like other
STDs, syphilis can be spread by any type of
sexual contact. Syphilis can also be spread
from an infected mother to the fetus during
pregnancy or to the baby at the time of birth.
Syphilis
 Chancroid
• What is a chancroid?
• Chancroid is a bacterial infection that causes
open sores on or around the genitals of men
and women. It’s a type of 
sexually transmitted disease (STD), which
means it’s transmitted through sexual contact.
It’s rarely seen in the United States. It occurs
most frequently in developing nations.
 Human papillomavirus
• What is human papillomavirus infection?
• Human papillomavirus (HPV) is a viral infection that is passed
between people through skin-to-skin contact. There are more
than 100 varieties of HPV, 40 of which are passed through
sexual contact and can affect your genitals, mouth, or throat.
• According to the Centers
for Disease Control and Prevention (CDC), HPV is the most
common sexually transmitted infection that affects both men
and women. It’s so common that most sexually active people
will get some variety of it at some point, even if they have few
sexual partners.
Human papillomavirus
 Herpes simplex
• What is herpes simplex?
• The herpes simplex virus, also known as HSV, is an
infection that causes herpes. Herpes can appear in various
parts of the body, most commonly on the genitals or
mouth. There are two types of the herpes simplex virus.
• HSV-1: Also known as oral herpes, this type can cause cold
sores and fever blisters around the mouth and on the
face.
• HSV-2: This type is generally responsible for genital herpes
outbreaks.
Herpes simplex
 Trichomonas vaginalis
• What is trichomoniasis?
• Trichomoniasis (“trich”) is a 
sexually transmitted infection (STI). It is very
common. According to the Centers for Disease
Control and Prevention (CDC), 
3.7 million Americans are infected with
trichomoniasis at any given time. Trich is easily
treated.
Trichomonas vaginalis
 NATURAL AND ARTIFICIAL METHODS OF
CNTRACEPTIONS
• Natural Methods
• Natural methods of birth control do not
involve medications or devices to prevent
pregnancy but rather rely on behavioural
practices and/or making observations about a
woman’s body and menstrual cycle.
 Abstinence
• Compliance
• 0 % failure rate
• Most effective way to prevent STD
 Calendar method
• The calendar method helps you predict your
fertile days by tracking the length of your
menstrual cycles over several months.
 Basal body temperature
The basal body temperature method — a
fertility awareness-based method — is a type of
natural family planning. Your basal body
temperature is your temperature when you're
fully at rest. Ovulation may cause a slight
increase in basal body temperature.
 Cervical mucus methods
• Cervical mucus methods help you predict
when you’re going to ovulate by tracking the
changes in your cervical mucus (vaginal
discharge) throughout your menstrual cycle.
 Symptothermal Method
• The Symptothermal Method
(STM) is an effective, co-
operative, scientifically-
based and inexpensive
method of natural family
planning. It is based on the
awareness of the fertility of
the couple.
 Ovulation predictor
• Ovulation predictor kits
(OPKs) detect the surge in
luteinising hormone (LH) just
before you ovulate. They look
similar and work in a similar
way to home pregnancy tests
in that they detect an
increased level of the
hormone in your urine .
Family Planning
 Contraceptives
• Nursing plays a primary role in providing
education about contraceptive choices and
teaching about the use of different methods
 Contraceptives
• Educate about “safe sex” practices

• Be sure to F/U(follow-up) in 1 – 3 weeks on

the effectiveness of the method chosen
 The Ideal Method Should Be
• Safe
• 100% effective
• Free of Side Effect
• Easily obtainable
• Affordable
• Acceptable to the user & sexual partner
• Free of effects on future pregnancies
 Abstinence
• Compliance
• 0 % failure rate
• Most effective way to prevent STD
 Oral Contraceptives
“The Pill”
• Prevents ovulation; mimics the hormonal state
of pregnancy
– Increased estrogen--- Diminishes hypothalamic
effect on GrHR--- Inhibits the release of FSH /
LH------NO OVULATION OCCURS

– Progestin
• Affects cervical mucus & endometrial lining
 Oral Contraceptives
“The Pill”
• Monophasic
– Provides fixed doses of both estrogen and
progestin throughout the 21 day cycle
• Triphasic
– Vary both estrogen / progestin throughout the
cycle
– Mimics woman’s natural hormonal pattern
 Oral Contraceptives
“The Pill”

• Side effects &

contraindications
– P. 107 Pillitteria
– Absolute
– Possible
• “ACHES” – Should
call health care
provider immediately
 Oral Contraceptives
Client Education
• A= Abdominal pain
• C= Chest pain
• H= Headache (severe)
• E= Eye problems (loss or blurring)
• S= Severe leg pain (calf or thigh)
 Oral Contraceptives
Client Education
• Missed pills
• Drugs (barbiturates, griseofulvin, isoniazide,
penicillin, tetracycline decreases the
effectiveness of the pill
• Avoid if BF’ing until milk supply is well
established
• Discontinue if pregnancy occurs
 Oral Contraceptives
Client Education
• Adolescent girls should have well established
menstrual periods (2 years) prior to starting
the pill
• When to start pills
– 1st Sunday after beginning period; after childbirth
Sunday 2 weeks post delivery; post Ab – 1st Sunday
after procedure
 Emergency Contraception

• “morning after pill”

• 75% effectiveness rate
• Combination
estrogen/progestin
• Progestin only
– < NV
– 89% effective
 Emergency Contraception
• Can be taken immediately and up to
72 hrs
• Taken 2 doses; 2nd dose taken 12 hrs
first
• Major SE – Nausea
– Call health care provider if severe – may
prescribe antiemetics
• Next period should begin within 2 –
3 weeks
• START IMMEDIATELY WITH AN
ACCEPTABLE METHOD OF
BIRTHCONTROL
 Norplant Implants
• Long acting hormonal method
• 6 silastic membrane capsules filled with
35 mg progestin
Inserted upper arm

Last for 5 years

 Norplant Implants
• Effective within 24 hours after
insertion

• Mode of action: suppress

ovulation, thicken cervical
mucus, creates a thin atrophic
endometrium, causes more
rapid tubal transport of ovum
 Norplant Implants
• Does not suppress lactation
• Side Effects
– Menstrual irregularities
– Amenorrhea after a few months
– Abdominal pain
– H/A
– Hair growth / hair loss
 Norplant Implants
• Contraindications
– Liver Dz
– Pregnancy
– Unexplained vaginal bleeding
– Breast CA
– Hx thrombophlebitis
 Depo- Provera (DMPA)
• Medroxyprogesterone Acetate
• Injectable progestin

• Mode of action: prevents ovulation, thickens

cervical mucus
 Depo- Provera (DMPA)
• Dose 150 mg single dose vial

• IM – Do Not massage (hastens absorption and

shortens the period of effectiveness

• Given with 5 days of onset of period

• Within 5 days from delivery
 Depo- Provera (DMPA)
• Contraception begins immediately and last for
3 months

• Instruct client to F/U for injection 2 weeks

before 3 months is up

• Usually will not have period after 1 year of use

 Depo- Provera (DMPA)
• Side effects and contraindications same as
Norplant
• 99.7 percent effective
• ***May be used during lactation
• Women who plan to get pregnant within 6 – 9
months suggest another method
 Intrauterine Device

• Progestasert & Paragard 380A

• Device inserted into uterus
• Mode of action
– Inhibits migration of sperm
– Speeds ovum transport
– Local inflammatory response in
uterine cavity- endotoxins are
releases that destroys sperm
– Cervical mucus
 Intrauterine Device
• Side Effects
– Increased Bleeding (anemia)
– Dysmenorrhea
– Pelvic Infections
– Ectopic Pregnancy
– Uterine perforation
 Intrauterine Device
• Contraindications
– Multiple sexual partners (risk for STD’s)
– Active, recent, or chronic pelvic infection
– Postpartum endometritis or septic abortion
– Pregnancy
– Endometrial or cervical malignancy
– Valvular heart disease
– Immunosuppression
 Intrauterine Device – Client Education

• Palpating string – check before intercourse

and after each period
• Inspect pads and tampons for an expelled IUD
• Advise alternate contraception 1st month after
insertion
 Intrauterine Device – Client Education
• Teach PAINS
• P – period late, abnormal spotting or bleeding
• A – abdominal pain, pain with intercourse
• I – infection exposure, abnormal vaginal
discharge
• N – not feeling well, fever, chills
• S – string missing, shorter or longer
 Intrauterine Device – Client Education

• Advise to wait 3 months after removal before

becoming pregnant – this reduces the risk of
ectopic pregnancy
• Annual F/U
 Diaphragm
• Mechanical Barrier to entry of sperm into the
cervix
• Used with a spermicide cream or jelly provides
additional protection
 Diaphragm
• Safe
• Flexibility according to frequency of
intercourse
• Used with spermicide protects against STD
 Diaphragm
• Complications
– Toxic Shock Syndrome
– Pg 1442 – 1443 Pillitteri
 Diaphragm
• Contraindications
– Hx of TSS
– Allergy to latex or spermicide
– Recurrent UTI
– Inability to learn insertion technique (mentally or
physically challenged)
– Abnormalities of vaginal anatomy that prevents a
good fit or stable placement – uterine prolapse,
extreme retroversion
 Diaphragm – Client Education
• S/S TSS
• Annual visits
• Needs to be refitted after significant weight
gain > 10 lbs, pelvic surgery, full term delivery
(after pregnancy should wait about 12 weeks
PP before using the diaphragm)
 Diaphragm – Client Education
• May be left in place up to 12 – 24 hrs
• Must be left in place 6 hrs after intercourse
• May be inserted up to 2 hrs before intercourse
• Must be fitted by MD or NP
 Cervical Cap
• Barrier method; soft rubber dome with a
flexible rim
• Shaped like a thimble
• Filled with spermicide
• Inserted prior to intercourse & should be left
in place at least 8 hours
• Should not be worn longer than 24 hours
 Cervical Cap

• Complications
– Cervical trauma
• Client should have
F/U 3 months then
annually

• Contraindications – p.
114
 Cervical Cap – Client Education
• Practice insertion & removal
• Cap should not be worn during periods
• Cleaning – mild soap & water
• Check for tears
• Do not use petroleum products
• Schedule RTC 3 months
• Should be refitted after delivery, gyn surgery,
significant weight gain / loss
 Male Condom
• Covers penis acts as a mechanical barrier to
prevent sperm from entering the vagina
• Protects against STD’s
• Inexpensive & available without a prescription
 Male Condom
• Contraindications
– Allergy to latex or collagenous tissue
– Inability to maintain erections
– Inability to use properly
 Male Condom – Client Education
• Application and removal – put on before
vaginal penetration; leave space in tip
• Should not be lubricated with petroleum
• Store in cool dry place (not wallet)
• To maximize protection against STD’s use with
spermicide
 Female Condom
• Vaginal Pouch
• Flexible ring that fits over cervix
• Provides some protection against STD’s
• May be inserted up to 8 hours before
intercourse
• Expensive
• One time use
 Vaginal Spermicides
• Creates a physical barrier and also kills sperm
secondary to a chemical action
• Safe & Simple
• Preps include: jellies, creams, foam,
suppositories, tablets, thin square film
 Vaginal Spermicides
• Inserted into the vagina about 5 – 10 minutes
before intercourse; usually are effective for 2
hours
• Tablets and suppositories take longer to
dissolve – insert 10 – 30 minutes prior to
intercourse
 Vaginal Spermicides
• Available without a prescription
• Protects against STD’s
 Vaginal Spermicides
• Contraindications
– Allergy to spermicidal
– Inability to use consistently at the time of
intercourse
– Physical / mental delays
– Cervicitis
 Vaginal Spermicides – Client Education

• Consistent use
• Times of insertion
• Good contraceptive to use during the
immediate PP period
• Need to add more if intercourse is repeated
 Breast Feeding
• Prolongs anovulation for a certain period of
time, but is not always effective and ovulation
may return before menstruation reoccurs and
PREGNANCY may result

• Not an absolutely reliable method

 Fertility Awareness Methods
• Rely on ovulation prediction by the couple
• Important points
– Ovulation occurs 14 days before the beginning of
the next menses
– Ovum can be fertilized for 24 hours; sperm are
viable for 72 hrs
– Regular cycles can vary by +/- 2 days
 Fertility Awareness Methods
• Important points
– Period of abstinence must be at least 8 days due
to variability of menstrual cycles
– *Risk of fertility is often 15 or more days, or about
half the cycle
 Fertility Awareness Methods
• Calendar Method
• Basal Body Temperature Method
• Cervical Mucus
• Symptothermal Method
• Ovulation Predictor Test
 Withdrawal – Coitus Interruptus
• Male ejaculates outside vagina
• Sperm are contained in pre-ejaculatory fluids
• Interfere with sexual satisfaction of both
partners
• **LEAST reliable method of contraception
Hormonal Imbalance Signs

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