2nd PUC Biology Notes Chapter 4 Reproductive Health

Karnataka 2nd PUC Biology Notes Chapter 4 Reproductive Health

Reproductive Health – Problems and Strategies:

→ Though reproductive health simply means healthy reproductive organs and their normal functioning, the term in its broader perspective includes the emotional and social aspects of reproduction.

→ The World Health Organisation (WHO) defines reproductive health as a total well being in the physical, emotional, behavioural and social aspects of reproduction.

→ A reproductively healthy society is the society with people having physically and functionally normal reproductive organs and normal emotional and behavioural interactions among them in all sex-related aspects.

→ India is the first country to initiate action plans/programmes at the national level to attain total reproductive health; these programmes were called Family Planning Programmes and were initiated in 1957

→ Later they have been improved to include more reproduction related areas and are currently called as Reproductive and Child Health Care (RCH) programmes.

→ The major tasks of these programmes are:

• Creating awareness among the people about various reproduction – related aspects and
• Providing facilities and support for building up a reproductively healthy bsociety.

→ Governmental and non – governmental agencies have taken up various steps to create awareness among people about reproduction – related aspects; they take help of audio visual and print media.

→ Introduction of sex education in schools should be encouraged to give right information and to avoid myths and misconceptions about sex-related aspects; proper information about reproductive organs, adolescence and the related changes, safe and hygienic sexual practices and sexually transmitted diseases (STDs) would help to lead a reproductivejy healthy life.

→ Educating people, especially the fertile couples and those in marriageable age group, about the following can help them to make up a socially – conscious, healthy family of desired size:

• Available birth control options.
• Care of pregnant women.
• Postnatal care of mother and child,
• Importance of breast feeding.
• Equal opportunities for the female and male child.

→ People should also be made aware of the problems due to uncontrolled population growth, social evils like sex abuse and sex-related crimes, to enable them to think and take up necessary steps to prevent them from these evils and build up a reproductively healthy society.

Population Explosion:

→ Increased health facilities and improvement in technology leading to better living conditions, have explosive impact-on the growth of population.

→ The world population was about two billions in 1900AD. and it is 6 billions in 2000AD.

→ The same trend is observed in India also; our population at the time of independence was about 350 million and it has reached one billion in 2000 AD. (it crossed one billion in May, 2000 A.D).

→ The probable reasons are,

• Decline in death rate,
• Decline in Maternal Mortality Rate (MMR), iii Decline in Infant Mortality Rate (IMR) and
• Increase in the number of people in the reproductive age.

→ According to 2001 census report, it is around 1.7%, i.e., 17/1000/year and at this rate, the population is expected to double in 33 years.

→ Measures to control over population:

• Education
• Raising of marriageable age
• Incentives
• Family planning

Fertility Control:

Family Planning methods: (Birth control or Fertility control): Planning a small family by adopting scientific methods of fertility control or birth control is called family planning. It is an important and effective way to check the population growth.

Methods of birth control include contraception, sterilization, medical termination of pregnancy and removal of gonads and uterus.

Spacing methods:
Contraception: Prevention of conception is called contraception. There are three major categories of contraception. They are natural, mechanical and chemical methods.

1. Natural contraception: This is the natural method of birth control which involves the rhythm method and coitus interrupts.
(a) Rhythum method or calendar method or physiological method: In this method, sexual intercourse should be avoided a few days prior to and a few days after ovulation to prevent fertilization of the ovum. This is based on the fact that a fertilizable ovum is available-in the uterine tube only for a period of 3 to 5 days in each menstrual cycle.

Generally, ovulation occurs in the 14thday in a 28 day menstrual cycle. In view of this intercourse should be avoided 5 days prior and 5 days after ovulation. It should commence on the 10th day of the menstrual cycle and end of the 20th day of the cycle. This period of 10 days (10th to 20th day of the cycle) is known as the danger period.

Then fertilization is likely to take place. The first 4 days of the cycle is knownas bleeding period. The remaining period from 5th to 9th day (5 days) and 21 st and 28th day are called the safe period, when fertilization is unlikely to take place. However, the rhythm method is not a very safe method because the cycles are not absolutely regular.

(b) Coitus interruptus (Withdrawal method): This is a method practised by men. It ! involves removal of the penis from the vagina before ejaculaton so as to prevent? the I entry of sperm into vagina. However, this is not a reliable method.

(c) Lactational amenorrhoea : It refers to the absence of menstruation during the period of intense lactation after a child birth. As ovulation does not occur in this period, chances of conception are nil. However it is effective, only for a maximum period of six months after child birth.

2. Mechanical contraception or Barrier methods: Prevention of conception by using mechanical devices is called mechanical contraception. Mechanical methods of conception include the use of condom, diaphragm and intrauterine devices (IUD).

(a) Condom (Sheath): This is used by men. Condom is a nonporous, elastic, tight fitting sheath of rubber which is unrolled over the penis before intercourse. The ejected semen is trapped in the condom and thus the entry of sperm into the vagina is prevented.

(b) Diaphragm (cap): This is used by women: Diaphragm is a flexible dome-shaped device made up of thin rubber. It is inserted into the vagina and positioned over the cervix s before intercourse. It prevents the entry of sperms into the uterus.

Cervical caps and vaults: are similar to diaphragm in function but are structurally modified. They are known as female condoms.

(c) Intra uterine device (IUD): Intrauterine devices are used by women. The device is in the form of small object made up of plastic, copper or stainless steel. It is in the form of a loop, coil or T. The IUD is inserted to the uterus with the help of an insertion tube by an experienced gynaecologist. The IUD is provided with strings which are useful to check and confirm its position. They are also useful in removing the IUD. An IUD could remain in the uterus upto three years. It should be replaced after 3 years. It prevents implantation. It is a reliable method of birth control. Loop and copper T are very widely used by women in our country.

3. Chemical contraception : Prevention of conception by using chemicals is called chemical contraception. It involves the use of oral pill and vaginal spermicides.

(a) Oral pill (oral contraceptive or hormonal method): It is used by women. This is a widely used method of oral contraception (OC). The pills are taken every day continuously for a period of 21 days starting from 5th day of the menstrual cycle. The pills contain the hormones estrogen and progesterone which inhibit the release of FSH and LH from the pituitary. Therefore, maturation of the Graafian follicle and ovulation do not occur as long as the pills are taken. When the pills are stopped on the 25thday, menstrual cycle is initiated again.

(b) Vaginal spermicides: Sperm killing chemicals in the form of foams, creams, jelllies and suppositories are introduced into the vagina before intercourse to kill the sperm. But this is not a reliable method.

(c) Injectables and implants: Progesterogens or progestogen – estrogen combination is used as injections or implants, under the skin. Their mode of action is similar to oral contraceptives, but are effective for longer periods.

Terminal Method:

I. Sterilization: Surgical sterilization is the most effective and reliable method of birth control. Both men and women can undergo sterilization. Surgical sterilization in men is called vasectomy and in women tubectomy and laparoscopic sterlization. Sterilization normally does not effect sexual performance.

(a) Vasectomy: This is a method of male sterilization. It involves surgical removal of a small portion of each vasdeferens. An incision is made in the scrotum on each side, the vas defens is located and each one is tied in two places. Then the portion between the two ties of cut-off. In this method, production of sperm continues in the testes but they cannot reach the urethra. Vasectomy is reversible.

(b) Tubectomy (tubal ligation): This is a method of female sterilization. It involves surgical removal of small portion of each uterine tube. A small incision is made into the abdominal cavity and the uterine dubes are squeezed to form a small loop called knuckle and a suture’ is tied at the base of the knuckle then the knuckle is cut. In about 4 to 5 days the suture is digested by the body fluids and the two severed ends of the tubes separate. Therefore, the ovum is prevented from passing into the uterus, and the sperms cannot reach the ovum. Tubectomy is reversible.

2. Medical Termination of Pregnancy (MTP). Termination of pregnancy is called abortion. Medical termination of undesired pregnancy is a method of birth control. However termination of advanced pregnancies is dangerous. This should be done within 2 – 2\(\frac { 1 }{ 2 }\) months of pregnancy.

3. Removal of gonads and uterus: This is a perfect method of birth control. But irreversible. Removal of gonads results in adverse effects because the gonads play an important role in the endocrine system. Therefore, these operations are performed only if the organs are diseased or damaged. Removal of testis is called castration. Removal of the ovary is called oophorectomy. Removal of the uterus is called hysterectomy.

Infertility:

An woman who is unable to conceive is called infertile. This infertility is caused due to defects in men or women or both.

Causes of Infertility of Men:

• Deficiency of FSH and ICSH lead to diminished production of sperms.
• To maintain fertility, there must be 20 millions of sperms in 1 ml of semen but sterility is caused due to less number of sperms i.e less than 10 millions in 1 ml of semen and it is called oligospermia.
• Due to infections caused by virus, bacteria and diseases like T-8 may affects the spermatogenesis. Some times, there will be no production of sperms in the semen, called Azoospermia.
• In some cases, when the testis remains in abdomen and does not descend in to the scrotal sacs, it is called cryptorchidism. This causes more temperature in the body and affects spermatogenesis.
• Inflammation of prostate gland and seminal vesicle.
• Impotence: It is the inability of the male to attain or hold an erection of the penis long enough for normal intercourse.
• Defective epididymis and vas deference.

Causes of infertility in women:

• Deficiency of FSH and LH of pituitary
• Blockage of fallopian tube leads to infertility.
• When uterus is very small and such a congenital defect may lead to sterility.
• Improper development of uterus lead to sterility.
• Injury or diseases of ovary leads to sterility.
• Deficiency of vaginal fluid (Mucous)leads to sterility.
• Non-canalization of vagina.

Infertility Control: The technique of preventing the infertility and maintaining the fertility is called infertility control.
It can be achieved by certain modem scientific techniques called Assisted reproductive techniques i.e ART. These basic procedures are

• Invitro Fertilization (IVF)
• Embryo transfer (ET)
• Tubal embryo transfer (TET)
• Gamete intra fallopian transfer (GIFT).
• Zygote intra fallopian transfer (ZIFT).
• Intra cytoplasmic sperm injection (ICSI):
• Artificial insemination:

IVF and ET:

→ These can be adopted when the ovaries are defective or fallopian tube is defective. This technique involves the collection of sperms. In the former case, ovary is stimulated to produce oocytes by the administration of proper doses of FSH and LH, then many oocytes must be collected by laproscope and they are graded, ^elected and preserved in an incubater. Collection of many oocytes from the ovary by administrating artificial FSH and LH is known as super ovulation . In the later case, sperms are also collected from a donor or from a sperm bank. These sperms are centrifuged and then incubated. The fast moving sperms are collected in a pipette.

→ The sperms and ova are released into the petridish or test tube containing a nutrient medium. Then both male and female gametes are fused in an artificial medium. Such a fusion process is called invitro fertlization. This results in the many zygotes in invitro medium undergo cleavage resulting ub blastocysts. The embryos can also be cultured in an artificial medium. Finally the embryos are transferred directly into the uterus by using an embryo transfer catheter.

→ Normally more than one selected embryos are transferred so as to increase the chances of implantation. This phenomenon is known as embryo transfer or tubal embryo transfer. This leads to the pregnancy and finally delivery is occurred by natural or by artificial method i.e, Caesarian. The baby bom out of IVF and ET is known as test tube baby. It was first carried out by doctors Steptoe and Edward. The baby, Louis Joy Brown was bom in 1978.

→ GIFT: Gamete intra fallopian transfer: Here both ova and sperms are transferred into the fallopian tube of the mother, when her both ovaries are defective. This leads to invitro fertilization (natural). Here failure of fertilization and pregnancy may happen.

→ ZIFT: Zygote intra fallopian transfer: In this case, after invitro fertilization, zygote is cultured and transferred into the uterus. This leads to pregnancy. Afterwards baby can be delivered either by Caesarian or by natural method.

→ Intra cytoplasmic sperm injection (ICSI): It is a technique in which a single healthy sperm is injected into each mature egg directly. ICSI increases the chance of fertilisation for men who have low sperm count or poor sperm quality.

→ Artificial insemination: It is a technique in which semen is directly introduced into a woman’s vagina or uterus, in order to ensure fertilisation.

→ Amniocentesis:  It is a prenatal diagnostic technique in which a sample of amniotic fluid from the womb of a pregnant Woman is taken during, the early stages of foetal development and the cells are cultured and analyzed.

→ In this method the chromosomes abnormalities the sex of the foetus and developmental disorders could be detected for treatment. Since it is misused for destroying the normal female foetuses, it is legally banned.

b

Sexually Transmitted Diseases (STDS):

→ Diseases or infections which are transmitted mainly through sexual intercourse are collectively called Sexually Transmitted Diseases (STDs) or Venereal Diseases (VD) or Reproductive Tract Infections (RTIs).

→ Other modes of transmission include sharing of injection needles, surgical instruments etc. with infected persons, transfusion of blood from an infected mother to the foetus too.

→ Early symptoms of most of these are minor and include itching, fluid discharge, slight pain, swellings etc in the genital area. Infected females may often be asymptomatic.

→ If timely detection and proper treatment is not taken it could lead to complications like Pelvic Inflammatory Diseases (PID), abortions, still births, ectopic pregnancies, infertility or even cancer of the reproductive tracts.

→ STDs include gonorrhea, syphilis, genital herpes, chlamydiasis, genital wrts, trichomoniasis, hepatitis B and AIDS.

→ Except for hepatitis B, genital herpes and HIV infections, other diseases are completely curable.

1. GONORRHOEA: Gonorrhoea is an infectious sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae (Gonococcus). It affects both men and women. It is transmitted through direct sexual contact. It may be transmitted even to a new born baby during birth from the infected mother.

Symptoms: Symptoms appear about 10 days after infection. Symptoms in men include a severe burning sensation in the penis during urination. A greenish yellow discharge called gleet comes out of the penis with a severe burning sensation. Symptoms in women include severe pain during urination, discharge of pus from the vagina and pain in the lower part of the abdomen.

Effects: Patients of gonorrhoea suffer from inflammation of urethra called urethritis, inflammation of the cervix called cervicitis, inflammation of synovial membranes of the joints which may lead to arthritis and inflammation of the lining of the heart which may even damage the valves of the heart. Gonorrhoea may also lead to infertility.

Prevention: Multiple sexual contacts should be avoided and a condom must be used as a protection against the disease.

Treatment: Penicillin is the most effective drug used to treat gonorrhoea. Other antibiotics like erythromycin, tetracycline, spiramycin etc., are also used, depending on the intensity of the infection.

2. SYPHILIS: Syphilis is an infectious sexually transmitted disease caused by the bacterium, Treponema pallidum. It affects both men and women. It may be transmitted even to a new born baby during birth, from the infected mother.

Symptoms: Symptoms of syphilis progress through the following four stages:
(i) Primary stage : Symptoms of primary stage usually appear between 14 and 28 days after infection. The chief symptom is the appearance of a painless localized ulcer or an open sore called chancre around the sex organs, anus and even month. However, they are painless and soon disappear without treatment.

(ii) Secondary stage: Symptoms of the secondary stage usually appear 6 to 24 weeks later. The symptoms include skin rashes, fever, body aches and pain in the muscles and joints.

(iii) Latent – stage: The second symptoms disappear temporarily. This symptomless period is called the latent stage or latent syphilis. During this period the bacteria may invade body organs. This stage may last upto 30 years.

(iv) Tertiary stage: This stage appears between 1 and 30 years after the latent stage. It is referred to as late syphilis. It results in serious disorders affecting various parts of the body.

Effects: Syphilis bacteria attack the nervous system resulting in blindness, partial paralysis due to nervous disorder and loss of memory. Patients may become irritable and develop hallucinations. Motor areas of the cerebrum may be extensively damaged and hence the patient may be unable to control urine and bowel movements (incontinence). Syphilis patients may develop liver and heart diseases also.

Prevention : Multiple sexual contacts to be avoided and use of a condom may be helpful in prevention.

Treatment: Penicillin is the most effective drug used for the treatment of syphilis. Other antibodies like erythromycin, tetracycline, spiramycin etc., are also used depending on the intensity of infection.

3. AIDS (Acquired Immune Deficiency Syndrome): AIDS is a sexually transmitted disease caused by the Human Immuno Deficiency Virus (HIV). It destroys the antibody producing lumphocytes and cripples the immune system. The first case of AIDS was discovered at the centre for disease control in Atlanta, USA in the year 1981. However the causative virus HIV was discovered in the year 1983. The first case of AIDS reported in our country was from Tamil Nadu in 1986.

AIDS is not a single disease but a syndrome. It is a set of diseases which results from destruction of body’s defence by HIV. The virus enters the body through blood, semen and vaginal fluids. HIV infected people eventually get AIDS, anybody can get AIDS.

Casuse: AIDS is spread when the blood, seminal fluid or vaginal secretion of a HIV infected person comes in contact with the blood or mucus membrane of a healthy person. HTV spreads in the following way.

• Having sexual intercourse with an infected person.
• Intravenous drug abuse.
• Using unsterilized needless and syringes.
• Transfusion of HIV positive blood.
• Using a common razor at the barber’s shop or tonsuring at religious places.
• Getting tattooed without sterilizing the needle.
• From an infected mother to.her unborn child.

Symptoms:

• Unexplained persistent fatigue.
• Sudden loss of more than 10 percent of body weight.
• Persistent fever accompanied by chill.
• Persistent dry cough.
• Persistent chronic diarrhoea.
• Swollen lymph nodes, especially in the neck and arm pits.

Diagnosis of HIV and AIDS:

The ELISA (Enzyme linked Immouno Sorbent Assay) blood test is conducted for diagnosis of HIV. It has to be confirmed by the western blot test or an ELISA test with a different kit. Generally it takes 3 to 24 weeks for persons to test positive after they have been infected.

Effects of AIDS:
AIDS victims eventually succumb to any of these various diseases like

• Chronic pneumonia
• Chronic diarrhoea
• Infections which block the throat, lungs and intestine.
• Cancer of skin and bone.
• Swelling in the brain.
• Destruction of brain tissue leading to loss of memory and personality changes.

Prevention of AIDS :

• Avoid intercourse with more than one partner.
• Use condoms during intercourse to reduce the risk of infection.
• Use thoroughly sterilised equipment for injection, acupuncture, tattooing and punching of ear and nose.
• Never inject drugs, share razors and tooth brushes.
• Use HTV negative blood for blood transfustion.
• Use rubber gloves while giving first aid and surgery. Cover cuts with water proof dressing.

Treatment for AID: There is as yet, no cure for AIDS. Therefore, awareness camps to educate people regarding the dangers of AIDS must be undertaken on a large scale by government and voluntary organisations. Messages regarding the effects the AIDS should be spread through media like television, radio, press and other methods.
WORLD AIDS DAY is observed on December 1, every year, to spread awareness on its prevention and control.

4. Chalamydiasis:
Cause: Bacteria – Chalamydia trichomatis.
Symptoms: Symptoms appear after 1-3 weeks of exposure. Characterized by abnormal discharge from the genitalia, swelling of genitalia, burning sensation while urinating, lower abdominal discomfort.

5. Trichomoniasis:
Cause: Protozoan flagellate.
Symptoms: Persistent inflammation of vagina, vulvar itching, painful urination, offensive odour, pelvic pain.

6. Genital Herpes:
Cause: Herpes simplex virus (HSV1 and HSV2).
Symptoms: Symptoms generally follow a pattern like feeling of unwell, tiredness, headache, tingling in the lower back, legs, genital area. Fluid filled blisters in the genital, anal and thigh, areas which burst within a day or two.

7. Genital Warts:
Cause: Human Papilloma virus (HPV).
Symptoms Appearance of warts around anal and genital area. Sometime they could also enter vagina and cervix.

8. Hepatitis B
Cause:  Hepatitis B virus.
Symptoms: General flu like symptoms i.e., joint pain, sore throat, nasal discharge, loss of appetite, nausea, vomiting and fatigue. This is followed by jaundice, late stage destruction of liver cells or cirrhosis.

2nd PUC Biology Notes