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Nursing questions:

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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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SCIENCE
HEALTH SCIENCE
NURSING
NUR 351

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