Notes after midterm 1 to midterm 2

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Department
Sexuality, Marriage, and Family Studies
Course
SMF 204
Professor
B.J.Rye
Semester
Fall

Description
After midterm #1: Menstruation: Menstrual cycle phases 1. follicular (5-13) o low progesterone o low estrogen,  FSH (hypothalamus and pituitary) o hypothalamus Gonadatropin releasing hormone (GnRH) – hemical message to the pituitary gland – releases 2 Gonadatropin o egg in follicle ripens  E o 25 follicles - 1 follicle is stimulated (called the graafian follicle) – producing estrogen – this is how estrogen levels rise o sometimes have 2 or 3 graafian follicle – usually only 1 • hypothalamus is like thermostat in house • graafian follicle moves to surface of ovary • E  endometrium to grow (proliferation phase) • E  LH surge (pituitary) • E  stop FSH • Cervical mucous is thinning (it’s usually thick) 2. ovulation (14) • rising E  LH surge • follicle ruptures o “Mittelschmerz” is when women feel follicle rupture – have cramps, may bleed • 14 days prior to menstruation • mucous thins • body temp dips  then rises • graph - dip at 14, after ovulation there is a rise, stays high until 26/27, cuts off 3. Luteal Phase (25-28) • follicle  corpus luteum • produces P (“secretory” phase) “secondary” • increase in Progesterone  decrease in LH and FSH • corpus luteum degenerates (because of  LH) • ends  decrease in E, P • luteal phase is constant (14-15 days) after 3 pm think flow, late at night spotting doesn’t count 4. Menstruation of Menses (1-5) • decrease in E = P • endometrium sheds • menarche: 2-3 oz – 4-6 tablespoons of discharge • end of cycle but day 1; start counting here • high P lowers sex drive • dysmenorrhea – 46% this class, 36% all classes from 99-13 Reproductive Issues: Conception, Pregnancy and Childbirth Ovulation: is first released into body cavity • drawn by fimbriae into fallopian tube • moved by cilia • sperm – 300,000,000 released • 2000 reach ovum • 1 penetrates ovum  conception has occurred Ova: • 7 million oognonia in fetal ovaries • 2 million primary oocytes in newborn • 40,000 oocytes by adolescence • 400 oocytes are ovulated Improving chances: 1. timing of coitus 2. amount of coitus 3. facilitative coitus • (3% of getting pregnant every time you have sex) • dependent on how far/close you are to ovulation • close to ovulation  higher chance of getting pregnant • have coitus every 48 hours • man on top – lay down for next 20 minutes Embryo development – “zygote” • down tube • cells divide, becomes a mass in a few days • 3-5 days to reach uterus • implants 5-7 days after conception •  embryo • 3 trimesters of development Pregnancy Signs: 1. presumptive – missed period 2. probable – human chorionic gonadatropin – a hormone secreted by embryo – acts like LH: helps to maintain lining (pregnancy test) 3. positive – fetal heartbeat, movement 1 Trimester: • cellular mass  trophoblast  becomes placenta • attaches to wall of the uterus • embryo and mother have separateblood systems • amniotic sac • massive body development  little time Detecting Birth Defects: • amniocentesis – usually performed around 16-18 weeks gestation • half oz of fluid from amniotic sac • uses ultrasound to insert needle CVS: • advantages over amnio st • earlier (1 trimester) • fluid withdrawn via catheter inserted into uterus via vagina and cervix – guided by ultrasound nd 2 Trimester: • 14 weeks fetus moves (quickening) • 18 weeks heart detected (20 weeks to go) • 20 weeks eyes open • 24 weeks light sounds • mother – high point psychologically – calm – sense of well-being 3 trimester: th • 7 month...head down position • weight gain • mother – increase in stress o heart strained and weight +22-27 lbs • Braxton-Hicks – false labour – theory of getting the uterus ready, “warming up” Labour: st • 1 signs: bloody show – “water breaks” • 1 stage: o mucous plug forms, blocks entry from substances into uterus o cervix effaces/thins o cervix dilates(opens)  10 cm o contractions of uterus (painful) o 2-24 hours a) Breech presentation (4% of births) b) Transverse presentation (1%) c) Normal, head-first, cephalic presentation (96%) nd 2 stage: • crowning – head is in vagina, “vaginal barrel,” visible • episiotomy – [ep-eez-ee-otomy] – cutting perineum, makes baby come faster • baby delivered 3 stage: • placenta delivered • stitching of episiotomy, tears *major stages in birth process diagram* Sex during pregnancy: • Old view – NO (e.g. Kellogg – sex will warp the character of the child – high fibre, low sugar cereal so bowls would be cleaned out so no sex) • Fear that 1. Infection or 2. precipitate premature labour or miscarriage • Current medical option: most people – intercourse will be acceptable to 4 weeks prior • After – > 2 weeks, 95% resumed by 12 weeks • Oral sex issue – blowing in the vagina could blow air bubble into vein and kill Contraception: • conception control vs contraception o contraception: devices that prevent conception Outline of methods: 1. sterilization (male and female) 2. condoms (male and females) 3. cervical coverings 4. ... Sterilization: a) vasectomy – cutting vas deferens, sterm can’t leave the vas deferns to meet with seminal fluid and prostate fluid, ejac = no sperm (CCS – 15% Canadian couples have this) b) tubal ligation – cut fallopian tubes (CCS – 8%) ...(CCS – hysterectomy removal of uterus – 3%) Vasclip: • new in us • implant – closes on vas without cutting • size: grain of rice • considered: permanent : Tubal sterilization laparoscopy: • tying of fallopian tubes Condoms: a) latex barrier – men b) polyurethane barrier – women • 1 in 5 Spermicides, Foams and Cervical Coverings: • spermicides and foams – chemical barriers o foam in tube, insert like you would tampon • 2 actions – physical barrier, chemically kills o physically like a wall, chemically kills sperm • CCS – 1% (form, jelly, sponge, combined) A= vaginal suppository or contraceptive film. Inserted deep in the vagina and intercourse needs to be timed according to the instructions. B=foam is inserted with applicator – deep in vagina so as to cover cervix Cervix coverings: a) sponge – wet b) diaphragm – dome (not in CSS) – block sperm • apply spermicide around rim and tablespoon in centre of dome • fold edges together • insert up through vagina • place covering the cervix • fits against vaginal wall c) cervical cap – smaller, less than 1% use • covers cervix *test-how does it work* “Natural:” • withdrawl – worry about cowper’s fluid ”pre-cum baby” • fertility awareness a) basal body thermometer – detects progesterone, prior to ovulation-dip, then rise/heat with progesterone b) calendar method – regularity o 28 days – ovulate 14 prior to menstruation  14 (13,15) o add 3 before, 2 after  abstain from intercourse from day 10-17 o irregular  record  months/year o subtract 18 from shortest cycle, 11 from longest cycle...e.g. abstain 8 to 23 from 26 to 34 days (day 1 to day 1 of next) c) post-menstruation: dryness • then cloudy  tacky  clearer • 2 peak days is clear and slippery and stringy  sense of lubrication • ovulation within 24 hours of last peak days • 4 days after last peak day....safe d) ovulation kit – LH in urine – expensive Hormones: • hormone implants and injections • 1. norplant – 6 rods, slowly released progesterone for 5 years/prevents pregnancy for 5 year (off the market/historical) • 2. depo-provera – 3 months, progestin • CCS – 2% use injection • 3. subdermal implants – implanon CCS – Canadian contraceptive study Implanon: • progestin only implant (etornorgestrel) • slow release of low dose hormone over 3 years • very effective (pearl 0.035) • hormone undetectable within 1 week of removal • estrogen levels remain in normal range oral contraceptives 1. combination – E+P high, 21 days 2. mini-pill – progestin only, thickens cervical mucus, suppress ovulation, mimics natural hormone changes – reduces symptoms of taking birth control 3. triphasic (sequential)– mimics natural • general pill “rules”: o same time o antibiotics o missed? take 2 4. emergency pill – 72 hour  high dosage of estrogen • motivation – 25% never start • 47% of users miss more than 1 pill per cycle • 22% of users miss more than 2 pills per cycle • Oral Contraceptives have greater failure for heavier women (175 lbs) o 6-7% vs. 2% failure rate Hormonal Contraceptives and Body Weight • may be an increase of failure (ie unintended pregnancy) in women of higher body weight • increase risk may be in lowest dose • phenomenon not unique to the OC or the contraceptive patch • EXAM *distinguish between how they work – implanon, patch, pill - all work the same way – deliver hormones, prevent pregnancy by hormones– action • *way they’re delivered/ “mode of delivery” is what differs – doesn’t matter – patch, pill, etc Antibiotics and OC efficiency • Rifampin, griseofulvin, ritonavir decrease efficacy • no evidence for decreased efficacy of OC with any other an
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