NUR1213

3. Orgasmic disorder: difficulty/inability to

General and Specific achieve orgasm in spite of stimulation and arousal.
problems in Reproduction
II. Vaginal Problems
and Sexuality
OUTLINE a. Vaginal infections
I. Alterations in Sexual Function  Reproductive tract infections – leading
II. Vaginal Problems cause of infertility
III. Cervical Problems  Yeast infection – do not cause infertility
IV. Uterine Problems but recurrent to infections.
V. Tubal Problems
VI. Ovarian Problems b. Anatomic abnormalities
VII. Male infertility
VIII. Diagnostic Studies Sexual Pain Disorders

Infertility – inability to conceive after at least 1 Dyspareunia: during intercourse due to

year of sexual intercourse at least four times per inadequate lubrication, infection, or hormonal
week without contraception. imbalance

Primary infertility – no previous history of either
partner conceiving or impregnating
Secondary infertility – inability to conceive after
a previous successful pregnancy
Sterility – the ability to conceive because of a
known condition, such as the absence of a uterus.
I. Alterations in Sexual Function
Male Dysfunction
1. Erectile dysfunction/impotence: inability to
achieve or maintain an erection sufficient for
sexual satisfaction for oneself or partner.
2. Rapid ejaculation: man is unable to delay
ejaculation long enough to satisfy his partner.
3. Retarded ejaculation: inability to ejaculate
into the vagina or delayed ejaculation. Male
difficulty to reach orgasm.
Vaginismus: involuntary spasm of lower third of
vagina which makes insertion of penis painful or
impossible.
Genital pain: pain with any type of sexual
stimulation other than sexual intercourse.
Highly acidic vaginal environment which
markedly decreases sperm survival
III. Cervical Problems
Cervical incompetence: Cervical stenosis is an
uncommon but potential cause of female
infertility/ With cervical stenosis, the cervical
opening is narrower than it should be and, in
severe cases, may be completed closed.
Exposure to Diethylstilbestrol in utero may have
structural reproductive tract anomalies, increased
infertility, and poor pregnancy outcomes.
IV. Uterine Problems

Female Dysfunction Fibromas (leiomyomas) can be rare cause of

subfertility if they block the entrance of the
1. Hypoactive sexual desire: a persistent or fallopian tubes into the uterus or limit the space
recurring absence of sexual thoughts or disinterest available on the uterine wall for effectiv3
in sexual activity. implantation.

2. Sexual arousal disorder: woman is unable to Overexposure to certain environmental factors

attain or maintain adequate vaginal such as pesticides, other chemicals, and radiation.
lubrication/decreased clitoral or labial sensation.
 NUR1213
Uterine myoma and Uterine fibroids are non-  Inadequate sperm production – 20 million
cancerous tumors that grow in the uterus. Also per ml (normal sperm count)
known as myomas.  Inadequate sperm motility
 Blockage if sperm along male reproductive
V. Tubal Problems tract.
 Inability to deposit sperm in vagina
Pelvic Inflammatory Disease is infection of the
pelvic organs: uterus, fallopian tubes, ovaries, and 4. Testicular Abnormalities
their supporting structures.
 Orchitis
Endometriosis refers to the implantation of uterine  Cryptorchidism
endometrium, or nodules that have spread from  Trauma
the interior of the uterus to locations outside the
 Irradiation
uterus.
5. Coital Difficulties: Obesity, Spinal nerve
VI. Ovarian Problems damage.
Anovulation is the absence of ovulation, the most VIII. Diagnostic Studies
common cause of subfertility in women. Often it
results from a hormonal imbalance caused by a
1. Semen analysis
condition such as hypothyroidism that interferes
with hypothalamus pituitary ovarian.
 After 2 to 4 days of sexual abstinence
Polycystic Ovary Syndrome PCOS is the most  The specimen are counted and then
common, but treatable causes of infertility. examined under a microscope within 1
Ovaries become larger than normal and can have hour
many tiny cysts that contain immature eggs.
2. Cervical mucus assessment
Secretory malfunctions
 Fern test
Inadequate progesterone secretion  Spinnbarkeit test

Inadequate luteal phase: the body doesn’t secrete 3. Postcoital test

enough progesterone, so the uterine lining doesn’t
properly develop making it difficult for a fertilized
egg to implant in the uterus.
VII. Factors Contributing to Male Infertility
1. Congenital factors: anomalies of the penis,
hypospadias (urethral opening on ventral surface),
epispadias (urethral opening on dorsal surface).
Absence of vas deferens or testis.
4. Basal temperature recording
5. Serum progesterone test 10 mg/ml or higher
6. Endometrial biopsy
 For luteal phase defect
 Done 2 to 3 days before an expected
menstrual flow

2. Ejaculation problems 7. Hysterosalpingography

 Retrograde ejaculation – semen enters  Scheduled after a menstrual flow to avoid

bladder instead of emerging through penis.
Cause by Diabetes, Nerve damage,
excessive drugs and alcohol, surgical
trauma.
3. Sperm Abnormalities
reflux of menstrual debris up the tubes and
unintentional irradiation of growing
zygote.
8. Hysteroscopy – visual inspection of the uterus
through insertion of a hysteroscope.
 NUR1213

4. Surrogate Embryo transfer

5. Accepting childlessness as a lifestyle

Medical Management

Female

Infertility of female Surgical treatment

partner
Irregular/absent Endocrine therapy
ovulation
- Clomiphene
citrate
- Pergonal (may
induce
ovulation)
Tubal factors Antibiotic therapy
Surgery
Hysterosalpingogram
Uterine conditions Removal of an IUD
Antibiotic therapy
Surgery
Vaginal/cervical Treatment with
factors antibiotics
Proper hygiene
Artificial insemination

Male

Impotence Psychological
counselling
Penile implants
Low/abnormal sperm - Use of
count hormone
- no good
therapy
Varicocele ligation
Infection in any area Antibiotic therapy
of the male
reproductive system

Alternatives for infertile couples

1. In vitro fertilization

- for blocked or damaged fallopian tubes

- with oligospermia

2. Adoption

3. Surrogate parenting