REPRODUCTIVE HEALTH

DR. SHWETHA HITNAL

ASST. PROFESSOR
DEPT OF OBG NURSING
BLDEA’S SHRI BM PATIL IONS
 CONTENT
• UNIT 1 :CONCEPT OF HEALTH AND
PRIMARY HEALTH CARE
• Unit -2: NATIONAL HEALTH PROGRAMMES IN
MCH
• Unit-3: INTRODUCTION TO REPRODUCTIVE AND
CHILD HEALTH
• Unit-4 :SEXUALITY, FERTILITY AND INFERTILITY
• Unit-5: SEXUALY TRANSMITTED DISEASES (STDS)
AND ACQUIRED IMMUNE DEFICIENCY
SYNDROME (AIDS)
 UNIT 1
CONCEPT OF HEALTH AND
PRIMARY HEALTH CARE
 INTRODUCTION
Health is a state of physical, mental, social and
spiritual wellbeing and not merely an absence of
disease or infirmity and health is affected by
many factors like heredity, environment, ways of
living, socio-economic status, health services
etc.
 Definitions of Health
A sound mind in a sound body, in a sound family, in a
sound community environment
OR
WHO states the definition, which is very popular
comprehensive and accepted universally in 1994 as
under.
It means that every organ and system in the body
functions normally and the body is able to perform all
the functions normally, the individual is able to adjust
with himself and with himself and with others and
with his environment etc.
 Spectrum of Health
• Health of any individual is not constant. It changes every now and
then i.e., it fluctuates under the influence of factors from within
the individual and his environment. It means health of an
individual fluctuates within a range of optimal health at one end
to severe illness and death at the other end as shown in Fig
• This refers to spectrum or continuum of health. Hence, the lowest
point on the health disease spectrum is death and highest point is
positive health
 Dimensions of Health
• The dimension of health refers to various aspects of
health. Accordingly to WHO definition of health, there
are four dimensions related to body, mind, soul and
social well being. These are physical, mental-emotional,
social and spiritual dimensions of health as shown in Fig
• i) Physical Health : It refers to normal functioning of all the
organs and systems resulting in harmonious functioning of the
body . Some of the characteristics of physically healthy
individual include clean and firm skin, bright and clear eyes,
good body posture, clear and healthy mouth and teeth, normal
vital signs, normal body weight, good appetite, sound sleep,
regular movements of bowel and bladder and co-ordinated
bodily movements.
The physical health can be assessed by:
• Self assessment of overall health
• General observations Clinical examination
• Nutrition and dietary assessment
• Biochemical and laboratory investigations
• ii) Mental Health :Mental health is related to mind. It
refers to normal functioning of the mind and not merely
the absence of mental illness. The individual said to be
mentally healthy if he/she is able to make harmonious
adjustments with himself/herself, with others and with
his/her surroundings.
• The characteristics of mentally healthy individual are:
The individual knows himself his strength and
weaknesses and accepts them. He is free from tensions.
He lives for his identity, has self confidence and sense of
self esteem. He has good control over his emotions.
iii) Social Health : It refers to socialization of an
individual in the context of existing social structure. The
individual is said to be socially healthy when he/she is
able to socialize normally with his family, neighbor,
friends and establish healthy, lasting and satisfying
relationships with them.
iv) Spiritual Health: Spiritual health is related to soul or
spirit of a person. It refers to individual's faith in
supernatural power and religious aspects which regulate
life and affect health. The individual is said to be
spiritually healthy when he/she:
• has faith and beliefs in supernatural power.
• respects ethical values, principles and practices them
in day to day life. maintains integrity
• understands meaning of life and leads a purposeful
life.
 Determinants of Health
• The health of an individual may be affected by
various factors. Health of an individual
depends upon a number of factors.
The factors within the individual and the factors
within the society are as follows:
i) Heredity
ii) Environment
i) Heredity: Heredity refers to transmission of
physical and mental characteristics from parents
to their children e.g., general appearance,
height, weight, natural immunity, intelligence
etc. These characteristics are passed on through
genes present on chromosomes in cell nucleus.
ii) Environment: Environment refers to surroundings in
which the person lives. Till the foetus is born, it grows and
develops within the environment surrounding mother's
womb. The health of foetus is influenced by mother's
general health, nutrition, and illness etc. As the foetus
comes out of his mother's womb he is exposed 'to all the
things in his external surroundings i.e., environment in
which he continues to live, grow and develop. The
environment has three components.
These are:
• Physical
• Biological
• psycho-social-cultural
a) Physical Environment: Physical environment includes
housing and building structures, air, water, food, soil,
light, sound; heat, humidity, etc. All these aspects of
physical environment either promote health or may cause
any specific disease. For example, dark and dingy house
may cause retarded growth in children, may expose
anyone to the risk of tuberculosis. Lack of sanitation,
unsafe water, and contaminated food may cause disease
like typhoid, diarrhoea, dysentery, and leads to mosquito
breeding
b) Biological Environment: This includes all
living things surrounding man e.g., viruses,
bacteria, insects, rodents, animals and plants
etc. These may act as disease producing agents,
reservoirs or host and vectors of disease in their
interaction with man. e.g., malaria, plague by
insects and rodents
• c) Psychological Environment: Psychological
environment refers to people who live in social
institutions like family, neighborhood, school, work
place, community etc. He tries to adjust and develop
harmonious relationship with them. Thus tries to attain
positive mental and social health.
iii) Life Style: Life style refers to the ways of living of the
people, It includes daily living activities, cultural
practices including customs and tradition and personal
habits. Healthy lifestyle promotes positive health. Poor
life style has ill effects on health. For example good
personal hygiene, adequate nutrition and safe dietary
practices, adequate education and suitable work, and
self care promote health. Whereas unhygienic practices
may cause scabies, worm infestation, trachoma etc.
iv) Socio-economic Conditions : include economic status,
education, occupation, and political system.
a) Economic status: It implies the amount of money the
individual/family has to spend to fulfill daily requirements.
The more the monthly income the more will be the
purchasing power i.e., individual and family will be able to
purchase various things for daily living and avail health
care services etc. This will improve their living standard,
life and thereby health and wellbeing. But too much of
money may lead to some bad habits e.g., excessive
drinking and smoking, over nutrition which may result in
cardiovascular disease, obesity and diabetes etc .
• Education: Education is very important factor. It
makes the individual knowledgeable . It helps him
to make right choices about daily living activities,
life style, occupation self and family care during
death and sickness. Thus it helps promote health
and quality living and reduces morbidity and
mortality rates.
• c) Occupation: A suitable productive and
paying occupation is very important for every
adult individual to promote his/her
comprehensive health. It not only gives money
power but keeps the individual busy in
constructive and useful work.
• d) Political System: The political system plays an
important role in improving health status of
people because political will and decisions
determine the National Health policy, health care
delivery system infrastructure and accessibility
and availability of health services, which
contribute in promoting health, preventing
disease and preserving life of people.
• v) Health and Family Welfare Services : The purpose of
Health and Family Welfare Services is to promote and
improve the health status of the population, prevent
disease and prolong life. For eg, immunization to
children can reduce the incidence of communicable
diseases in them. Maternal and child health services can
reduce the morbidity and mortality rate in mothers and
children and promote their health.
 Concept of Disease
• According to Oxford Dictionary "Disease is
defined as condition in which the body, some
part or organ of the body is impaired and does
not function normally."
Or
• In other words disease is defined as
departure/deviation from complete state of
health and wellbeing which includes physical,
mental, social and spiritual aspects
 Concept of Disease Causation
• Before 10th century, occurrence of any
disease was considered to be the curse of god
or evil spirit, bad air. In 19th century disease
producing micro-organisms were discovered.
It was found that every single disease was
caused by one specific organism (disease
agent e.g., cholera due to vibrio cholera ,
tuberculosis due to tuberculosis bacterium
etc.
• Disease is caused only when there is an interaction of
agent, host and environment It means disease will occur
only if the host is weak, the agent is strong and enters
the host through right channel and in sufficient amount,
and when the environment conditions facilitate the
interaction of host and agent e.g., poor environmental
sanitation ,malnutrition of a child and contaminated
water can cause diarrhea.
Natural History of Disease:
1) The Pre-pathogenesis Phase: This phase is
before the onset of disease in man. The disease
agent has not yet entered the host (man) but the
factors that favor its (agent) interaction with the
human host exist in the environment e.g., poor
environmental sanitation, climatic conditions,
prevalence of insects, This means that man is
always exposed to the risk of disease . But, the
disease process in man starts only when there is
interaction among agent, host and environmental
factors
• ii) The Pathogenesis Phase : This phase begins with
the entry of the disease agent through appropriate
channel in the susceptible human host
• e.g., entry of Chicken Pox Virus Varicella-Zoster
through the respiratory tract. The agents i.e., the virus
grows and multiplies and bring about physiological
changes in the body. The host remains apparently
healthy for few days. After a lapse of some period
which varies in different diseases the signs and
symptoms begin to appear. This period between entry
of agent in host till appearance of signs and symptoms
is called incubation period which is usually 14-16 days
in chicken pox. The disease process may end into
complete recovery, or it may end into some kind of
disability, defect, chronic state or death.
 Iceberg of Disease
According to this concept" disease in a community may be compared
with an iceberg. Floating tip of iceberg represents what doctor see as
clinical cases in community and sub-clinical cases. Doctors and other
health workers can diagnose only those cases who are recognizable. It
is like an iceberg which has a small floating tip (i.e., few clinical cases)
which is visible on the surface of water and a large sub-merged part in
the water which cannot be seen (large number of undiagnosed cases).
Hence, the name iceberg of disease which denotes the presence of a
small number of known cases and large number of unknown and
missed cases.
 HEALTH FOR ALL (HFA)
• In May 1977, WHO in its 30th World Health Assembly
decided on the attainment of a goal of "Health for All"
by 2000 by all the member countries of WHO.
• HFA has been defined as "the attainment of a level of
health by all the people that will enable them to lead a
socially and economically productive life."
 PRIMARY HEALTH CARE
• Primary Health Care is defined as "Essential Health
Care" based on practical, scientifically sound and
socially acceptable methods and technology, made
universally accessible to individuals and families in the
community through their full participation at a cost that
the community and country can afford to maintain at
every stage of their development and in the spirit of
self-reliance and self determination.
 Elements of Primary Health Care
• i) Education concerning existing health problems and
methods of preventing and controlling.
• i) Provision of food supply and proper nutrition.
• iii) An adequate supply of safe drinking water and basic
sanitation.
• iv) Maternal and child health care and family planning.
• v) Immunization against major communicable diseases.
• vi) Prevention and control of locally endemic diseases.
• vii) Appropriate treatment of common disease and injuries.
• viii) Provision of essential drugs.
 Principles of Primary Health Care
• There are five basic principles identified in the
Primary Health Care approach:
• 1) Equitable distribution
• 2) Manpower development
• 3) Community participation
• 4) Multi sectoral approach
• 5) Appropriate technology.
• 1) Equitable Distribution : It means that health
services must be shared equally by all people i.e.,
people rich or poor, rural or urban - must have
access to health services.
• 2) Manpower Development: It includes both
professional and auxiliary health personnel, member
of the community and supporting staff. All these
personnel are to be trained and re-trained in order
to apply their technical skills to solve health
problems.
• 3) Community Participation : It is the process by
which individuals, families and communities assume
responsibility in promoting their own health and
welfare.
• 4) Multi sectoral Co-ordination : The components
of primary health care cannot be provided by
health sector alone. In addition to the health sector,
all related sectors in particularly agriculture, animal
husbandry, food industry, education, housing,
public works, communication and other sector.

• 5) Appropriate Technology: Appropriate

technology means that technology which is simple,
locally available, affordable but scientifically sound,
culturally acceptable by the people, easily
understood and applied by the community health
workers and community people.
 LEVELS OF PREVENTION OF DISEASE
Primary Prevention:Primary prevention refers to the action
taken before the onset of the disease to promote health
and prevent the occurrence of disease.
• a) Health Promotion
• b) Specific Protection
 Secondary Prevention
• This level of prevention refers to the actions taken during
the pathogenesis period of disease , to control the
progress of a disease and prevent complications.
• Specific interventions are early diagnosis (e.g. case
finding, screening tests) and treatment which helps to
arrest the progress of disease in man and its spread to
other members of the family and community.
 Tertiary Prevention
This refers to action in the late pathogenesis
period to reduce or limit the disability and help
the person to adjust to his permanent impairment
and disability. For example, teaching a person with
amputated legs to walk with crutches
 UNIT 2

NATIONAL HEALTH
PROGRAMMES IN
MCH
 INTRODUCTION
India was the first country in the world to launch a
National Family Planning Programme in 1952 with
sole objective of reducing the birth rate to stabilize
the population. Medical Termination of Pregnancy
(MTP) act was passed in 1972. In 1977 the
programme was also renamed as Family Welfare
instead of Family Planning.
 MATERNAL HEALTH AND CHILD HEALTH
PROBLEMS
• a) Reproductive Tract Infections (RTIs) :Young
girls are more vulnerable to RTIs specially STD, as
compared to older women, women infected with
HIV transmit it to their foetus
• b) Infections: Many women get infected with
herpes simplex virus, cytomegalovirus, protozoon
which causes toxoplasmosis, E Coil causing
nephritis or cystitis. Infection during pregnancy
can cause various harmful effects on fetus
• c) Malnutrition: Malnutrition is a very common problem
among women. Pregnant and nursing mothers are especially
prone to the effects of malnutrition
• d) Anaemia: Anaemia is very common among women in India
due to various reasons which include malnutrition, infection
especially hookworm infestation, repeated pregnancies,
abortions, antepartum and post partum haemorrhages,
• e) Unregulated Fertility: Unregulated fertility has been
recognized to cause many maternal health hazards. These
include abortions, premature deliveries, low birth weight
babies, antepartum hemorrhages
• f) Complications of Deliveries: In India most of the deliveries
take place at home under unhygienic environment and mostly
by untrained dais .
• g) Abortions: Abortions is increasing because of unwanted
pregnancies.
 VARIOUS HEALTH PROGRAMMES
• 1) Programmes for Communicable Diseases
• National Vector Borne Diseases Control Programme
(NVBDCP)
• Revised National Tuberculosis Control Programme •
National Leprosy Eradication Programme
• National AIDS Control Programme
• Universal Immunization Programme
• National Guinea worm Eradication Programme
• Integrated Disease Surveillance Programme
• 2) Programmes for Non Communicable Diseases
• National Cancer Control Programmes
• National Mental Health Programmes
• National Diabetes Control Programmes
• National Programmes for Control and treatment of
Occupational Diseases
• National Programmes for Control of Blindness
•3) National Nutritional Programmes
• Integrated Child Development Services Scheme
• Midday Meal Programme
• Special Nutrition Programme (SNP)
• National Nutritional Anaemia Prophylaxis
Programme
• National Iodine Deficiency Disorders Control
Programme
•4) Programs Related to System Strengthening Welfare
• National Rural Health Mission
• Reproductive and Child Health Programme
• National Water Supply & Sanitation Programme
5) National Health Policies
• National Health Policy 2002 and National Population
Policy 2000
• • National Health Policy 2012 (Draft was put on website
for further suggestions and is under process)
• • National AIDS control and Prevention Policy and
National Blood Policy
PROGRAMMES RELATED TO MATERNAL AND
CHILD HEALTH
• Child Survival and Safe Motherhood
Programme (CSSM): CSSM was launched in 1992
and developed with the assistance of UNICEF
and World Bank. The programme was for five
years and for covering the entire country.
 CSSM Programme intervention
Child Survival
• Essential newborn care
• Immunization
• Management of diarrhoea
• Management of Acute Respiratory Infections (ARIs)
• Vitamin A Prophylaxis
• Safe motherhood
• Immunization of Pregnant women.
• Prevention and treatment of anemia.
• Antenatal care and early identifications of maternal
complications
• Delivery by trained personal.
• Promotion of Institutional delivery.
• Management of obstetric emergencies.
• Birth spacing
 Universal Immunization Programme (UIP)
• UIP, was launched in 1985 in a phase manner.
Immunization is one of the most cost effective
interventions for disease prevention. The aim
is to achieve 100% full immunization status by
2009 to 2010 and to maintain it for long.
 Integrated Child Development Scheme (ICDS)

• Started in 1975 in pursuance of the National

Policy for children, having strong nutritional
component in the form of -Supplementary
nutrition ,Vitamin A prophylaxis -Iron and folic
acid distribution.
 School Health Programme
• School health services were first introduced in
India in 1909, when health check up was carried
out for the school children in Baroda city
(Gujarat)
• Health Screening and Remedial Measures: It is
recommended to be carried out twice a year
 Nutritional Programme
• The various nutritional programmes are in
operation in India since 1st five year plan period.
International agencies such as WHO, UNICEF, FAO
are assisting the Govt. in these Programmes to
improve nutrition of the people with special
emphasis on mother and children.
a. Vitamin-A Prophylaxis Programme: At 9th month
I,OO, OOO IU , I5th - 16th months Mega dose of
2.00,000 IV , 18 - 24 months 2.00.000 , till 24 - 30
months 2.00,000 IV, 30 - 36 months 2,00,000 IU.
b) National nutritional anaemia prophylaxis
programme : Children in the age group of 1-5 years are
given one tablet of iron containing 20 mg elementary
iron (60 mg of ferrous sulphate and 0.1 mg of folic
acid) daily for a period of 100 days.
c) National Goiter control programme (NGCP): The
government of India launched the programme in 1962.
• It aims at replacement of ordinary salt by iodized
salt, particularly in the goiter endemic regions.
d) Applied Nutrition Programme (ANP): The ANP was first
introduced in 1960 in Orissa and Andhra Pradesh. Specific
objectives:
• To make people conscious of their nutritional needs and to
increase production of nutrition foods and their consumption

e) School Lunch Programme (Mid Day Meal Programme) :1st

organized in 1957 in Tamil Nadu.
Objectives were:
• To improve the nutritional status of children and imparting
nutritional education.
• To ensure universal primary education.
• To attract more children for admission to schools and retain
them to improve literacy rate
 ROLE OF NURSE IN MCH PROGRAMME

• Identifying eligible couples who desire to have children

and those who do not want to have them
• Helping in planning, implementing and evaluating family
welfare services and organizing family welfare camps.
• Follow up of those who have adopted devices or are
operated,
• Initiating and contributing towards research
• Participating in planning, conducting, evaluating training
programme for other paramedical staff
 UNIT 3

INTRODUCTION TO
REPRODUCTIVE AND CHILD
HEALTH
 INTRODUCTION
Reproductive and Child Health Programme was
launched in October 1997. The main aim of the
programme is to reduce infant, child and
maternal mortality rates.
 Definition of RCH
• People have the ability to reproduce and regulate their
fertility, women are able to go through pregnancy and
child birth safely, the outcome of pregnancies is
successful in terms of maternal and infant survival and
wellbeing and couples are able to have sexual relations
free of fear of pregnancies and of contracting diseases.
 Major Interventions under RCH-I
• Prevention and Management of unwanted
pregnancies
• Maternal Care
• Child Survival
• Prevention and Management of RTIs / STIs
 Package of Health Services under RCH-I Services
for mothers
• Tetanus toxoid immunization
• Prevention and treatment of anemia
• Antenatal care and early identification of maternal
complications
• Deliveries by trained personnel and promotion of
institutional deliveries
• Management of obstetric emergencies and birth spacing
• Safe abortion and treatment of RTI and STDs
 Services for the children
• Essential newborn care with resuscitation of
newborn with asphyxia, prevention of hypothermia,
• Prevention of infection.
• Exclusive breast feeding, weaning and immunization
• Appropriate management of diarrhea and ARI
• Vitamin A prophylaxis
• Prevention and control of anemia in children
• Hepatitis B vaccination
 Women of reproductive age
• Must receive counseling on importance and care of
girl child
• Optimal timing & spacing of birth and Small family
norms.
• Use and choice of contraceptives
• Prevention of RTI / STI
• Information on Availability of MTP Services
• IUD & sterilization services
 REPRODUCTIVE AND CHILD HEALTH
PROGRAMME (RCH-II)
• RCH Programme-ll began from 1st April, 2005,
to reduce Infant Mortality Rate (IMR),
Maternal Mortality Rate (MMR), Total Fertility
Rate (TFR), to increase Couple Protection Rate
(CPR), and Immunization coverage, especially
in rural areas.
 Components of RCH-II

• Population Stabilization
• Maternal Health
• Newborn Care and Child Health
• Adolescent Health
• Control of RTIs / STIs
• Urban and Tribal Health
• Monitoring arid Evaluation
 Package of Services under RCH-II
For the mothers:
• Tetanus Toxoid Immunization and Prevention
and treatment of anaemia.
• Antenatal care and early identification of
maternal complications
• Deliveries by trained personnel and Promotion
of institutional deliveries and Management of
obstetric emergencies and Birth spacing
For the children:
• Essential newborn care and exclusive breast
feeding and weaning
• Immunization and Appropriate management
of diarrhoea and ARI and Vitamin A prophylaxis
and Treatment of Anaemia
For eligible couple:
• Prevention of pregnancy and Safe abortion
• Prevention and treatment of reproductive tract infection
(RTI) and sexually transmitted diseases (STD).
• Women of reproductive age must receive: Counseling on
importance of care of girl child and small family norms
• Use and choice of contraceptives and Prevention of RTI / STI
• Information on Availability of MTP Services IUD &
sterilization services
• Family Planning Services and Condom distribution and Oral
contraceptives
ROLE OF NURSES UNDER RCH PROGRAMME
• participate in in-service training for up gradation of knowledge
and skills.
• should be a good motivators and counselor
• should motivate and counsel adolescents in the area about
reproductive health
• should motivate the community for delayed marriage explaining
that before a particular age the human body is not ready for the
stress of child bearing.
• should motivate recently married couples to use the temporary
methods of contraception.
• should motivate women of the community to avail facilities for
antenatal care during pregnancy.
• should encourage women to have institutional deliveries.
• must counsel all pregnant women to have two doses of Tetanus
Toxoid,, balanced diet and adequate rest.
 UNIT- 4

SEXUALITY, FERTILITY
AND INFERTILITY
 Human Sexuality
• human sexuality is how people experience and
express themselves as sexual beings.
• Human sexuality includes desires, feelings,
value and attitude
 SEXUAL HEALTH
• Sexual health is a state of physical, mental and
social well-being in relation to sexuality.
 FERTILITY
• Fertility means the actual bearing of children.
• The ability to produce children or power of
reproduction
 Factors affecting Fertility
1) Age of marriage
2) Duration of married life
3) Spacing of children
4) Education about Contraception
5) Economic Status
6) Religion, culture and caste
7) Nutrition
8) Family Planning
 Control of Fertility
• Contraceptive methods are preventive
methods to help women avoid unwanted
pregnancies.
They include:
• 1) Temporary methods
• 2) Permanent methods
• The contraceptive methods are broadly grouped as:
• 1) Barrier methods: Aimed to prevent live sperms meeting
ovum.
• a) Physical: Condoms, Female condoms.
• b) Chemical: foams, cream, suppositories
• c) Combined
• d) Intra-uterine devices- copper T
• e) Hormonal - oral pills, male pills, inject tablets
• f) Post Conceptual: menstrual regulations, menstrual induction

2) Terminal methods
a) Male sterilization .
b) Female sterilization

Family planning is the best way to control fertility in India.

 Infertility
Definition: Infertility is defined as the inability to conceive or carry a
pregnancy to term after 12 months of trying
Causes of Female Infertility:
i) Congenital Causes
ii) Vaginal Factors
iii) Cervical Mucus Disorders
iv) Uterine Factors
v) Tubal Factors
vi) Ovarian Factors
vii) Other Causes: Other causes that may occasionally cause female
infertility are addiction to alcohol, tobacco and certain drugs,
severe malnutrition
 Causes of Male Infertility
• i) Systemic Factors: Aging over 45 years, severe
diabetes mellitus, extreme obesity, fatigue, heavy
smoking, and alcoholism
• ii) Endocrinopathy Factor: Hypothalamic pituitary
dysfunction, hypothyroidism
• iii) Psychological Factor: Nervous, tension about
sex and psychiatric illness may cause impotency.
• iv) Genital Factor: Disorder in sperm production
or blockage of sperm ducts, e.g., the man does
not have sperms (azospermic) or has very low
concentration (oligospermic)
 Tests and Diagnosis
For men:
• General physical examination
• Semen analysis
• Hormone testing
• Trans rectal and scrotal ultrasound

For woman:
• Ovulation testing
• Histosalphangiography
• Laparoscopy
• Hormone testing
• Ovarian reserve testing
• Genetic testing and pelvic ultrasound
 Treatment of Infertility
• Injectable fertility drugs increase the chance of
multiple births
• Careful monitoring: blood tests, hormone tests,
ultrasound measurement of ovarian follicle size
• Surgery
• Artificial Insemination of Husband: The semen of the
husband obtained by masturbating is instilled at
external orifice of wife
• In Vitro Fertilization and Embryo Transfer: This is
now widely used to treat infertile couple with
irrepairable tubal damage, severe endometriosis
• Adoption
 UNIT 5

SEXUALY TRANSMITTED DISEASES

(STDS) AND ACQUIRED IMMUNE
DEFICIENCY SYNDROME (AIDS)
 What are STDs/RTI

Sexually Transmitted Infections (STIs):

Infections spread from person to person during
sexual contact.
Reproductive Tract Infections (RTIs) : Infections
of the reproductive tract that occur due to poor
personal hygiene or unsterile techniques
 FACTORS AFFECTING STI TRANSMISSION
1) Agent Factors: More than 20 pathogens have
been found to be spread by sexual contact.
N. gonorrhoea causes gonorrhoea, Urethritis,
Cervicitis, epididymitis, salphingitis etc.
T. Pallidum causes Syphilis
C. Trachomatis causes urethritis and many
infections.
HIV- AIDS, Herpes simplex virus- Genital herpes.
2) Host factors affecting STI transmission:
• Age: younger more vulnerable
3) Behavioural factors affecting STI transmission :
unprotected sex with multiple partners
4) Social factors affecting STI transmission: Low
status of women in most societies, such as
prostitution, Easy money, Lack of knowledge of STIs
 PREVENTION OF SEXUALLY TRANSMITTED
DISEASES
• Promoting Condom Use
• Prevention through Changing Sexual
Behaviour
• Counselling a Client
• Notification and Management of Sexual
Partners
AIDS (Acquired Immuno Deficiency Syndrome)
The first case of the disease was identified in 1981
in South Africa followed by other cases in USA and
other parts of the world. AIDS stands for Acquired
Immuno Deficiency Syndrome caused by a virus
called the Human Immuno Deficiency Virus (HIV).
The causative organism is a human retrovirus
which destroys the immune system's capacity to
cope with infections.
 WHAT IS HIV?
• Human : Can live only in humans
• Immunodeficiency: Damage the immune
system of people it infects
• Virus : Retrovirus
 Mode of Transmission of HIV
• i) Sexual Contact
• ii) Infected Blood and Blood Products
• iii) Infected Needles and Parenteral Drugs Use
• iv) Transmission from Mother to Baby

b) HIV DOES NOT SPREAD BY

• Kissing/hugging
• Contact with sweat, tears, urine or faeces
• Insects bites (e.g. mosquitoes and bed bugs)
• Bathing/Swimming in the same pond/pool
• Sharing cooking utensils, cups, toilet seats, bedding, telephones or
towels
• Eating food prepared by an infected person
 Signs and Symptoms of Aids
a) Major signs
• Weight loss
• Chronic diarrhea for more than one month
• Prolonged fever for more than one month
b) Minor Signs
• Generalized lymphadenopathy
• Oropharyngeal candidiasis
• Repeated upper respiratory infections
• Persistent cough for more than one month,
 ANTI- RETROVIRAL THERAPY (ART)

Drugs used as Anti-Retroviral Therapy(ART) have been

designed to interrupt the life cycle of the virus at different
stages (by inhabiting either reverse transcriptase or
protease enzymes) and not destroying the virus, thereby
decreases the viral replication (viral load) and slows down
the decline of immunity. This results in lesser opportunistic
infections and delays the onset of AIDS. Thus, ART can
prolong the life an improves the quality of life.
 PREVENTION OF HIV TRANSMISSION
• Primary prevention includes Integrated Counseling and
Testing (ICT)
• Education about safe sex and Condom promotion
• Promoting access to safe blood
• Prevention of Parent- To-Child Transmission (PPTCT)
• Safe Sex and ABC approach: The ABC stand for:
Abstinence-
Be faithful- Getting tested for HIV
Condom use