REPRODUCTIVE HEALTH

Reproductive health means a total

well-being in physical , emotional ,
behavioral and social aspects of
reproduction.
Health
Health is affected by
1.Genetic disorders and deficiencies with which
an individual is born.
2.infections.
3.life style that includes
a.food and water.
b. rest.
c. exercise.
d. habits.
Reproductive health-problems and
strategies
A reproductive healthy society is the society with
people having physically and functionally normal
reproductive organs and normal emotional and
behavioural interactions among them in all sex
related aspects.
India is the first country to initiate action plan at
the national level to attain total reproductive
health, these programmes are called FAMILY
PLANNING and were initiated in 1957.
Currently it is called as Reproductive and Child
Care Health (RCH) programmes.
The major tasks of RCH programmes.
1.creating awareness among the people
about various related aspects.
2. providing facilities and support for building
up a reproductively healthy society.
3. governmental & non governmental
agencies have taken up various steps to create
awareness among people about reproduction
related aspects, they take the help of audio
visual and print media.
4. introduction of sex education in schools should
be encouraged to give right information and to
avoid myths and misconception about
sex related aspects,
proper information about reproductive organs,
adolescence and related changes.
Safe and hygienic sexual practices.
Sexually transmitted diseases(STDs)-these would
help people to lead a reproductively healthy life.
Educating people , especially the fertile
couples and those in marriageable age group,
about the following can help them to make
up a socially- conscious healthy family life of
desired size.
Available birth control options.
Care of pregnant women.
Post natal care of mother and child.
Importance of breast feeding.
Equal opportunities for the male and female
child.

People should know about
the problems of uncontrolled population
growth.
Social evils like sex abuse and sex related
crimes.
To enable to think and take up necessary steps
to prevent them from these evils and build
up a reproductively healthy society.
Population explosion
The following reasons have an explosive impact on
population explosion.
Increased health facilities.
Improvement in technology.
Better living conditions.
Reasons.
Decline in death rate.
Decline in Maternal Mortality Rate.(MMR).
Decline in Infant Mortality Rate (IMR)
Increase the number of people in the reproductive age
.
BIRTH CONTROL.
The most important step to control
population growth is to motivate smaller
families by using contraceptive methods.
OTHER STEPS INCLUDES.
Raising marriageable age to 18 for females
and 21 for males.
Incentives given to couples with small
families.
An ideal contraceptive should be
User friendly.
Easily available..
Effective.
Reversible with no or less side effects.
Non interfering with the sexual drive/desire
and the sexual act of the user.
Methods of birth control.
The contraceptive methods are grouped into
the following categories.
Natural methods.
Barrier methods.
Intra-Uterine Devices.(IUDs)
Oral contraceptives.
Injectables and implants.
Surgical methods.

Natural methods
This methods work on the principle of
avoiding chances of meeting between the
gametes.
The natural methods are not 100% effective
1. Periodic Abstinence.
In this method ,the couples avoid or abstain
from coitus (sexual intercourse) from the day
10-17 th of the menstrual cycle, when
ovulation is expected to occur and chances of
fertilization is high
2.Coitus interruptus.(withdrawal).
In this method, the penis is withdrawn from the
vagina before ejaculation and insemination is
avoided.
3. Lactational amenorrhea.
It refers to the absence of menstruation during
the period of intense lactation following
parturition.
As ovulation does not occur in this periods and
chances of conception is almost nil.
But this method is effective for a maximum
period of six months after parturition.

Barrier methods.
The ovum and sperm are prevented from coming
closer with the help of barriers.
Barrier methods are available for males and females.
Ex . Male condoms and female condoms these are
made up of rubber or latex sheath to cover penis in
male or vagina and cervix in females.
Condoms are also provide protection against sexually
transmitted diseases..
Diaphragms , cervical caps and vaults are the barriers,
used by females ,they are reusable.
Spermicidal creams are used along with these barriers
to increase their contraceptive efficiency.
Male condoms
How to use male condom
Female condom
How to use female condom
Use of diaphragm

Function of diaphragm
Intra-Uterine Devices(IUDs)
These are the devices introduced into uterus.
IUDs are the following types.
Non medicated IUDs eg. Lippes loop.
Copper releasing IUDs-CuT, Cu 7,Multiload375
Hormone releasing IUDs.eg.Progestasert
.LNG20.
Position of IUDs
IUDs prevent contraception in the following
ways.
Be increasing phagocytosis of sperms within
the uterus.
By suppressing sperm motility and thereby
fertilizing ability)by cu releasing IUDs.
By making unsuitable for implantation.
By making the cervix hostile to sperms.
Oral contraceptives
It is the hormonal preparations in the form of pills.
They are either progesterone or progesterogen- esterogen
complex.
Eg .Mala-D. Mala-L(DAILY PILLS)
Functions-
They alter /inhibit ovulation and implantation.
They modify the quality of cervical mucus to
prevent/retard entry of sperms.
SAHELI is an example of oral contraceptive , that contains a
non-steroidal content called centchroman.
It is developed in INDIA in Central Drug Research Institute,
Lucknow.
It is a once week pill.
ORAL CONTRACEPTIVE pills have to be taken daily for a
period of 21 days starting within the first five days of
menstrual cycle.

Injections and Implants.
PROGESTOGENS or progestogen-esterogen
combination is also used as injections or
implants under the skins
Their mode of action is similar to oral
contraceptives , their effective periods are
longer.
Inserting implant
Surgical methods


Tubectomy
Vasectomy

Surgical methods

These are advised as a terminal method to prevent
pregnancy.
It block the transport of gametes and there by
conception.
Vasectomy is the sterilization procedure in males,
where a small portion of the vas deference is
removed or tied up ., through an incision through
scrotum.
Tubectomy is the sterilization procedure in
females,where a part of fallopian tube is removed or
tied up through a small incision in the abdomen or
through vagina.
Medical termination of pregnancy
(MTP)
MTP has been legalized by the Govt. of India in
1971. with strict conditions to avoid its misuse,
especially indiscriminate and illegal female
foeticides.
MTP is essential where pregnancy could be
harmful to the mother or the foetus or both.
MTP are safe during the first trimester (12 weeks
of pregnancy ).
MTP IS RISK DURING THE SECOND TRIMESTER.
Infertility
The reasons for infertility could be physical,
congenital diseases, use of certain drugs,
immunological reactions or psychological.
Infertility clinics could diagnose the problem
and give corrective treatments for many of
these problems.
Special techniques are called Assisted
Reproductive Technologies(ART) help the
couple to have children's.
ART are as follows
1.TEST TUBE BABY PROGRAMMES.
In this methods ,ova from the wife or a donor
female and the sperm from the husband or a
donor are allowed to fuse under simulated
conditions(as that of the body ) in the laboratory.
It is called in vitro fertilization(IVF) .
The zygote /early embryo is transferred into the
uterus or fallopian tube for further development.
This process is called Embryo Transfer (ET).

TYPES OF ET..
The zygote or the embryo up to eight
blastosis transferred into the fallopian tube.
It is called Zygote Intra Fallopian Transfer
(ZIFT).
Embryo with more than eight balstomeres are
transferred into the uterus, it is called Intra
Uterine Transfer(IUT).
2.GAMETE INTRA FALLOPIAN
TRANSFER(GIFT).
This methods involves the transfer of an
ovum collected from a donor female into
another female, who can not produce an ova
but can provide a suitable conditions for
fertilization and further development of the
foetus upto parturition.
3.INTRA CYTOPLASMIC SPERM
INJECTION(ICSI)
In this method the sperm is directly
injected into the ovum to form an embryo in
the laboratory and the embryo transfer is
carried out.
4.ARTIFICIAL INSEMINATION(AI)
In this method ,the semen collected from the
husband or an healthy donor is artificially
introduced into the vagina or into the uterus,it
is called intra uterine insemination(IUI).
This method is used incase where infertility
is due to the inability of the male partner to
inseminate the female or due to very low
sperm counts in the ejaculates.
Sexually Transmitted Diseases(STDs)
SYPHILIS.
GONORRHOEA.
CHLAMYDIASIS
TRICHOMONIASIS
AIDS
HEPATITIS-B
GENETAL HERPS.
Sexually Transmitted Diseases
transmitted during coitus or genital contact
1 in 4 will contract STD between 15-55 yrs
of age
require moist environments (transitional
zones)
STDs
common areas of infection:
vulva, vagina urethra in females
penis, urethra in males
mouth, oral cavity, eyes, anus in both sexes
if untreated, can pass from transitional zone
to other tissues
person usually has >1 STD at a time

Causes
BACTERIA :
single-celled, microscopic organisms
cause disease by producing toxins
can be prevented by vaccines; killed by
antibiotics
Examples of bacterial STDs: chlamydia,
gonorrhea, syphilis

Gonorrhea
Bacterial STD
Symptoms similar to those of chlamydia

Syphilis
STD caused by bacterium
1st epidemic: 15th century, W. Europe
34,000 cases reported per year
rates on the rise again
bacterium thrives in moist regions
9/10 cases due to transmission during coitus
Diagnosis / treatment of syphilis
Cultures; blood test for antibodies
several antibiotics are effective
curable, like gonorrhea
may cause permanent damage if tertiary stage
is reached
Herpes genitalis
most common viral STD (1 million in U.S. contract / year)
incurable
caused by herpes simplex type 2 virus
other herpes viruses exist (cause fever blisters, cold
sores, chicken pox, infectious mononucleosis)
type 2 invades areas below the waist; type 1 invades
above the waist
20% of infections in genital region are due to type 1
Herpes
likewise, type 2 is sometimes found in mouth
sores
condoms not 100% effective in preventing
transmission
type 2 can be transmitted by nonsexual
contact

Herpes: Symptoms
Burning sensation followed by appearance
of blisters
Blisters rupture in 1-2 days; become painful
ulcers
Possible flu-like symptoms
in males > sores occur on penis
in females > on labia, clitoris, cervix, vagina,
urethra, perineum
http://std-gov.org/stds/std.htm
Herpes Symptoms
in both sexes: painful urination and coitus;
sometimes fever and enlargement of lymph
nodes
sores heal between 1-6 weeks
if virus comes into contact with eye, can cause
blindness

Herpes: Transmission
even with no sores, virus is harbored
within body in nerve cells near spinal cord
a person is most infectious when sores are
present; transmission at other times?
sores can reappear throughout a persons
lifetime
Herpes: Transmission
triggers for recurrence:
sunlight
stress
menstruation
sex
sometimes, antibodies are developed that
alleviate or stop recurrences
Herpes: Treatment
no cure for herpes
drugs can disrupt viral reproduction
some forms resistant
proper hygiene helps reduce spread
vaccine is currently being developed that
decreases frequency of sore recurrence
Herpes
vaginal deliveries can result in infection of
newborn:
25% can develop blindness, brain damage
25% develop skin lesions
rarely, virus can cross placenta

Human papilloma virus
Over 70 strains
Some cause venereal warts -moist, soft,
cauliflower-like bumps (within 3 weeks - 8
months)
appear on cervix, labia, vulva, perineum in
females
on penis in males, urethra, scrotum
treated topically with dry ice, liquid nitrogen
> warts dry up and fall off in a few days
warts may recur
Human papilloma virus
major cause of cervical cancer (95% of cases associated with
HPV)
also associated with cancer of the penis, vagina, anus
http://www.dermnet.com/thumbnailIndex.cfm?moduleID=16
&moduleGroupID=242&groupIndex=0&numcols=0
http://www.dermnet.com/thumbnailIndex.cfm?moduleID=16
&moduleGroupID=241&groupIndex=0&numcols=0


AIDS
AIDS = acquired immune deficiency syndrome:
condition is caught, not inherited
virus attacks immune system
certain infections, cancers occur in infected persons
caused by human immunodeficiency viruses (HIV)
live and reproduce in helper T cells
host cells die as viruses depart to infect other cells
consequence: decrease in helper T cells, which are
necessary for stimulating antibody production by B cells
and activity of killer T cells
AIDS, contd.
between 4.2 and 15 years, HIV infection leads
to fullblown AIDs
stages:
window period (incubation period):
can be as long as six months
virus replicates slowly; no antibodies detected
acute phase of HIV disease (after
seroconversion):
lasts 2-4 weeks
accompanied by flu-like illness (fever, swollen glands,
muscle aches, weight loss)
AIDS, contd.
asymptomatic phase:
little or no symptoms
virus continues to replicate, destroy T cells
symptomatic phase:
opportunistic infections begin
examples: bacterial skin infections, diarrhea, fever,
tuberculosis
AIDS, contd.
T cell count less than 200 cells per
microliter of blood (normal is 900-1200
cells)
accompanied by one or more opportunistic
infections:
pneumonia
neurological problems (meningitis, seizures)
cancers of skin, cervix, lymph nodes
death follows in about 2 years
AIDS: Transmission of HIV
virus is present in bodily fluids: blood, semen, cervical
and vaginal secretions
low levels also present in urine, saliva, tears (no evidence
that virus can be transmitted by these fluids)
transmitted when contaminated fluid enters anothers
body
risk of contraction is greatest in receptive partner during
anal or vaginal intercourse
common modes of transmission: use of contaminated
needles, sexual contact, during pregnancy
AIDS: Transmission of HIV
virus does not live long outside of the body
cannot be contracted from classroom
activities, bathrooms, swimming pools,
kissing, sharing food, coughing, sneezing,
sweating, sharing utensils, giving blood
Pregnancy and HIV
Use of protease inhibitors during pregnancy
can reduce risk of infecting fetus (25% to 8%)
HIV-positive women are advised not to
breastfeed
Assignments. previous papers.
5 marks .
1. Describe vasectomy and tubectomy with diagrams.
2.Expand the followings.
ART, GIFT,ICSI, RTI,IUI.
3 MARKS./2 MARKS.
1.How are assisted reproductive technologies helpful to humans ? How are ZIFT
and GIFT are different from intra uterine transfers? Explain.
2.What is amniocentesis ? Why has government imposed a statutory ban in
spite of its importance in the medical field ?
3.How do copper and hormone releasing IUDS act as contraceptives explain?
Mention example for each.
4.Name an oral pill used as contraceptive by human females. Explain how does it
prevent pregnancy?
4. (a) How do pills acts as contraceptives in females ?
(b) Why saheli considered to be an improved form of oral contraceptive for
human females ?
5.Describe the lactational amenorrhea method of birth control .
6. At the time of independence, the population of India was 350 million, which
expolded to over 1 billion by may 2000.List any reasons for this rise in
population and any two steps taken by the government to check this population
explosion.
All NCERT text book questions.( CHAPTERS 01 ,02 ,03 .AND 04 ).
SUBMISSION DATE BEFORE 30 TH JUNE-2014,)
NCERT TEXT BOOK QUESTIONS- CHAPTERS- 01
.O2, 03