LECTURE The theme PROTECTION OF THE REPRODUCTIVE HEALTH

LECTURE: The theme: PROTECTION OF THE REPRODUCTIVE HEALTH. FAMILY PLANNING. For the IV course students Lecturer: ANTONOVA G. A.

Plan of lecture: 1. The role of early sexual life prophylactic at protection of reproductive health. 2. Definition of a subject- reproductive health. 3. The revue of the modern methods of family planning. 4. Hormonal contraceptive drugs: - Combined oral contraceptive drugs. - Barrier methods of contraception. - The new perspective contraceptive drugs. - Voluntary surgical sterilization. - Traditional methods of contraception. - Urgent contraception.

What can happen if you have sex? Pregnancy Emotional issues STDs: l l l Chlamydia Gonorrhea Genital Warts (HPV) Herpes HIV

Sexually transmitted diseases (STD) Sexually Transmitted Diseases or Venereal diseases: Infections transmitted mainly through sexual interactions.

Common Sexually Transmitted Diseases… Gonorrhea and Chlamydia HIV/AIDS Herpes Syphilis Genital Warts (Human Papilloma Virus)

Some general symptoms of STD’s None at all Painful urination Abdominal Pains Rash Warts Genital/Oral/Anal Ulcers Foul smelling discharge

STD’s and teens. . . • 1 in 4 sexually active teenagers get an STD • 1 in 4 college females has Genital Warts… I have genital warts… 1. 2. 3. 4.

Although some STD’s can be treated… Delayed treatment can result in: life threatening infection chronic abdominal pain Infertility and massive scarring Others have no cure and result in: • Life long painful ulcers • life long, disfiguring warts • DEATH!

Can an STD cause Cancer? Yes, certain strains of Human Papilloma Virus (HPV) cause Cervical Cancer in women. Once infected with HPV, lesions may occur for the REST OF YOUR LIFE!

What does someone with HIV/AIDS look like? They can look like anyone else…

HIV (Human Immunodeficiency Virus) HIV is the virus that causes AIDS Half the people with HIV develop AIDS within 10 years after getting HIV. There is no cure for HIV or AIDS.

What if I get infected? Infection can take between 25 days to 6 months before it is detectable. Early detection and treatment is important. There is no cure, but treatment to help slow HIV down is available.

Miscellaneous facts… Tattoos and prior blood transfusions are risk factors for hepatitis and HIV/AIDS. Anal sex increases the risk of getting STD’s due to increased trauma to the area.

Sexual Relationships and what you need to know!!! I never had sex before you Todd I love and want to be careful… Let’s have OK!!! sex!!!

What you should know if you are planning to have sex… Have you Alright, had sex I guess before? so… Don’tbut Yes, worry, she only was clean! once… I had a blood transfusion ? ? I have a tattoo

? ? ? ? The Sexual Network Lisa Marie Damn!!! Patricia Nicholas Minnie Penelope Matt Claire Tom

Can I get pregnant if I have sex during my period? YES!!!

But if contraceptives are use then…… NO!!!

According to the definition by WPHO“ reproductive health “ is the condition of the complete physical, mental and social wellbeing , but not the simple absence of diseases in all cases, closing to reproductive system and its functions and processes”. Reserve for the protection of women health is family planning

“ Family planning is possibility of the married couples and persons free and responsible to decide a question about quantity and time of children delivery and have information about means , helping them to make this choose , using the all diapason safe and effective methods”.

With the single family position , single woman, practice of family planning has direction on satisfaction of wishing quantity of healthy children. Family planning means the healthy family. Management of it is through :

Decreasing of STD frequency among the fertile age women. Decreasing of the pregnancy cases among teenagers. Decreasing of ID, as an abortion’s results in cases of undesirable pregnancy. Decreasing of the small weight newborns delivery due to pre term labour and newborns with SIUR. There is good possibility of education receiving in the family. The optimum of breast feeding protection.

There are 5 main principles of family planning: prophylaxis of pregnancy among teenagers prophylaxis of pregnancy among the women elder than 35 years following the inter-genital interval, at least 2 years eliminate the multipara’s in the risk group , with the prophylaxis management. to treat the women with extragenital pathology protection from pregnancy in cases , when pregnancy is contra- indicated.

The modern methods of contraception. There are using the synthetic analogs of female sexual hormones – estrogens and progesterone. There are using such hormonal mediums: - combined estrogen- gestagen’s oral contraceptive drugs, that content only gestagen’s, oral gestagen‘ s- mini- pills prolonged injection ‘s contraceptives implants

Choosing of a contraception method is depending upon many factors, such as possibility to be confident in its safety, cost, threat for health. Such factors, as religion, cultural, social may have effect on a choosing of contraception method.

Types of Contraceptives ü Barrier protection w male and female condoms w diaphragm w contraceptive sponge w cervical cap ü Non-barrier protection w birth control pills w spermicides

Types of Contraceptives ü Barrier protection w male and female condoms w diaphragm w contraceptive sponge w cervical cap ü Non-barrier protection w birth control pills w spermicides

COC – Combined oral contraceptives. The mechanism of action is the same for the different forms and doesn’t depending on phase of prepared, dose and progesterone’s component. The main action is the blockage of ovulation. It is performing due to disturbance of FSH and LH rhythmical production by hypophysis. Hormonal drugs make a cervical mucus more thick. Effect on endometrium is atrophic changes of its.

As a rule there is a fixated coordination between estrogens and gestogens contents, but bi- phase, three- phase oral contraceptive drugs exist. Mono-phase contraceptive drugs are - marvelon, microgenon, femoden, silest, bi- phase- anteovin and another, its has a constant doze of estrogens and changing doze of gestagen’s. Three- phased – threequilar, three - rugol has three types of tablets, that have a different contents of estrogens and gestagen’s. In this cases there are changing of estrogen’ s contents during month , that help to decrease the summer doze of estrogens.

In our time the low dozed mono phased COC are more popular. Low dozed tablets has concentration of estrogens less than 50 microgram. Per oral contraceptive drugs, which content only progesterone are less safe and have bigger quantity of complications and due to that are using not often. In tablets ethinilestradiol contents more often , but may be mestranolum. As a progesterone norgestrel is using more often, but now is dezogestrel is using, that doesn’t has an androgen activity.

According a literature date about 50 women from 750 are not going for hospitalization in cases of COC using due to positive effect of these drugs for prevention of cancer of endometrium, ovaries, breasts, inflammatory diseases of internal sexual organs.

Contraindications for COC using are: pregnancy heavy hypertension, IHD smoking of women, elder 35 years liver diseases at the present time or in the past, disturbance of liver function; hormone depending of ovaries tumors, cancer of ovary, endometrium; presence of vaginal bleeding of not clear etiology; sever obesity ( 50 % from norm)

The regime of COC using is - from the 1 day of cycle during 21 days and interruption during 7 days. It should be used during many years without interruption. It should be know, that a high concentration of estrogens makes high risk of serious complications, when a low concentration may have possibility of between menstruation bloody discharges

After beginning of COC using women should be examined in 3 months, after that every 6 months. Gestagene’s contraceptive drugs have indications: smokers at the lactation period for patients with hypertension, diabetes mellitus in cases of allergy to estrogens

Very interesting fact is that a half of condoms are bought by women, it is method of contraception for men. Condom should be wear in case of erection, prevent going of sperm in vagina, it is a safe method of temporary contraception The best condoms are with lubrication or with special reservoir for sperm. Rupture of such condoms is rarely occurs.

What works? ü Barrier-Protection ü Something that physically prevents sperm from entering the cervix. ü Male latex condoms are the best method for STD/HIV protection of all the different barrier contraceptives.

THE PILL: The Pill is the most popular type of birth control. There are many different brands of the Pill and they come in packs of 21 or 28 pills. The first 21 pills have a combination of synthetic estrogen and progesterone hormones. The Pill stops ovulation, preventing the ovaries from releasing eggs. The Pill also thickens cervical mucus, making it harder for sperm to enter the uterus. The hormones in the Pill prevent fertilization. The last 7 pills of a 28 -day pack have no hormones and are called spacer pills. The Pill is 92 -99. 7% effective as birth control.

IMPLIANTS: Implants are up to 99 percent effective , but there is more popular such implant, as Norplant. Implant can work up to five years, costing between $500 and $900 with a $100 to $300 removal fee. Six implants are placed in the upper arm the skin.

CERVICAL BARRIERS: A diaphragm is just one of the many types of rubber barriers used during intercourse to stop the flow of sperm to the cervix. The sponge and cervical cap can also be used for the same type of protection. The average cost for these products ranges from $20 to $45 at the health center. Diaphragms can be easy removed. Always bring a back-up method, such as an easier to apply condom.

INJECTIONS: DEPO-PROVERA, the most common injection administered, is 99 percent effective. A shot is injected every three months by a health care professional. It costs approximately $30 to $65 per shot. recommended for smokers.

Vaginal Ring (NUVARING) A thin, transparent, flexible ring that you insert into the vagina yourself to provide contraception protection. Leaving the Vaginal Ring in for 3 weeks, it slowly releases estrogen and progestin hormones into the body. These hormones stop ovulation and thicken the cervical mucus, creating a barrier to prevent sperm from fertilizing an egg. Work continuously for three weeks followed by a week off, each Vaginal Ring provides one month of birth control. The Vaginal Ring is 9299. 7% effective as birth control.

Intrauterine Device (IUD) A small object that is inserted through the cervix and placed in the uterus to prevent pregnancy. A small string hangs down from the IUD into the upper part of the vagina. The IUD is noticeable during intercourse. IUDs can last 1 -10 years. They affect the movements of eggs and sperm to prevent fertilization. They also change the lining of the uterus and prevent implantation. IUDs are 99. 2 -99. 9% effective as birth control.

Emergency Contraceptive Pills (PLAN B) It works by giving the body a short, high, burst of synthetic hormones. This disrupts hormone patterns needed for pregnancy. EC disturbs the ovaries and the development of the uterine lining, making pregnancy less likely. EC is used within 120 hours (5 days) after intercourse. It is most effective within the first 24 hours. Emergency Contraception reduces the risk of pregnancy by 75%.

RHYTHM METHOD A woman practices rhythm, or natural family planning, by learning to recognize the days she is fertile, and not having sex before and during those days. The rhythm method does not work for all couples. Women who have regular menstrual cycles and who are very careful about when they have sex usually find it to be effective. Women who have irregular cycles and who are not so careful often end up becoming pregnant.

How Does It Work? Methods include keeping track of changes in body temperature and vaginal discharge (fluid from the vagina) to pinpoint which days you are fertile. Ask your doctor how best to use the rhythm method.

What doesn’t work? ü Non-Barrier Protection Only protects you from getting pregnant DOES NOT PROTECT AGAINST STD/HIV!!

Remember: Every method of contraception has advandages and disadvantages. Before using of any method You should go to doctor for consultation

Any Questions?

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Questions for students: 1. Tell, please the mechanism of COC action. 2. Which types of COC are useful in practice. Mechanism of IUD action.