Reproduction and Sexual Health

• Infertility


  Unable to become pregnant after unprotected sex for 1 year
• Causes of infertility


  • Genetic problems
  • Ovarian problems (developmental abnormalities, anovulation, pituitary/hypothalamic hormone disorder, adrenal gland disorder, congenital adrenal hyperplasia, disruption of hypothalamic-pituitary-ovarian axis, amenorrhea, premature ovarian failure, increased prolactin)
  • Uterine, tubal, and peritneal problems (developmental abnormalities, reduced tubal motility, tubal inflammation, tubal adhesions, endometrial/myometrial tumors, uterine adhesions, endometriosis, chronic cervicitis, pelvic inflammatory disease, inadequate cervical mucous)
  • Other (anemia, obesity, thyroid dysfunction, idiopathic conditions)
• Causes of male infertility

  • Hormonal (low testosterone, hypopituitarism, endocrine disorders)
  • Structural/anatomical complications (testicular damage, undescended testes, hypospadias, varicocele, obstructive lesions of vas deferens or epididymis, retrograde ejaculation)
  • Other (STI, toxin exposure, scrotum exposed to high temp, nutritional deficiencies, obesity, antisperm antibodies, substance abuse, change in sperm motility, decrease in libido, impotence from alcohol, antihypertensive medications, idiopathic conditions, smaller and softer testes w/age)
• First trimester pregnancy complications

  • Rubella
  • Toxoplasmosis
  • Ectopic pregnancy
  • Trauma
  • Miscarriage
• Second trimester pregnancy complications

  • Fetal congenital/chromosomal abnormalities
  • Maternal systemic conditions
  • Infections
• Third trimester pregnancy complications

  • Preterm labor
  • Premature rupture of membranes
  • Placenta previa
  • Abruptio
  • Trauma
  • Fetal stress
  • Intrauterine fetal death
• Unplanned pregnancy


  Engaging in sexual intercourse without contraceptive measures
• Causes of unplanned pregnancy


  • Contraception fails/is not used
  • Lack of education regarding contraception and pregnancy
• History assessments for reproduction

  • Sexual history
  • Contraceptive history
  • Surgical history
  • Alterations in pelvic support
  • Pap test history
  • Menstrual history
  • Immunization status
  • Mental health history
  • Dietary history
  • Alcohol/caffeine intake
  • Drug use
  • Family history
  • Subjective assessment (pregnant): nausea, fatigue, vomiting, enlarged breasts/fullness/sensitivity, increased urinary frequency, Braxton-Hicks contractions
• Examination findings in pregnancy

  • Expected: VSS, little discomfort, weight gain WNL, softening and compression of lower uterine segment, softening of cervical tip, violet blue vaginal mucosa, breasts enlarge and nipples darken
  • Fetus found at 5 wks, heartbeat at 6 wks, fetal heart tones auscultated at 8 wks, palpable fetal movement at 19 wks
• Diagnostic tests for reproduction

  • Pregnancy testing (urine, serum)
  • CBC, blood type, Rh factor, rubella titer
  • Maternal assay
  • Screening from STIs
  • Ultrasound
  • Amniocentesis- genetic analysis
• Pregnancy monitoring schedule


  • Once a month for first 2 trimesters
  • Every 2 weeks for third trimester
  • Weekly visits after 36 wks- birth
• Primary prevention for reproduction

  • Safe sex
  • Contraception
  • Avoidance of smoking, alcohol, drug use
  • Nutrition
  • Exercise
  • Education
• Secondary prevention for reproduction

  • Prenatal care monitors the progress of the pregnancy and allows early detection of problems (weight gain, BP, fundal height, edema, fetal heart sounds, labs)
• Collaborative interventions for high-risk pregnancy

  • Biophysical factors (genetics, nutritional status, obstetric related illness)
  • Psychosocial factors (nicotine, alcohol, caffeine and drugs)
  • Sociodemographic factors (low income, lack of prenatal care, adolescents or older mothers, parity, marital status, place of residence/ race/ethnicity)
  • Environmental factors (infection, radiation exposure, chemical exposure, drugs, cigarette smoke, pollutants, poor diet, stress)
• Assisted reproductive technologies


  • Treatment of infertility (in vitro fertilization embryo transfer, zygote intrafallopian transfer, gamete intrafallopian transfer, therapeutic donor insemination, intracytoplasmic sperm injection)
  • Abortion (vacuum aspiration, dilation and curettage, dilation and extraction)
• Etiology of sexual disorders


  • Physiological factors (acute illness, infection, surgery, trauma, medication, loss of mobility, decreased activity tolerance, hormonal changes, substance abuse)
  • Psychological factors (fear, anxiety, fatigue, reproductive health concerns, adverse childhood events, alterations in self-image, role confusion, person conflicts, mental health condition)
  • Maturational factors (knowledge deficit of sexuality, birth control, safe sex, changes with age, lack of social skills)
  • Environmental factors (pollutants, toxins, isolation, absence of partner, lack of privacy/appropriate environment)
• Female sexual disorders


  • Hyposexual activity disorder
  • Sexual aversion disorder
  • Sexual arousal disorder
  • Orgasmic disorder
  • Sexual pain disorder
  • Persistent genital arousal disorder
• Male sexual disorders


  • ED and Ejaculatory disorder (caused by: psychological or medical cond, medication, surgery, stress, vascular disease, diabetes, antidepressants, antihypertensive meds, alcohol, drugs, and prostate surgery)
• Sexual history assessments


  • Partners (number and gender)
  • Protection from infection
  • Past history of infection
  • Prevention of pregnancy
• Female physical examination


  • External inspection and palpation
  • Internal inspection of vagina and cervix
  • Bimanual palpation (uterus and ovaries)
  • Collection of specimens as needed
• Male physical examination


  • External inspection and palpation of penis, scrotum, testicles
  • Digital rectal examination
  • Collection of specimen as needed
• Diagnostic tests for sexual health

  • Specimen collection
  • Tissue biopsy
  • Aspiration
  • Ultrasound
  • X-ray
  • Laparoscopy
  • Colposcopy
  • Colonoscopy
  • Genetic testing
  • Cancer screening
  • STI testing
  • Hormonal testing
• Primary prevention for sexual health

  • Patient education (condom use, safe-sex practices, HPV vaccine)
• Secondary prevention for sexual health

  • STI screening
  • Pap test
  • HIV screening
  • Screening for intimate partner violence
• Collaborative interventions for sexual health

  • Pharmacotherapy (antibiotics for STI, HRT for menopause, PDE-5 for ED)
  • Surgical procedures (hysterectomy, penile implant, minor procedures)
  • Cognitive-behavioral therapy
  • Other (vacuum construction device for ED)