L-15 Concept of Sexual and

Reproductive Health (SRH)

Problems and their prevention & control among
adolescents

10/05/2021 SzP 2
 Learning Objectives
After this session the students would come to know
about…
• The various issues of sexual health and the sexually
transmissible infections, which can create social
problems for wide population in a community
setting.
• The preventive measures that can be taken in order
to control the reproductive health complications.
• The importance and methods of creating social
awareness amongst population of varied age range
and learning about the importance of quality life
and healthy living.
10/05/2021 SzP 3
10/05/2021 SzP 4
Reproductive System and Reproductive
Health
• The reproductive system or genital system is a
system of sex organs within an organism which work
together for the purpose of sexual reproduction.

• Many non-living substances such as fluids, and

hormones,  are also important elements of the
reproductive system.

• Reproductive health refers to the diseases,

disorders and conditions that affect the functioning
of the male and female reproductive systems
during all stages of life.
10/05/2021 SzP 5
 Disorders of Reproductive System

 Birth defects
 Developmental disorders
 Low birth weight
 Preterm birth
 Reduced fertility
 Impotence
 Maternal Mortality
 Eclampsia
 Menstrual Problem
 Abortion
 Sexual Transmitted Infections (STI)
 Breast, Cervical or Ovarian Cancer
 Enlarged Prostate or Prostate Cancer
10/05/2021 SzP 6
 What is Sexual Health?
According to the World Health Organization, 2006,
Sexual Health is:

“…a state of physical, emotional, mental and social

wellbeing in relation to sexuality; it is not merely
the absence of disease, dysfunction or
infirmity/illness. Sexual health requires a positive
and respectful approach to sexuality and sexual
relationships, as well as the possibility of having
pleasurable and safe sexual experiences, free of
coercion, discrimination and violence..” (WHO,
2006)
10/05/2021 SzP 7
 Reproductive Health….
Reproductive Health includes…
 Adolescence Health
 Family Planning
 Sexually Transmitted Diseases, HIV/AIDS,
 Post-abortion Care
 Safe Pregnancy and Safe Motherhood,
 Reproductive Tract Infections
 RH Services For Adolescents
 Maternal and Infant Nutrition
 Cancer Of the Reproductive Tract
 Infertility
 Gender-based Violence 
 Female Genital Mutilation, human sex trafficking
 Fertilization
 Definition:
• Fertilization is a process in sexual reproduction that
involves the union of male (sperm) and female
(ovum) gametes.
 Chromosomes
We receive 23 pairs of chromosomes from
each parent.
Of these, 22 pairs are identical in structure.
• The 23rd pair, the sex chromosomes,
determines whether we are genetically male
or female.
 More Chromosomes
If we receive an X
from both parents,
we will be female
(XX).
A ‘y’ from our
father, and we are
male (Xy).
 One gene on the
‘y’ leads to testes
development.
10/05/2021 SzP 11
 The Gonadal Stage
 Males and females have identical gonads
(reproductive organs) until about 6 weeks
after conception
 Once the testes or ovaries become functional
their release of hormones controls further
differentiation

10/05/2021 SzP 12
Human Reproduction
 https://www.youtube.com/watch?v=cIK9-
i2DuHM

10/05/2021 SzP 14
 Causes of Infertility
FEMALE MALE
 Ovulation Problem  Abnormal sperm
 Poor Egg Quality production or function
 Endometriosis (Azoospermia)
 Ovarian Cyst  Problems with the
 Fibroid Uterus delivery of sperm
 Fallopian Tube Damage  Overexposure to certain
 Repeated Induced chemicals and toxins
Abortion  Damage related to cancer
 Early Menopause and its treatment
 Thyroid Problem  Other Factors:
 Cancer & Its Treatment  Smoking cigarettes
 Other Factors:  Drug Abuse
 Diabetes  Kidney diseases
 Kidney Diseases  Mumps
 Menstruation
• Menstruation, also known as
a period or monthly, is the
regular discharge of blood
and mucosal tissue from
the inner lining of the
uterus through the vagina
• The first period usually begins
between 12 to 15 years of age, a
point in time known as menarche
• Periods stop during pregnancy
• However, periods may occasionally
start as young as 8 years old and
still be considered normal.  pregnancy.
• Menstrual cycle helps women’s
body prepare for pregnancy every
month.
10/05/2021
o Woman have 2 ovaries, and each
one holds a bunch of eggs. The eggs
are super tiny.
o During menstrual cycle, hormones
make the eggs in woman’s ovaries—
when an egg is mature, that means
it’s ready to be fertilized by a sperm
cell.
o These hormones also make the
lining of the uterus thick and
spongy. So if the egg does get
fertilized, it has a nice cushy, of
nutrients place to land and start a
o If pregnancy doesn’t happen, her
body doesn’t need the thick lining in
uterus. So lining breaks down, and
the blood, nutrients and tissue
SzP 16
flow out of her body.
 Pre Eclampsia & Eclampsia
 Pre Eclampsia:
Pre-eclampsia is a disorder
of pregnancy characterized
by high blood pressure and
a large amount of protein in
the urine.

 Eclampsia:
Eclampsia is a condition in
which one or more
convulsions occur in a
pregnant woman suffering
from high blood pressure,
often followed by coma.
10/05/2021 SzP 17
ABORTION: Every year there are 25 million unsafe abortions in the world.

10/05/2021 SzP 18
 Abortion in Bangladesh
In 2014, an estimated 430,000 menstrual regulation(MR)
procedures were performed in health facilities nationwide.
Some 257,000 women were treated for complications of
induced abortion nationally in 2014.
27% of women seeking MR services at public and
private facilities were rejected caused they missed
the window of time or social and cultural reasons

10/05/2021 SzP 19
 Speak Up…..
Many unspoken problem which men and women
suffer silently in relation to Reproductive Health
due to…
 Cultural sensitivity
 Conditioned behavior
 Ignorance
 Fear and
 Embarrassment
Many of these can prevented and treated if present,
However, many men and women suffer pain,
stress, and even death from inability to seek help
10/05/2021 SzP 20
 Contraception
Contraception aims to
control birth by using
contraceptives
Prevention of conception
or fertilization of ovum
during sexual intercourse
is called contraception
An ideal contraceptive
should be user friendly,
easily available,
effective and reversible
with no or least side effects
10/05/2021 SzP 21
 Factors Influencing
Contraceptive Choices
 Effectiveness  Effect on sexual
 Convenience satisfaction
Popularity  Reversibility
 Availability  Side Effects &
 Comfort/Pleasure/Fu Risks
n/Spontaneity  STI Protection
 Religious or personal Frequency of
beliefs Intercourse
 Duration of  Superstition
protection  Male partners
 Cost choice
10/05/2021 SzP 22
 Nonprescription Methods

 Abstinence
 Withdrawal
 Male Condom
 Female Condom
 Vaginal Diaphragm
 Vaginal Sponge
 Cervical Cap
 Spermicides
 Natural family planning
10/05/2021 SzP 23
 Nonprescription Methods

Abstinence
 Definition can vary.
 Theoretical
effectiveness= 100%
Withdrawal
 Oldest contraceptive
method on record
 Defined as withdrawing
the penis from vagina
prior to ejaculation
 Theoretical
effectiveness= 96%
 Use effectiveness= 73%

10/05/2021 SzP 24
 Nonprescription Methods

Male Condom Female Condom

 Latex, lambskin, and ■ Loose-fitting sheath
made of polyurethane
polyurethane with rings on both ends
•Lambskin is not as ■ Theoretical
effective in preventing HIV
effectiveness= 95%
 Theoretical effectiveness=
98% ■ Use effectiveness= 75%
 Use effectiveness= 85%
 Consistent and proper
use

10/05/2021 SzP 25
 Spermicides
 Kills or immobilizes sperm
on contact
 Prevents sperm movement
toward egg
 Can include:
 Film
 Suppository
 Gel & foam
 Theoretical effectiveness=
82%
 User effectiveness= 71%
10/05/2021 SzP 26
 Contraception..continue
 Methods:
Barrier Method
Hormonal Birth Control
Intrauterine Devices (IUD)
Terminal Method
Behavioral Method

10/05/2021 SzP 27
 Hormonal Birth Control
A. Oral Pills
 Combined Pill
 Mini Pill
 Emergency Pill
 Once a Month Pill
 Male Pill
B. Depot
Formulations
 Injectable
 Subcutaneous
Implant
 Vaginal Rings
10/05/2021 SzP 28
 Contraceptive Patch…..

 Combine hormonal method

 Three weekly patches followed by one
week off
 Theoretical Effectiveness= 99.7%
 User Effectiveness= 92%
 Side effects to consider:
– Local skin reaction
– Possible increase in blood clots due
to higher levels of estrogen
absorbed
10/05/2021 SzP 29
 Vaginal Ring
• Combine hormonal contraceptive method
• Inserted in the vagina and left in place for
3 consecutive weeks and then one week off
• Exact position of the ring in the vagina is
not critical
• Theoretical Effectiveness= 99.7%
• User Effectiveness= 92%

10/05/2021 SzP 30
 Depo-Provera

 Progestin-only contraceptive
 Shot given every 12 weeks
 Theoretical Effectiveness= 99.7%
 User Effectives= 97%
 Side Effects may include
– Weight gain
– Irregular unpredictable bleeding
– Decrease in bone density

10/05/2021 SzP 31
 Implanon/Nexplanon
 Subdermal Hormonal
Implant
 Releases Etonogestrel
 Effective for 3 years
 Theoretical
Effectiveness= 99.5%
 User Effectiveness=
99.5%
 Side Effects include:
– Irregular
breakthrough bleeding
10/05/2021 SzP 32
 Intrauterine Devices (IUDs)

■The risk of upper

tract infection is
increases in the first
21 days after
insertion
• – Upper tract
infection is related
to STIs, not the
device itself
10/05/2021 SzP 33
Rape….
 Sexual Violence

10/05/2021 SzP 35
 Sexual Violence

10/05/2021 SzP 36
 FGM/Harmful Practice
Research studies on the prevalence and classification of female genital
mutilation
Prevalence of FGM among young Egyptian girls
 The Demographic and Health Survey in Egypt (2000)
 97% of married women experienced Female Genital Cutting (i.e. FGM).
 Egyptian Ministry of Health and Population in 2003
 Over 94% of married women had been exposed to genital cutting and 69%
of those women agreed to the procedure being carried out on their
daughters.
 Another study by the Health Insurance Organization
 41% of female students in primary, preparatory and secondary
schools had undergone genital cutting.
o The educational levels of the mother and father were negatively
associated with genital cutting.
o The genital cutting was usually carried out between the ages of 4 and 12
years, though some girls underwent the procedure as late as 15 years and
some shortly after birth.
10/05/2021 SzP 37
These 7 Strategies are Effective for Preventing Violence Against Women

R –elationship skills strengthened

E –mpowerment of women
S –ervices ensured
P –overty reduced
E –nvironments made safe
C –hild and adolescent abuse prevented
T –ransformed attitudes, beliefs, and norms
10/05/2021 SzP 38
 Sexuality
and
SexualOrientation
10/05/2021 SzP 39
 Sexuality and Sexual Orientation
 Sexuality is an important part of who we are as
humans. Beyond the ability to reproduce, sexuality
also defines how we see ourselves and how we
physically relate to others. 
 Sexual orientation is a term used to refer to a person's
emotional, romantic, and sexual attraction to
individuals of a particular gender (male or female).
 Sexual orientation is usually divided into three
categories:
 Heterosexual: attracted to individuals of the opposite sex
 Bisexual: attracted to members of either sex
 Homosexual: attracted to individuals of one's own sex, e.g.
– Lesbian, Gay/MSM
 LGBT (Lesbian, Gay, Bisexual, Transgender)

LGBT rights in Bangladesh:

According to Section 377 of the Bangladeshi Penal Code (law of
the British colonial reign), "Whoever voluntarily has
intercourse against the order of nature with any man, woman
or animal, shall be punished with imprisonment for life, or
with imprisonment of either description that is, hard labor or
simple for a term which may extend to ten years, and shall
also be liable to fine".
 Gender identity/expression No
 Discrimination protections No
o Family rights:
 Recognition of relationships No
 Adoption
10/05/2021
No SzP 41
 Research on this issue…

In 2003, Dr. Gary Dowsett, an Australian

professor, Jeffrey Grierson and Stephen McNally
published a report titled  “A Review of
Knowledge About the Sexual Networks
and Behaviors of Men Who Have Sex
with Men in Asia” as part of a study on how
the AIDS pandemic is impacting the nation
A research-based engagement with a School of
Public Health at a University in
Bangladesh recently aimed to raise public
debate on sexuality and rights.
10/05/2021 SzP 42
 Hijras in Bangladesh
On 11 November
2013, Hijras, who do not
consider themselves male or
female, will also be identified as
a separate gender on official
documents.
 A survey done by the Ministry
of Social Welfare showed
that as of 2013, there are
10,000 Hijras in the country.
Hijras are deemed as
individuals of third gender
who do not fall into the
conventional definitions of male
or female.
10/05/2021 SzP 43
 Hijras in Bangladesh..continue..
While majority of Hijras never exhibit a sexual
orientation towards males or females, they label
themselves as the third gender.
Physiologically, Hijras could be born with
*ambiguous (hermaphrodite) genitals, male genitals
or female genitals.
Scientifically speaking, abnormal levels of sex
hormones during the fetal development is said to be
the main factor giving birth to Hijra.

• (*A lack or deficiency of male hormones in a genetic male fetus can cause ambiguous genitalia,
while exposure to male hormones during development results in ambiguous genitalia in a genetic
female. ... Chromosomal abnormalities, such as a missing sex chromosome or an extra one, also
can cause ambiguous genitalia).
 What is STI?
 According to WHO, “The sexually
transmitted Infections (STIs) are a group of
communicable diseases which are
transmitted by sexual contact and caused by a
wide range of bacterial, viral, protozoal,
fungal and parasites.”
 It is an infection passed from person to person
through intimate sexual contact. STIs are also
called sexually transmitted diseases, or STDs.
 More than 1 million people acquire sexually
transmitted infection (STI) every day.
 RTI’s, STI’s
Reproductive Tract Infection (RTI) are
defined as any infections of the reproductive
system….
They include Sexually Transmitted Infections
(STIs), such as chlamydia, gonorrhea, chancroid,
and human immunodeficiency virus (HIV);
Although RTIs affect both women and men,
research shows that women are more susceptible
to infection and often less likely to seek
treatment than men.
 In addition, complications can be more serious in
women and infections can be transmitted to the
offspring
10/05/2021
of pregnant women.
SzP 46
 Reproductive Tract Infections

The symptoms associated with STIs and other RTIs

vary from none to severe.
People without symptoms often transmit the
infection to others unknowingly.
STI prevention means reducing exposure—by
using condoms and reducing numbers of sex
partners.
Condoms must be used correctly and
consistently to prevent STI.
Adolescents should receive support for decisions
to delay sexual activity.
10/05/2021 SzP 47
 How STI Transmitted?
Sexual transmission (genital-anal, genital-genital,
oral-genital/anal)
Skin-to-skin contact (i.e., kissing, non-penetrative
sex, body rubbing)
Mixture of infectious body fluids (blood, semen,
vaginal secretions)
Sharing of needles and other drug paraphernalia and
needle stick injuries
Through breast milk
From mother to child during pregnancy and childbirth
Infestations (scabies and pubic lice) can also be
transmitted through shared clothing, bedding,
linens
10/05/2021
etc. SzP 48
 High Risk Group
Sex Workers & Their Clients
Homo Sexual
Frequent Traveler (e.g. bus
driver, truck driver etc.)
Drug Abuser
Polygamy
10/05/2021 SzP 49
Common Sign & Symptoms of STI
 An unusual or bad-smelling genital
discharge/Vaginal Discharge
 Urethral Discharge in Men
 Burning or Pain During Urination
 Genital Ulcers
 Abdominal Pain
 Itching or painful genitals
 Sores or blisters on the genitals
 Pain during intercourse
 Rash  
 Fever
 Headache
 IS STI Curable?
 4 are currently curable
 Syphilis
 Gonorrhoea
 Chlamydia
 Trichomoniasis
Other 5 are viral infections and are incurable, but can
be mitigated or modulated through treatment:
 Hepatitis B & Hepatitis C
 Herpes Simplex
 HIV
 HPV
Condoms are the only way to protect
against STIs!

It is very important to use condoms

every time someone having sex
 Prevention of STI
Vaccination
 Screening
 Usage of Condom During Sex
 Avoid Casual Sex
 Health Education
 Safe Delivery of Baby
 Monogamy
10/05/2021 SzP 53
 Menopause
Menopause is a natural part of aging.
However, because their bodies are changing,
some women don’t feel well during menopause.
Some signs are:
• Feeling very hot, gaining weight feeling sad or
angry, having trouble sleeping, and having
sexual problems.

10/05/2021 SzP 54
 Staying Active
 Regular exercise including healthy life, food choices is
very important for good health and sexual wellbeing

Exercise can strengthen muscles, prevent weight gain

10/05/2021 and make youSzP feel happier 55
 How to Maintain Good Reproductive
Health?
Access to accurate information and the safe, effective, affordable
and acceptable contraception method of individual’s choice.
Must be informed and empowered to protect from sexually
transmitted infections(STI).
When decide to have children, women must have access to services that
can help themMALES FEMALES
have a fit pregnancy, safe delivery and healthy baby.
 Preventing STD’’s  Preventing STD’s

 Preventing Infertility  Preventing Infertility

 Regular Medical Check Up  Regular Medical Check Up

 Preventing Trauma  Preventing Vaginal Irritation

 Preventing Jock Itch  For women A regular menstrual
 Preventing Hernias cycle is a good sign of reproductive
health

10/05/2021 SzP 56
Strategies to Prevent Problems Related to
Reproductive Health
Improve Family Planning Strategies
Establishment of Laws
Reduce Maternal Mortality
Proper Medical Care
Awareness
Sex Education
Prevention of Sex Abuse & Sex Related
Crime

10/05/2021 SzP 57
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