Nursing questions: Discusion 1. Imagine yourself working

Nursing questions: Discusion 1. Imagine yourself working in a program with teenage individuals. What are some ways to discuss healthy relationships while being aware of the risks of sexually transmitted diseases, pregnancy, and rape? references: 1 : https://www.youtube.com/watch?v=C63Xn–i13o&t=8s 2: https://www.youtube.com/watch?v=RFDatCchpus&t=2s 3: https://www.youtube.com/watch?v=ZtrynEEffMw 4: https://www.youtube.com/watch?v=IEffOROmkbQ 5: Reproductive Health Birth Control vs. Contraception Percentage of U.S. Women Ages 15-44 Using Contraception and Reasons Figure 5-1 Percentage distribution of women aged 15 to 49 years, by current contraceptive status: United States, 2015-2017. Data from Daniels, K., Abma, J.C. (2018). Current contraceptive status among women aged 15-49: United States, 2015-2017. NCHS Data Brief, no 327. Hyattsville, MD: National Center for Health Statistics. Available at: https://www.cdc.gov/nchs/data/databriefs/db327-H.pdf Legal Perspectives of Birth Control Griswold v. Connecticut (1965) Mandated coverage for contraception for federal employees via an act of Congress (1998) All new health insurance plans must cover all FDA-approved methods of birth control, sterilization, and related education and counseling without cost sharing (2010). Race and Religion Also Influence Contraception Use Figure 5-3 Percentage of all women aged 15-49 who were currently using female sterilization, oral contraceptive pill, male condom, or LARCs, by Hispanic origin and race: United States, 2015-2017. Data from National Health Statistics Reports. National Survey of Family Growth, 2015-2017. Available at: https://www.cdc.gov/nchs/products/ databriefs/db327.htm Fertility Awareness Methods “Free, no equipment necessary, but not reliable” Calendar method Avoidance of intercourse during fertile time of month by calculating time of ovulation Basal body temperature Fertility cycle related to changes in basal body temperature Cervical mucus or ovulation method Fertility cycle related to variations in type of cervical mucus Pros vs. Cons of Fertility Awareness Methods Pros Cons ❑ No side effects ❑ Used by anyone ❑ Cost-effective ❑ Limited effectiveness ❑ Need to abstain from sexual intercourse certain days/month ❑ No protection from STIs Birth Control Pills Most commonly used form of contraceptive 99% effective Suppresses a woman’s reproductive hormone cycle One type of birth control pills. © Christy Thompson/Shutterstock Oral Contraceptives Used by 16% of women aged 15-44 years Pros Cons ❑ Lighter and less painful periods ❑ Reduced PMS symptoms ❑ Improved skin ❑ Protection against ovarian and endometrial cancers, ovarian cysts, benign breast disease, and PID ❑ Mood changes ❑ Spotting ❑ Weight changes ❑ Drug interactions ❑ Decreased libido ❑ Headaches ❑ Fluid retention ❑ Health risks for some women Hormone Delivery Methods Depo-Provera Injectable progestin every 3 months Contraceptive patch (Xulane) Patch worn on skin for 1-week intervals; fourth week is patch-free NuvaRing Flexible, plastic ring inserted into the upper vagina and worn for 3 weeks; removed during week of menstruation Barrier Methods (1 of 5) Spermicides Figure 5-4 Spermicidal agents. Barrier Methods (2 of 5) Diaphragm, cervical cap Dome-shaped latex cup sealing cervix Figure 5-5 Diaphragm Figure 5-6 Cervical cap. Barrier Methods (3 of 5) Condoms Figure 5-7 Condom use Barrier Methods (4 of 5) Female condoms Polyurethane sheath lining entire vagina and external genitals Figure 5-8 The internal condom. Barrier Methods (5 of 5) Pros Cons Condoms offer protection from STIs. Can be used as backup for pill users (or with other methods) Can be used for the short or long term Small risk of bacterial infection or toxic shock syndrome for diaphragm, sponge, and cervical cap Must be used properly May have higher long- term costs Intrauterine Device (IUD) Small object inserted by clinician into a woman’s uterus Effectiveness is superior to that of pills, patch, or ring An IUD is a small object placed in the uterus through the cervix by a clinician. © Spike Mafford/Photodisc/Thinkstock Permanent Methods Female sterilization Tubal ligation = fallopian tubes cut and tied – Laparoscopic sterilization – Minilaparotomy – Essure Male sterilization Vasectomy = vas deferens cut and tied Other Forms of Contraception Abstinence No penis-in-vagina intercourse Withdrawal Coitus interruptus Breastfeeding Lactational amenorrhea method (LAM) Emergency Contraception (EC) NOT the same as RU-486, otherwise known as “the abortion pill” Use of high-dose birth control pills taken within 72 hours of unprotected sex Plan B = progestin-only form of emergency contraception ella = another form of emergency contraception available by prescription Failure Rates A failure rate is the chance that the average couple using a given birth control method will become pregnant in a given year. Failure rates can be either for “perfect use” (ideal conditions) or “actual use” (failure rate in the real world) Failure rates range from less than 1% to 30%. Condoms, sponges, and diaphragms have the largest difference between these rates. Contraceptive Failure High rates of effectiveness—oral contraceptives, hormone injectables and implants, IUDs, condoms, vaginal hormonal ring, hormone patch, sterilization Lower rates of effectiveness—diaphragms, cervical caps, sponges, spermicidal agents, fertility awareness methods, rhythm method, withdrawal Handling an Unplanned Pregnancy Adoption—can be “open” or “closed”; private or public Abortion Abortion A controversial issue of debate or a very common medical procedure? …both, actually Abortion continues to be one of the greatest debates in American society. © Rena Schild/Shutterstock Perspectives on Abortion (1 of 2) Why do women choose abortions? Pregnancy would reduce a woman’s ability to work, finish school, or care for others. Cannot afford a(nother) baby Relationship issues or not wanting to be a single mother Completed childbearing Not ready for a(nother) child Did not want people to know she was pregnant or had sex Perspectives on Abortion (2 of 2) Characteristics of U.S. abortion patients More than half are in their 20s; women ages 20 to 24 have the highest rates. 36% are non-Hispanic White, 30% are non-Hispanic Black, 25% are Hispanic, and 9% are other races. Six in ten already have one child. Three in ten have two or more children. Women in poverty have more abortions than wealthy women. Abortion Procedures Surgical abortion Vacuum curettage Dilation and curettage (D&C) Dilation and evacuation (D&E) Medical abortion (“abortion with pills”) Mifepristone, misoprostol (RU-486) Global Perspectives Motherhood continues to be a major risk to life and health in the developing world (most of Asia, Africa, and Latin America) Informed Decision Making If you want to prevent pregnancy Review your and your partner’s needs Personal medical history Review failure rates Risks and benefits of method Reevaluate periodically 6: Sexual Health Sexual Health Defined: “A state of physical, emotional, mental and social well- being related to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexualelationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled.” World Health Organization [WHO]. (2006). Defining Sexual Health. Report of a technical consultation on sexual health 28-31 January 2002, Geneva, Switzerland: WHO. Available at: http://www.who.int/reproductivehealth/publications/en/ Perspectives on Sexual Health and Sexuality (1 of 4) Cultural and religious dimensions “Marriage” is universal theme in all cultures sanctioning sexual privileges and obligations. Sexual behavior is often defined by cultural values. – Normative sex roles – Acceptable types of sexual activity – Sanctions/prohibitions on sexual behavior – Premarital sex – Sexual restraint for females – Same-sex relationships – Contraception decision making Perspectives on Sexual Health and Sexuality (2 of 4) Economic dimensions Daughter in marriage = dowry Value of bride = virginity Sexual aggression = power and economic dynamics Commercial sex industry/prostitution Perspectives on Sexual Health and Sexuality (3 of 4) Legal dimensions Laws prohibiting certain types of sexual behavior/intimacy—cohabitation, fornication, sodomy Same-sex partners Marriage, annulment, separation, divorce, child custody, child support Perspectives on Sexual Health and Sexuality (4 of 4) Political dimensions Sex education in schools – Abstinence-only until marriage programs – Comprehensive or abstinence-plus programs Class Discussion What are some current national or international news items related to: The commercial sex industry or prostitution? Marriages between same-sex partners? Sex education curricula in schools? Sexual Behavior among Youth in the United States Figure 4-1 Sexual behaviors among U.S. youth, 2017. Data from Centers for Disease Control and Prevention. (2018). Youth risk behavior surveillance—United States 2017. Surveillance Summaries. Morbidity and Mortality Weekly Report 67(SS-8):1-114 Sex, Gender, and Gender Identity Sex: An individual’s biological status (male, female, intersex): anatomy, chromosomes, and biological characteristics Gender: The economic, social, and cultural attributes and opportunities associated with being masculine, feminine, or a combination of both Gender identity: An individual’s personal subjective sense of being male, female, or somewhere in between Homologous Sex Structures Figure 4-3 External genital differentiation-male and female. Definitions (1 of 2) Intersex A person who is born with sex chromosomes, external genitalia, or internal reproductive organs not considered “standard” as male or female Gender expression The way a person acts to communicate gender within a given culture, such as clothing and interests Androgyny Having characteristics of both sexes, but appearing gender neutral Definitions (2 of 2) Transgender Umbrella term for anyone whose biological sex is not aligned with the person’s sense of self or gender identity Gender dysphoria Psychological term used to describe a strong and persistent cross-gender identification Transitioning Process in which transgender people work to change their appearance and societal identity to match their gender identity Class Discussion (1) What are some of the challenges faced by transgender people? As individuals? In school? In social situations? In various public places? What are some possible solutions to these challenges? Sexual Stereotypes: Discussion Women are undersexed and men are oversexed. Women are inexperienced and men are experts. Women are recipients and men are initiators. Women are controllers and men are movers. Women are nurturing and supportive, and men are strong and unemotional. Women are sensitive and men are insensitive. Women are dependent and men are independent. Women are passive and men are aggressive. Sexual Orientation Sexual orientation refers to one’s sexual and romantic attraction to other people, whether the attraction is to members of the opposite sex, the same sex, or both sexes. Opposite sex = heterosexual Same sex = gay, lesbian, homosexual Both sexes = bisexual Issues Homophobia Profiling Discrimination in medical care External Female Sexual Anatomy Figure 4-4 External female sexual anatomy. Internal Female Sexual Anatomy Figure 4-6 Internal female sexual anatomy. Common Problems Related with Menstruation Dysmenorrhea – Painful menstrual flow Premenstrual syndrome (PMS) – Group of symptoms linked to menstrual cycle Premenstrual dysphoric disorder (PMDD) – Severe form of PMS Amenorrhea – Lack of menstrual flow Physical Health and the Well- Woman Exam Exam steps Medical history General physical examination – Breast examination and pelvic examination Pelvic examination – Phase I = external examination – Phase II = use of speculum; collection of specimens – Phase III = bimanual examination Sexual Arousal and Sexual Response Masters and Johnson: Female Sexual Response Cycle Four Phases 1. Excitement 2. Plateau 3. Orgasm 4. Resolution Figure 4-7 Masters and Johnson’s model lists three variations among women in the sexual response cycle. Forms of Sexual Expression Traditional heterosexual positions Masturbation Petting Oral-genital stimulation (cunnilingus, fellatio) Anal intercourse Use of sex toys and accessories Sexuality Through the Life Span (1 of 4) Childhood Self-genital stimulation Engage in play that may be viewed as sexual in nature Curious about secondary sex characteristics Children are innately interested in their bodies. © Asiaselects/Getty Images Sexuality Through the Life Span (2 of 4) Adolescence Puberty – Secondary sex characteristics o Hair growth, breast budding, vaginal walls thicken, uterus enlarges, vaginal pH increases in acidity – Menarche o About 2 years after breasts start to develop and by the age of 15 Sexuality Through the Life Span (3 of 4) Young to middle adulthood Increasing number of single, sexually active adults Marriage at later age Increase in the number of women who never marry Placing career goals and advanced education before marriage Increased divorce rate Increase in cohabitating adults Increase in the number of women who no longer depend on marriage to ensure economic stability Sexuality Through the Life Span(4 of 4) Older adulthood Climacteric—physiological changes that occur during period from female fertility to infertility Menopause—cessation of menstruation – Vaginal dryness and thinning, delayed lubrication, hot flashes Decline in frequency and intensity of sexual activity Quality vs. quantity of sexual expression Sexual Dysfunction Prevalence – About 44% of U.S. women report sexual problems, with low desire being the most commons sexual problem (38.7%). Historically called “frigidity” Areas of dysfunction – Sexual desire disorders – Sexual arousal disorders – Orgasmic disorders – Sexual pain disorders Sex Research Well-known studies Kinsey Report (1948 and 1953) – Factors affecting sexual behavior in males/females Masters and Johnson (1966) – Sexual response cycle phases Redbook Survey (1977) – Sexual behavior and attitudes of American women Hite Report (1976) – Sexual practices of American women Blumstein and Schwartz (1983) – Sexual and nonsexual components of relationships ABC Primetime Poll (2004) – Found most Americans were monogamous and happy about it Class Discussion (2) How do definitions of terms like “virginity” or “premarital” complicate sexual health research? Communication contributes greatly to the satisfaction of an intimate relationship. © Iofoto/Dreamstime.com Sexual Violence as a Public Health Problem Types of sexual violence Sexual assault and rape Female genital mutilation (FGM) Forced sterilization Informed Decision Making Gynecological checkup Understanding personal feelings, thoughts about sexual well-being Understanding the medical language associated with sexual health Understanding responsible sexual behavior Understanding myth vs. fact Communication between parents and children Knowledge of healthcare resources

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