Unit C and D: Fertility and Family Planning + STI and infectious disease

Where is Estrogen secreted from

ovaries during childbearing years

Where is progesterone secreted

corpus luteum

Where is testosterone secreted from in women

ovaries

Where are prostaglandins and what are they produced by

oxygenated fatty acids produced by cells of endometrium

Estrogen controls the...

1. Development of female _______ ____ _______
2. Increases ______ sensitivity to _______
3. Contributes to and increase in ______ ______

secondary sex characteristics

uterine/oxytocin

sexual desire

What does estrogen control, promote, and contribute to

control: development of women’s secondary sex characteristics

Promote: maturation of ovarian follicles

Contributes: increase in sexual desire

What is known as hormone of pregnancy

progesterone

What is progesterone responsible for

temperature rise that occurs with ovulation and maintaining the temperature above the baseline after ovulation

What other hormone does testosterone work with and what do they do together

estrogen

maintain and repair reproductive tissues and bone mass

___________________ secretes gonadotropin releasing hormone

hypothalamus

What does neurohormonal mean

hormones produced in the brain

What is follicle-stimulating hormone (FSH) responsible for

maturation of the ovarian follicle

Luteinizing hormone is produced where

anterior pituitary

What is luteinizing hormone responsible for

luteinizing of the cells that cause the rupture of the follicle causing estrogen production to decrease and progesterone secretion to continue

How long is the follicular phase

days 1-14

How long is luteal phase

days 15-28

Luteal phase breaks down into two:

secretory phase

ischemic phase

What happens in the secretory phase

follows ovulation

increases vascularity of uterus in preparation for fertilized ovum

What happens in the ischemic phase (4)

Estrogen levels are low

corpus luteum begins to degenerate

small blood vessels rupture, and cells escape into stromal cells

menstrual flow begins

When is human chorionic gonadotropin (hCG) secreted

if ovum is fertilized and implants in endometrium

Sperm need an environment pH near ___________ to survive

7.5

Once inside the female reproductive system, sperm can be viable up to _________

72 hours

some texts says 24-48 hours

What are testosterone responsible for in men

development of secondary sex characteristics

The average volume for an ejactualtion contains ______________

200-500 million spermatozoa

Ova are viable for ___________

sperm are viable for ______________

12-24 hours

72 hours

name the four types of family planning

Calendar method

basal body temperature

cervical mucus

predictor test

The calendar method is based on

previous cycles of menstruation and ovulation

Calendar method:

The fertile period is determined by the number of days in the _______ cycle minus . The last fay of the fertile period is calculated by the number of days in the _____ cycle minus __. Method must be updated every _ months for accuracy.

shortest

18

longest

11

3

Effectiveness of Calendar Method:

Not dependable if ______ cycles or if on _______ replacement therapy. Not recommended for women in the - years following menarche, the pre-menopausal years, women who have given ____ _______ or who are _______.

irregular

hormone

3-4

birth recently

breastfeeding

What is the billings Ovulation method

assessment of cervical mucous

Basal body temperature method is based on

taking a woman's temperature at the same time using the same method each AM before arising

Basal Body Temperature:

Avoid the period when the temperature drops and then goes back up by ___-___ degrees above previous reading. The most fertile time is the period when temp _____ and hours after temp ___. Need to avoid sex for days post temperature change. Once ovulation has occurred the temperature will ___ and stay until ____ occurs.

0.5-1.0

drops

24

rises

3

rise

up

menses

name 5 things that may effect the effectiveness of basal body temperature

illness

distress

interrupted sleep

smoking/alcohol

electric blankets

Cervical Mucus:

Check cervical mucus each day post menstruation. During ovulation mucus becomes _______, ___, _____, and ____; avoidance of that period plus - days post mucus. Mucus switches to _____ and ______ post ovulation.

slippery

wet

stretchy

clear

3-4

tacky

cloudy

name three things that can effect the effectiveness of cervical mucus check

douching

semen

yeast infection

Lactational Amenorrhea:

Exclusive breastfeeding at least months post delivery including at least feeding per night on both breasts with no more than - hours between feedings; only for the first months post delivery. Requires at least -_ feedings per day (every 2-3 hours).

3

1

5-6

3

8-12

Lactational Amenorrhea:

Ovulation typically returns prior to return of ________.

menstruation

Natural Family Planning:

Disadvantages include requiring daily ________ and a regular _____. It also takes - asexual cycles to determine the baseline.

observation

cycle

3-6

IUD:

T-shaped plastic device with attached string inserted in the uterus by a healthcare provider. It causes a local foreign body _________ response; inhibits fertilization by inhibiting ________, and may affect ______ ____ by the release of chemicals or hormones.

inflammatory

implantation

cervical mucus

The hormonal IUD (5 year) suppresses the _______ by inducing a weak foreign body reaction and ______ the cervical mucus. It can be inserted at any time during the cycle but performed timing is after ___. A back-up method must be used for _ days if inserted in the middle of a cycle.

endometrium

thickens

LMP

7

type of IUD that is a T-shaped plastic device wrapped in wire and must be replaced every 10 years

copper (para-gard)

The copper IUD works by inhibiting ____ implantation, damaging the ____, and impairing sperm ______ and _______.

ovum

ovum

motility

viability

how long after post-partum can an IUD be implanted?

6 weeks

after removal of a cooper IUD, how long does it take for fertility to return?

1-2 months

after removal of a hormonal IUD, how long does it take for fertility to return?

1 year

list the DANGER signs of IUDs

pain with intercourse

abdominal discomfort

infection

not feeling well (flu-like symptoms)

string shorter or longer

Use condoms with ________. Use _____ based lubricant to prevent breakdown. Never use ______ condoms at once.

spermicide

water

multiple

What is a female condom

vaginal sheath with flexible rings at both ends

Female condoms allow heightened sensation for ___ and protect better against ____. Female and male condoms should not be used ______.

men

STI

together

Disadvantages of the female condom include being pulled out of the vagina during _______ and during _______. An advantage is that they may be placed ______ _____ before intercourse.

withdrawal

intercourse

several hours

Cervical cap is more effective in women who have _____ had a baby. It is most effective if used with ______.

never

spermicide

What is a cervical cap

a deep rubber cap that is inserted against the cervix; stays in place with suction and support of the vaginal wall

An advantage of the cervical cap is that it may be inserted ___ hours before the sex act. It should be replaced every -_ years.

6

1-2

The cervical cap must stay in place for hours after sex act and may be left in for up to days. Do not use during __________.

6

2

menstruation

What is a diaphragm

reusable dome shaped rubber cup with flexible rim inserted to cover the cervical os

A diaphragm is held in place by _______ _____. It needs to be fitted by a ___ and is typically used with _______ on the inner surface to aid with application to the cervix.

vaginal muscle

HCP

spermicide

what two hormones is phasic birth control (combination pill, skin patch, vaginal ring, injection, implant) made of?

estrogen

progestin

With the combination pill, the ______ the dose of estrogen the fewer side effects.

lower

how does a skin patch work

slowly releases hormones estrogen and progestin through the skin

The skin patch is applied weekly for weeks (period should start after removal for one week) to buttocks, upper body (NOT _____), abdomen (below the _____), or upper outer arm. A woman may still ____ or _______.

3

breasts

waist

swim

tub bathe

The skin patch is less effective in women over ...

198 lbs

Advantages of Phasic Birth Control:

1. Protection against ________ and ______ cancer
2. Protection against postmenopausal ________
3. Used to treat irregular cycles, __________, and _________

endometrial/ovarian

osteoporosis

endometriosis/menorrhagia

Disadvantages of Phasic Birth Control:

1. BCP or _______ medication may be less effective if taken ______ (antibiotics, valium, antacids, vitamin C)
2. Increases risk of _________ complications
3. _______ BP
4. Increased risk of ______ _____
5. Increased risk of failure with patch and BCPs with ________

prescribed/together

cardiovascular

elevated

blood clots

obesity

what is depo-provera

IM progestin contraceptive that provides 3 months protection

Effectiveness of Depo-provera is ____ because it works by preventing _______. Do not _______ use.

high

ovulation

prolong

May use mini-pill or depo-provera while _________ but not until after _ weeks post-delivery so milk supply is well established.

breastfeeding

6

Prolonged use of depo-provera (_+ years) can contribute to bone loss and increased risk of ________. Return to fertility may be delayed for up to - months after stopping use.

2

osteoporosis

12-18

Vasectomy:

First few post-vasectomy ejaculations may contain _____. Post sperm count required weeks and weeks after surgery (should be zero).

sperm

2

6

What is the most common reason for women to seek gynecologic care

Lower Genital Tract Infection (Vaginitis)

What is the most prevalent vaginal infection in United states

Bacterial Vaginosis

What is bacterial vaginosis

overgrowth of bacteria within normal vaginal flora

What does bacterial vaginosis discharge look like

thin

watery

white-gray discharge with odor

How do you test for bacterial vaginosis

wet mount

What is treatment for bacterial vaginosis

metronidazole or clindamycin

What is the most common cause of vulvovaginal candidiasis

candida albicans

What does discharge look like in vulvovaginal candidiasis

thick and white

what is vulvovaginal candidiasis

fungal/yeast infection

What is the treatment for vaginitis

fluconazole or clotrimazole cream

What are implications and risks to pregnancy if the mother has an STI

preterm premature rupture of membranes

preterm labor

anomalies in organ development

sepsis

what two pre-pregnancy tests should be completed?

rubella titer

varicella immunity

How is Trichomoniasis caused by

tichomonas vaglnalls

What are symptoms of trichomoniasis

yellow-green, frothy, odorous discharge

vulvar itching

dysuria, dyspareunia

What is the screening for trichomoniasis

wet mount

What is the treatment for trichomoniasis

metronidazole

What are implications of pregnancy if trichomoniasis is present

preterm premature rupture of membranes

preterm labor

What is chlamydia caused by

chlamydia trachomatis

what are symptoms of chlamydia

thin, mucopurulent discharge, especially from penis

friable cervix, spotting

What screenings are done for chlamydia

Nucleic amplification test (urine sample)

What is the treatment for chlamydia

azithromycin

doxycycline

What is gonorrhea caused by

Neisseria gonorrhoeae

what are symptoms of gonorrhea

Thin, mucopurulent discharge, especially from penis
Friable cervix, spotting

What screening is done for gonorrhea

nucleic amplification test (urine sample)

What is the treatment for gonorrhea

ceftriaxone IM

azithromycin or doxycycline PO

What is syphilis caused by

treponema pallidum

what are the symptoms of syphilis

Chancre appears

then possibly rash

fever,
weight loss

malaise

Syphilis can cause trans-placental transmission meaning it can

cause fetal demise

anomalies

neurological effects

What screenings are done for syphilis

serological testing (VDRL, RPR)

What is the treatment for syphilis

penicillin G

doxycycline

tetracycline

How is herpes simplex transmitted

sexual contact

skin to skin contact with an infected site

What are the implications in pregnancy with herpes

risk for rash, sepsis, encephalitis