TOPIC: REPRODUCTIVE HEALTH DISORDERS

Instructional Materials

• White board and maker

• Projector/ Laptop

• Pictures

• Videos

• Posters 

Teaching methods

• Line-up

• Lecture 

• Discussion

• Brainstorming  

Type of Assessment

• MCQ

• Assignments

• Essay 

• Fill in the blanks

Learning Objectives: At the end of the lesson, learners will be able to:

• Define Menstrual Disorders

• Describe Menstrual Disorders

• Describe Sexual Dysfunction

• Discuss Infertility

• Discuss the Syndromic Approach to STI management

3. Introduction

Many parts of the male and female reproductive system can be afflicted by diseases with some having poorer outcome than others e.g. cancer 

3.1 Reproductive Health Disorders 

It refers to the diseases, disorders and conditions that affect the functioning of the male and female reproductive system during all stages of life.

3.2 MENSTRUAL DISORDER 

A menstrual disorder is an irregular condition in a woman’s menstrual cycle. Every woman’s body is unique. For some a cycle is as short as 21 days or as long as 35 days, and for some women each cycle is different from the previous. What is irregular for one woman may be normal for another.

The amount of blood flow considered to be normal is about 30 – 80 mls (2 tablespoons – about 1/3 cup). According to some physicians anything less or more than that could be considered abnormal menstrual bleeding, menstrual periods usually last 4-8 days, with an average of 6 days.

Menstrual Disorders can presents in various forms; either as painful cramps, heavy bleeding, absence of menstruation or light/infrequent menstruations.

3.2.1 Classification of Menstrual Disorders.

1. Dysmenorrhoea

It is described as painful menstruation or camps. It involves menstrual periods that are accompanied by either sharp, intermittent pain or dull, aching pain usually in the pelvis or lower abdomen. It is classified into either primary or secondary, based on the onset.

1. Primary dysmenorrheoa: It generally begins when a girl first starts her periods (menarche). It has no underlying medical cause.

2. Secondary dysmenorrhoea: It typically occurs later in life and is the result of a problem with the woman’s reproductive system e.g. infection, cyst, fibroid, tumor etc.

2. Disorders of cycle length.

It is a disorder which affects the duration of the cycle.

(a) Polymenorrhoea: Is the menstrual cycle with intervals of 21days or fewer.

(b) Oligomenorrhoea: It is the infrequent, often light menstrual periods with intervals exceeding 35days.

(c) Metrorrhagia: It is irregular bleeding that occurs in between the expected menstrual period. Sometimes after intercourse. It is considered as irregular menstruation because of variation of more than eight days in the cycle length.

(d) Amenorrhoea: It is the absence of menstrual period in a woman of reproductive age. Physiologic states of amenorrhoea are seen during pregnancy, lactation and menopause. Amenorrhoea can be either of the following:

• PrimaryAmenorrhoea - is when a girl who passed puberty (16yrs) has not started menstruation.

• SecondaryAmenorrhoea - is the absence of menstrual periods for at least3 months in a woman who previously have a regular cycle.

3. Disorders of flow; It is a disorder which has to do with amount of blood that a woman loses.

(a) Hypomenorrhea: It is abnormally light menstrual periods.

(b) Menorrhagia: It is excessive, dysfunctional uterine bleeding that occurs as part of a woman’s normal menstrual cycle. Blood flow maybe high in volume (over 80mls) and may last longer than a normal period (usually 8-10days).

(c) Menometrorrhagia: It is diagnosed when menorrhagia occurs at short intervals.

4. Premenstrual Disorders

(a) Premenstrual syndrome (PMS) - is a group of physical and emotional symptom that occurs in the latter half of menstrual cycle following ovulation. Symptoms include backache; bloating; irritability; and headache are typically most intense during 7 days prior to the start of menses.

(b) Premenstrual dysphoric disorder (PMDD) - is a more severe form of PMS that also includes a psychological component which interfere with daily living.

Causes of Menstrual Disorders

1. Hormonal imbalance.

2. Genetic factors.

3. Clotting disorders.

4. Pelvic diseases.

Complications

1. Anaemia

2. Osteoporosis

3. Infertility

4. Quality of life is affected e.g. heavy & painful bleeding affects school and work productivity and social activities.

Risk Factors

1. Weight (either over or under).

2. Stress.

3. Smoking/ Alcoholism.

4.  Age, e.g dysmenorrhoea affects girl starting menstruation by age of 11 years and women approaching menopause.

5. Nature of cycle and flow, e.g. longer & heavier cycles can cause dysmenorrhoea.

6. Multigravidas – risk of menorrhagia.

7. Chronic pelvic pain.

3.3 SEXUAL DYSFUNCTION

Sexual dysfunction (also known as sexual malfunction) is defined as any difficulty experienced by an individual or a couple during any stage of a normal sexual activity.

3.3.1 SEXUAL RESPONSE CYCLE (SRC)

It is described in 4 phases and it applies to both sexes:-

(a)The excitement phase

(b)The plateau phase

(c)The phase of orgasm

(d)The phase of resolution

Sexual Response in Women:

All these phases merge into one another in real life.

The Excitement Phase: Is initiated more by body contact than visual stimuli, although a times sight might play a role. Sexual arousal varies in women depending on the time of month e.g mid cycle, just before and during menstruation. The excitement phase of a woman is slower than that of a man. At this time the nipples become harden, the clitoris is erected and the labia have become soft and thicker due to increased blood supply, while the bartholin’s gland secretes mucus. Fluid from the pelvic tissue seeps into the vaginal wall to add lubrication. Any act of penetration before this will lead to pain. This phase is also called “Arousal phase”.

The Plateau Phase: At this stage, the woman is ready for intercourse. She has reached a peak where all she wants is direct contact of the sexual organs. If the right pattern of stimulation continues, she enters the next phase.

The Orgasm Phase: It is the feeling of intense pleasure which is the peak of sexual arousal. It starts deeps in the pelvis but later spread over the whole body leading to jerkin reflexes. A man’s orgasm is also associated with the jerking movement but it differs from that of the woman due to the presence of ejaculation.

The Resolution Phase: In both sexes the jerking and the deep pleasure of orgasm are followed by relaxation. But in contrast to the penis, the clitoris does not immediately become tender. .If a woman is stimulated to the Plateau phase without having orgasm repeatedly; it may lead to physical and mental frustration and may be an underlying cause of several psychosomatic gynecological disorders.

Sexual Response in Men:

The most obvious sign of sexual excitement in a man is erection of penis. With further excitement a clear secretion emerges from the eye of the penis and lubricates the glans. Once penile erection has occurred and the arousal stimulus continued, the man seeks to have sex or masturbates. In essence, there is little difference as far as the penis is concerned. As orgasm approaches, a time is reached when the man knows that within a few moments ejaculation will occur. The phase lasts for about 3-4 seconds and even if all movement is ceased, ejaculation is inevitable. The main difference between SRC in men and female is ejaculation, which is absent in women.