Family is defined as a group of people related by blood, marriage, or adoption living together.

by US Census Bureau Two or more people who live in the same household, share common emotional bond, and perform certain interrelated social tasks Types of Family 1. Dyad Family Refers to two people living together, usually a woman and a man, without children.

Nuclear Family Composed of a husband, wife and children. Cohabitation Composed of heterosexual couples who live together like a nuclear family but remain unmarried. Extended Family - Includes not only the nuclear family but also other family members such as grandmothers, grandfathers, aunts, uncles, cousins and grandchildren. 4. Single-parent family only one parent lives in the home. 5. Blended family (remarriage or reconstituted family) a divorced or widowed person with children marries someone who has children. 6. Communal Family comprise groups of people who have chosen to live together as an extended family. Their relationship to each other is motivated by social or religious values rather than kinship. 7. Gay or Lesbian Family Individuals of the same sex live together as partners for companionship, financial security and sexual fulfillment. 8. Foster Family Children whose parents can no longer care for them may be placed in a foster or substitute home. Foster parents may or may not have children of their own. 9. Adoptive Family Families of a great many types (nuclear, extended, single-parent, gay and lesbian adopt children. Stages of Family Development Stage 1: Marriage and the Family During this first stage of family development, members work to achieve three tasks: a. establish a mutually satisfying relationship b. learn to relate well to their families of orientation c. If applicable, engage in reproductive life planning Stage 2: The Early Child-Bearing Family The birth or adoption of a first baby is usually an exciting yet stressful event that requires economic and social role changes. Stage 3: The family with Preschool children A family with preschool children is a busy family because children at this age demand a great deal of time related to their growth and developmental needs and safety considerations as unintentional injuries become a major health concern. Stage 4: The family with School-Age Children Parents of school-age children have the important responsibility of preparing their children to be able to function in a complex world while at the same time maintaining their own satisfying marriage relationship. Stage 5: The family with Adolescent Children The primary goal for a family with teenagers differs considerably from the goal of the family in previous stages, which was strengthen family ties and maintain family unity. Stage 6: The Launching Center Family The stage at which children leave to establish their own households is the most difficult stage because it appears to represent the breaking up of the family. Stage 7: The family of middle years A stage which may view as the prime time of their lives ( an opportunity to travel, economic independence, and time to spend on hobbies or as a period of gradual decline (lacking the constant activity and stimulation of children in the home, finding life boring without them, or experiencing empty nest syndrome. Stage 8: The family in Retirement or Older Age These individuals are more apt to suffer from chronic and disabling conditions than younger persons. Although families at this stage are not having children, they remain important because they can offer a great deal of support and advice to young adults who are just beginning their families Trends in Maternal and Child Health Care Implications for Nursing 1. Families are smaller than in previous decades Fewer family members are present as support in a time of crisis. Nurses must fulfill this role more than ever before.
2. Single Parents are increasing in number A single parent may have fewer financial resources; this is more likely if the parent is a woman. Nurses need to inform parents of care options and to serve as a back up opinion when needed. Health care must be scheduled at times a working parent can bring a child for care. Problems of latch-key children and the selection of child care centers need to be discussed. Good interviewing is necessary with mobile families so a health data base can be established; education for health monitoring is important. Screening for child or intimate partner abuse should be included in family contacts. Families are ripe for health education; providing this can be a major nursing role. Comprehensive care is necessary in primary care settings because referral to specialists may no longer be an option. Fewer family members are present as support in a time of crisis. Nurses must fulfill this role more than ever before. A single parent may have fewer financial resources; this is more likely if the parent is a woman. Nurses need to inform parents of care options and to serve as a back up opinion when needed.

1. 2. 3.

3. An increasing number of mothers work outside the home. 4. Families are more mobile than previously; there is an increase in the number of homeless women and children. 5. Abuse is more common than before. 6. Families are more health-conscious than previously. 7. Health care must respect cost-containment 1. Families are smaller than in previous decades 2. Single Parents are increasing in number

3. An increasing number of mothers work outside the home. 4. Families are more mobile than previously; there is an increase in the number of homeless women and children. 5. Abuse is more common than before. 6. Families are more health-conscious than previously. 7. Health care must respect cost-containment.

Health care must be scheduled at times a working parent can bring a child for care. Problems of latch-key children and the selection of child care centers need to be discussed. Good interviewing is necessary with mobile families so a health data base can be established; education for health monitoring is important. Screening for child or intimate partner abuse should be included in family contacts. Families are ripe for health education; providing this can be a major nursing role. Comprehensive care is necessary in primary care settings because referral to specialists may no longer be an option.

TRENDS IN THE STATUS OF REPRODUCTIVE HEALTH IN THE PHILIPPINES Maternal and Child Health Reduction in maternal mortality by one half of the 1990 levels by 2000 and a further one half by 2015. Expand the provision of maternal health services in the context of primary health care, i.e, based on the concept of informed choices, should include education on safe motherhood, prenatal care(International conference on Population and Development ICPD) Reduce maternal mortality rate by three quarters by 2015. Increase access to reproductive health services to 60% by 2005, 80% by 2010, and 100% by 2015.Slow decrease in maternal death Increasing number of pregnant women in high risk category Major causes of maternal deaths are postpartum hemorrhage, eclampsia, severe infection and abortion. The leading causes of infant mortality are respiratory conditions of fetus, congenital anomalies, diarrhea, measles and nutritional deficiencies. The lack of access to quality health care is a major determinant in maternal and child mortality. a. prenatal care b. postpartum care c. skilled delivery attendants during delivery d. immunization Abortion: UP Population Institute Study: 403,000 to 1.32 million women undergo induced abortion each year Young mothers account for 17% of induced abortions and 6% of spontaneous abortion. 12% of all maternal deaths are due to abortion. 36% of women who are treated for abortion complications in various hospitals are young women. ETHICOLEGAL ASPECT OF MATERNAL AND CHILD HEALTH CARE Legal concerns arise in all areas of health care. Maternal and Child health nursing carries some legal concerns that extend above and beyond other areas of nursing, because care is often given to an unseen client the fetus or to clients who are not of legal age for giving consent medical procedures. Understanding the scope of practice and standards of care can help nurses practice within appropriate legal parameters. Key points: Informing clients about their rights and responsibilities is helpful in protecting them. o Documentation is essential in protecting the nurse and justifying his or her actions. o Nurses should be conscientious about obtaining informed consent for invasive procedures o Nurses are legally responsible for reporting inappropriate or insufficient care provided by another practitioner. FEMALE REPRODUCTIVE SYSTEM Mons Veneries Rounded, soft, fatty, lose connective tissue over symphysis pubis. Dark and curly pubic hair growth in typical triangular shape that begins one or two years before the onset of menstruations. Labia Majora Lengthwise fatty folds and skin extending from mons to the perineum that protect the labia minora, urinary meatus, and vaginal introitus. Labia Minora Thinner, lengthwise folds of hairless skin, extending from clitoris to fourchette i. Glands in the labia minora lubricate the vulva ii. Very sensitive because of rich nerve supply iii. Space between the labia is called the vestibule Clitoris Small erectile organ located beneath the arch of the pubis, contains more nerve endings sensitive to temperature and touch, and secretes of fatty substance called smegma. Vestibule The flattened, smooth surface inside the labia. It also enclose the openings to the endings and vagina. Skenes glands (Paraurethral Glands) Located lateral to the vaginal opening on the both sides. Secretion helps lubricate the external genitalia, during coitus. Bartholins Gland (Vulvovaginal Glands) Located lateral to the vaginal opening on the both sides. It lubricates the external vulva during coitus and alkaline ph of their secretions helps to improve sperm survival in the vagina. Hymen A tough but elastic semicircle of tissue that covers the opening to the vagina Fourchette Thin fold of tissue formed by merging of the labia major and labia minora below the vaginal orifice. Perineum Muscular, skin-covered area between vaginal opening and anus. It is easily stretched during childbirth to allow enlargement of vagina and passage of fetal head.

INTERNAL STRUCTURES Fallopian Tube Arises from each of the upper corner of the uterine body and extend outward and backward. It conveys the one from the ovaries to the uterus and to provide a place for fetilization of vary by the sperm Parts: 1. Interstitial lies within uterine wall 2. Isthmus the portion that is cut or sealed in a tubal ligation 3. Ampulla the longest portion and it is where fertilization usually occurs 4. Infundibular rim of the funnel is covered by fimbriated (hair covered) cells that help guide the ova into the fallopian tube. Ovaries Oval, almonds sized organs on either side of uterus that measures 4 by 2 cm. in diameter and 1.5 cm. thick. It is responsible for the production, maturation and discharge of ova and secretions of estrogen and progesterone. Uterus Hallow, muscular pear-shaped located in he lower pelvis posterior to the bladder and anterior to the rectum. The function of the uterus is to receive the ova from the fallopian tube, provide a place for implantation and nourishment during fetal growth, furnish protection to a growing fetus and expels it from the womans body 3 Division of the Uterus 1.Cervix lowest portion and represent one third of the total uterus. Half of it lies above the vagina and half extends into the vagina. The cavity of it is termed cervical canal. The function of the canal at the isthmus is the internal cervical as and the distal opening to vagina is called external cervical os. 2. Isthmus the short segment between body and cervix. It enlarge greatly to aid in accommodating the fetus. The portion that is cut when a fetus is delivered by a cesarean birth. 3. Fundus upper segment and the most vascular. The portion that can be palpated to determine uterine growth and during pregnancy and force of contraction and for he assessment that the uterus is returning to its nonpregnant state following childbirth.

BANDLS RING pathologic retraction ring; a line that separates the uppers and lower segment Layers: inner layer, highly vascular, shed during menstruation and following delivery middle layer, comprised of smooth muscle fibers running in three direction; expels fetus during birth process then contracts around blood vessels to prevent hemorrhage outermost layer of uterus comprises connective tissue; it offers added strength and support to the structure. Vagina Hollow muscular membranes canal located posterior to the bladder and anterior to the rectum. It acts the organ of intercourse and to convey sperm to the cervix so sperm can meet with the ovum in the fallopian tube. With childbirth, it expands to serve as the birth canal. Doderleins bacillus is the normal flora of the vagina which makes the ph of vagina acidic, detrimental to the growth of pathologic bacteria. Pelvis Serves to both support and protect the reproductive and other pelvic organs. It is a bony ring formed by four united bones, two innominate bones that form the anterior and lateral portion of the ring and the coccyx and sacrum which compose the posterior aspects. Each innominate bone is divided into three parts namely the ilium, ischium and the pubis. The sacrum forms the upper posterior portion of the pelvic ring. There is a marked anterior projection of this bone at the point where it touches the lower lumber vertebrae. This landmark is identified when securing pelvic measurements. The coccyx comprises five very small bones fused together. There is a degree of movement in the joints between the sacrum and coccyx. Because of this, it permits the coccyx to be pressed backwards, allowing more room for the fetal head as it passes through the bony pelvic ring during delivery. MALE REPRODUCTIVE SYSTEM - EXTERNAL STRUCTURE PENIS Comprises three cylindrical masses of erectile tissue, two termed corpus cavernosa and a third the corpus spongiosum. The urethra passes through the layers of erectile tissue that serves as both urinary and reproductive tract. The glans is the distal end of the organ which is the bulging sensitive ridge of the tissue. The prepuce is retractable easing of the skin that protects the nerve sensitive at birth. Scrotum Rugated skin covered muscular pouch suspended from the perineum. It contains the testes, epididymis and lower portion of the spermatic cord Testes Each testes is encased by a protective white birous capsule and comprises a number of lobules, each lobule containing interstitial cell. (Leydigs Cell) and seminiferous tuble. Seminiferous tubules produce spermatozoa while the Leydig are responsible for production of testosterone. INTERNAL STRUCTURES Epididymis A tightly coiled tube that totals approximately 20 feet. It is responsible for the conduction of sperm from testes to vas. It is where some sperm are stored and a part of the fluid that surrounds sperm (semen or seminal fluid) is produced by cells lining the epididymis Vas Defense (Ductus Deferens) Hallow tube surrounded by the arteries and veins and protected by a thick fibrous coating. It carries sperm from epididymis through the inguinal canal into abdominal cavity. The blood vessels and vas deferens together are referred to as the spermatic cord. Seminal Vesicle Two convoluted pouches that lie along lower portion of posterior surface of bladder and empty into urethra by way of ejaculatory ducts. It secrete a viscous portion of semen, which has a high content of basic sugar & protein, is alkaline in pH. Prostate Gland Lies just below the bladder. It secretes a thin alkaline fluid that when added to the secretion from the seminal vesicles that already accompanying sperm from epididymis further protects sperm from being immobilized by natural low pH level of the urethra due to passage of urine through the same lumen Urethra 3

Hollow tube leading from the base of bladder that, after passing through the prostate gland, continues to the outside through the shaft and glands of penis. Bulbourethral Glands (Cowper's Gland) Lie beside the prostate gland and by short ducts empty into the urethra. They secrete an alkaline fluid that helps counteract the acid secretion of urethra and ensures safe passage of spermatozoa Semen The content of semen or fluid that accompanies spermatozoa is derived from the prostate gland (60%) seminal vesicles (30%) epididymis (5%) and bulbourethral (5%). It is alkaline in nature and contains a basic sugar and mucin (protein) PHYSIOLOGY OF MENSTRUATION Menstruation is the periodic discharges of blood, mucus and epithelial cells from the uterus Menstrual cycle - or female reproductive cycle is defined as periodic uterine bleeding in response to cyclic hormonal changes Menarche first menstrual period that occurs typically at age 12 but many occurs as early as 9 or as late 17 Menopause the cessation of menstrual cycles that occurs between 40 and 55 years Term Beginning (Menarche) Interval between cycles Duration of menstrual flow Amount of menstrual flow Color of menstrual flow Characteristics of Normal Menstrual Cycle: Description Average age of onset: 12 or 13 years; average range of age 9-17 years Average 28 days: cycles of 23 to 35 days not unsual Average flow: 2-7 days; ranges of 1-9 days not abnormal Difficult to estimate; average 30-80 mL per menstrual period; saturating a pad or tampon in less than an hour is heavy bleeding Dark red; a combination of blood, mucus and endometrial cells

REPRODUCTIVE HORMONES 1. Follicle stimulating hormone (FSH) Secreted by anterior pituitary gland during the first half of menstrual cycle Stimulates development of graafian follicle Thins the endoemetrium 2. Luteinizing hormone (LH) secreted by pituitary gland stimulates ovulation and development of corpus luteum thicknes the endometrium 3. Estrogen secreted primarily by the ovaries, by the adrenal cortex and by placenta in pregnancy stimulates thickening of the endometrium; causes suppression of FSH secretions assists in maturation of ovarian follicles responsible for the development of secondary sex characteristics stimulates uterine contraction mildly accelerate sodium and water reabsorption by kidney tubules; increase water content of uterus high estrogen concentration-inhibits secretion of FSH and prolactin but simulates secretion of LH low estrogen concentration after pregnancy, stimulates secretion of prolactin accelerate protein anabolism 4. Progesterone secreted by corpus luteum and placenta during pregnancy inhibits secretions of LH has thermogenic effect (increase temparature) relaxes cervical secretion of thick mucous maintain thickness of endometrium allows pregnancy to be maintained 5. Prostaglandins fatty acids categorized as hormone produced by many organs of the body, including the endometrium affects menstrual cycle influences the onset and maintenance of labor 4 Body structures are involved in the physiology of the menstrual cycle:

1. 2.

3. 4.

Hypothalamus- releases LHRH or GnRH - deficiency results in delayed puberty and diseases causing early activation lead to abnormally early sexual development or precocious puberty Pituitary gland- releases FSH and LH FSH- hormone that is active early in the cycle and is responsible for the maturation of the ovum LH- a hormone that becomes most active at the midpoint of the cycle and is responsible for ovulation or release of the mature egg cell from the ovary and growth of the uterine lining during the second half of the menstrual cycle. Ovaries - contain 2 million immature ova (oocytes) at birth, formed during the first 5 months of intrauterine life - FSH- Estrogen; LH- Progesterone Uterus Phases of the Menstrual Cycle Proliferative Phase (first phase of Menstrual Cycle) - occurs immediately after menstruation, first 4-5 days of a cycle - endometrial lining is very thin -FSH stimulates the release of Estrogen which cause a very rapid increase in the thickness of the endometrium (Proliferate) from approximately day 5- day 14. - also termed as proliferative, estrogenic, follicular, or postmenstrual phase

Secretory Phase (second phase of the menstrual cycle) -happens after ovulation, LH stimulates the formation of progesterone in the corpus luteum which causes the glands of the uterine endometrium to become twisted in appearance and dilated with quantities of glycogen and mucin until the lining takes on the appearance of rich, spongy velvet. - also termed as progestational, luteal, premenstrual, or secretory phase. Ischemic Phase (third phase of the menstrual cycle) - the degeneration of the endometrium approx. day 24 or day 25 of the cycle wherein the capillaries rupture, with minute hemorrhages, and the endometrium sloughs off. - occurs when the corpus luteum regresses after 8-10 days of ovulation which then decreases the production of progesterone and estrogen since fertilization did not take place. Menses (Final phase of the menstrual cycle) Products discharged include: Blood from the ruptured capillaries Mucin from the glands Fragments of endometrial tissue Microscopic, atrophied, and unfertilized ovum The Cervix First half of the cycle: low hormone secretion- cervical mucus becomes thick and scant- poor sperm survival At the time of ovulation: estrogen level is high- cervical mucus becomes thin and copious- excellent sperm survival Discomforts of Menstruation 1.Breast tenderness and feelings of fullness 2.Tendency towards fatigue 3.Temperament and mood changes -- because of hormonal influence and decreased levels of estrogen and progesterone 4.Discomfort in pelvic area, lower back and legs 5.Retained fluids and weight gain Abnormalities of Menstruation 1. Amenorrhea absence of menstrual flow 2. Dysmenorrhea painful menstruation 3. Oligomenorrhea infrequent menstruation 4. Polymenorrhea too frequent menstruation 5. Menorrhagia excessive menstrual bleeding 6. Metrorrhagia bleeding between periods 7. Hypomenorrhea abnormality shot menstruation 8. Hypermenorrhea abnormality long menstruation CONCEPTS ON SEXUALITY Sexuality and sex are two different things. SEXUALITY is often described as the sense of being female or male. It has biological, psychological, social, and ethical components. Sexuality influenced by life experiences. The word SEX has a more limited meaning. It usually describes the biological aspects of sexuality such as genital sexual activity. Sex may be used for pleasure and reproduction. As a result of lifes changes or a choice, Sexual activity may be absent from a persons life for brief or prolonged periods. Theories of Gender Role Development Cognitive Development theory process that gender role development emerges through children's growing cognitive awareness of their identity. Behavioral theory gender role behavior are conditioned by the environment. Social Learning theory gender role are learned through invitation of sex-typed behaviors. Identification theory a psychoanalytic theory that suggest a child develops a gender role by interacting closely with and emulating the behavior of the parent of the same sex. SEX = A person's biological status as either a male or female. Denotes specific sexual behavior such as sexual intercourse. GENETIC SEX/ BIOLOGIC SEX = Biological maleness or femaleness as determined by our chromosomal make up. ANATOMICAL SEX = Physical characteristics and features that distinguish female from male. SEXUAL IDENTITY = One identity as either female /male based on biological characteristics, both genetic and anatomical. GENDER = The social meanings attached to being a female or male. GENDER IDENTITY = Is the sense of being feminine and masculine. Determine by biologic sex, socio-cultural influence. GENDER ROLE = The way that a person acts as female or male. Public expression of gender identity. GENDER-ROLE-STEREOTYPE = A generalization that reflects our beliefs as males and females. SEXUAL ORIENTATION = Clear, persistent, erotic preference of a person for one sex or the other TRANSEXUAL = The inner of sexual identity, which does not match the biological body TRANSVESTITE = A heterosexual man who usually dresses like a woman for psychological and sexual relief. SEXUAL PREFERENCE = The choice of sexual partners. APHRODISIAC = A substance thought to increase sexual arousal, desire or potency. PATTERNS OF FUNCTIONING EROTIC SEXUALITY Eros- Greek name of the Lord of Love Love-a complex phenomenon and is variously defined and understood - often romanticized and create strong personal expectations Erotic Love-expressed as sexual relationship which may include affection, caring and intimacy shared between sexual partners MAN -Sex first, love later -Sexuality awakened by nature -need orgasm for procreation

Differences Between Man and Woman WOMAN

-love first, sex later -not aroused by nature -does not need necessarily orgasm for procreation

-active-aggressive role -rapidly aroused, reach sustained sexual - excitement easily and have single orgasm

-passive-submissive role -slow sexual response and in reaching sexual - excitement capable of multiple orgasm

Types of Sexual Relationships 1. Premarital having sex before marriage. 2. Post marital having sex during after a death of a spouse. 3. Extra marital having sex with another man or woman. 4. Non traditionals A. Homosexuality B. Bisexual C. Autosexual A. Forms of Sexual Stimulations 1. Tactile stimulations touching any body area. Erogenous zones parts of body richly supplied with nerve endings and give sexual pleasures. 2. Kissing involves senses of touch, taste and smell. Lip to lip, teeth and tongue or licking, kissing, sucking. 3. Breast Stimulation tactile stimulation of the breast which can produce pleasurable contractions in m the pelvic region. 4. Genital Stimulation sexual stimulation to the female organs. Forms: Cunnilingus stimulation of female genitalia by tongue and mouth. Fellatio oral stimulation of penis. Soixante neuf (69) - simultaneous oral genital stimulation by 2 person's. Masturbation Normal self stimulation of genitals. Coitus sexual intercourse. - sexual connection between man and woman while using the vagina to receive the penis. 5. Anal stimulation Anilingus oral anal stimulation. Sodomy penis entering the rectum. 6. Sexual Fantasies involved idealized sexual stimulation. a. Body the entire body, particularly the skin. b. Lips respond to touch, kissing or licking. c. Neck/ nape d. Back of the Ears e. Breast -nipple f. Buttocks g. Thighs inner thigh h. Genitals G (grabenburg) spot Pinpointing Erogenous Zones

B. The Sexual Response Pattern 1. Reflexogenic cerebral cortex and higher brain centers are not involved. - stimulation center is on the lower part of the spinal cord. 2. Psychogenic stimuli are processed through higher brain centers. - include sensory, inputs as sight, sound, taste, smile, touches, thoughts, fantasies, memories and images. Psychological Mediators of Sexual Response: A. Informational response consist of belief, knowledge, labels concerning aspects of sexuality B. Emotional -perception/ feelings about sexual stimulus- joy, happy, excitement, anxious, quiet, fear C. Imaginative Capacity memories, images and fantasies. Human Sexual Response Cycle Sexual Physiology is how the body responds to sexual arousal. Foreplay or pre-coital stimulation 1. Kissing 2. Petting Orgasms rhythmic contractions of genital organs & surrounding tissues, which reach an apex and culmination in sexual excitement. Myotonia muscle contractions Types of Sexual Orientation 1. Heterosexuality- finds sexual fulfillment with a member of the opposite gender. 2. Homosexuality finds sexual fulfillment with a member of his/her own sex, men -gay; women- lesbian 3. Bisexuality sexual satisfaction from both homosexual and heterosexual relationships. 4. Transsexuality individuals who are genetically of one sex but psychologically and emotionally of another. -biologic gender feels as he or she should be at the opposite gender. - surgery or operation (synthetic vagina or penis is created).. Types of Sexual Expression 1. Celibacy abstinence from sexual activity. 1. Transvestism achievement of sexual gratification by dressing in the clothing of the opposite sex. 2. Fetishism use of objects for sexual arousal. 3. Voyeurism sexual arousal by looking at another's body. 4. Sadism hurting somebody 5. Masochism hurting oneself 6. Masturbation- is self-stimulation for erotic pleasure; it can also be a mutually enjoyable activity for sexual partners Other types of Sexual Expression 1. Exhibitionism- revealing genitalia in public 2. Pedophilia- having sexual encounters with children 3. Obscene phone calling

PHASES OF MASTERS AND JOHNSON'S SEXUAL RESPONSE CYCLE Excitement phase: - occurs with physical and psychological (i.e., sight, sound, emotion, or thought) stimulation causes parasympathetic nerve stimulation. vaginal lubrication occurs arterial dilation and venous constriction in the genital area overall muscle tension increase nipples, become erect and breast size increase in men, erection increase and scrotal thickening, elevation of testes heart rate, respiratory rate and blood pressure increase. Clitoris increase in size, vagina widens in diameter and increases in length Plateau Phase- reached just before orgasm nipples become further engorged in women, formation of orgasmic platform in men, full distention of the penis flushing may spreads to abdomen, thighs and back breathing becomes deeper, heart rate and blood pressure increase markedly Secretions from Cowpers gland in male. Orgasmic Phase - occurs when stimulation proceeds through the plateau stage to a point at which the body suddenly discharges accumulated sexual tension (Masters et al,1998) the shortest stage in the sexual response cycle strong muscular contractions both voluntary and involuntary in many parts of the body including rectal sphincter muscle contraction of uterine muscles respiratory rate reaching a peak of two or three times normal, heart rate doubling and blood pressure increasing as much as one third above normal ejaculation of males semen. Resolution Phase generally takes approximately 30 minutes for both men and women general muscle relaxation occurs flushing disappears heart rate and blood pressure return to normal external and internal genital organs return to an unaroused state

1.

THE KAPLAN THREE- STAGE MODEL (HELEN SINGER KAPLAN) DESIRE PHASE specific neural system in the brain produces sexual desire or libido, which leads a person seeds out or become responsive to sexual experiences. - Highlights characteristics of human beings that differentiate us from other animals. LIBIDO sexual desire; instinctual sexual drive. In freudian psychoanalytic theory, the driving force of the id.

2. 3.

EXCITEMENT PHASE characterized primarily by genital congestion. ORGASM PHASE - vasoconstriction and myotonia developed from sexual stimuli are released.

TYPICAL SEXUAL BEHAVIORS involve sexual activities that are statistically common and acceptable Examples of these are: LOVE - the emotion that encompasses care of another person; the family and friends; spontaneous excitement, and physical/ sexual expression. CELIBACY or the choice not to engage in genitals sexual intercourse MASTURBATION - or self-stimulation of the genitals intended to produce sexual pleasure TYPICAL AND ATYPICAL SEXUAL BEHAVIORS

EROTIC FANTACY - such as dreams that serve to enhance sexual arousal and erotic dreams SHARED TOUCHING - a form of sexual expression since the entire body surface is a sensory organ. OROGENITAL STIMULATION or oral stimulation of the vulva or the male genitals Cunnilingus oral stimulation of the female genitalia, usually the labia and the clitoris Fellatio oral stimulation of the penis. ANAL STIMULATION - is engaged in by couples for arousal, orgasm and variation. COITAL POSITION diversity of coital position for greater satisfaction under certain situational indications such as pregnancy, medical or post-surgical conditions or handicapped. Autoeroticism- Self-stimulation of the genitals to the point of sexual arousal

ILLNESS AND SEXUALITY Illness alone has a great impact on sexuality. Some illnesses cause physiological changes that may interfere with normal sexual functioning. Some pharmaceutical agents to treat diseases interfere with normal sexual functioning. Depression, a common side effect of illness, may lead to decrease libido. 2. 3. There are very few Chronic Illnesses that affect sexuality and these are: Diabetes Mellitus Myocardial Infraction

4. 5. 6. 7.

Hypertension Miscellaneous illness chronic renal disease, stroke, emphysema, CHF, neurological disorders and arthritis Surgical Procedures removal of prostate gland, excision of both testes Spinal cord injuries

SEXUAL DYSFUNCTION The term sexual dysfunction refers to an impairment in the ability to obtain gratification from sexual intercourse. Problems that prevent an individual or couple from engaging in or enjoying satisfactory sexual intercourse and orgasm. PRIMARY A. Male Impotence/Erectile dysfunction inability to achieve or maintain an erection Premature ejaculation exclusively short period of orgasm or before penile vaginal contact. Retarded ejaculation inability to ejaculate into vagina. - is a condition in which an erection is maintained but ejaculation is delayed for prolonged period. B. Female Inhibited sexual desire/orgasm - is a disorder in which a woman either has no orgasms, has orgasms that are delayed much longer than she and her partner desire, or has orgasms that are difficult to achieve despite appropriate stimulation. Orgasmic dysfunction/ anorgasm inability to achieve orgasm.

Vaginismus involuntary contraction of muscles at the outlet of vagina when coitus is attempted. is an involuntary contraction of the lower vaginal muscles that prevents the penis from penetrating the vagina.

Dyspareunia painful intercourse; genital or deep pelvic pain experienced during intercourse. - can be due to endometriosis, vaginal infection or hormonal changes such as during menopause Low Sexual Desire Disorder/ Inhibited sexual desire - is a persistent loss of sexual fantasy and little desire for sexual activity. Sexual Aversion Disorder - is persistent, extreme aversion to virtually sexual activity, characterized by fear and sometimes accompanied by panic attacks. Sexual Arousal Disorder in Women - is the persistent failure to attain or maintain sexual excitement despite adequate sexual stimulation, it is similar to impotence in men. Both disorders have physical or psychologic causes. SECONDARY SEXUAL DYSFUNCTION Causes: 1. Chronic diseases- e.g., peptic ulcers, chronic pulmonary disorders 2. Obesity 3. STDs- e.g., genital herpes PSYCHOLOGIC CAUSES OF SEXUAL DYSFUNCTION Anger toward a partner. Depression Fear of losing control, of dependence on another person, or of pregnancy. Guilt Anxiety Ignorance or inhibitions about sexual behavior. Previous traumatic sexual experiences ( for example rape, incest or sexual abuse, or sexual failure ) Performance anxiety ( worrying about performance during intercourse ) Feeling like a spectator rather than participant Discord or boredom with a partner PSYCHOSEXUAL DISORDERS Transsexualism = is a distinct gender identity disorder. People with this disorder believe that they are a victim of a biologic accident (that occurred before birth). Paraphilias = ( deviant attractions ) in extreme forms are socially unacceptable deviations form the traditionally held norms of sexual relationships. Fetishism = sexual activity makes use of physical objects, sometimes in preference to contact with humans. Transvetism = a man occasionally prefers to wear womens clothing, or less commonly, a woman prefers to wear mens clothing. Pedophilia = is a preference for sexual activity with young children. Exhibitionism = ( usually a man ) exposes his genitals to unsuspecting strangers and becomes sexually excited when doing so. Voyeurism = a person becomes sexually aroused by watching someone who is disrobing, naked, or engaged in sexual activity. Masochism = it constitutes sexual enjoyment in being physically harmed, threatened, or abused. Sadism = an opposite of masochism, is a sexual enjoyment a person receives from inflicting actual physical or psychologic suffering on a sex partner. Zoophilla = Bestiality or sexual contacts between humans and animals. Necrophilla = Sexual interest in having intercourse with corpses.

IMPLICATIONS FOR NURSING Just like all other humans, nurses are sexual being and their nursing practice is influenced by their beliefs, attitudes, emotions, and knowledge concerning sexual matters.
The role of the nurse includes dealing with patients experiencing sexual problems, and the nurses background influences her practice. The following are beginning steps the nurse can take to be more effective when she plans to have help provide sexual health care: 1. Learn about sexuality. 2. Learn to know one self. The nurse must first be comfortable with her own sexuality before she can effectively deal with sexual matters concerning her patients. She should study her own feelings, values, and emotions in relation to sexual matters. 3. Use various techniques when learning to promote self-awareness: discuss sexual matters with others in group discussions or with one other person for whom you have respect; ask for feedback on yourself from another person or from group members; read as extensively as possible on the subject of sexuality while practicing keeping an open, unbiased mind; evaluate your own past

behaviors carefully and objectively and purposefully work on establishing self-awareness on sexual matters. 4. Recognize that knowledge and attitudes change, which in turn, requires revising, modifying, and expanding ones view on sexuality over time. 5. Continually practice developing communications skills. A helping nurse patient relationship, whether dealing with sexual matters or any other aspect of care, depends on sound communication. INTERVENTION IN SPECIAL SITUATIONS There may be times when patients may flirt with staff members. They may make suggestive comments, tell off-color jokes, expose themselves needlessly, and put their hands on parts of the nurses body. There may be many reasons why a patient may act out such sexual behavior. There are several appropriate actions the nurse can take when sexual advances are made to her: Assess the patients need to talk about sexual matters and attempt to meet his need to converse. Convey empathy and understanding in relation to how hospitalization leads to an interruption of sexual life. Define the nurse-patient relationship and indicate that there is no intention of acting on the patients suggestions. Establish limits in the nurse-patient relationship. Issues and Concerns on Sexuality Sexual education in the home Relationship of adolescents and parents Sex education for adolescents and parents Extramarital relationships Legal separation/ annulment/divorce Negative feelings about ones own sexual anatomy Widowhood Sexuality in later years

Sexual education in the home Parents are the key influence on the psychosexual development of their children. Therefore, they need to establish an atmosphere in the home where they can comfortably share concerns of children that are usually shared with peers. Parents who are positive models to their children influence the sexual behavior of their children as they grow.

Relationship of adolescents and parents Sex education at home should start when the children start asking questions about sex. If they dont ask, parents can initiate by sharing feelings through non-stressful questions. Topic such as menstruation, first ejaculation or wet dreams not nocturnal orgasm can be discussed with the parent taking the initiative. Sex education for adolescents and parents Adolescent and parents relations maybe strained by their changing roles. The less sex information young people have, the more likely they are sexually involved. Sex education for adolescents should start with their parents. Hence, parents should be in a position to provide factual sex information to their children. Widowhood Widowhood happens with the death of one partner. As in legal separation or divorce, this will entail changes and adjustments in sexual, interpersonal relations and lifestyle. Sexuality in later years Sexuality in later years can continue to be expressed by partners in non-procreation terms.

FAMILY PLANNING Fertility Management/ Responsible Parenthood Contraception the planned prevention of pregnancy/ contraception. Ovulation -a discharge of a mature ovum from the ovary. Basal Body Temperature lowest body temperature of a healthy person. Fertile/ Fertility capable of growing, developing, breeding or reproducing or a state of being fertile. Fertilization -a process of union of germ cell. Family Planning (WHO) the use of a range of methods of a fertility regulation to help individuals or couples attain certain objectives: 1. avoid unwanted birth. 2. bring about wanted birth. 3. Produce a change in the no. of children born. 4. Regulate the intervals between pregnancies. 5. Control time at which birth occur. 3 important elements in family planning 1. proper spacing 2. proper timing 3. number of pregnancies Family welfare a state of well being of the family as a whole and the individual. - means a level of satisfaction of the basic needs of family (adequate food, water, shelter, employment, health and education). Responsible Parenthood the essence of family planning. - pregnancy is planned and a child us desired and is assured of parent's love, protection, etc.

Importance of Family Planning Family planning is concerned and efforts to promote physical, mental and social well -being of its members and reduce the risk of mortality and morbidity in the country. A. Benefits to Mother 1. Reduce the health risk by helping woman bear them children during their healthiest years. Below 20y.o. And above 35 y.o. At risk of developing complications during pregnancy. 2. Help mother to fully recover from physical strain of child bearing. Those more than 4 children considered high risk. 3. Help reduce number of maternal death due to abortion. 4. Offers non -contraceptive heath benefits. - preventing STD. - Oral contraceptive have protective effect against ovarian CA and endometrial CA, benign breast masses. B. Health Benefits to Children 1. Ensures better chance of survival at birth. 2. Promote better childhood nutrition. 3. Promote physical growth and development. 4. Prevent birth defects. C. Health Benefits to Father 1. Allows father to keep a constant balance between their physical, mental, social, well -being. 2. More relaxed sexual relationships- confident not to produce unwanted pregnancy. 3. Increase father sense of respect because he is able to to provide the type of education and home environment. D. Benefits to Whole Family Health - help the family enjoy the better kind of life. A. Vital 1. 2. 3. 4. 5. Family Planning Program Statistics 60% of 9 million married woman of reproduction ages are at risk. Below 20 or above 35. have had 4 deliveries. Spacing between 2 deliveries is less than 24 months. Suffering from medical condition that contraindicated pregnancy.

B. Legal Mandate Executive Order 119 a legal mandate which considered FP as basic Human right. Phil. Constitution Recognizes: 1. sanctity of family life and the need to protect the life of mother and the unborn from conception. 2. Family as foundation of nation. 3. Right of spouse to found a family in accordance with their religious conviction and demands of responsible parenthood. 4. Right of family association to participate in the planning and implementation of policies and program that affect them. Program Policies: 1. Improvement of family welfare with main focus on women's health, safe motherhood and child survival. 2. Freedom of choice 3. Promotion of Family Solidarity and Responsible parenthood. A. NATURAL CONTRACEPTIVES METHODS = Abstinence from coitus during the fertile (ovulation) phase of the menstrual cycle. Methods of Natural Family Planning 1. Daily Basal Body Temperature uses the single sign of rise in EBT to predict ovulation a. Temperature is take orally or rectally each morning before rising b. EBT lowers before ovulation: EBT rises 0.4 0.8 degree with ovulation in response to production of progesterone from the corpus luteum c. Abstinences begins the first day of menses and continues until the third day of temperature elevation 2. Billings Method- uses cervical mucus characteristics With ovulation (the peak day) the mucus becomes thin and watery, transparent, feels slippery, and stretches a distance of at least 1 inch before strand breaks. All days the mucus is present and the 3 days after the peak day are fertile days or days the woman must maintain sexual abstinence to avoid conception. 3. Symptothermal method- combines observation of cervical mucus and basal body temperature. the woman notes other changes often associated with ovulation such as breast tenderness and a more anterior position of the cervix to help confirm her time of ovulation. 4. Coitus interruptus the oldest and the least effective method of contraception. The couple proceeds with coitus until the movement of ejaculation, Then, the man withdraws and spermatozoa are omitted outside the vagina. Ejaculation may occur before withdrawal is complete and some spermatozoa may be deposited in the vagina. Lactational Amenorrhea Method use of lactation for natural suppression of ovulation Ovulation Awareness the use of over-the-counter ovulation detection kit detects the midcycle surge of LH in urine that occurs 12-24 hours before ovulation 98%-100% accurate in predicting ovulation

5. 6. -

B. ARTIFICIAL CONTRACEPTIVES METHODS 1. Contraceptive pill - Comprises of synthetic estrogen combined with small amount of synthetic progesterone. It prevent ovulation by inhibiting FSH

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and decrease the permeability of cervical mucus. The woman should not take more than 2 pills a day and the arrow on the peak should be followed. Side effects a. Nausea b. Weight pain c. Headache d. Breast tenderness e. Bleeding f. Monileal vaginal infection g. Mild hypertension Contraindications a. Smoking b. Hx of thromboembolic disease c. CVA d. 35 year old and above e. Hypertension f. DM g. Hx of liver disease

2. Intrauterine devices (IUD) A small plastic object inserted into uterus where it remains in place. It interferes with the ability of the ovum to develop as it transverse the fallopian tube. Side effects Contraindications a. Heavy menstrual bleeding a. History PID b. Dysmenorrhea b. Abnormally shaped uterus c. Fever c. Ectopic (tubal) pregnancy d. Cramping d. Menorrhagia 3. Diaphragm A circular rubber disk that fits, over the cervix and forms a barricade against the entrance of the spermatozoa. If should remain in place 6 hour following coitus and may be left for 24 hours. May be used with vaginal cream to be effective. Contraindications: a. Prolapsed and retroverted uterus b. Cystocele and rectocele (walls of vagina are displaced by bladder or bowel c. Acute cervicitis 4. Condoms A rubber of synthetic sheath that is placed the erect penis before coitus. It prevents pregnancy because spermatozoa are deposited in the tip of the condom. It also prevents the spread of sexually transmitted disease. There is no contraindications to the use of condoms except for rare rubber sensitivity. 5. Cervical Cap Soft rubber shaped like a thimble and fits snugly over the uterine cervix. As with diaphragm, it is filled with spermicidal jelly before insertion. It can be placed longer than the diaphragm and it does not put pressure on vaginal walls. 6. Spermicidal Creams Inserted into the vagina causing the death of spermatozoa before they can enter the cervix. It changes the vagina pH to strong acid level, unconducive to sperm survival. It should placed one hour before the coitus and douching is avoided 6 hours following coitus to complete spermicidal action. Subcutaneous Implants Norplant- a subdermal hormonal implant; a form of contraception that received the US Food and Drug Administration (FDA) approval in 1991. - release hormone suppressing ovulation, rapidly moving an ovum through the fallopian tube, stimulating thick cervical mucus, and changing the endometrium so implantation is difficult. - disadvantages: weight gain, irregular menstrual cycle, hair loss, potential depression, scarring at insertion site, high cost Intramuscular Injections DMPA or Depo-Provera- medroxyprogestration acetate single injection that is given every 12 weeks inhibits ovulation, alters the endometrium, and changes the cervical mucus. Effectiveness rate: nearly 100% C. PERMANENT METHODS 1. Vasectomy A small incision is made in each side of the scrotum. The vas deferens at the point is then cut and tied, blocking the passage of spermatozoa. The man can resume sexual coitus within one week, an additional birth control should be used until two negative sperm reports have been examined. The testes will continue to produce sperm and the man will still have full erection and ejaculation capacity. 2. Tubal Ligation Occluding the fallopian tubes cautery, crushing, clamping or blocking the tube and prevents passages of the sperm into the tube to meet the ova. It should not be undertaken unless the woman view it as a permanent irreversible produce. The most common operation for female sterilization is laparoscopy. CONCEPTION AND GENETICS Process of Conception: Every 28 days egg is released, which contains 23 chromosomes Gametes cells that have only 23 chromosomes. Rx indicates that only about half of all conceptions are likely to survive to birth. Male gamete + female gamete = zygote Two Types of Chromosomes: 22 of the pairs of chromosomes are called autosomes Sex chromosomes = X or Y Female has two X chromosomes (XX) Male has one X and one Y Gender of a child is determined by the sex chromosome from the sperm (because mom only has X chromosomes) 8. 7.

Chromosomes are comprised of DNA (deoxyribonucleic acid) that is further subdivided into genes.

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Pregnancy Pregnancy begins when the zygote (male gamete + female gamete) implants itself in the lining of the womans uterus.

Conception & Genetics When does life begin? Process of Conception: Every 28 days egg is released, which contains 23 chromosomes Gametes cells that have only 23 chromosomes. Rx indicates that only about half of all conceptions are likely to survive to birth. What are some reasons for this large number of fertilized eggs not surviving? Male gamete + female gamete = zygote Two Types of Chromosomes: 22 of the pairs of chromosomes are called autosomes

Sex chromosomes = X or Y Female has two X chromosomes (XX) Male has one X and one Y Gender of a child is determined by the sex chromosome from the sperm (because mom only has X chromosomes) Chromosomes are comprised of DNA (deoxyribonucleic acid) that is further subdivided into genes.

Genetics Genotype specific genetic material on an indivs chromosomes. Phenotype the observed characteristic of the indiv (brown eyes; blonde hair) DOMINANT AND RECESSIVE CHARACTERISTICS Characteristics in the left-hand column dominate over those characteristics listed in the right-hand DOMINANT TRAITS DOMINANT TRAITS dimples unattached earlobes brown eyes freckles farsightedness broad lips normal vision Immunity to poison ivy normal vision Normal hearing normal vision Normal blood clotting Normal pigmented skin dark hair non-red hair curly hair full head of hair widow's peak RECESSIVE TRAITS RECESSIVE TRAITS no dimples attached earlobes grey, green, hazel, blue eyes no freckles normal vision thin lips nearsightedness Susceptibility to poison ivy night blindness Congenital deafness color blindness* Hemophilia albinism blonde, light, red hair red hair straight hair baldness* normal hairline

facial features Other eye coloring vision

hair

DOMINANT AND RECESSIVE CHARACTERISTICS Characteristics in the left-hand column dominate over those characteristics listed in the right-hand column.

Dominant-Recessive Genes Simplest set of genetic rules = dominant-recessive pattern a single dominant gene strongly influences phenotype Because inherit one chromosome from each parent, our genetic instructions either=

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Homozygous (the same) Heterozygous (different) Homozygous for curly hair if received a gene from each parent for curly hair. Heterozygous if received a gene for curly hair from mom and a gene for straight hair from dad.

Multi-Factorial Traits Physical traits influenced by both genes and environment. Height is an example: If a child is ill, poorly nourished, or emotionally neglected, s/he may be smaller than others her/his age. Psychological traits (intelligence, personality) influenced by both nature and nurture (multi-factorial) Pregnancy Pregnancy begins when the zygote (male gamete + female gamete) implants itself in the lining of the womans uterus. Zygote send chemical messages for menstruation to stop. TERMS TO DENOTE FETAL GROWTH Name Ovum Zygote Embryo Fetus Conceptus Time Period From ovulation to fertilization From fertilization to implantation From implantation to 5-8 weeks From 5-8 weeks until term Developing embryo or fetus and placental structure throughout pregnancy

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