REPRODUCTIVE

HEALTH
 RCH – Reproductive and Child Health Care program is established to create awareness
among people about facts regarding reproduction. This is done to provide facilities and
support for a reproductively healthy society.

 Strategies related to Reproductive health

- Family Planning – parents should be made aware of the need and benefits of a small
family and they can be guided by family planning centers. They should also be informed
the rising population rates.

 Population explosion – the high growth rate of population in a given time unit creating
resource crisis and lack of social, economic and political stability.

- Government efforts: they have trying to provide an appropriate meal to the needy by
checking hoarding and maintenance of reserve stocks.

 Methods of contraception

o NATURAL METHODS: to lower the chance of sperm and ovum meet.

1. Safe period (Rhythm method): couples are advised to avoid intercourse

during the ‘fertile period’ (10th to 17th days of menstrual cycle). This is
because ovulation occurs on the 14th day and ovum remains alive for 1-2
days only but sperms stay alive for 3 days in the female genital tract. The
effectiveness of the method is not guaranteed because of the irregularity of
the menstrual cycles of most women.

2. Withdrawal method / coitus interruption : the male partner withdraws his

penis from the vagina just before ejaculation to avoid insemination. Not a
totally effective method as some sperm might pass anyway.

3. Lactational Amenorrhoea: menstruation stops temporarily for 6 months

after parturition as it is the period of intense lactation.

o BARRIER METHODS: mechanical ways to prevent contact of sperm with ovum

1. Condom: tubular latex sheath for penis which traps the ejaculated sperm. It
also protects from STDs. (Most common – NIRODH)

2. Fem Shield: polyurethane pouch with ring at both sides with the inner one
closed. It covers the genitalia and provides protection from STDs.

3. Diaphragm: dome shaped vaginal barrier with a flexible steel spring in the
rim and fits into the cervix.
 4. Cervical Cap: rubber nipple which fits into the cervix.

5. Vault Cap: semispherical dome like rubber/plastic cap with a thick rim which
fits before cervix and can be removed only after 6 hours of sex.

o INTRAUTERINE DEVICES (IUDs): devices made of plastic, metal or a combination of

the two into the uterus. These are called loops, rings, bows, shields and copper Ts.
Ideal contraceptives for female.

1. Inert IUDs: polyethylene saturated with barium sulphate or stainless steel

E.g. – Lippes Loop). loss of functionality of sperm ascent occurs. Due to quick
tubal motility, the fertilized is prematurely migrated into the uterus even before
it is ready to receive it. These also have a spermicidal effect.

2. Copper Ts (Cu releasing IUDs): e.g. – Cu T, Multiload 375 and Cut 380. These
have ionized Cu which slowly diffuses at the rate of 50 microgram/day. These
suppress sperms motile and fertilizing ability. These devices have to be usually
replaced within 3 – 5 years but Cu T 380 can be replaced within 7 – 10 years.

3. Hormone releasing IUDs: Progestasert and LNG 20. These make uterus
unsuitable for implantation and cervix hostile to sperm.

o CONTRACEPTIVES – ORAL PILLS: oral administration of small doses of progesterone

pills or progestogen-estrogen pills. These are taken orally for 21 days starting of 5 th
day of menstrual cycle and are repeated after 7 days (after actual menstruation).
They hamper motile and secretory activity of sperm and inhibit ovulation. These
causes alteration in endometrial lining which makes it unsuitable for implantation.
E.g. – Mala D (taken daily) and Saheli (taken weekly – highly contraceptive with
minimum side effects).

o Surgical methods (permanent):

1. Vasectomy: surgical removal of a part of vas deferens. A small incision is made in

the side of the scrotum and part of the vas deferens is removed and the cut
ends are tied up hence, preventing sperm to reach urethra.

2. Tubectomy: surgical removal of a part of fallopian tube preventing the ovulated

egg from entering the fallopian tube.

 Medical Termination of Pregnancy (MTP) / induced abortion:

Voluntary termination of pregnancy, before the foetus becomes viable.

This is done to avoid the birth of unwanted child.

- Casual sex

- Rape

- Failure of contraceptive

- Where continued pregnancy may pose threat to foetus, mother or both

 Cause of infertility
 Inability to conceive or produce children in spite of unprotective sex.

- Low sperm count

- Abnormal sperm structure

- Poor sperm motility

- Cryptorchidism (failure of testes to descend into scrotum)

- Hyperthermia (higher temperature in scrotal sac)

- Alcoholism (inhibits spermatogenesis)

- Deficiency of gonadotropins

- Irregular or no ovulation at all

- Defect in cervix

- Deficiency of sex hormones

 Assisted reproduction technologies

o IVF – ET (In Vitro Fertilization – Embryo Transfer): TEST TUBE BABY

Fertilization takes place in a glass container instead of the uterus. Two types:

1. Intra-Uterine Transfer (IUT) – transfer of embryo is done at 32 blastomere

stage

2. Zygote Intra-Fallopian Transfer (ZIFT) – done at 8 blastomere stage

Surrogate mother – the women in whose uterus the in vitro fertilized ovum is kept in

Drawbacks – damaged uterine wall, lack of facilities, high expense and ethical status

o GIFT (Gamete Intra-Fallopian Transfer)

Washed sperm and 2 retrieved ovum is transferred to the fallopian tube with the
help of a laparoscope.

Application: husband with low sperm count

o AI (Artificial Insemination) OR IUI (Intrauterine Insemination)

Placing the sperm in the vagina or cervix when the woman is ovulating using a thin
flexible catheter.

In IUI, sperm may be directly introduced in the uterus.

Application:

a. Very low sperm count or absent

b. Decreased sperm mobility

c. Retrograde ejaculation (semen and sperm released in the urinary bladder)

d. Ejaculation disfunction
 e. Cervical condition is hostile of the cervix

f. Cervical scar caused due to any past operation may hinder the sperm’s
ability to enter the uterus.

o ICSI (Intracytoplasmic Sperm Injection)

A single healthy sperm is introduced is injected into the ovum

Application: very low sperm count

 Amniocentesis

- Aspiration of amniotic fluid from the amniotic sac around the foetus

- Drawbacks: used for malpractices like abortion of female babies

- Role in detecting genetic defect:

a. Sex and sex abnormalities of the baby

b. Genetically controlled congenital diseases (syndromes) due to chromosomal

abnormalities

c. Gene related metabolic disorders of the foetus such as sickle anemia,

thalassemia, phenylketonuria etc.

 Sexually transmitted diseases

Name of the STD Cause Symptoms Treatment

Caused by a 1st stage: painless ulcer/chancre around Incubation

SYPHILIS spirochaete vaginal opening, penis, mouth or anus, and period: 10 – 90
bacterium; swelling of local lymph glands. days
Treponema 2nd stage: lesions on the lips, mouth or Effective drugs:
pallidum genitalia, rashes, hair loss, swollen joints. penicillin and
3rd stage: chronic ulcers appear on palate, Tetracycline
nose and lower legs; paralysis, brain damage, during
blindness and aortic impairment. pregnancy

GONORRHOEA Diplococcus Pus containing discharge, pain over genitalia Penicillin and
bacterium, and burning sensation during urination; Ampicillin
Neisseria arthritis and eye infection (drugs)
gonorrhoeae
GENITAL HERPES Herpes Vesiculopustular lesions, clusters of reddish Acyclovir,
simplex, a ulcers over genitalia; swelling of inguinal valacyclovir or
virus lymph nodes, dysuria, malaise famcyclovir
(medicines)
CHLAMYDIASIS Bacterium, Trachoma, perinatal infection, pain and Tatracycline,
Chlamydia burning sensation during urination, urethritis, Erythromycin
trachomatis epididymitis, mucopurulent, cervicitis, and Rifampacin
inflammation of oviducts, rectal pain with (antibiotics)
mucus and occasional bleeding; high risk of
cervix cancer.
 Men: red sore penis tip, white watery
discharge
Women: mucus like discharge, abdominal
pain
TRICHOMONIASIS Protozoan, Parasitic infection. Simultaneous
Trichomonas Men: urethritis, epididymitis and prostatitis treatment.
vaginalis Women: vaginitis with foul smelling, yellow Standard
discharge and burning sensation. treatment:
Metronidazole
GENITAL WARTS HPV (human Usually clears off after viral cycle and shows Warts can
papilloma no symptoms; exceptions: clusters of skin out disappear, not
virus) growths on penis, scrotum, groin, thighs the virus. Anti-
Women: warts in & around vagina, anus and viral drugs and
cervix and discharge, itching, bleeding, topical
burning preparation.
Warts may appear on hands, mouth, throat.
HEPATITIS B Viral disease Headache, fever, jaundice skin and eyes, dark Prevented by
urine and fatigue, vomiting and abdominal vaccine to
pain; acute and chronic liver hepatitis or liver infant with a 3-
cancer in extreme cases. dose schedule
AIDS (ACQIURED Retrovirus ARC (AIDS-related complex), loss of appetite No treatment.
IMMUNE (RNA virus), and weight, dry cough, pneumonia, shingles, Prolonged life
DEFICIENCY HIV (human pharyngitis, lymphoma, tuberculosis and by building an
SYNDROME) immune- severe diarrhea. immune
deficiency Remains dormant for 6 years after infection. system:
virus Zidovudine
(AZT),
Didanosine,
Azidothymidine
(AZT), ribavirin,
Zalcitabine &
Glycyrrhizin.

EXTRA INFORMATION:

 Vesiculopustular lesions – mixed eruptions or rashes in the form of vesicles and pustules

 Dysuria – pain during urination

 Malaise – general discomfort

 Chlamydia trachomatis is found in semen and vaginal fluid.

- Infects cervix and urethra & can even live in rectum or throat

- Obligate intracellular pathogen

 Genital warts – soft out growths on moist skin of genitalia or around anus

- More than 70 types

- May cause cancer of cervix and vulva

 HIV is also called Retrovirus because it has RNA which can synthesize DNA in the presence of
reverse transcriptase, an enzyme.

- Multiplies inside T4 lymphocytes (helper cells) and break down the immune system.