Biyernes, Nobyembre 30, 2012

Lesson on Family Planning - Health IV



Family Planning
• The concept of enhancing the quality of families w/c includes:
• Regulating & spacing childbirth
• Helping subfertile couples beget children
• Counseling parents and would-be parents
• The privilege and the obligation of the (married) couple exclusively to decide w/ love when and how many children provided: the motive is justified and the means are moral.
• Involves personal decisions based on each individual’s background, experiences and sociocultural beliefs. It involves thorough planning to be certain that the method chosen is acceptable and can be used effectively.

METHODS USE TO PREVENT CONCEPTION
Natural methods ( The only method accepted by the catholic church)
Coitus interruptus (least effective method)
• Oldest type of birth control practiced by man.
• The premature withdrawal of the penis before ejaculation during sexual intercourse
• Reliability is low because sperms are emitted in varying quantities in the normal lubricating fluid secreted throughout intercourse
• Psychological disadvantage
• Not accepted by the Catholic Church
Coitus reservatus
• Male does not reach orgasm and therefore no ejaculation occurs
• Requires considerable control over the sexual urge
Coitus interfemora – “ipit” (kaskas lang)
Rhythmic abstinence
• Identification of the periods of fertility and the periods of sterility in the menstrual cycle of a woman and the restriction of sexual intercourse to the sterile periods or the time when the pregnancy is unlikely because the woman is biologically unprepared to conceive.
• Also known as “safe or infertile period” technique and “natural birth control” or NFP because there is nothing artificial used to prevent conception.
• These methods are based on the ff. principles:
• The human ovum is susceptible to fertilization for approx. 18-24 hours after ovulation
• The sperms deposited in the vagina are ordinarily capable of fertilizing the ovum for no more than 72 hours
• Present methods of determining ovulation time are inexact and seldom sufficiently predictive (by at least 48 hours) so that in practice, it is necessary to avoid intercourse for a far longer period of time than 72 hours before ovulation and 24 hours after ovulation


Calendar method
• The use of mathematical calculations to predict the probable time of ovulation. “Ovulation most often takes place 14 days before the onset of the next menstruation.”




Ogino-knaus formula:
1.Determine the shortest and longest cycle
ex. Shortest cycle = 28 days
Longest cycle = 36 days
2.If the cycle is irregular, subtract 18 from the shortest and 11 from the longest
ex. 28-18=10 ex. 25-18=7
36-11=25 29-11=18
3. The difference between the shortest cycle and 18 determines the earliest time when ovulation occur.
4. The difference between the longest cycle and 11 determines the last day when ovulation can occur
5. OVULATION CAN OCCUR ANYTIME IN BETWEEN.
6. In a regular 28 day cycle, abstinence should be observed from day 9 to day 17. (count 5 days before the earliest ovulation and 3 days after the last day)
Basal Body Temperature
• This relies on slight changes (0.3 to 0.6ºC) in basal body temp. that may occur just before ovulation
• Pre-ovulatory temperature is low because of high estrogen levels
• Post-ovulatory temp. rise is due to high progesterone
• The temperature is taken every morning at the same time with the same thermometer just before arising and after at least 4-6 hours of continuous sleep.
• 3 days of elevation indicate temperature change is due to ovulation
• Abstinence should be observed 5 days before and 3 days after temperature rise.
Billings or CERVICAL MUCUS METHOD
• A particular type of cervical mucus felt by the woman at the vaginal opening is a signal of ovulation
• Research shows this type of mucus appears necessary for conception. Without the mucus, sperm transport is impeded.
Lactational Amenorrhea Method
• LAM is based on scientific evidence that a woman is not fertile and unlikely to become pregnant during full lactation or exclusive breastfeeding. Full lactation describes breastfeeding when no regular supplemental feeding of any type is given (not even water) and the infant is feeding both day and night with little separation from the mother.
• LAM provides maximum protection as long as:
• Menstruation has not resumed and
• Bottle feeds or regular food supplements are not introduced and
• Baby is less than 6 months of age.









Successful use of natural methods to prevent pregnancy depends upon:
• The accuracy of the method in identifying the woman's actual fertile days
• A couple's ability to correctly identify the fertile time
• The couple's ability to follow the rules of the method they are using
Advantages of natural family planning method
• Safe and has no side-effects
• Inexpensive
• Acceptable to religious affiliations that do not accept artificial methods of contraception
• Helpful for planning pregnancy and avoiding pregnancy
• Promotes communication about family planning and contraception between couples.
Disadvantages
• Involves long preparation and intensive recording before it can be used.
• There is a need to abstain on certain days which may be inconvenient for the couple.
• Not ideal to women with irregular cycles.
• Not very reliable because of menstrual cycle variations that may occur anytime.
LOCAL BARRIER METHODS
CONDOM
Disadvantages:
• Self-lubricated type breaks easily



• Penis must be withdrawn from the vagina before
it becomes flaccid
• Lessen sexual enjoyment by the male











Vaginal Diaphragm
• A shallow,dome-shaped rubber device with a flexible wire rim that covers the cervix; maybe inserted several hours before intercourse and left in place for at least 6 hours after the last intercourse
• Initially fitted by a health professional
• Weight loss/gain of 15 lbs may require re-fitting
• Inserted before intercourse with the woman in squatting or supine position, or with one leg elevated on a chair
• May cause cervicitis if left in place for too long
• Washed with mild soap & water, lasts for 2-3 years
• 97% efficiency



Cervical Cap
• Comes in 2 types: presized (S-M-L) and custom fitted (a plastic cap fitted to conform to the individual woman’s cervix made after making a mold of cervix with non-toxic substance used to make contact lenses)
• Contraindications: hx of TSS, PID, cervicitis, cervical Ca, vaginal bleeding, an allergy to latex/spermicide
• most durable than diaphragm no need to apply spermicide
C/I: abnormal pap smear










Intravaginal contraceptives (spermicides)



Advantages
• Available without a prescription.
• Lubrication may increase pleasure.
• Use can be part of sex play.
• Does not affect future fertility.
Disadvantages                   
• Does not protect against HIV/AIDS.
• Must be readily available and used prior to penetration.
• Can be messy.
• Can have a bad taste during oral sex.
• Possible genital irritation.
• When used frequently spermicides may irritate the vagina making it easier to catch HIV/STI

Side-Effects of Spermicides
• You or your partner may be allergic to materials in spermicide. This can cause genital irritation, rash, or itchiness. If this happens and your spermicide has nonoxynol-9, try a spermicide without this chemical.











Contraceptive pills
• Estrogen & progesterone prevent pregnancy by inhibiting the hypothalamus and anterior pituitary so that ovulation does not occur. They also inhibit fertility by:
1. Altering the motility of the fallopian tubes
2. Inadequately developing the endometrium
3. Keeping cervical mucus unreceptive and unsupportive of sperm

Implant (Norplant)
• 6 tiny silicone rubber capsules or 2 rods containing progestin (evonorgestiel), surgically implanted under the skin of the upper arm; removed surgically in about 5 years or when the woman wishes to discontinue the method.
disadvantage if keloid skin
as soon as removed – can become pregnant

Advantages:
• Long term reversible contraception
• Do not interfere with coitus
• Has no estrogen related side-effects
• Can be used during breastfeeding
• Can be used by adolescents
• Rapid return of fertility w/c occurs 3 months after removal


Disadvantages:
• Expensive
• Scarring at insertion site
Contraindications:
• Pregnancy
• Desire to get pregnant within 2 years
• Undiagnosed vaginal bleeding


















Injectable contraceptive (Depo-provera, Noristerat, etc.)
• Synthetic progestin hormones injected into muscle: administered every 3 months

They exert their contraceptive effect by inhibiting ovulation, altering cervical mucus and preventing endometrial growth. The woman does not menstruate with this contraception. It has the same advantages, disadv., and contraindications as implants.
Disadvantages:
• Fertility return is usually delayed by 6 months
• Higher risk for osteoporosis so advise to increase calcium intake and engage in weight bearing exercise
Impair glucose tolerance in women at risk for DM




















Prevention of Implantation

IUD (Intra-Uterine Device)
Ø An object made of plastic or non-reactive metal (nickel-chromium alloy) that fits inside the uterine cavity
Ø Manufactured in several shapes (loop, coil, spiral)
Ø Causes a chronic inflammatory response in the endometrium, discouraging implantation of a fertilized ovum
Ø Conception may occur; if implantation takes place, it causes early abortion
Ø Usually inserted during the menstrual phase
IUDs come with increased risk of ectopic pregnancy and perforation of the uterus and do not protect against sexuallytransmitted disease. IUDs are prescribed and placed by health care providers.









STERILIZATION/ PERMANENT CONCEPTION CONTROL
Tubal Occlusion / Bilateral Tubal Ligation
- Involves tying, cutting or cauterizing the fallopian tbes
- Usually done immediately after delivery (within 24-48 hours) when the incidence of morbidity & failure are lowest
- May also be done in any phase of the menstrual cycle
methods




Vasectomy / Vas ligation
• Accomplished without entry into the abdominal cavity; twin incisions are made in the area where the scrotum joins the body, just over the vas deferens
• The tubes are tied and seperated; portions maybe excised
• Follow-up sperm counts maybe done after.
After vas ligation, the man is considered sterile: After 20 or more ejaculation, zero sperm count


A Lesson On Human Sexuallity - Health IV


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A Lesson Plan from Life Planning Education: A Youth Development Program
Purpose: To develop and understand a broad definition of sexuality

Materials: Newsprint and markers, board and chalk, one copy of the handout,
Circles of Sexuality(pdf), for each participant, and the Leader's Resources, Circles of Sexuality (pdf), An Explanation of the Circles of Sexuality and Sexual Development through the Life Cycle ; pens or pencils
Time: 45 minutes

Planning Notes: Review the Leader's Resource,
Circles of Sexuality (pdf), and draw a large version of it on newsprint or the board.

Procedure:
  1. Explain that when many people see the words "sex" or "sexuality," they most often think of sexual intercourse. Others also think of other kinds of physical sexual activities. Tell the group that sexuality is much more than sexual feelings or sexual intercourse. It is an important part of who every person is. It includes all the feelings, thoughts, and behaviors of being female or male, being attracted and attractive to others, and being in love, as well as being in relationships that include sexual intimacy and physical sexual activity.
  2. Write sexuality on the board and draw a box around the letters s-e-x. Point out that s, e, and x are only three of the letters in the word sexuality.
  3. Display the five circles of sexuality and give each teen a handout. Explain that this way of looking at human sexuality breaks it down into five different components: sensuality, intimacy, identity, behavior and reproduction, and sexualization. Everything related to human sexuality will fit in one of these circles.
  4. Beginning with the circle labeled sensuality, explain each circle briefly. Take five minutes to read the definition of the circle aloud, point out its elements, and ask for examples of behaviors that would fit in the circle. Write the examples in the circle and ask participants to write them on their handouts. Continue with each circle until you have explained each component of sexuality.
  5. Ask if anyone has any questions. Then conclude the activity using the discussion questions below.
Discussion Questions:
  1. Which of the five sexuality circles feels most familiar? Least familiar? Why do you think that is so?
  2. Is there any part of these five circles that you never before thought of as sexual? Please explain.
  3. Which circle is most important for teens to know about? Least important? Why?
  4. Which circle would you feel interested in discussing with your parent(s)?
  5. Which circle would you feel interested in talking about with someone you are dating?








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A Lesson Plan from Life Planning Education: A Youth Development Program
            Sexuality is much more than sexual feelings or sexual intercourse. It is an important part of who a person is and what she/he will become. It includes all the feelings, thoughts, and behaviors associated with being female or male, being attractive and being in love, as well as being in relationships that include sexual intimacy and sensual and sexual activity. It also includes enjoyment of the world as we know it through the five senses: taste, touch, smell, hearing, and sight.
















Circle #1—Sensuality
Sensuality is awareness and feeling about your own body and other people's bodies, especially the body of a sexual partner. Sensuality enables us to feel good about how our bodies look and feel and what they can do. Sensuality also allows us to enjoy the pleasure our bodies can give us and others. This part of our sexuality affects our behavior in several ways.
  • Body image—Feeling attractive and proud of one's own body and the way it functions influences many aspects of life. Adolescents often choose media personalities as the standard for how they should look, so they are often disappointed by what they see in the mirror. They may be especially dissatisfied when the mainstream media does not portray or does not positively portray physical characteristics the teens see in the mirror, such as color of skin, type or hair, shape of eyes, height, or body shape.
  • Experiencing pleasure—Sensuality allows a person to experience pleasure when certain parts of the body are touched. People also experience sensual pleasure from taste, touch, sight, hearing, and smell as part of being alive.
  • Satisfying skin hunger—The need to be touched and held by others in loving, caring ways is often referred to as skin hunger. Adolescents typically receive considerably less touch from their parents than do younger children. Many teens satisfy their skin hunger through close physical contact with peers. Sexual intercourse may sometimes result from a teen's need to be held, rather than from sexual desire.
  • Feeling physical attraction for another person—The center of sensuality and attraction to others is not in the genitals (despite all the jokes). The center of sensuality and attraction to others is in the brain, humans' most important "sex organ." The unexplained mechanism responsible for sexual attraction rests in the brain, not in the genitalia.
  • Fantasy—The brain also gives people the capacity to have fantasies about sexual behaviors and experiences. Adolescents often need help understanding that sexual fantasy is normal and that one does not have to act upon sexual fantasies.





Circle #2—Sexual Intimacy
Sexual intimacy is the ability to be emotionally close to another human being and to accept closeness in return. Several aspects of intimacy include
  • Sharing—Sharing intimacy is what makes personal relationships rich. While sensuality is about physical closeness, intimacy focuses on emotional closeness.
  • Caring—Caring about others means feeling their joy and their pain. It means being open to emotions that may not be comfortable or convenient. Nevertheless, an intimate relationship is possible only when we care.
  • Liking or loving another person—Having emotional attachment or connection to others is a manifestation of intimacy.
  • Emotional risk-taking—To have true intimacy with others, a person must open up and share feelings and personal information. Sharing personal thoughts and feelings with someone else is risky, because the other person may not feel the same way. But it is not possible to be really close with another person without being honest and open with her/him.
  • Vulnerability—To have intimacy means that we share and care, like or love, and take emotional risks. That makes us vulnerable—the person with whom we share, about whom we care, and whom we like or love, has the power to hurt us emotionally. Intimacy requires vulnerability, on the part of each person in the relationship.












Circle #3—Sexual Identity
Sexual identity is a person's understanding of who she/he is sexually, including the sense of being male or of being female. Sexual identity consists of three "interlocking pieces" that, together, affect how each person sees him/herself. Each "piece" is important.
  • Gender identity—Knowing whether one is male or female. Most young children determine their own gender identity by age two. Sometime, a person's biological gender is not the same as his/her gender identity—this is called being transgender.
  • Gender role—Identifying actions and/or behaviors for each gender. Some things are determined by the way male and female bodies are built or function. For example, only women menstruate and only men produce sperm. Other gender roles are culturally determined. In the United States, it is considered appropriate for only women to wear dresses to work in the business world. In other cultures, men may wear skirt-like outfits everywhere.
There are many "rules" about what men and women can/should do that have nothing to do with the way their bodies are built or function. This aspect of sexuality is especially important for young adolescents to understand, since peer, parent, and cultural pressures to be "masculine" or "feminine" increase during the adolescent years. Both young men and young women need help sorting out how perceptions about gender roles affect whether they feel encouraged or discouraged in their choices about relationships, leisure activities, education, and career.

Gender bias means holding stereotyped opinions about people according to their gender. Gender bias might include believing that women are less intelligent or less capable than men, that men suffer from "testosterone poisoning," that men cannot raise children without the help of women, that women cannot be analytical, that men cannot be sensitive. Many times, people hold fast to these stereotyped opinions without giving rational thought to the subject of gender.
  • Sexual orientation—Whether a person's primary attraction is to people of the other gender (heterosexuality) or to the same gender (homosexuality) or to both genders (bisexuality) defines his/her sexual orientation. Sexual orientation begins to emerge by adolescence although many gay and lesbian youth say they knew they felt same sex attraction by age 10 or 11. Between three and 10—percent of the general population is probably exclusively homosexual in orientation. Perhaps another 10 percent of the general population feel attracted to both genders.
Heterosexual, gay, lesbian, and bisexual youth can all experience same-gender sexual attraction and/or activity around puberty. Such behavior, including sexual play with same-gender peers, crushes on same-gender adults, or sexual fantasies about same-gender people are normal for pre-teens and young teens and are not necessarily related to sexual orientation.

Negative social messages and homophobia in the wider U.S. culture can mean that young adolescents who are experiencing sexual attraction to and romantic feelings for someone of their own gender need support so they can clarify their feelings and accept their sexuality.
Circle #4—Reproduction and Sexual Health
These are a person's capacity to reproduce and the behaviors and attitudes that make sexual relationships healthy and enjoyable.
  • Factual information about reproduction—Is necessary so youth will understand how male and female reproductive systems function and how conception and/or STD infection occur. Adolescents often have inadequate information about their own and/or their partner's body. Teens need this information so they can make informed decisions about sexual expression and protect their health. Youth need to understand anatomy and physiology because every adolescent needs the knowledge and understanding to help him/her appreciate the ways in which his/her body functions.
  • Feelings and attitudes—Are wide-ranging when it comes to sexual expression and reproduction and to sexual health-related topics such as STD infection, HIV and AIDS, contraceptive use, abortion, pregnancy, and childbirth.
  • Sexual intercourse—Is one of the most common behaviors among humans. Sexual intercourse is a behavior that may produce sexual pleasure that often culminates in orgasm in females and in males. Sexual intercourse may also result in pregnancy and/or STDs. In programs for youth, discussion of sexual intercourse is often limited to the bare mention of male-female (penile-vaginal) intercourse. However, youth need accurate health information about sexual intercourse—vaginal, oral, and anal.
  • Reproductive and sexual anatomy—The male and female body and the ways in which they actually function is a part of sexual health. Youth can learn to protect their reproductive and sexual health. This means that teens need information about all the effective methods of contraception currently available, how they work, where to obtain them, their effectiveness, and their side effects. This means that youth also need to know how to use latex condoms to prevent STD infection. Even if youth are not currently engaging in sexual intercourse, they probably will do so at some point in the future. They must know how to prevent pregnancy and/or disease.
Finally, youth also need to know that traditional methods of preventing pregnancy (that may be common in that particular community and/or culture) may be ineffective in preventing pregnancy and may, depending on the method, even increase susceptibility to STDs. The leader will need to determine what those traditional methods are, their effectiveness, and their side effects before he/she can discuss traditional methods of contraception in a culturally appropriate and informative way.
  • Sexual reproduction—The actual processes of conception, pregnancy, delivery, and recovery following childbirth are important parts of sexuality. Youth need information about sexual reproduction—the process whereby two different individuals each contribute half of the genetic material to their child. The child is, therefore, not identical to either parent. [Asexual reproduction is a process whereby simple one-celled organisms reproduce by splitting, creating two separate one-celled organisms identical to the original [female] organism before it split.] Too many programs focus exclusively on sexual reproduction when providing sexuality education and ignore all the other aspects of human sexuality.
Circle #5—Sexualization
               Sexualization is that aspect of sexuality in which people behave sexually to influence, manipulate, or control other people. Often called the "shadowy" side of human sexuality, sexualization spans behaviors that range from the relatively harmless to the sadistically violent, cruel, and criminal. These sexual behaviors include flirting, seduction, withholding sex from an intimate partner to punish her/him or to get something, sexual harassment, sexual abuse, and rape. Teens need to know that no one has the right to exploit them sexually and that they do not have the right to exploit anyone else sexually.
  • Flirting—Is a relatively harmless sexualization behavior. Nevertheless, upon occasion it is an attempt to manipulate someone else, and it can cause the person manipulated to feel hurt, humiliation, and shame.
  • Seduction—Is the act of enticing someone to engage in sexual activity. The act of seduction implies manipulation that at times may prove harmful for the one who is seduced.
  • Sexual harassment—Is an illegal behavior. Sexual harassment means harassing someone else because of her/his gender. It could mean making personal, embarrassing remarks about someone's appearance, especially characteristics associated with sexual maturity, such as the size of a woman's breasts or of a man's testicles and penis. It could mean unwanted touching, such as hugging a subordinate or patting someone's bottom. It could mean demands by a teacher, supervisor, or other person in authority for sexual intercourse in exchange for grades, promotion, hiring, raises, etc. All these behaviors are manipulative. The laws of the United States provide protection against sexual harassment. Youth should know that they have the right to file a complaint with appropriate authorities if they are sexually harassed and that others may complain of their behavior if they sexually harass someone else.
  • Rape—Means coercing or forcing someone else to have genital contact with another. Sexual assault can include forced petting as well as forced sexual intercourse. Force, in the case of rape, can include use of overpowering strength, threats, and/or implied threats that arouse fear in the person raped. Youth need to know that rape is always illegal and always cruel. Youth should know that they are legally entitled to the protection of the criminal justice system if they are the victims of rape and that they may be prosecuted if they force anyone else to have genital contact with them for any reason. Refusing to accept no and forcing the other person to have sexual intercourse always means rape.
  • Incest—Means forcing sexual contact on any minor who is related to the perpetrator by birth or marriage. Incest is always illegal and is extremely cruel because it betrays the trust that children and youth give to their families. Moreover, because the older person knows that incest is illegal and tries to hide the crime, he/she often blames the child/youth. The triple burden of forced sexual contact, betrayed trust, and self-blame makes incest particularly damaging to survivors of incest.