Disturbances in Reproduction and Sexuality

❖SUBFERTILITY - pregnancy has not occurred after at  structural problems, like blockage of the part of the
least 1 year of engaging in unprotected coitus (Kumar et testicle that contains sperm (epididymis), or
al., 2007). damage or injury to the reproductive organs
 Overexposure to certain chemicals and toxins, such
 PRIMARY subfertility – there have been no as: pesticides, radiation, tobacco smoke, alcohol,
previous conceptions. marijuana, and steroids. In addition, frequent
 SECONDARY subfertility – there has been a exposure to heat, such as in saunas or hot tubs, can
previous viable pregnancy but the couple is elevate the testicular temperature, impairing sperm
unable to conceive at present. Couple with production.
previous pregnancy including  Damage related to cancer and its treatment,
miscarriage/ectopic. including radiation or chemotherapy. Treatment for
❖STERILITY - inability to conceive due to a known cancer can impair sperm production
condition, (Müllerian Agenesis - absence of a uterus). o Causes of female infertility
• Etiology:  Ovulation disorders, hinder or prevent the ovaries
from releasing eggs
✓Male factors (eg. Sperm count, motility, morphology,
 Uterine or cervical abnormalities, including
etc.)
problems with the opening of the cervix or cervical
✓Female factors (eg. Anovulation, PCOS, hormonal mucus, or abnormalities in the shape or cavity of
imbalance, etc.) ✓Unexplained -20% the uterus.
 Fallopian tube damage or blockage, which usually
✓Mixed – 15% results from salphingitis. This can result from PID,
caused by STI.
❖SUBFERTILITY  Endometriosis, endometrial tissue implants and
o Causes of male infertility grows outside of the uterus — often affecting the
function of the ovaries, uterus and fallopian tubes
 Abnormal sperm production or function due to  Primary ovarian insufficiency, also called early
various problems, such as: (undescended menopause, when the ovaries stop working and
testicles), genetic defects, health problems menstruation ends before age 40.
(diabetes), prior infections (mumps), trauma or  Pelvic adhesions, bands of scar tissue that bind
prior surgeries on the testicles or inguinal region. organs after pelvic infection, appendicitis, or
Enlarged veins in the testes can increase blood abdominal or pelvic surgery
flow and heat, affecting the number and shape  Thyroid problems. Disorders of the thyroid gland,
of sperm. either too much thyroid hormone (hyperthyroidism)
 Problems with the delivery of sperm due to or too little (hypothyroidism), can interrupt the
sexual problems, such as: menstrual cycle or cause infertility.
 premature ejaculation,  Cancer & its treatment. Female reproductive
 retrograde ejaculation (semen enter bladder cancers — often severely impair female fertility.
instead of emerging through penis during Both radiation and chemotherapy may affect a
orgasm, woman's ability to reproduce.
 genetic diseases, (cystic fibrosis),
 Disturbances in Reproduction and Sexuality

❖SUBFERTILITY ❖Subfertility
o Risk factors oDiagnostic Tests for men

✓Age. Infertility in older women may be due to  Semen analysis. Analyzes the semen specimen for
the number and quality of their eggs. the health of sperm and the semen fluid.
 Hormone testing. A blood test to determine the
✓Tobacco use. Miscarriages are more frequent in level of testosterone and other male hormones is
women who smoke. Smoking can increase the risk common.
of erectile dysfunction and low sperm count in  Transrectal & scrotal ultrasound. Look for evidence
men. of conditions such as retrograde ejaculation and
ejaculatory duct obstruction.
✓Alcohol use. Alcohol use increases the risk of
 Genetic testing. Done to determine whether there's
birth defects, and it may also make it more
a genetic defect causing infertility.
difficult to become pregnant. For men, heavy
 Testicular biopsy. Results will tell if sperm
alcohol use can decrease sperm count and
production is normal
motility.
oDiagnostic Tests for women
✓Being overweight. a man's sperm count and
testosterone levels may be affected.  Ovulation testing. To measure hormone levels.
Hysterosalpingography. Evaluates the condition of
✓Being underweight. Women at risk of fertility uterus and fallopian tubes.
problems include those with eating disorders,  Ovarian reserve testing. Determine the quality and
such as anorexia or bulimia, and women who quantity of the eggs available for ovulation.
follow a very low calorie or restrictive diet.  Imaging tests. Pelvic ultrasound looks for uterine or
✓Exercise issues. Lack of or not enough exercise fallopian tube disease.
contributes to obesity, which increases the risk of
infertility. • Laparoscopy. Viewing device to examine fallopian tubes,
ovaries and uterus; identify endometriosis, scarring,
❖Subfertility o Symptoms blockages or irregularities of the fallopian tubes, and
problems with the ovaries and uterus.
✓inability for a couple to get pregnant.
• Genetic testing. Determine whether there's a genetic
✓In some cases, an infertile woman may have
defect causing infertility
irregular or absent menstrual periods.

✓An infertile man may have signs of hormonal

problems, such as:
- sexual function
- reduced sexual desire
- problems with ejaculation
- He may also have small testicles or a swelling in
the scrotum
 Disturbances in Reproduction and Sexuality

❖Subfertility ❖Subfertility
o Treatments and drug for men Complications of treatment (Female Infertility)
 Treating infections. Antibiotic treatment  Multiple pregnancy. Most common
may cure an infection of the reproductive complication
tract, but doesn't always restore fertility.  Ovarian hyperstimulation syndrome (OHSS).
 Treatments for sexual intercourse Injectable fertility drugs to induce ovulation can
problems. Medication or counseling can cause OHSS, in which the ovaries become
help improve fertility in conditions such swollen and painful. Symptoms may include
as erectile dysfunction or premature mild abdominal pain, bloating and nausea that
ejaculation. lasts about a week, or longer if you become
 Hormone treatments & medications. pregnant. Rarely, a more severe form causes
Hormone replacement or medication in rapid weight gain and shortness of breath
cases where infertility is caused by high requiring emergency treatment.
or low levels of certain hormones .  Bleeding or infection
 Surgery. For example, a varicocele can  Premature delivery or low birth weight. The
often be surgically corrected or an greatest risk factor for low birth weight is a
obstructed vas deferens repaired. multiple fetus pregnancy. In single live births,
 Assisted reproductive technology (ART). there may be a greater chance of preterm
Obtaining sperm through normal delivery or low birth weight.
ejaculation, surgical extraction or from a  Birth defects. Increased risk of certain birth
donor, depending on a specific case or defects, such as heart and digestive problems
wishes (in vitro fertilization) and cleft lip or cleft palate
Treatments and drug for women o Prevention (Men)
 Stimulating ovulation with fertility drugs.  Avoid drug and tobacco use and excessive
Main treatment for women who are alcohol consumption, which may contribute to
infertile due to ovulation disorders. male infertility.
These medications regulate or induce  Avoid high temperatures as this can affect
ovulation. sperm production and motility (avoid hot tubs
 Intrauterine insemination (IUI). Healthy and steam baths).
sperm that have been collected and  Avoid exposure to industrial or environmental
concentrated are placed directly in the toxins, which can impact sperm production.
uterus around the time the woman's  Limit medications that may impact fertility,
ovary releases one or more eggs to be both prescription and nonprescription drugs.
fertilized.  Exercise regularly, eat a balanced diet, and
 Surgery to restore fertility. Uterine maintain a healthy weight. Obesity is directly
problems such as endometrial polyps, a related to testosterone levels, which is a key
uterine septum or intrauterine scar tissue hormone responsible for sperm production
can be treated with hysteroscopic
surgery.
 Disturbances in Reproduction and Sexuality

❖SEXUAL DYSFUNCTION - problem with sexual • Treatment Options

desire or response.
 Erectile dysfunction - Sildenafil (Viagra), tadalafil
 Men - erectile dysfunction (ED) & (Cialis), and vardenafil (Levitra) but may have
premature or delayed ejaculation. potentially serious side effects in some men.
 Women - include spasms of the vagina Vasodilators.
& pain w/ sexual intercourse.  Problems related to menopause - creams or gels for
 Both sexes - include problems with women who have vaginal dryness. Women who have
sexual desire & response pain with intercourse may try taking naproxen or
ibuprofen before having sex
• Causes
❖Reproductive Tract Infection
 Being age 65 or over in men
 Childhood sexual abuse ✓PELVIC INFLAMMATORY DISEASE (PID) - infection of the
 Taking certain prescribed medications female reproductive organs. Causes
(antidepressants)
 Hormonal imbalances  When the disease-causing organisms travel from the
 Drug abuse cervix to the upper genital tract. Untreated
 Depression, anxiety, or other gonorrhea & chlamydia cause PID.
psychological issues  Other causes include: - abortion - childbirth - pelvic
 Stressful life events procedures
 Certain medical conditions (diabetes, Risk Factors
CHD, HPN & sleep apnea)
 Vaginal infections o Women with STDs
 Injury (pelvic fracture) o Women w/ history of PID
o Sexually active teenagers.
• Signs and Symptoms o Women with many sexual partners
 Premature or delayed ejaculation in o Being in a sexual relationship with a person
men who has more than one sex partner
 Erectile dysfunction Symptoms
 Pain during sexual activity
 Lack or loss of sexual desire o Dull pain or tenderness in the stomach or
 Lower urinary tract symptoms lower abdominal area, or pain in the right
 Difficulty having an orgasm upper abdomen.
 Vaginal dryness o Abnormal vaginal discharge that is yellow or
green in color or that has an unusual odor.
o Painful urination.
o Chills or high fever.
o Nausea and vomiting.
o Pain during sexual intercourse
 Disturbances in Reproduction and Sexuality
❖Reproductive Tract Infection Adolescent and Young Adult

✓PELVIC INFLAMMATORY DISEASE ❑STDS / STIS - diseases that are spread through sexual contact
(PID) with an infected partner (anal, oral, or vaginal sex).

Complications  May be spread among women having sex w/ women or

men having sex w/ men.
• Recurrent episodes of PID can result in  Diseases discovered in young children are possibly cause
scarring of the fallopian tubes, which can by sexual abuse.
lead to:
General Symptoms:
- infertility
 skin changes(sores, rashes, bumps, warts)
- ectopic pregnancy  irritation or burning sensation during urination • unusual
- chronic pelvic pain. discharge from sex organs
 noticeable pelvic pain
Diagnostic Tests  (possible to have no symptoms)
 Blood tests General Complications:
 Ultrasound (sonogram)
 Endometrial biopsy  death
 Laparoscopy  emotional pain (fear, shame, guilt)
 pre and/or post pregnancy problems
Treatment  risk of infertility
 (Approximately 75% of people don’t know they’re infected
• Antibiotics therefore, they continue to spread the disease instead of
• Surgery - to remove abscesses or organ being treated)
with abscess to prevent from rupturing & Chain of Infection
causing widespread infection throughout
the pelvis & abdomen (hysterectomy or ✓Agent:
oophorectomy).
 Bacteria: syphilis, Chlamydia, gonorrhea, vaginitis & non
Prevention gonococcal urethritis
 Viruses: herpes, AIDS, Hepa B & C, Fungi (yeast infections)
• Avoid multiple sexual partners.
✓Reservoir: Human body
• Use barrier methods of birth control
✓Place of Exit / Entry:
• Avoid IUDs if you have multiple sexual
partners. - male/female organ
• Seek treatment immediately if with - rectum
signs of PID or any STD
- mouth, mucous membranes & blood
• Have regular gynecologic check-ups &
screenings - open cuts/sores on skin
 Disturbances in Reproduction and Sexuality

Adolescent and Young Adult Adolescent and Young Adult

❑STDs / STIs ❑STDs / STIs (cont.)

Chain of Infection ✓CANDIDIASIS (YEAST INFECTIONS, THRUSH OR

MONILIASIS) - vaginal infection spread by the fungus
✓Route of Transmission: Candida albican, an organism that thrives on glycogen
- Intimate or close sexual contact (penis to (hyperglycemia provides a glucose-rich environment for
candidal growth).
rectum, mouth to penis) ✓Susceptible Host:
 Occasionally the yeast multiplies uncontrollably,
- those involved with sexual contact
causing pain & inflammation.
- those participating in drug use  May also infect the blood stream or internal
organs such as the liver or spleen.
- newborns of infected women  These can be bothersome infections, but are not
- (rarely) those receiving blood transfusions. life threatening.

Risky Behaviors Signs and Symptoms: An adolescent will notice:

 vulvar and vaginal reddening
✓Some of the things that increase a person's
 burning and itching
chances of getting an STD are: > Sexual activity
 bleeding fromhairline fissures
at a young age.
 vagina sometimes shows white “patches” on the
> Lots of sex partners. walls
 thick, cream cheese
> Unprotected sex.  like discharge at the vaginal introitus.
Prevention  pain on coitus or on tampon insertion.

✓Abstinence or condomuse. ✓Therapeutic Management (Candidiasis)

 vaginal suppositories
✓Choosing sexual partners who are at low risk
 cream applications of antifungal preparations:
for infection (avoiding persons who are
miconazole (Monistat) or clotrimazole (Lotrimin).
intravenous drug users or those with multiple
 If with frequent candidal infections, urine should
sexual partners).
be tested for glucose to rule out DM.
✓Educating adolescents about safer sex
✓Prevention:
practices.
 wipe from front to back after going to the toilet.
✓Treatment of most STIs begins with
 don't use soap around the vagina - soap kills the
determining the causative organism so that the
bacteria you want to keep, and has no effect on
appropriate antimicrobial or antifungal agent
yeast.
can be prescribed
 Disturbances in Reproduction and Sexuality

Adolescent and Young Adult ✓TRICHOMONIASIS

❑STDs / STIs (cont.) Diagnostic Exam
✓TRICHOMONIASIS - STD caused by
a small organism called Trichomonas • P.E and Lab tests for vaginal fluid or urethral fluid to look for the
vaginalis. It is the most common disease-causing parasite
curable STD in young, sexually active . Treatment
women.
 oral antibiotic of metronidazole (Flagyl), this drug could
Signs and Symptoms harm the baby in cases of pregnancy.
• Men often do not have symptoms &  during treatment, should avoid sex until complete
usually do not know they are infected treatment and have no symptoms.
until their partners need treatment. If Trichomoniasis is not treated:
But when symptoms do occur, they
include:  In pregnant women may cause PROM and early delivery.
 Increase a woman's risk of acquiring HIV infection
- Irritation inside the penis
✓TRICHOMONIASIS
- Mild discharge
Prevention
- Slight burning after urination or
ejaculation  Use condoms correctly.
 Limit number of sex partners.
Signs and Symptoms  Practice sexual abstinence
• Women do have S/S that includes:  If you think you are infected, avoid sexual contact & see a
doctor.
- Greenish-yellow, frothy vaginal  Any genital symptoms such as discharge or burning during
discharge with a strong odor urination or an unusual sore or rash should be a signal to
stop having sex & to consult a doctor immediately
- Painful urination
✓CHLAMYDIA - easily spread because it often causes no
- Vaginal itching and irritation symptoms & may be unknowingly passed to sexual partners. In
- Discomfort during intercourse fact, about 75% of infections in women & 50% in men are w/o
symptoms. When symptoms occur, usually noticeable within 1 to
- Lower abdominal pain (rare) 5 weeks of contact.
- Symptoms usually appear within Symptoms in men
five to 28 days of exposure in women.
 Small amounts of clear or cloudy discharge from the tip of
the penis
 Painful urination
 Burning and itching around the opening of the penis
 Pain and swelling around the testicles
 Disturbances in Reproduction and Sexuality

Adolescent and Young Adult ❑STDs / STIs (cont.)

❑STDs / STIs (cont.) ✓Chlamydia (cont.)
✓CHLAMYDIA For women. Chlamydia infection can cause:
Symptoms in women  PID w/c can lead to damage of fallopian tubes
 infertility
 Abnormal vaginal  increase the risk of ectopic pregnancy
discharge that may  premature births
have an odor  infection can be passed along from the mother to the baby during
 Bleeding between childbirth, causing an eye infection, blindness, or pneumonia in the
periods newborn
 Painful periods
 Abdominal pain with For men. Chlamydia can cause:
fever
 Pain when having sex  nongonococcal urethritis (NGU) -- an infection of the urethra (the tube by
 Itching or burning in or which men and women pass urine)
around the vagina  epididymitis -- an infection of the epididymis (the tube that carries sperm
 Pain when urinating away from the testes)
 proctitis -- an inflammation of the rectum.
Diagnosis
Prevention
 swab to take a sample
from the urethra (men)  Use condoms correctly.
or from the cervix  Limit the number of sex partners
(women)  Practice sexual abstinence
 tests which check a  If you think you are infected, avoid sexual contact and see a doctor.
urine sample for the  Any genital symptoms such as discharge or burning during urination or an
presence of the unusual sore or rash should be a signal to stop having sex & consult a
bacteria. doctor immediately.
 Doctors recommend that all persons who have more than 1 sex partner
Treatment should be tested for chlamydia regularly, even in the absence of symptoms
 oral antibiotics, usually ✓Human Papillomavirus (HPV) and Genital Warts - causes fibrous tissue
azithromycin overgrowth called genital warts (condyloma acuminatum) on the external vulva,
(Zithromax) or vagina or cervix.
doxycycline.
 hospitalization, IV  HPV infections are serious - associated with the development of cervical
antibiotics & pain cancer later in life.
medicine in severe  If infected by HPV, it may take 1-3 months (or longer in some cases) for
cases. warts to appear.
 after taking antibiotics,  Genital warts look like small flesh-colored, pink or red growths in or around
people should be re- the sex organs similar to the small parts of a cauliflower or they may be
tested to be sure the very tiny and difficult to see. They often appear in clusters of 3 or 4, may
infection is cured. grow and spread rapidly.
 Disturbances in Reproduction and Sexuality

✓HUMAN PAPILLOMAVIRUS (HPV) AND GENITAL ❑STDs / STIs (cont.)

WARTS (CONT.) GENITAL WART
✓Human Papillomavirus (HPV) and Genital Warts (cont.)
Symptoms Prevention
 In women, warts can develop outside and  abstain from sex or limit sexual contact to one
inside of the vagina, cervix or around the uninfected person.
anus.  condoms may provide some protection
 In men, seen on the tip of the penis, shaft of  The vaccine, Gardasil, is recommended to be
the penis, on the scrotum, or around the routinely administered to early teenage girls in three
anus. doses. A 2nd dose is 2 months after the 1st dose &
the 3rd dose is 6 months after the first dose
❖Genital warts also can develop in the mouth or
throat of a person who has had oral sex with an ✓GONORRHEA - contagious disease transmitted most often
infected person. through sexual contact with an infected person.
❖The presence of vulvar lesions appears to have no > Gonorrhea may also be spread by contact with infected
effect on the fetus during pregnancy, but if they are bodily fluids, so that a mother could pass on the infection to
present at the time of birth & so large that they her newborn during childbirth.
obstruct the birth canal, a cesarean birth may be
scheduled. Causes

Lab Test • Neisseria gonorrhoeae, a bacterium that can grow and

multiply easily in mucus membranes of the body:
 Application of a mild acetic acid (vinegar)
solution to highlight less visible growths  female internal reproductive organ cervix, uterus &
 A complete pelvic exam & Pap smear (for fallopian tubes
women)  urethra in women and men
 Biopsy of cervical tissue to make sure there  bacteria can also grow in the mouth, throat & anus
are no abnormal cells that could develop Signs and Symptoms:
into HPV related cervical cancer.
 Examination of the rectum Occur often w/in 2-7 days after exposure, but they can take
up to 30 days to develop. In women:
Treatment
 slight yellowish vaginal discharge
 Unfortunately, no treatment can kill the HPV  Lower abdominal or pelvic pain
virus that causes the genital warts.  Burning when urinating
 Small growths may be removed by applying  Bleeding between periods & spotting after
podophyllin (Podofin). intercourse
 Large lesions may be removed by laser  Swelling of the vulva (vulvitis)
therapy, cryocautery or knife excision. Sitz  Burning in the throat (oral sex)
baths and a lidocaine creammay be  Swollen glands in the throat (oral sex)
soothing during the healing period  Bartholin’s glands may become inflamed and painful
 Trichloroacetic acid (TCA) or bichloroacetic
acid (BCA) applied to the lesions weekly and
can be used during pregnancy.
 Still, recurrence remains a problem
 Disturbances in Reproduction and Sexuality

❑STDs / STIs (cont.) ❑STDs / STIs (cont.)

✓GONORRHEA ✓SYPHILIS - highly contagious disease spread primarily by sexual

activity, including oral & anal sex.
In men
• Pregnant women can spread it to their baby (congenital syphilis),
 Greenish yellow or whitish discharge from which can cause abnormalities or even death to the child.
the penis
 Burning when urinating • Syphilis cannot be spread by toilet seats, door knobs, swimming
 Painful or swollen testicles pools, hot tubs, bath tubs, shared clothing, or eating utensils
 Swollen glands & burning in the throat
 Symptoms usually appear 2 to 14 days ❖Syphilis is caused by the bacteria Treponema pallidum
after infection Stages (Early or primary syphilis)
 Urethritis (pain & frequency of urination
 Occurs shortly after infected with the bacteria.
Complications  Begins with a small & painless, but highly infectious, round
• In women, if left untreated can cause: sore called a chancre that may appear on or inside the
mouth or genitals, wherever the bacteria entered the
 PID, which may damage the fallopian body.
tubes  On average, the sore shows up around 3 weeks after
 Infertility infection, but it can take between 10 and 90 days. The
 Increase the risk of ectopic pregnancy sore remains for anywhere between 2 and 6 weeks.
 Syphilis is transmitted by direct contact with a sore. This
.• In men, gonorrhea can cause: usually occurs during sexual activity.
 infection may spread to testes, scarring Stages (Secondary)
the tubules and causing permanent
sterility if left untreated.  patient may experience skin rashes & a sore throat. The
 affect the prostate and can lead to rash will not itch & is usually found on the palms & soles.
scarring inside the urethra, making Some people do not notice the rash before it goes away.
urination difficult.  Other symptoms of secondary syphilis may include:
 gonorrhea can spread to the blood or
joints. o low grade fever & headache
 people with gonorrhea can more easily o swollen lymph glands
contract HIV o fatigue and joint pain
o weight loss
Prevention
• These symptoms will go away whether or not you receive
• Use condoms correctly every time you have sex. treatment. However, without treatment you will still be infected
• Limit the number of sex partners.
• Practice sexual abstinence
• If you think you are infected, avoid sexual
contact and see a doctor
 Disturbances in Reproduction and Sexuality

✓SYPHILIS Effect in Pregnant Woman

Stages (Latent Syphilis)  a chance of having a stillbirth (IUFD)
 giving birth to a baby who dies shortly after birth.
• The 3rd stage is a latency period or hidden stage that  If not treated immediately, an infected baby may be born
may last from a few years to several decades. The only without symptoms but could develop them within a few
indication is the serologic test, which continues to yield weeks. Untreated babies may become developmentally
a positive result delayed, have seizures, or die.
Stages (Tertiary ) Prevention
• can occur years or decades after you are infected &  Avoid intimate contact with a person you know is infected.
is very serious. Some potential outcomes of tertiary  practice safe sex
syphilis include:  avoid having sex with multiple partners
 blindness & deafness  get screened for sexually transmitted infections
 mental illness or memory loss  avoid sharing needles
 destruction of soft tissue and bone
 neurological disorders (e.g., stroke and
meningitis) ✓GENITAL HERPES - common & highly contagious infection usually
 heart disease spread through sex. It is caused by herpes virus hominis type 2 (also
 neurosyphilis (brain or spinal cord infection) called herpes simplex virus type 2, or HSV-2).
 death
 The virus is also spread by skin-to-skin contact, entering
Diagnostic Test through a break in the skin or mucous membrane.
 It is an infection of the genitals, buttocks, or anal area.
 Blood test - serologic serum tests, usually the
Venereal Disease Research Laboratory test Transmission
(VDRL), the automated reagin test (ART), the
rapid plasma reagin test (RPR), or the  Direct contact with infectious blisters or sores usually on
fluorescent treponemal antibody–absorption genitals, anus, or mouth
test (FTA-ABS). Incubation
 urine test and lumbar tap for the tertiary stage
of syphilis.  3-14 days
Treatment Typical Symptoms
 Penicillin is usually enough to destroy the  Painful blisters or sores form (heal in 2 to 4 weeks).
infection in primary and secondary stage.  Sores may reappear throughout life
 People who are being treated must abstain  Reoccurrences stimulated by stress, fatigue, and illness
from sexual contact until the infection is
completely gone. Sexual partners of people Diagnosis
with syphilis should be tested & if necessary be  Visual examination and tissue culture.
treated.
Treatment
❖If syphilis is left untreated, it can cause serious &
permanent problems such as dementia, blindness, or  Medications (acyclovir)
death.
 Disturbances in Reproduction and Sexuality

❑STDs / STIs (cont.) ✓HEPATITIS B

✓HEPATITIS B - serious disease Treatment
caused by the hepatitis B virus (HBV).
Infection with this virus can cause  Interferon. Side effects: fatigue, depression, loss of appetite & it
scarring of the liver, liver failure, liver can lower the number of WBCs.
cancer & even death.  Lamivudine (Epivir). Can cause a worsening of liver functioning in
rare instances.
 Hepatitis B is spread in  Adefovir (Hepsera). Works well in people whose disease doesn't
infected blood & other bodily respond to Epivir. It can cause kidney problems especially in people
fluids such as semen & that already have kidney disease, but it can occur in anyone.
vaginal secretions.  Entecavir (Baraclude). Studies are showing it may be one of the
 If you are carrying the virus most effective antiviral drugs available for hepatitis B.
you should not donate blood,  Viread (Tenofovir): Used in patients who have both HIV & Hepatitis
plasma, body organs, tissue B. It can also be used as a single agent for Hepatitis B
or sperm.
 Both hepatitis B and hepatitis Prevention
C can be spread by semen as  Get vaccinated (if you have not already been infected).
well as blood and therefore  Use condoms every time you have sex.
are considered STIs.  Wear gloves when touching or cleaning up body secretions on
 Incubation period: 120 days personal items, such as bandages/band aids, tampons & linens.
on average  Cover all open cuts or wounds.
Signs and Symptoms  Do not share razors, toothbrushes, manicuring tools, or pierced
jewelry with anyone.
 Jaundice  Do not share chewing gum or pre-chew food for a baby.
 Unusually light colored stool  Needles for drugs, piercing, or tattooing are properly sterilized
 Unexplained fatigue that
persists for weeks or months ✓Bacterial Vaginosis - mild infection of the vagina caused by bacteria.
 Flu-like symptoms like fever, Normally, there are a lot of "good" bacteria & some "bad" bacteria in the
loss of appetite, nausea & vagina. The good types help control the growth of the bad types. It is an
vomiting inflammation that results from the overgrowth of one of several types of
 Abdominal pain bacteria normally present in the vagina, upsetting the natural balance of
vaginal bacteria.
Diagnostic Test
Cause
 complete physical exam&
blood tests to look at the • Imbalance of organisms (flora) that naturally exist in the vagina.
function of the liver. • Bacterial vaginosis results from an overgrowth of one of several
 liver biopsies to detect the organisms normally present in vagina. Usually, "good" bacteria (lactobacilli)
severity of the disease outnumber "bad" bacteria (anaerobes) in the vagina. But if anaerobic
bacteria become too numerous, they upset the natural balance of
microorganisms in the vagina, resulting in bacterial vaginosis
 Disturbances in Reproduction and Sexuality

✓BACTERIAL VAGINOSIS SYMPTOMS Tests & diagnosis

 An excessive grayish white vaginal discharge, • Take a sample of vaginal secretions. To check for
unlike normal vaginal discharge. Some an overgrowth of anaerobic bacteria in the vaginal
women describe the discharge as "yellow." , also to check the acidity of the vaginal
 A bothersome "fishy" odor, which is usually environment by placing a pH test strip in the
worse after sex (intercourse). vagina. A vaginal pH of 4.5 or higher is another sign
 Other conditions with similar symptoms of bacterial vaginosis
include some STIs (especially trichomoniasis,
Treatments & drugs
chlamydia, and gonorrhea) and vaginal yeast
infection.  Metronidazole (Flagyl, Metrogel-Vaginal).
To avoid the potential for stomach upset,
Risk factors
abdominal pain or nausea while using this
 Multiple sex partners. Bacterial vaginosis medication, avoid alcohol during treatment
occurs more often in women who have & for at least one day after completing
multiple sex partners. Also seems to occur treatment.
more frequently in women who have sex  Clindamycin (Cleocin, Clindesse). One
with women. effect of using clindamycin cream is that it
 Douching. The practice of rinsing out the may weaken latex condoms during
vagina with water or a cleansing agent treatment & for at least 3 days after you
(douching) upsets the natural balance of the stop using the cream.
vaginal environment. This can lead to an  Tinidazole (Tindamax). Has the potential
overgrowth of anaerobic bacteria, which in for stomach upset & nausea as oral
turn can result in bacterial vaginosis. metronidazole does, so avoid alcohol
 Natural lack of lactobacilli bacteria during treatment & for at least one day
after completing treatment
Complications
Prevention
 During pregnancy: higher risk of early
delivery or uterine infection after pregnancy.  Minimize vaginal irritation. Stay out of hot
Also, have an increased risk of miscarriage. tubs & whirlpool spas. Rinse soap from
 After gynecological surgery: increased risk of your outer genital area after a shower &
developing more serious infection or dry the area well to prevent irritation. Use
inflammation, such as PID or endometritis. mild, nondeodorant soaps and unscented
 When exposed to HIV or other STI: increased tampons or pads.
risk of becoming infected with the sexually  Don't douche. Repetitive douching disrupts
transmitted infection (HIV). the normal organisms that reside in the
vagina & can actually increase the risk of
Tests & diagnosis vaginal infection. Douching won't clear up
a vaginal infection.
• Ask questions about your medical history. may ask
 Avoid a STI. Use a male latex condom, limit
about any previous vaginal infections or STIs.
your number of sex partners or abstain
• Pelvic exam. visually examines the external genitalia from intercourse to minimize the risk of a
for signs of vaginal infection, to check your pelvic STI.
organs for unusual characteristics that may indicate
disease
 Disturbances in Reproduction and Sexuality

❑ STDS / STIS (CONT.)

Complications
✓VARICOCELE - enlargement of the veins within the  Shrinkage of the affected testicle (atrophy). The bulk
scrotum. It is similar to a varicose vein that can occur in of the testicle comprises sperm-producing tubules.
the leg. When damaged, as from varicocele, the testicle
• Varicoceles are a common cause of low sperm shrinks and softens. It's not clear what causes the
production & decreased sperm quality, which can cause testicle to shrink, but the malfunctioning valves
infertility. allow blood to pool in the veins, which can result in
increased pressure in the veins & exposure to toxins
• Varicoceles can also cause testicles to shrink. in the blood that may cause testicular damage.
 Infertility. It's not clear how varicoceles affect
• No treatment is necessary unless fertility becomes a
fertility. The testicular veins cool blood in the
concern, at which time the varicocele can be surgically
testicular artery, helping to maintain the proper
removed.
temperature for optimal sperm production. By
Symptoms blocking blood flow, a varicocele may keep the local
temperature too high, affecting sperm formation
• A varicocele often produces no signs or symptoms. and movement (motility) and function.
Rarely, it may cause pain that may:
Tests and diagnosis
- vary from dull discomfort - a feeling of heaviness - to
sharp  Physical examination, which may reveal a twisted,
nontender mass above your testicle that may feel
- increase w/ standing or physical exertion especially over like what's been described as a bag of worms.
long periods & worsen over the course of a day.  Scrotal ultrasound. create precise images of
structures inside the body, may be used to ensure
- be relieved when you lie on your back.
there isn't another reason for the symptoms.
- may enlarge and become more noticeable.
Treatments and drugs
Causes
 Varicocele treatment may not be necessary.
• The spermatic cord carries blood to & from the testicles. However, if your varicocele causes pain, testicular
Many experts believe, a varicocele forms when the valves atrophy or infertility, or if you are considering
inside the veins in the cord prevent the blood from assisted reproductive techniques, you may want to
flowing properly. The resulting backup causes the veins to undergo varicocele repair. Indications for repairing a
widen (dilate). This may then result in damage to the varicocele in adolescence include progressive
testicle & result in worsened fertility. testicular atrophy, pain or abnormal semen analysis
results.
• Varicoceles often form during puberty. It usually occur  Varicocele repair presents relatively few risks, which
on the left side because of the position of the left may include:
testicular vein. However, a varicocele in one testicle can o ✓Buildup of fluid around the testicles
affect sperm production in both testicles (hydrocele)
Risk factors o Recurrence of varicoceles
o Damage to an artery
• Some research suggests that being overweight may
increase the risk.
 Disturbances in Reproduction and Sexuality

✓VARICOCELE
TREATMENTS AND DRUGS (CONT.)
 Open surgery. surgeon will
approach the vein through
the groin (transinguinal), but
it's also possible to make an
incision in the abdomen or
below the groin.
 Laparoscopic surgery. to see
and to repair the varicocele.
 Percutaneous embolization. A
radiologist inserts a tube into
a vein in your groin or neck
through which instruments
can be passed. Viewing your
enlarged veins on a monitor,
the doctor releases coils or a
solution that causes scarring
to create a blockage in the
testicular veins, which
interrupts the blood flow and
repairs the varicocele.