Reproductive Health
The following topics deal with common concerns people may have about their reproductive health. The sections on this page summarize the main points on these concerns, but as always, it is preferable to consult a clinician or other health care provider to answer your specific questions about your own reproductive health.
- Menstrual Problems
- Pelvic Inflammatory Disease (PID)
- Urinary Tract Infection (UTI)
- Toxic Shock Syndrome
- Masturbation
- Premature Ejaculation
- Erectile Dysfunction
Menstrual problems: During their reproductive lives, most women experience menstrual problems to some degree. Fortunately they are usually not serious and are almost always temporary. Because they are so common, most women may have their own methods of addressing and dealing with the respective problems, but questions will always come up. Many treatments exist for each problem, from prescribed medications, to over the counter painkillers, to natural at home remedies.
Menstrual Cramps (Dysmenorrhea): Cramps are painful muscle spasms in the lower abdomen, which occur just prior to and during menstrual bleeding. Most women have experienced cramps, which tend to be worse during the first years of menstruation. Multiple causes have been attributed, including high levels of prostaglandin hormones, a narrow opening of the cervix, and a relative lack of blood supply to the muscles of the uterus during cramping.
- Treatment:
- Aspirin and ibuprofen both have anti-prostaglandin effects and are especially useful if taken before cramping begins. (Note Tylenol does not have this effect)
- Calcium and magnesium supplements taken a few days before menstruation is due.
- Resting in a comfortable position, stretching, or yoga.
- Warm baths or the application of heat to the lower abdomen.
- Orgasm. Orgasm reduces the congestion of blood and fluid in the pelvic area.
- See a clinician if cramps are severe. Birth control pills and other medications may help to manipulate menstrual cycle and reduce cramps.
Premenstrual Syndrome (PMS): PMS is the name given to the set of symptoms that begin a short time before menstruation occurs. Fluid retention is the main cause of PMS symptoms, which can include swollen legs and breasts, pelvic aching, headache, nervousness, irritability, and loss of ability to concentrate. Symptoms usually disappear once actually menstrual bleeding occurs.
- Treatment: In addition to those listed above for cramps
- Relaxation and stress reduction techniques
- Avoiding salt and salty foods, as well as alcohol up to a week prior to menstruation (due to increased dehydration)
- Eating potassium-rich foods such as bananas, cranberry juice, and other fresh fruit
- Drinking between 6-8 glasses of water per day
- Taking Vitamin B6 and a complex Vitamin B supplement
- Exercise
Missed Periods (Amenorrhea): While missed periods are frequent among all women, it should be investigated if any previously menstruating woman misses three or more periods (regardless of her cycle length) or if she has not menstruated for six months or more. Pregnancy is the most common reason for this, but there are other causes as well.
- Possible causes of amenorrhea:
- Pregnancy
- Illness
- Depression
- Strenuous Exercise
- Emotional Stress
- Travel
- Change in sleep patterns
- Excessive weight loss or gain
- Treatment: Often simply removing the cause of stress or reducing exercise will bring back normal periods. It is common for college students, for example, to miss periods while at school, only to resume them once they return home. If eliminating causative factors fails, different hormone treatments may be used to bring on bleeding and ovulation.
Irregular Periods: Women’s menstrual cycles vary widely, and are considered regular if they can be predicted within a few days, do not last more than seven days, and do not cause the loss of more than four tablespoons of blood. When a woman’s menstrual cycle is unpredictable, it may be the result of a hormone imbalance or a lack of ovulation. These imbalances are very common during the first few years of menstruation, just prior to menopause, and during stressful times in a woman’s life.
- Treatment: Unless there is a medical condition causing irregular cycles, treatment is not usually necessary. Most women’s cycles will eventually settle into a regular pattern. However, a clinician should be consulted for all persistent irregular bleeding patterns because there may be underlying causes such as infections, hormonal imbalances, or pregnancy.
Pelvic Inflammatory Disease (PID)
- Pelvic inflammatory disease is an infection of the upper reproductive tract in women (cervix, uterus, fallopian tubes, and ovaries). It is caused by a wide variety of sexually transmitted organisms, especially gonorrhea and chlamydia, and if left untreated can have serious or fatal complications. Bateria move upward from a woman’s vagina or cervix into the internal reproductive organs. affects more than 1 million women each year, of which around 100,000 become infertile.
- Symptoms: Can be asymptomatic, goes unrecognized 2/3 of the time
- Abdominal, cervical, and/or uterine pain
- Fever
- Pus-like vaginal discharge
- Who is at risk?:
- Women with STIs — especially gonorrhea and chlamydia.
- Women at risk for STIs (multiple partners, partners with multiple partners).
- Women with prior episodes of STIs (They have increased risk of another episode because the body’s defenses are often damaged during the initial bout of infection).
- Sexually active women under age 25 are more likely to develop than older women.
- Women who douche.
- Testing and Diagnosis: is difficult to diagnose because the symptoms are often mild and subtle. Many episodes are undetected because there are no precise tests for . Initial diagnoses can often be made based on a history of symptoms and on a pelvic exam, which shows evidence of . Cultures of cervical secretions will confirm an infection of the genital tract. An ultrasound can view enlarged fallopian tubes or an abscess. A laparoscopy (a minor surgical procedure in which a thin, flexible tube with a lightened end is inserted through a small incision in the lower abdomen, allowing the doctor to view the internal pelvic organs and take specimens for laboratory studies) may be necessary to confirm the diagnosis.
- Treatment: can be cured with antibiotics, and prompt treatment can prevent severe damage to pelvic organs. Treatment does not reverse any damage already done. is usually treated with multiple antibiotics because more than one organism may be responsible. All medication must be taken to prevent reinfection, even if partners have no symptoms. Hospitalization or surgical intervention may be required in more serious cases.
- Complications: Infection causing bacteria can causes normal tissue in the fallopian tubes to turn into scar tissue, which blocks or interrupts the normal movement of eggs into the uterus. About one in five women with become infertile, with increased chances of infertility after multiple episodes. A partially blocked or slightly damaged fallopian tube may cause a fertilized egg to get stuck in an ectopic pregnancy if the egg begins to grow. Ectopic pregnancy can rupture the fallopian tube, cause severe pain, internal bleeding, and even death. Scarring in pelvic structures can also lead to chronic pelvic pain.
- Prevention: can be prevented by making safer choices to avoid initial STI infection, and with frequent testing for treatment of STIs. Safer choices include:
- Always using barrier methods (male and female condoms, dental dams) during sex (oral, anal, and vaginal) and limiting number of sexual partners
- Get tested with your partner and stay monogamous
- Do not engage in sexual activities with anyone but yourself
Urinary tract infections (UTIs) are bacterial infections of the urinary system, often developing after irritation of the urethra. UTIs are more common in women than in men. Organs which may be affected include the urethra (urethritis), bladder (cystitis) and/or the kidneys (pyelonephritis). Because kidney infections are a serious problem, it is important to receive treatment as soon as possible in order to avoid spread of the infection. Several factors increase the likelihood of developing a UTI, including frequent and vigorous sexual activity after a period of little sexual activity (“honeymoon cystitis”). Failure to urinate frequently enough, drink enough water, and poor hygiene are also causes. Many products, including feminine hygiene sprays, douches, bubble baths, and vaginal deodorants contain chemicals irritating to the urethra that may result in a UTI. In addition, some birth control methods (the diaphragm and cervical caps) may cause UTIs by putting pressure on the urethra. Recent studies have also found that users of these methods develop abnormally high amounts of bacteria in their vaginas, which may be the cause of the more-frequent UTIs found in these women.
Symptoms:
a) Burning during urination.
b) An urge to urinate frequently, often accompanied by an inability to void any urine
at all.
c) Visible blood and/or cloudiness may be present in the urine.
d) Aching or cramping in the lower abdomen.
e) If the infection has progressed to the kidneys, fever and general flu-like
symptoms may be present, along with back pain.
Testing and Diagnosis: Symptoms are fairly diagnostic of a UTI. Microscopic examination
of the urine can also be used to detect the presence of bacteria.
Treatment: A practitioner will prescribe antibiotics to eliminate the infection. It is important
to finish this medication, even if symptoms disappear, so that the infection does not return.
Drinking copious amounts of fluids will help discomfort by keeping the walls of the bladder
from touching each other, which can be uncomfortable. This also dilutes the urine so that
the bacteria have less of a chance to cause irritation. Several over the counter medications
can be taken to reduce pain, burning, but these do not cure a UTI (Azo-Standard® and
Prodium ®)
Complications: Kidney infections resulting from untreated UTIs can cause permanent
kidney damage.
Prevention: These guidelines can be especially useful for women prone to UTIs.
• Drink plenty of water each day (6-8 glasses) and do not put off urinating.
• Avoid irritating the urethra. Use extra lubricant during intercourse if needed.
• Urinate immediately following intercourse.
• Avoid the diaphragm and the cervical cap.
• Always wipe from front to back after using the bathroom.
• Avoid caffeine, alcohol, and strong spices, all of which are irritating to the urethra.
• Drink cranberry juice (prevents E. coli from attaching to the walls of the bladder)
Toxic shock syndrome: Toxic shock syndrome is a rare, but serious illness, caused by toxins thought to be released from the staphylococcus aureus bacteria. This potentially serious problem usually develops in menstruating women who are using a tampon or contraceptive sponge during their periods, but has also occurred in non-menstruating women, in men, and in children. In menstruating women, who make up the vast majority of cases, it is believed that the bacteria grow in the blood trapped in the vagina by the tampon or sponge. In other individuals, the bacteria grow in a cut or in an open sore.
- Symptoms: The symptoms develop rapidly, and almost always during menstruation. A woman who develops any of these symptoms while menstruating should get medical help immediately.
- A sunburn-like rash
- Fever (101 degrees or more)
- Diarrhea
- Vomiting
- Muscle aches
- Testing and Diagnosis: The infection is diagnosed based on symptoms and a culture of vaginal secretions.
- Treatment: Antibiotics are used to treat the illness. Because this serious disease develops very quickly, it is important to get immediate medical help if symptoms develop.
- Complications: This is a very serious illness because 10% of patients who are hospitalized for die. The infection is extremely rare, though, and affects only 3 out of every 100,000 menstruating women.
- Prevention:
- Avoid super-absorbent tampons. Use “regular,” rather than “super” tampons.
- Avoid scratching or irritating the lining of the vagina when the vagina is dry or if there is little bleeding (if the tampon sticks to the walls of the vagina).
- Don’t use tampons 24 hours a day. Alternate with pads (maybe wear pads at night).
- Wash hands before inserting tampons. Be sure that tampons and applicators are clean and contamination free.
- Don’t use tampons if you have had , if you believe you have had mild symptoms, or if staph bacteria have been found in your vagina.
Although masturbation is one of the safest alternatives to sexual intercourse (with no risk of STDs and unintended pregnancies), it is hardly ever talked about in abstinence only programs or around the dinner table. With all the societal stigma, many people feel uncomfortable discussing masturbation and how it can play into their lives. It has been studied in many mental health circles and determined that there are tangible benefits from masturbation such as a decrease in depression, stress and an increased sense of self-worth. It has also been found to decrease insomnia and lower one’s blood pressure that carries through to other stressful situations in one’s life.
Female Masturbation Techniques
• Relax! Get comfortable being with yourself naked
• Fantasizing is a way women can calm themselves down and prepare themselves mentally
• Inserting one or more fingers into the vagina to stroke the frontal wall where the g-spot is located
• Stroking around and on the clitoris
• Using warm running water to stimulate the clitoris
• Straddling a pillow (or something similar) and rubbing the vulva and clitoris against the objects
• Many women purchase vibrators and sex toys to provide direct and intense stimulation to the clitoris
• Some women can orgasm by crossing their legs tightly and clenching the pelvic or leg muscles, which creates pressure and enhances blood flow to the genitals
Male Masturbation Techniques
• Allow yourself to let go of anxiety or any pressure related to intercourse with a partner
• Hold the penis with a loose fist and move the hand up and down the shaft
• Some men prefer lubrication during manual masturbation
• Since the prostate is sensitive, some men enjoy inserting a finger or dildo through the anus and into the rectum
• Using a vibrator along the penis and near the anus
Whether you are ejaculating “prematurely” or not is in the eye of the beholder. There are no absolutes when it comes to how long intercourse “should” take place before a man ejaculates. Whether the time involved is a minute or an hour, ejaculation is only premature if either partner wishes it had been delayed.
Exercises:
The best way to gain control over one’s physical responses is to increase rather than decrease awareness of sensation. Learn to identify the moment of “ejaculatory inevitability” right before orgasm. Start by masturbating. Pay attention to your level of arousal, and when you feel you’re about to reach orgasm, top moving, stop touching yourself for a moment and let the arousal ebb slightly before starting up again. Repeat this a few times and see how long you can stimulate yourself each time before you have to back off again. It’s usually recommended that a man learning to control ejaculation progress from masturbating with no lubricant, to masturbating with lubricant, to intercourse with his partner on top of him while he lies still, to intercourse with him moving.
Some men utilize a variation of the stop-start method known as the “squeeze technique”. With this method, you forestall an imminent orgasm by grasping the area right below your glans (with your four fingers lined along the bottom of the penis while the thumb squeezes the top of the tip) between your thumb and forefingers, and squeezing. After a few seconds of squeezing, you can resume stimulation and build yourself up to the point of ejaculatory inevitability again.
More commonly referred to by the loaded term, impotence, the inability to sustain an erection is something that all men experience at one point or another in their lives, whether as a result of a few too many drinks, physical fatigue, or lack of desire. Recurring erectile dysfunction is another matter and is generally the result of ongoing psychological rather than temporary situational problems.
Erection is a completely physical process and problems can occur at any stage in this process. Your brain must send a signal pumping blood into the penis, the tissues in the penis must fill with enough blood to create an erection, and the erectile tissues must expand against their surrounding membrane with enough force to squeeze shut the veins that would normally carry the blood back out of the penis. Issues can arise from pelvis surgery, spinal cord injuries, multiple sclerosis, diabetes, hardened arteries, injuries to the pelvic area, diabetes, smoking, and aging.
In order to determine whether the symptoms are physical or psychological, a doctor can set you up with a cock ring, which will measure the quantity and firmness of the erections you have throughout the night. If you are having erections when you sleep, presumably your difficulties with erection during waking hours are psychological, not physiological in origin. If the problem is physical, you and your doctor can explore a number of treatments, including a vacuum pump that you can use to pump up erections as desired, injections that produce temporary erections or surgical implants. Either way, it is important to remember that your partner is less attached to intercourse than you might think and would be happy to build a sex life based on any one of the numerous pleasurable alternatives.
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