CHAPTER-04

REPRODUCTIVE Number of teaching hours : 05

Total marks: 05

HEALTH
 REPORODUCTIVE HEALTH

 Reproduction is the fundamental property of all living beings and is essential for multiplication and maintenance
of species.
 The term ‘reproductive health’ refers to healthy reproductive organs with normal functions.
 According to world Health organization [WHO] ‘reproductive health’ means “A total wellbeing in physical,
emotional, behavioral and social aspects of reproduction”.
Thus the person having physically and functionally normal reproductive organs and normal emotional and
behavioral interactions among them in all sex related aspects may be called reproductively health. Therefore for a
healthy society it is important to maintain reproductive health.

Reproductive health – problems and strategies.

There are some major problems which are associated with reproductive health. They are
1) Over population
 Main problem of India is its excess population which is directly connected with reproductive health.
 India first initiated action plan and program at a national level to attain total reproductive health as a social
goal. One such program is family planning which was initiated in 1951.
 Presently improved programs are conducted under the name ‘Reproductive and child health care
programme ’ (RCH)
 The major objectives of RCH programmes are
i) To create awareness among the people about various aspects related to reproduction.
ii) To provide facilities and support for building up a reproductively healthy society.

2) Awareness about reproduction :

 With the help of audio –visual and print media, government and non-government agencies have taken
various steps to create awareness among the people about reproduction related aspects like safe and
hygienic sexual practice, sexually transmitted diseases [STD’s] etc.
3) Sex education :
 Sex education in schools should also be introduced and encourage to provide right information about
myths and misconceptions about sex related aspects.
4) Educating the marriages couple and those in marriages ages group about reproductive organs,
adolescence, safe and hygiene sexual practices, STD’s like syphilis, AIDs etc.
5) Birth control and care of mother and child:
 Fertile couple and peoples of marriageable age group should know about

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 a) Available birth control options.
b) Care of pregnant women
c) Postnatal (after birth) care of mother and child
d) Importance of breast feeding.
e) Equal opportunities for male and female child
6) Infrastructural facilities and material support :
 It is essential to provide medical assistance and care to people in reproduction related problems like
pregnancy, delivery, STD’s abortions, contraception, menstrual problems, infertility etc.
Implementation of better technique, new strategies are also required.
7) Amoniocentesis is the foetal sex determination test based on chromosomal pattern in amniotic fluid
surrounding the developing embryo. There must be statutory ban on amniocentesis for sex determination to prevent
female foeticides.
8) Research on reproduction related areas:
 Research on various reproduction related areas are encouraged and supported by governmental and non-
governmental agencies to find out new methods.
Eg: ‘Saheli’ a new oral contraceptive of female developed by the scientists at central Drug Research
Institute [CDRI] in Lucknow, India.
9) Medical facilities:
 Increased medical facilities for all sex related problems indicate improved reproductive health of the
society. These medical facilities must aim at increased number of medically assisted deliveries and better
postnatal care leading to decreased maternal and infant death rates, increased number of couples with
small families, better detection and care of STD’s etc.

Population explosion and birth control :

 Population is defined as “the total number of individuals of a species in a particular area at a given time”.
 The tremendous increase in sized and growth of population is called population explosion.
 The scientific study of human population is called Demography.
 The world population which was around two billion in 1900, increased about six billion by 2000.
 A similar tread was observed in India too. Our population which was approximately 350 million at the time of
our independence and reached one billion in the year 2000 (may 2000) that means every 6 th person in the
world is an India.
Reasons for population explosion in India :
 Better medical facilities.
 Decline in death rate.

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  Decline in maternal mortality rate (MMR) and infant mortality rate (IMR).
 Large part of population under reproductive age * Child marriage * Lack of Education approval
 Desire of male child
 Traditional religious belief etc.
According to 2001 census report the population rate was still around 1.7% i.e., 17 per 1000 per year. A
rate at which our population could be doubled in 37 years. Such a growth rate could lead to shortage of basic
resources. Therefore the government forced to take up serious measures to check this population growth rate.
Measures to control over population :
 People particularly those in the reproductive age group should be educated about the advantage of small family.
 Statuary raising the age of marriage is more effective means to control the population. Which will reduce the
reproductive span.
 By using contraceptive methods, these helps to avoidunwanted pregnancies.
 The couple of reproductive age are motivated to family planning by adopting birth control measures.
 Couples with small families should be given incentives.
Birth control :

 Conception : Fertilization and subsequent establishment of pregnancy are together called as conception.
 Contraception : Prevention of conception is called contraception.
There are various contraceptive methods are available to control the birth of a child.
Characteristic features of an ideal contraceptive :
 An ideal contraceptive should be user friendly, easily available, effective and reversible with no or least side
effect.
 It also should in no way interfere with the sexual drive, desire or the sexual act of the user.
Contraceptive method for birth control :
The contraceptive methods are grouped into following methods :
1) Natural method
2) Barrier method
3) Intra-uterine device (IUD)
4) Oral contraceptive
5) Injectables and implants
6) Surgical method.
1) Natural method:
 Natural methods of contraception work on the principle of avoiding chance of mating of sperm and ovum.
 This method includes.
i) Periodic abstinence or calendar method or physiological method/
ii) Coitus interrupts
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 iii) Locational amenorrhoea (absence of menstruation)

i) Periodic abstinence :
 In this method the couples avoid or abstain from coitus from 10th to 20th day of menstrual cycle when
ovulation is excepted to occur.
 This period is known as the danger period when fertilization is likely to takes place.
 The remaining period from 5th to 9th day and 21st to 28th day is called the safe period when fertilizations
not likely to takes place.
 This method is not very safe method because the cycles are not absolutely regular.
ii) Coitus interrupts (withdrawal method):
 This is a method practiced by men. It involves removal of the penis form the vagina before ejaculation of
sperm during coitus. So that semen is not deposited in the vagina and there is no fertilization.
iii) Locational amenorrhoea :
 During the lactation period, menstrual cycles do not occurs in women. This period is called lacteal
amenorrhoea.
 As the ovulation does not occur in this period, chance of conception is almost nil , but this period is
effective for maximum period of 6 months after parturition.

2) Barrior methods or mechanical method :

 Prevention of conception by using mechanical devices is called barrior method or mechanical method of
contraception.
 Barrior method of contraception includes condom, Diaphragm, cervical caps and vaults etc.,
i) Condoms :
 Condoms are an elastic nonporous rubber or latex sheath that is used to cover the penis in the male or
vagina and cervix in the female just before coitus or intercourse. The ejected semen is trapped in the
condom, thus the entry of sperms into the vagina is prevented.
 Condoms prevent conception and also protect the user from the sexually transmitted diseases (STD’s).
Condoms are available for both male and female a popular band of condom for male is ‘Nirodh’
ii) Diaphragm, cervical caps and vaults :
 These barrios are used by women.
 These barrios are made up of thin rubber and inserted into vagina and placed over the cervix just before the
intercourse.
 They block the entry of sperms through the cervix into uterus and thus prevents conception. These barrios
are reusable and are used only at the time of intercourse.
 Spermicidal creams, jellies and foams are generally used along with these barriors to increase their
efficiency.

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 Spermicides : The chemical substances used to kill the sperm are called spermicides.
Ex: Citric acid, lactic acid etc.
Spermicides are injected into the female reproductive system before intercourse. It is in the form of foam, jelly,
cream etc.
3) Intrauterine devices (IUD’s):
 Intra-uterine devices are small, flexible object made up of plastic, copper or stainless steel, which are available
in various shapes like a loop, coil, T or 7.
 The IUD’s are inserted into the uterus with the help of insertion tube by the doctor (gynecologist) or expert
nurse.
 The IUD’s is provided with string which are useful to check and confirm its position and also removing
IUD’s. An IUD may remain in the uterus up to three years. It should be replaced after three years.
 IUD’s are available in the following 3 forms.
1) Non –medicated IUD’s : These increase the phagocytosis of the sperm with in the uterus
eg: Lipper’s loop.
2) Copper releasing IUD’s : These are increase phagocytosis of sperm. The CU ions release by such
IUD’s suppresses the sperm motility and fertilizing capacity of sperm.
Eg: Cu-T (extensively used), Cu-7, Multilobed -375, T-cu-375 etc.
3) Hormone releasing IUD’s : These increases phagocytosis of sperm and also makes the uterus
unsuitable for implantation, thus prevent pregnancy.
Ex: Progestasert, LNG-20:
Note :
1) Uses of IUD’s : IUD’s are ideal contraceptive for the female who want to delay pregnancy or space
between the children.
2) In India IUD’s are most widely accepted method of contraception.
How IUD’s prevent conception ?
IUD’s prevent conception in the following way
i) By increasing phagocytosis of sperms with in the uterus.
ii) By suppressing sperm motility and there by fertilizing ability of sperm (Cu ion released by some
IUD’s)
iii) By making the uterus unsuitable for implantation.
iv) By making the cervix hostile to sperms
4. Oral contraceptive pills or hormonal method :
 These are hormonal tablets taken oraly and hence are commonly called oral contraceptive pills.
 The pills contain the hormones estrogen and progesterone combination or progesterone.
 These pills inhibit the release of FSH and LH form the pituitary. Hence it prevent the formation of
Graaffian follide and ovulation as long as the pills are taken.

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  The pills are taken every day continuously for a period of 21 days form 5th day of menstrual cycle.
Ex: Mala –D, Mala -M
 These pills are used by the female.

Saheli:
 ‘Saheli’ is a non-steroidal for oral contraceptive for the females. A pill is taken once is a week.
 It has a very few side effect and high contraceptive value.
 It was developed by the scientists at Central Drug Research Institute ( CDRI ) in Lucknow.
5. Injections and implants :
 Projesteron or progesterone –estrogen combination is used as injections or implants under the skin.
 Their mode of action is similar to oral contraceptive but heirs effective period are longer.
 The injected hormones or implanted hormones prevent ovulation and implantation by inhibiting the
secretion of FSH and LH from the pituitary.
Note :
1) Injection is given once in every three months, that releases hormone slowly and prevent ovulation. They are
convention and highly effective with no serious side effects.
2) Implants:
 These are six matchstick sized capsules containing steroids(estrogen and progesterone).
 They are inserted under the skin of inner arm above the elbow.
 The capsules slowly release the synthetic progesterons about 5 years.
 Minor surgical procedure is needed for insertion and removal.
 It is very safe, convenient effective and long-lasting (5y).
 The women has irregular periods or periods may be absent.

6. Surgical methods or sterilization methods or terminal methods or permanent methods.

 These methods involve sterilization of male or female partner to avoid pregnancies.
 This method blocks gamete transfer and prevent conception.
i) Tubactomy :
 The sterilization procedures in female is called Tubactomy.
 In tubactomy a small portion of fallopian tube is removed andcut ends are tied up with the synthetic
threads through a small incision in the abdomen or through vagina.
 Tubactomy can also be performed with the help of an instrument called leproscope. A method of
female sterilization by using leproscope is called leproscopy.
ii) Vasectomy :
 The sterilization procedure in male is called vasectomy. In vasectomy a small part of vas difference is
removed and cut ends are tied up with the synthetic threads, through small incisions on the scrotum.

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These are the most effective contraceptive techniques, but their reversibility is very poor.

Medical termination of pregnancy (MTP) or Induced abortion :

 Voluntary or intentional termination of pregnancy before the full term is known as medical termination
of pregnancy (MTP).
 MTP has an important role in decreasing the population though it is not done for that purpose. About 45-50
million of MTP’s are performed in a year in the world.
 Government of India legalized MTP in 1971 with some conditions to avoid misuse.
 MTP is safe up to 12 weeks (1sttrimester) of pregnancy. In second trimester MTP is much riskier.
 MTP is essential where pregnancy would be harmful to mother or to the foetus or both.
 One of the dangerous trend in the misuse of amniocentesis to determine the sex of the foetus. If the foetus is
found to be female in many case. It is followed by MT, such female foeticide is illegal.

Sexually TransmittedDiseases (STD’s)

 The term sexually transmitted diseases (STD’) refer to the “diseases or infection which is transmitted
through sexual intercourse”. STD’s are also called veneral disease or reproductive tract infections(RTI).
 STD’s are caused by virus, bacteria, protozoa, Chlamydia etc.
 Some common ex’s of STD’s are Gonorrhea, Syphilis, Genital herpes, chlamydiasis, Genital warts,
Trichomonsis, hepatitis –B, HIV.

1) GONORRHOEA :
 Casual organism : Nisseria gonorrhea a diplococcus bacteria,
 Mode of transmission.
 Through sexual contact with infected person.
 Blood transfusion from an infected person
 Infected mother to children.
 Sharing injection needles, surgical instruments with infected person.
symptoms
In female
i) Severe pain during urination.
ii) Yellow or white pus discharge from vagina
iii) Cervitis (information of cervix)
iv) Abnormal menstrual discharge
v) Infertility
In male
i) Itching or burning sensation in urinary passage.
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 ii) Painful urination,
iii) white or yellow pus discharge form urethra
iv) Urethratis (inflammation or urethra)
v) Enlargement of prostate gland and testis.
vi) Infertility
Treatment :
Antibodies like penicillin, tetracycline are effectively used.
Preventive measures
i) By practicing safe sex
ii) By avoiding heterosexual contact
iii) By using condoms
iv) By bringing community awareness

2) SYPHILIS
 Causative agent : Trepanoma pallidum a spiral bacterium.
 Mode of transmission
 Through sexual contact with infected person.
 Blood transfusions from infected person.
 Infected mother to children
 Sharing of injection needles with infected person.
Symptoms
1) Primary symptoms like painless ulcers on the genital organs.
2) Secondary symptoms like
a. Rashes appears all over the body
b. Enlargement of lymph nodes
c. Severe pain in legs
3) Tertiary symptoms like
a. Appearing of soft tumours called gummas
b. Chronic ulcers appears on pellate nose; lower legs etc.,
c. There can be paralysis, brain damage, blindness, heart trouble if not treated.
d. There can be paralysis, brain damage, blindness, heart trouble if not treated.
Treatment :
Antibodies like spiromycin, penicillin, tetracycline etc.
Prevention
i) Avoid sex with unknown partners.
ii) Always use condoms during intercourse.

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 iii) By practicing safe sex.
3) Chlamydiasis :
 Causative agent: Chlamydia trachamatis, an obligate inter cellular pathogen (affect both male and female
partners)
 Symptoms :
i) Unilateral scrotal pain
ii) Swelling of testis
iii) Yellow mucus and pus discharge
iv) Cerevits
v) Rectal pain with mucus associated with occasional bleeding.
 Treatment : Course of antibiotic drugs like tetracyclin, erythromycin, azithromycin etc.

4) Trichomonasis
Causative agent : Trichomonas vaginalis, a tetraflagellated protozoa (It infects both male and female)
Symptoms :
In female,
i) It causes vaginitis, with foul’s smelling
ii) Yellow vaginal discharge and bringing sensation
In Male :
i) It causes urethritis,
ii) epidymis and
iii) prostatitis resulting in pain and burning sensation
Treatment : Both parents treated simultaneously with a standard drug metronidazole

5) Genital warts
 Casual agent : Human papilloma virus (HPV), a virus
 Symptoms :
 Warts (hard outgrowth with horny surface) developing over the skin and mucosal surface of external
genitalia and perianal area (around the anus).
 In woman, infection may enter vagina and cervix
 Treatment : Surgical removal of warts.

6) Genital herpes
 Causative agent : Herpes simplex virus
 Symptoms :
 Cluster of reddish ulcer over external genitalia and perianal area

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  Swelling of lymph nodes.
 Itching and pain.
 Vaginal and urethral discharge.
 head ache

7) Hepatitis
 Causative agent : Hepatitis –B virus [HBV]
 Symptoms :
i) Fatigue ii) Jaundice (yellowing skin)
iii) Persistent low-grade fever iv) Cirrohasis and possibility of cancer of liver
v) Abdominal pain

8) AIDS : (Acquired Immune Deficiency Syndrome)

 Causative Agent: Human Immuno deficiency virus (HIV), a retrovirus.
 Symptoms :
i) Fever ii) lethargy iii) weight loss
iv) head ache v) Rahus etc
 HIV attacks T-lymphocytes, the patients get immune deficiency and he/she is unable to protect her /himself
against infection.
 Tests :
It is diagnosed by ELISA
 Treatment :
 Anti retroviral therapy (ART) can prolong the life of patient but the disease has no cure.
 All these diseases except Hepatitis, her and AIDS completely curable if detected early and treated properly.
 The STD’s infected persons do not speak medical help for the following reason.
 Absence or less significant symptoms in the early stages of infections.
 Social stigma attached to STD’s.
 The early genital symptoms of STD’s includes the following in genital reasons.
 Itching
 Fluid discharge
 slightly pain
 swelling
These diseases are reported to be high among individuals of age group of 15 -24 years.

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 Infertility :

 The inability of a couple to produce children even after 2 years of unprotected sexual co-habitation is called
infertility.
 The reasons for infertility could be physical, congenital diseases, drugs, immunological or even
psychological.
Note:
Causes of male sterility :
 Deficiency of gonadotropin,
 Decline in the production of sperms
 Obstruction along the reproductive duct due to infection or inflammation
 Azospermia (production of non sperms or complete absence of sperms in semen)
 Oligospermia (presence of less number of sperms in semen i.e, 20 million of sperms presence against 50 -150 per
ml of semen)
 Blockage of vasdeference
 Increased temperature in scrotum
 STD’s (sexually transmitted diseases)
 Failure of delivering sperms during intercourse.
Causes of female sterility
 Deficiency of gonadotrophins
 Absence of ovulation
 Obstruction along the fallopian tube
 Obstruction along the uterus and veginal canal due to inflammation or tumour
 Unfavourable secretions ofuterus, cervix preventing the entry of sperm
 Abnormal development of uterus, STD’s etc.

Other reasons : Sexual incompatibility and absence of sexual intercourse at the time of ovulation.
Remedial measures of infertility :
The childless couple are assisted to have children though certain special techniques commonly called Assisted
Reproductive Technologies(ART).
Some important assisted Reproductive technologies (ART) are
1) IVF-ET(Invitro fertilization –Embryo transfer)
 It is commonly called test tube baby technique.
 Fertilization takes place outside the body female in controlled laboratory condition is called invitro fertilization
(IVF).
 It was developed by British physiologist Patrick steptoc and Robert Edwards in 1978.

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IVF-ET technique involves the following sequential steps:
1) Super ovulation : Administration of FSH and LH into the woman to obtain more number of ova called super
ovulation.
2) Collection of ova : The matured oocytes (ova) are collected by using leproscope or ultrasonography
techniques and collected eggs left in glass dish containing nutrient media.
3) Collection of semen : The semen is collected from male or donor.
4) Invitro-fertilization (IVF) :
 The collected semen is transferred into a glass dish containing egg and sterile culture medium similar
to the fluid in fallopian tube. with in 24 hours the egg fertilized by the semen in the glass dish. The
process is called IVF. (The fusion of egg and sperm outside the body of mother and with in the test tube or
glass dish under controlled laboratory conditions is called IVF)
5) Embryo culture : The transfer of fertilized egg into another medium to allow further growth and fertilized egg
reaches the blastocyst stage and it is ready for implantation.
6) Embryo transfer (ET) : The embryo in the morulla/ blastocyst stage are transferred into the uterus of mother
by using transfer catheter for implantation. Within the uterus normal development of foetus takes place.
Note:
a) The first test tube baby Louis Brown born in England on July 25th 1978.
b) The India first test tube baby born in Bombay KEM hospital in 1987.
c) The validity period of ovum is 12 Hrs. and sperm is 48 hrs in female reproducing tract in normal condition.

2) Gamete intrafallopian transfer (GIFI) :

In this technique ovum and semen is collected from donor female and male as in IVF-ET and it is transferred into
the fallopian tube of another female who cannot produce the ovum, but can provide suitable environment for
fertilization and further development of embryo. such transfer of the ovum and semen is called GIFT.
3) Zyote intrafallopian transfer (ZIFT) : The zygote or embryo upto 8 blastomeres transferred into the fallopian
tube is called ZIFT.
4) Intra-Cytoplasmic sperm-infection (ICSI): In this method the sperm is directly injected into the ovum to form
an embryo in the laboratory and then embryo transfer is carried out.
5) Artificial insemination (AI)
 This method is used in cases where infertility is due to the inability of the male partner to inseminate the female a
due to very lower sperm counts in the ejaculation.
 In this method the semen is collected from the husband or a healthy donor, artificially introduced in the vagina or
into the uterus, it is called intrauterine insemination (IUM)

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