REPRODUCTIVE

SYSTEM
 FEMALE REPRODUCTIVE PROCESS

• The ovaries produce the egg cells, called the ova or oocytes. The oocytes are then
transported to the fallopian tube where fertilization by a sperm may occur. The
fertilized egg then moves to the uterus, where the uterine lining has thickened in
response to the normal hormones of the reproductive cycle.

• Once in the uterus, the fertilized egg can implant into thickened uterine lining and
continue to develop. If implantation does not take place, the uterine lining is shed as
menstrual flow. In addition, the female reproductive system produces female sex
hormones that maintain the reproductive cycle.
DRUGS RELATED FOR
PREGNANCY
Iron
• Iron is essential during pregnancy and lactation.

• It gives stamina to the mother, and is essential in proper brain development and blood cell formation for
the baby.

• Iron supplements are recommended if pregnancy lab tests show that the mother is anemic.

• The goal is to prevent maternal deficiency anemia.

• Greatest iron demand occurs in the third trimester: 22.4 mg/day, 6.4 mg/day in the first trimester, and
18.8 mg/day in 2nd semester.

• Those with below 30% hematocrit in the 3rd trimester will have supplemental iron dosages increased.

• No teratogenic effects.
• ADVERSE REACTIONS OF IRON

• Common side effects are nausea, constipation, black tarry stools, GI irritation, epigastric pain,
vomiting, discoloration of urine, and diarrhea.

Super Iron-Rich Foods for Pregnancy & Lactation

• Fortified Cereals.
• Green leafy vegetables - e.g., spinach, methi (fenugreek)
• Dried seeds and nuts.
• Whole grains.
• Pulses and beans - e.g., lentils, peas, soy, kidney bean.
• Fruits - e.g., figs, dates, apples, raisins (dried fruits)
COMPLEMENTARY AND ALTERNATIVE THERAPIES
• Herbal preparations are not recommended during pregnancy. The following herbs should
be avoided:
• Feverfew and sage stimulate blood flow in uterus

• Kava decreases platelets.

• Dong-quai, and gingko biloba increase bleeding when used with anticoagulants.

• Ginseng decrease action of anticoagulants. Pennyroyal is an abortifactant.

 G E N E R A L A D V E R S E E F F E C T S O F S U B S TA N C E S C O M M O N LY U S E D D U R I N G P R E G N A N C Y

Substance Maternal effects Fetal and neonatal effect

Alcohol 1 oz twice a week increased risk for Fetal alcohol syndrome

spontaneous abortion

Caffeine 2 cups increase epinephrine 6-8 cups is toxic to embryo

concentrations after 30 min
Decrease intervillous blood flow with
potential for spontaneous abortion

cocaine Incidence of spontaneous abortion in Hypertonic, tremulous, and has

first trimester; premature delivery and impaired motor development
abruptio placentae

heroin Cause first trimester spontaneous Neonatal meconium aspiration

abortion; premature delivery syndrome

cannabis Placental complications and results to Adverse fetal outcomes

babies with lower birthweights
FOLIC ACID (vitamin B9, Folate)
• Improves the outcome of pregnancy
• Deficiency may contribute to premature birth, low birthweight, abruptio placentae
• Folic acid is very important because it can help prevent some major birth defects of the
baby's brain (anencephaly) and spine (spina bifida).
• Women who are planning pregnancy take a supplement containing 0.4 mg to 0.8 mg 1
month before and for the first 2-3 months after conception.
Folate rich foods
• Dark green leafy vegetables
• Asparagus
• Papaya
• Strawberries and oranges.
• bread, rice, cornmeal, pasta and cereal.
MULTIPLE VITAMINS

• Prenatal vitamins preparations are recommended for pregnant women. Large doses of
minerals and vitamins above recommended amounts do not improve health and can
cause harm to the pregnant patient and fetus.

Preparations:

1. Vitamin A

2. Vitamin B-complex

3. Zinc and copper

4. Calcium

5. Vitamin D

6. Vitamin E

7. Iron
Antidepressant Drugs

• Depressive disorders and exposure to antidepressant drugs have been associated with
adverse birth outcomes

• Adverse outcomes are low birthweight (LBW), infants born small for gestational age (SGA),
preterm delivery, and increased neonatal irritability and decreased attentiveness.

• Taking of selective serotonin reuptake inhibitors are prone for adverse outcomes mentioned
above.

• It is better to choose psycho-therapy than taking medication that can affect the fetus inside
your womb.
 DRUGS FOR PAIN CONTROL

• Headache may occur frequently in 26 weeks of pregnancy. It is not unusual for

pregnant to experience backaches, joint pains and etc.

• Non pharmacologic pain relief measures should be tried initially, including rest,
calming environment, relaxation exercises, ice packs and correct body
mechanics.

ACETAMINOPHEN

• A para-aminophenol analgesic.

• It may be used during all trimesters of pregnancy on a short term basis.

• Does not have significant anti-inflammatory effects.

ASPIRIN & IBUPROFEN

• Aspirin, a salicylate is a mild analgesic. It can inhibit and prolong labor through its effects
in the uterine contractility. This can cause great blood loss during delivery.

• Ibuprofen is a prostaglandin synthetase inhibitor. Bleeding risks are similar with aspirin.
It may cause premature closure of the ductus arteriosus.

SEDATIVES

• Systemic drugs used during labor include sedative-hypnotics(Secobarbital), narcotic

agonists(Fentanyl citrate) and mixed narcotic agonist-antagonist(Butorphanol tartrate).

• These drugs should be administered at the onset of labor because it decreases neonatal
drug exposure because blood flow is decreased to uterus and fetus.
Anesthesia

• Represents the loss of painful sensations with or without loss of consciousness.

• Visceral and Somatic are the two types of pain in childbirth

• Visceral pain from cervix to uterus

• Somatic pain is caused by pressure of presenting part and stretching of the perineum and
vagina.

Regional Anesthesia

• Most common type of pain relief that reduces discomfort during childbirth by numbing
nerves in your lower abdominal and pelvis.

• It is the preferred type of anesthesia by many pregnant women and their physicians
because of the comfort it provides for you and the safety it offers for your baby.
DRUGS THAT DECREASE UTERINE MUSCLE CONTRACTILITY

TOCOLYTIC THERAPY

 When patients in true PTL (Preterm Labor) have no contraindications, they become candidates for tocolytic
therapy.
 Tocolytic therapy is given when conveyance would result in untimely birth.
 No medication has been approved by the FDA as tocolytic.
 The most common tocolytic agents used for PTL are magnesium sulfate (MgSO4), indomethacin, and
nifedipine.
 Goals:
1) Inhibit utero contractions to create additional time for fetal maturation in utero.
2) Delay delivery so antenatal corticosteroids can be delivered to facilitate fetal lung maturation.
3) Allow safe transport of patient to an appropriate facility.
CORTICOSTEROID THERAPY IN PRETERM LABOR
Bethamethasone
 When PTL occurs before 32nd week of gestation, this therapy is prescribed.
 Route and dosage: 12 mg q24 x 2 doses
 Adverse reactions: rare but include seizures, headache, vertigo, edema, hypertension, increased sweating,
petechiae, ecchymoses, and facial erythema.
 Contraindicated in severe gestational hypertension and in systemic fungal infection.
 Metabolized in liver and excreted by kidneys: crosses placenta; enters breast milk.
 Onset: 1-3h; peak: 10-36 min; duration: 7-14 d; t ½ : 6.5h
Dexamethasone
 Corticosteroid used to accelerate fetal lung maturity during weeks 24-34 of gestation.
 Has a rapid onset of action and a shorter duration of action, it must be prescribed in a shorter frequency than
betamethasone.
 Adverse reactions: insomnia, nervousness , increased appetite, headache, hypersensitivity reactions, and
athralgias.
 Route and dosage: IM 6mg q12h x 4 doses.
 Uses and contraindications are same as betamethasone but with shorter half-life.
DRUGS FOR GESTATIONAL HYPERTENSION

Gestational hypertension

 An elevated high blood pressure without proteinuria after 20 gestational weeks in

patients normotensive before pregnancy, the most common serious complication of
pregnancy.

Preeclampsia

 Gestational hypertension with proteinuria.

• Observed after 20 weeks gestation, intrapartum, and during the first 72 h postpartum
 HYPERTENSIVE DRUGS

• High blood pressure can lead to many serious health problems, such as heart attack, heart
failure, stroke and kidney disease.

• Diuretics are some of the most commonly used drugs for treating high blood pressure. They
help kidneys get rid of excess water and sodium, or salt.

• Beta-blockers work by blocking the actions in your body that stimulate your heart. Allows
your heart to beat with less speed and force.

• Alpha-blockers work by blocking catecholamines from binding to alpha-receptors. Blood can

flow through blood vessels more freely and your heart beats normally.
 OTC HERBAL DRUGS

• A product made from plants and used solely for internal use is called an herbal supplement. Many
prescription drugs and over-the-counter medicines are also made from plant products, but these
products contain only purified ingredients and are regulated by the FDA.

Example:

• Echinacea

• Flaxseed

• Ginseng

• Gingko

• Evening primrose
LABOR, DELIVERY, AND
POSTPARTUM
 DRUGS THAT ENHANCE UTERINE MUSCLE
CONTRACTILITY

• Uterotropic drugs enhance uterine contractility by stimulating smooth muscle of the uterus.

• Oxytocin, the ergot alkaloids, and some prostaglandins constitute the uterotropics.

Oxytocin

 Synthesized in the hypothalamus and is transported to nerve endings in posterior pituitary glands.

 It facilitates uterine smooth muscle contraction

 Oxytocin prepared in synthetic form is approved by FDA.

Ergot Alkaloids

 One of a large group of alkaloids derived from fungi, act by direct smooth muscle
cell-receptor stimulation.

 These drugs are not used during labor because they can result in tetanic
contractions that could result in fetal hypoxia and rupture of uterus.

 The most common used ergot derivative is methylergonovine maleate (can be given
by mouth but frequently administered intramuscularly).
 NONPHARMACOLOGIC MEASURES FOR COMMON POSTPARTUM NEEDS
Indication Intervention
Uterine  Patient is positioned on the abdomen with a pillow under abdomen for 20-30 mi for 3-4 d.
contractions  Distraction, breathing techniques, and ambulation may be used.
 No heat should applied to the abdomen.

Perineal  Ice packs with a nonlatex glove filled with crushed ice and covered in a thin absorbent material applied
wound for 6-8 h after delivery.
resulting from  Patient is positioned on her side with pillow between legs.
episiotomy or  Cool sitz bath should be taken 2-3 h after delivery along with warm sitz baths 12-24 h after delivery 2-
laceration 3 times daily.
 Patient is advised to tighten buttocks.
 Advise no intercourse

Hemorrhoids  As above but:

 Ice
 Sims position
 Warm, moist heat
 Witch hazel pads
Lactation  Tight bra worn 10-14 d
suppression  Normal fluid intake
 No stimulation of breasts
 Pyridoxine 200 mg for 5 d

Engorgement  Same for lactation suppression

 Cold cabbage leaves placed inside bra is helpful

Sore or  Wear absorbent breast pads.

cracked  Do not use soap or nipples.
nipples  Air dry nipples after nursing.
 DRUGS USED IN POSTPARTUM PERIOD

Lactation Suppression

 Due to severe effects, such as thrombophlebitis and potential carcinogen effects,

medications that were once prescribed for lactation suppression are no longer used.

 Nonpharmacologic effects are recommended such as wearing a well-fitted bra or

breast binder for 72 hrs after giving birth.

 If breast engorgement occurs, ice pack to the breast can help decrease the
discomfort and swelling. Use of cabbage leaves helps decrease the engorgement.
 VITAMIN K

• Vitamin K plays a role in helping blood clot and preventing excessive bleeding

• Vitamin K is not typically used as a dietary supplement.

• Vitamin K is actually a group of compounds. The most important of these compounds appears to be vitamin K1 and
vitamin K2.

• Vitamin K1 is obtained from leafy greens and some other vegetables. Vitamin K2 is a group of compounds largely
obtained from meats, cheeses, and eggs, and synthesized by bacteria.

While vitamin K deficiencies are uncommon, you may be at higher risk if you:

• Have a disease that affects absorption in the digestive tract, such as Crohn's disease or active celiac disease

• Take drugs that interfere with vitamin K absorption

• Are severely malnourished

• Drink alcohol heavily

IMMUNIZATIONS

Rho(D) Globulin

 A patient who lacks the Rhesus (Rh) factor in her own blood (Rh-negative mother) may
carry a fetus who is either Rh negative or Rh positive.
 Administered to women with maternal/fetal blood mixing, such as after abortion or with
threatened abortion, obstetric manipulation or trauma, or ectopic pregnancy.
 If abortion occurs up to and including 12 weeks` gestation, microdose is administered if
less than 2.5 ml of Rh-incompatible RBCs were administered.
 During the postpartum period, Rho(D) immune globulin should be administered within 72 h,
one full dose (300 mg) is given postpartum if newborn is Rh positive, as antepartum
prophylaxis at 26-28 weeks` gestation.
DRUGS ADMINISTERED TO
PRETERM NEONATES
Synthetic Surfactant

o A lipoprotein is necessary to decrease the surface tension of the alveoli to allow the
lungs to fill with air and prevent the alveoli from deflating.

o One approach use to minimize respiratory difficulties in preterm neonatal is surfactant

replacement.

o Supplementing the amount of endogenous surfactant available to maintain distention

of the alveolar sacs is the focus of this therapy.

• Beractant

o A natural bovine lung extract, contains phospholipids, neutral lipids, fatty acids and
surfactant-associated proteins to which palmitic acid, and tripalmitin are added.

o Does not require reconstitution

Calfactant
o Does not require reconstitution, nor does it need to be warmed at room temperature prior to use.
Poractant Alfa
o Porcine lung surfactant and indicated for rescue treatment.
o Should be slowly warmed to room temperature and does not need reconstitution.

Drugs administered to full-term, healthy neonates

o According to WHO newborn should receive eye care, phytonadione and immunization for hepatitis B
o Anti infective agent may apply to chord stump during the first few hours after birth and for up to 1 week at
risk newborns.
Erythromycin Ophthalmic Ointment
 Common anti infective administered to a newborns eye within the first hour of birth.
 Given as prophylaxis against eye infection
 Side effects includes chemical conjunctivitis in about 20% of neonates
 Manifesting as edema and inflammation that last about 24 to 48 hours.
Drugs administered to newborns
Erythromycin Ophthalmic
Ointment
Hepatitis B immune globulin
Phytonadione
Within 1 h of delivery and without
touching the tip of the tube to the
eye, fingertips or any other
surface, place a 1-cm of ointment
in the lower conjunctiva sac of
each eye, beginning at the inner
canthus.
IM: 0.5 ml within 12 h after birth
into the anterolateral thigh (vastus for HBsAG for passive immunity,
lateralis)
5-1 mg into the anterolateral thigh
within 1 h after birth; check health
care provider or agency standing
orders for dosage.
Prevention of ophthalmia
neonatorum, an eye infection
among newborns are protection
against gonococcal and
chlamydial conjunctivitis. Most
state mandate erythromycin
ophthalmic ointment but consult
your facility’s policy.
For newborns of mothers positive
obtain consents from parents.
Initiated recombinant HB as a
separate injection at different sites;
aspiration is not required.
An anticoagulant antagonist for
prevention of hemorrhagic disease
of the newborn. Drug is readily
absorbed after IM administration
Recombinant hepatitis B IM/Subcu: 0.5 ml within 12 h
after birth, subsequent doses at
1 and 6 mo of age into
anterolateral thigh
Stimulate the immune system
to produce anti- HBsAG
antibodies without the risk of
developing active infection.
Because hepatitis D occurs
only in person infected with
hepatitis B, recombinant HB
protects against hepatitis D.
Protection usually occur 1
month after the third dose.
WOMEN’S REPRODUCTIVE
HEALTH
 Women have specific health care needs throughout their reproductive and post-reproductive
life cycle. The woman’s reproductive life cycle begins with menarche, the start of spontaneous
menstruation, and continues through menopause, the permanent cessation of menstruation.
Successful contraception is essential to the health and well-being of sexually active women of
reproductive age. During the productive the reproductive years, many disorders can occur in
women’s health. These gynecologic conditions interfere with a woman’s overall health and well-
being and many impede her ability to become pregnant.
Under the Affordable Care Act, conception is classified as preventive health service. Drugs for
infertility are addressed with an emphasis on drugs that stimulate ovulation.
 ETHINYL ESTRADIOL 

• The most commonly used synthetic estrogen found in CHCs.

• This combination hormone medication is used to prevent pregnancy. It contains 2

hormones: levonorgestrel (a progestin) and ethinyl estradiol (an estrogen). It works mainly
by preventing the release of an egg (ovulation) during your menstrual cycle. It also makes
vaginal fluid thicker to help prevent sperm from reaching an egg (fertilization) and changes
the lining of the uterus (womb) to prevent attachment of a fertilized egg.

• Ethinyl Estradiol may be in a patch form. The patch is placed once a week for 3 weeks and
fourth week is patch free to allow withdrawal bleeding.
ORAL CONTRACEPTIVE

• A pill is ingested daily that is absorbed by the gastrointestinal tract and metabolized by the liver.

• Oral contraceptives are hormonal preparations that may contain combinations of the hormones

estrogen and progestin or progestin alone.

COMBINE HORMONAL CONTRACEPTIVES

• Contains synthetic version of estrogen and compound known as progestin.

• This prevent the formation of a dominant follicle.

• One of the most commonly used methods of reversible contraception because of their ease of use,
high degree effectiveness and safety.

• Reduce the incidence of PID, ectopic pregnancy, endometrial and ovarian cancer risk, and deaths
from colorectal cancer.
Progestin Contraceptive

Includes:

Progestin-Only Oral Contraceptive Pill, Depot Medroxyprogesterone Acetate, Progestin Implant

• Do not contain estrogen. The estrogen component of contraceptives increases the risk of circulatory
disorder, therefore these products allow contraception to be available on women who cannot take CHC.

• Advantages – Safe, easy to use, spontaneity of sexual intercourse and reversibility

• Disadvantages – Higher incidence of irregular bleeding and spotting as well as possibility of depression,
mood changes, decreased libido, fatigue and weight gain.

– Well absorbed from the GI tract. Peak plasma levels occur 1 to 2 hours after ingestion. Progestins are
bound to plasma proteins.
Spermicides
- Chemical agents that inactivate sperm before they can travel through the cervix.
- Most common spermicide is nonoxynol-9 (jellies, cream, foam, suppositories and films)
- When combined with other barrier methods such as condom or diaphragm, it increases protection.
- This can cause vulvovaginal abrasions and altered vaginal flora which increase susceptibility to pathogens.
Intrauterine Contraception
- Intrauterine devices and intrauterine systems are safe methods of contraception with high patient satisfaction
rates.
- Have highest effectiveness rates of reversible forms of contraception.
Barrier methods
- Both male and female condoms are available OTC.
- Female condom is polyurethane pouch with flexible rings at each end
- Male condoms are available in latex, lambskin, and polyurethane. This offers excellent protection against
STIs and HIV.
- More effective to use with spermicides.
- Cervical caps and diaphragm are another example.
 MEDICAL ABORTION

• This ends a pregnancy that is less than 63 days from the first day of LMP or less than 9 weeks’
gestation.

• Uses drugs to disrupt an established pregnancy.

• Surgical abortion refers to procedures used to remove the products of conception from the uterus.

• Mifepristone is a drug that stops the pregnancy in the uterus and also treat an early ectopic pregnancy.

• Mifepristone is an antiprogestin that blocks the hormone progesterone.

• Misoprostol is given to cause the uterus to contract and expel the products of conception.
 COMMON DISORDERS IN WOMEN’S HEALTH

• IRREGULAR OR ABNORMAL UTERINE BLEEDING

- Irregular uterine bleeding is a term that describes many different medical conditions or pathologies
related to the menstrual cycle.

- Common reason why women seek gynecologic care.

• AMENORRHEA

- Absence of menses.

- Primary amenorrhea is defined as no menses by age 14 and 16 without secondary sex

characteristics.

- Secondary amenorrhea is the absence of spontaneous menstrual period for 6 consecutive months.
• POLYCYSTIC OVARIAN SYNDROME

- Another common cause of secondary amenorrhea is PCOS

- Disorder in the metabolism of androgens and estrogen. This may be caused by dysfunction of the HPO axis.

- Women with PCOS experience menstrual dysfunction, anovulation, hyperandrogenism, hirsutism, infertility,
obesity, metabolic syndrome, diabetes, and sleep apnea.

- Diet and exercise are first-line treatment for PCOS.

• DYSFUNCTIONAL UTERINE BLEEDING

- Most common classification of irregular bleeding.

- Diagnosis is made when no organic pathology can be determined to cause irregular bleeding.

- Increasing levels of estrogen by administration of estrogen drug product is usually effective in stopping
prolonged DUB.
 DYSMENORRHEA

• Also called cyclic pelvic pain (CPP), is pelvic pain associated with menstrual
cycle. Other symptoms are uterine cramping, lower back pain, abdominal
cramps, changes in bowel patterns, increased bowel movements and nausea
and vomiting.

• Primary dysmenorrhea when there is no apparent underlying pathology. It is

caused by larger amounts of prostaglandins at the start of menstrual period

• Secondary dysmenorrhea when there is an underlying cause for pelvic pain like
urinary tract infection, PID, irritable bowel syndrome, uterine leiomyomata and
endometriosis.
 PREMENSTRUAL SYNDROME

• Comprises a collection of cyclic physical symptoms and perimenopausal mood alterations.

• PMS can result in decreased work effectiveness and distressing mood variations.

• There is no universal agreement about the definition, etiology, symptoms, or treatment of PMS.

• Researchers theorize that etiology of PMS could be hormonal excess or deficits.

• Diagnosis of PMS by recording 3 variables:

1. group of symptoms

2. severity of symptoms

3. impact on function

• Symptoms usually have negative impact on the ability to function effectively.

 DRUG USED TO PROMOTE FERTILITY

• INFERTILITY
- Defines as the inability to conceive a child after 12 months of unprotected sexual intercourse.
- Women older than 35 years may be considered infertile after 6 months of attempting preganancy.
- Primary infertility if a couple has never conceived or has never carried a pregnancy to term.
- Secondary infertility describes a couple who has conceived and brought pregnancy but unable to
conceive afterward.
- Fertility rates decrease in both men and women as they get older.
- Infertility risk for female is higher than males.
- The monthly chance of achieving pregnancy decreases to 5% after 40 years old.
- Clomiphene citrate is an ovulation stimulant. With binding of CC to the estrogen receptors, the
hypothalamus receives a signal that circulating estrogen levels are low.
 MENOPAUSE

• The transitional process experienced by women as the move from the reproductive years into
the nonreproductive stage of life.
• A naturally occurring event and part of normal life cycle of a woman. It occurs between their
mid- forties and mid-fifties but may start early as the late thirties.
• Menopause has 3 stages: Perimenopause, Menopause and Postmenopause.
PERIMENOPAUSE
 This includes the years before the natural cessation of spontaneous menstruation.
 Women may experience short cycles (<25d), long cycles (>35d), heavy bleeding, or period of
longer and shorter periods.
 Symptoms include insomnia, headaches, irritability, anxiety, mood swings, memory lapses and
joint aches.
 During perimenopausal period, ovarian follicles become depleted, causing estrogen levels to diminish.

MENOPAUSE
 Menopause us the permanent end of spontaneous menstruation caused by cessation of ovarian
function.
 Women who experience menopause before 40 years of age are said to have premature ovarian failure.
 Menopause can occur as a secondary effect of oophorectomy (surgical removal of ovaries), radiologic
procedures in which ovarian function is destroyed, severe infection, ovarian tumors or endometriosis.
 Women should use contraception until menses has ceased for 1 year.

POSTMENOPAUSE
 Is the stage when the body adapts to a new hormonal environment.
 The production of estrogen and progesterone decreases.
 The ovaries continue to secrete androgens in varying amounts as a result of the increased LH levels.
• HORMONE THERAPY

- Significantly improves vasomotor symptoms and vaginal dryness, two frequently encountered symptoms of
menopause.

- Vasomotor symptoms have the potential to disrupt sleep quality and to exacerbate irritability, mood swings,
depression, and problems with concentration.

- Decreases in systemic estrogen cause vaginal dryness and atrophic vaginitis, leading to dyspareunia and
sexual dysfunction.

- Decreased estrogen also has an effect on libido, sexual arousal and the achievement of orgasm.

- Current guidelines do not support the use of Hormone therapy for the prevention of cardiovascular disease,
osteoporosis, or dementia.

- HT is used only for the relief of symptoms related to menopause, hot flashes, vaginal dryness and sleep
disorders.
 DRUGS RELATED TO MALE
REPRODUCTIVE DISORDERS
DRUGS RELATED TO MALE REPRODUCTIVE DISORDERS
 
Androgen
o Male sex hormones, control the development and maintenance of sexual processes.
o Accessory sexual organs cellular metabolism, bone and muscle growth.

Testosterone
o An anabolic steroid, the principal male sex hormone.
o The prototype of the androgen hormones.
o Synthesize primarily in the testes, and to lesser extent, in the adrenal cortex.

Pharmacokinetics
o Testosterone secretion is greater in men than in women in most stages of life.
o 98% of circulating testosterone is bound to both sex hormone-binding globulin and albumin protein.
o 2% unbound or circulating free in plasma; this unbound is biologically active.
o Estrogen elevates the production of sex hormone-binding globulin (SHBG), result in more protein bound
testosterone in women.
o 90% of testosterone is excreted in the urine as glucuronic and sulfuric acid conjugates and its metabolites.
o Synthetic androgens may be excreted as unaltered hormone or as metabolites.
 INDICATION FOR ANDROGEN
NATURAL ANDROGEN
Drug Uses and consideration Route and dosage
Testosterone  

Testosterone nasal
Transdermal testosterone patch
Testosterone Topical gel
Buccal testosterone
For primary hypogonadism,
male and hypogonadotropic
hypogonadism male.
Drug is started at the full dose
and adjusted according to
tolerance and therapeutic
response
Less skin irritation occurs with
the gel than with the patch
Pregnancy category: X ; BP:98;
10-100 min
Nasal: 5.5 mg per gel pump
actuation; 1 pump actuation in
each nostril 3 time/ d
Transdermal patch: 2mg/ 24 h
or 4 mg/ 24 h patch; apply to
nongenital skin; avoid bong
areas
 1% Gel: 50-100 mg once daily
2% Gel: 40- 70 mg once daily
Buccal: 30 mg twice daily
Transdermal testosterone patches
o Adequate serum concentrations when applied to the arm, back or upper buttocks
o Daily application of one to two TT 2 mg/ 24 h at 10 pm result in serum testosterone concentrations

Testosterone Gel
o Applied to clean dry skin of shoulder or upper arm.
o Should not be applied to genitals
o Carries a boxed warning, as it can be transferred to others through personal contact with skin or clothing.
o Caution is Advice

Side effect
o Hypogonadal men on androgen therapy may experience frequent erection or priapism,
o Gynecomastia; mammary gland enlargement in men
o Urinary urgency
o Halt spermatogenesis; formation of spermatozoa
o Abdominal
o Nausea
o Insomnia
o Diarrhea or constipation
o Hives or redness of injection
Drugs that cause sexual dysfunction
Drug category Drugs or Drug Families
 
Anticholinergics - Atropine, Scopolamine, Benztropine, Trihexyphenidyl
 
Antidepressants - Tricyclic antidepressants, Monoamine oxidase inhibitors, Selective serotonin
 
Antihistamine - Dephenhydramine, Hydroxyzine
 
Antihypertensive - Centrally acting alpha2 agonist, alpha and beta receptor, Diuretics
 
Antipsychotics - Phenonthiazines, Thioxanthenes, Butyrophenone
 
Antiulcer drugs - Cimetidine, Ranitidine, Famotidine

 Sedative drugs - alcohol, Barbiturates, Diazepam, Chlordiazepoxide, Cannabis, Cocaine, Opiates,

Methadone
 
 
CAUSES OF MALE REPRODUCTIVE DISORDERS

• DELAYED PUBERTY
- This happens when testicle enlargement , followed by penile growth and pubic hair development
has not begun by age 14.
- Delayed in growth may be a normal part of a maturation process but the cause could also be
androgen deficiency.
- Secretion of GnRH, LH or FSH is insufficient.
- Treatment only begun after 14 years of age like full evaluation including:
- Luteinizing Hormone
- FSH
- thyroid stimulating hormone
- testosterone levels
• SEXUAL DYSFUNCTION

- The inability to experience sexual desire, erection, ejaculation, and detumescence.

- Inhibited sexual desire can result form androgen deficiency.

- Individuals who experience premature ejaculation related to excessive anxiety about sexual intercourse may
be helped by treatment with one of the many antidepressants alone or in conjunction with psychotherapy.

• ERECTILE DYSFUNCTION

- Is the inability to achieve or maintain erection satisfactory for sexual performance.

- This happens when not enough blood flows to the penis during sexual stimulation.

- May be caused by psycho-emotional problems, diabetes, hypertension, lower urinary tract symptoms, pelvic
surgery, neurologic disorders and androgen deficiency.

PHOSPODIESTERASE INHIBITORS

- Facilitates erection by enhancing blood flow to the penis.

 NON-SEXUALLY TRANSMITTED INFECTIONS

• Drugs used to treat acute or chronic prostatitis, orchitis, or epididymitis are the same as those used to treat urinary tract
infections.

BENIGN PROSTATIC HYPERPLASIA

- Abnormal increase in the number of cells, results in hypertrophy or enlargement of gland.

- Its cause is unknown. But common to older men.

- Although BPH is not a life threatening condition, but its symptom’s impact can be significant in life.

MALIGNANT TUMORS

- Prostatic cancer accounts for about 10% of cancer deaths among American men.

- Most of prostatic cancers are adenocarcinomas.

- Asymptomatic but urinary obstruction is commonly the first sign

- Treatment may include surgical resection, cryotherapy, antiandrogen administration, radiation therapy, chemotherapy and
pain management.
SEXUALLY TRANSMITTED
INFECTION (STI)
 Every day, over 1 million new cases of sexually transmitted infections (STI) occur worldwide. The incidence
of STI’s has been among since 2013. Young adults are at risk, particularly among women, but infections
among men are also rising. Over bacteria, viruses and parasites can cause STIs. Majority of persons with
STIs experience few or no symptoms, making it difficult to diagnose and treat to stop the spread of
infections. STIs are spread through sexual contact, via blood product, and through mother-to-child
transmissions during pregnancy and childbirth.
Sexually Transmitted Infections
• Sexual transmission of pathogens can occur through breaks in the vaginal or cervical mucosa or in the skin
covering the shaft or glans of penis.
• Each act of coitus results in tiny friction induced fissures on these surfaces.
• Seminal fluid, spermatozoa, vaginal secretions, blood, and other body fluids can carry pathogens.
• Anal penetration is risky because of the likelihood of tissue trauma that results in the partner’s exposure to
enteric microorganisms.
• Other high risk practices are anal or vaginal intercourse with no condoms, contact with menstrual blood
during sexual activity.
Bacterial Pathogens
 Sexually transmitted bacterial pathogens can be effectively treated with antibiotic therapy.
 When present, symptoms are vaginal discharge, urethral discharge or burning (in men), genital ulcers and
abdominal pain.

Chlamydia
• Chlamydia trachomatis is the most common STI in US in young adults.
• Women who contract the infection are at risk for pelvic inflammatory disease (PID), ectopic pregnancies,
and infertility.
• The CDC recommends azithromycin 1g orally.
• Doxycycline is contraindicated in the second and third trimesters of pregnancy.
• Neonates may contract C. trachomatis from exposure to the mother’s infected cervix during delivery.
• Person treated for Chlamydia infection should be instructed to abstain from sexual intercourse for 7 days
after single dose therapy.
Gonorrhea
• Second most common communicable disease.
• Greenish yellow or whitish discharge from penis accompanied by burning with urination.
• In women, it is asymptomatic. If left untretated, infection develops PID.
• Dual drug therapy is recommended with ceftriaxone 250 mg given IM plus azithromycin 1 g orally.
• Neonates may contract N. gonorrhoeae from exposure to mother’s infected cervix.
Syphilis
 Caused by Treponemia pallidum
 Treatment for primary syphilis and secondary syphilis is benzathine penicillin G, 2.4 million units to given IM
in one dose.
 Infants and children should be treated with benzathine penicillin G, 50,000 units/kg IM up to the adult dose of
2.4 million units in a single dose.
 Adults with early latent syphilis should treated with benzathine penicillin G, 2.4 million units Im in a single
dose.
 Persons with tertiary syphilis should receive CSF analysis.
Viral Pathogens
 Infections caused by viral pathogens are not curable.
 Medication therapy is palliative.
 Include herpes simplex virus1 (HSV-1; cross-contaminated form oral to genital) and HSV-2, HPV, and
HIV.
 
Herpes Simplex Virus
 Genital herpes is a life-long viral infection.
 2 kinds of HSV can cause genital herpes; HSV-1 and HSV-2.
 Systematic antiviral drugs can control some of the signs and symptoms.
 Three antiviral drugs used in management of genital herpes: (1) acyclovir, (2) valacyclovir, and (3)
farciclovir.
 The recommended drug regimen for suppressive therapy of pregnant women with recurrent genital
herpes is acyclovir 400 mg orally three times a day or valacyclovir 500 mg orally twice a day with
treatment recommended starting at 36 weeks of gestation.
  
Human Immunodeficiency Virus
 Blood and genital secretions is extremely elevated.
 Antiretroviral therapy (ART) during acute HIV infection is recommended because it substantially reduces
transmission to others.
 Partner notification for HIV infection should be confidential.
 All pregnant women should be tested for HIV infection during the first prenatal visit. A second test during
the third trimester, preferably at less that 36 weeks' gestation, is recommended for those known to be at
high risk for HIV.
 OTHER PATHOGENS

PEDICULOSIS PUBIS
- Parasitic infection caused by Phthirus pubis, seek treatment because of extreme pruritus of the
body part where lice are moving and laying eggs.
- Infected person may notice lice or nits in their pubic hair.
- Transmitted by sexual contact.
- Recommended treatment is permethrin 1% cream or pyrethrins with piperonyl butoxide r
- applied to affected areas and washed off after 10 mins.
SCABIES
- Infection with Sarcoptes scabie causes pruritus which takes up several weeks to develop.
- Scabies in adults are sexually acquired while in children are not.
- Treatment is permethrin 5% cream applied all areas of body and washed off after 8-14 hrs.
TRICHOMONIASIS
- Protozoan parasite Trichomonas vaginalis most common curable STI in US.
- Most people with T. vaginalis have minimal or no symptoms.
- Men may develop urethritis, epididymitis, or prostatitis
- Women may develop a diffuse vaginal discharge that is malodorous and yellow green, with or without
vulvar irritation.
- Nitroimidazoles are the only class of antimicrobials effective against T. vaginalis.
VULVOVAGINAL CANDIDIASIS
- Caused by Candida albicans but also may caused by other Candida species.
- Symptoms are pruritus, vaginal soreness, dyspareunia, external dysuria, and abnormal vaginal discharge.
- Treatment with topically applied azole drugs results in symptomatic relief and negative cultures in 80-90%
of patients who complete therapy
 The Right way to Use a Male Condom
Condom Dos
 Do use a condom every time you have sex
 Do put on a condom before having sex
 Do read the package and check the expiration date
 Do store condom in cool, dry place
 Do use latex or polyurethane condoms
 Do use water or silicone-based lubricant to prevent breakage
 Do remember that condoms come in many sizes and thickness find a brand that work best
for you and your partner
And Don’ts
 Don’t store condom in a car or keep them in your wallet
 Don’t use oil-based product like baby oil, lotion and petroleum jelly
 Don’t reuse a condom
 Don’t use more than one condom at a time
 Don’t flush condoms as thing may clog the toilet.
How to put on a Male condom
 Carefully open and remove condom from wrapper
 Place condom on the head of the erect, hard penis, if uncircumcised pull back the foreskin first
 Pitch air out of the tip of the condom
 Unroll condom all the way down the penis
 After sex but before pulling out hold the condom out the base and withdraw the penis
 Carefully remove the condom and throw it to the trash.
How to use Female condom
 Before using the condom for the 1st time during sex, you should practice placing in your vagina
 When ready to have sex, check the expiration date, apply lubricant to the close end
 When ready to insert the condom, find position that works for you try squatting, lying down, and
put one foot at the chair while standing.
 Using your thumb and forefinger, squeeze the side of the inner ring together. Make sure to have
a firm grip before attempting to insert.
 Using your forefinger as a guide, insert the inner ring much like you would a tampon,
and push it up towards your cervix with your finger.
 Once reach the cervix, the condom will expand naturally
 Gently remove the condom and make sure that at least one inch is hanging outside of
the vagina
 When ready to have sex, let your partner insert his penis in the outer ring and into the
condom. If you want to help him, make sure that his penis is actually entering the
condom not just pushing it to the one side.
Thank you! 

Fernandez, Rein Heart Mar

Lamprea, Maerald
Lecobo-an, Crizel Mae
Maternal, Crysler
Soberano, Elbhie Ann