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Reproductive Health: Friendship, Marriage, Sex

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TEST

Questions for Self-study

Do the following for self-study. Do not submit the answers.

Sterilization does not effect the sex drive in male or females.

Men make sperms all their life, women are born with a lifetime supply of ova.

RU-486 is a injectable contraceptive that lasts 3-6 months.

Suction curette is the abortion method used in the early 2nd trimester.

Explore some relationship assessments: Relationship Health Profile, Anderson Marriage Test,   Marriage Compatibility Test,  Relationship Assessment

 1. RELATIONSHIPS

Since there are many types of behaviors in this area, some of them described on the Internet and in the textbook, you must read all information critically and evaluate it in light of your own value system and moral background. Just because a majority or minority engage in a certain type of behavior does it not make it appropriate for you. Make your own decision based on adequate information and your own life plans.

Contrast dating, love marriage and, parenting

1.1 What is a friendships?

1.2  How do you date?

1.3 How do you know you are in love?

1.4 When is it wise to move toward marriage?

1.5 What all does parenting involve?

What is Marriage?

Every year, thousands of couples get married.  No two of these marriages will be exactly alike.  People having differing reasons for getting married, and everyone brings a distinctive set of beliefs and expectations into a marriage based on cultural and religious traditions.  This means that the relationship between partners in marriage will be as unique as the individuals themselves.

Marriage is a developing relationship.  It requires you to accommodate the needs and wants of your partner, without losing sight of your personal goals and sense of self.  You may find you need to be more your own person, particularly in relation to the family you grew up in. This will give you and your partner the space you need to build a new family.

To grow as a couple, it is important for you and your partner to achieve intimacy in a range of ways— emotionally, intellectually, socially, recreationally, spiritually, and physically. Too much separateness can lead to loneliness and a feeling of distance from your partner. There is a danger, however, that in becoming too alike one of you will lose his or her individuality. In a marriage, it is important to realize that you are both still individuals.

As individuals, you will need the freedom to develop separately, to have independence. Yet, as part of a couple, you can help and support your partner by offering security, love, encouragement, and approval. This will enrich your life together: both of you will be more fulfilled and content as individuals. The goal is to be intimate and connected to your partner, without giving up your individuality.

Marriage gives a certain "public" side to a couple's relationship. Accordingly, you may find that family and friends view your relationship as different or as having changed as a result of marriage. This view may alter the expectations your family has of you and your partner (e.g., to "settle down" and raise children). None of these changes need be of concern if both you and your partner bring a strong sense of identity and self-worth to the relationship.

Making Marriage Work

Recognizing What's Important
Finding the balance between being an individual and part of a couple can be challenging. It requires commitment and closeness. But what else helps make a marriage work? Research has shown that marriage partners usually feel most satisfied when they share some of the same values. Also, things tend to work better when each partner meets the other's expectations, at least to some extent.

Certainly no one's expectations of married life ever fully match the reality ahead. Nor do two marriage partners ever hold to exactly the same set of values. All marriages contain "gaps" and differences of one sort or another. This is both normal and healthy. Where there is love, respect, and commitment to the relationship, different values can exist side by side. When each partner is willing to be adaptable and to meet the other halfway, the gap between your expectations and the reality of married life can be closed. You and your partner may be able to make your future relationship even better by thinking and talking about your values and expectations.

Things That Have Influenced You
What do you and your partner each consider important in life? Why do you each hold the values and expectations that you do? Trying to put your values into words may be difficult, if not impossible. Values are closely bound up with feelings. They are often only expressed through your decisions and actions. However, one way to answer these questions is to take a look at your past experience.  Your values and the expectations you have of marriage will have been affected by many things: your past relationships with other people, the views of friends, your schooling, the messages and models that society gives us through the media (newspapers, radio, television, etc.), family experiences.

Perhaps the most important influence of all, however, has been your family upbringing. The views, attitudes, and behaviors that we hear and are taught in our families remain important to us throughout our lives. Often, these things are absorbed unconsciously. Still, they contribute enormously to making us what we are.  To find out about this, you and your partner might wish to think about your own families' attitudes or behavior with respect to such things as:  expressing anger, showing affection, family discipline ,spending money, education, dealing with crises.

Looking at Your Expectations
What does each of you expect of the other?  A good way of trying to answer this question is to look very carefully at roles within the marriage.  It can be both fun and revealing to identify: the domestic tasks you expect to do, the tasks you expect your partner to do, the tasks you expect to share.

Taking on certain domestic jobs and responsibilities lets you exercise some control over one particular aspect of your shared lifestyle.  Thus, looking at individual roles within a marriage has its serious side as well.  Of course, it is important to your marriage that you and your partner both feel comfortable with your roles.  Self-awareness and communication can help you identify where your expectations may not mesh with those of your partner.  This identification is the first step in narrowing the gap between expectations and reality.

Understanding Conflict
There are times when conflicts occur even in the happiest of marriages.  Generally, people fear conflict because they think it is always negative or it will have harmful consequences.  This is not always so.  Conflicts resolved in a caring manner can be creative and helpful.  Good communication can help resolve conflicts in a positive way.  Also, being honest about your feelings in certain situations and respecting differences will help.  Being able to laugh at yourself can often help a situation, too.  Shared laughter can defuse a situation and create an intimate moment.  

Overcoming Difficulties
What can couples do to lessen the possibility of harmful conflict occurring in their relationship?  Psychologists, marriage therapists, and family counselors agree that communication is the key.  They identify five elements for good communication:

o being willing to communicate, in words as well as in actions and decisions.  This is necessary if couples are to get at the real causes of any friction.

o being prepared to make time and to find the right place for communication.  This is necessary if couples are to be free of things that interrupt and distract them.

o being able to listen carefully and completely without interrupting and without becoming defensive (wanting to argue) or judgmental (wanting to express a personal opinion about what one is hearing) This is important if partners are to understand one another.

o being able to accept and respect each other’s feelings (knowing that someone can control personal behavior, but cannot really avoid his or her feelings).  This is very important if partners are to trust in the process of communicating with one another.

o being careful to use language that describes their own feelings about an issue rather than language that blames or attacks the other for making them feel that way.  This is vital if partners are to communicate in a way that is helpful rather than damaging.
These five elements may make good communication seem challenging, which it is!  Good communication between people requires a positive and willing attitude.  It also depends on a set of skills that can be learned and practiced.  By gaining these skills, you and your partner may have greater control over the happiness of your marriage.  (Training in communication skills is offered in many marriage preparation and marriage enrichment courses.)

The Common Experiences of Marriage

Living with Life's Changes
Like all living things, marriages change over time. Often, the changes in the marriage reflect the personal changes that the marriage partners go through. Sometimes, however, the relationship seems to have a life of its own. Many partners and marriages move through the following phases to some extent:

o In the earliest stage of marriage, the partners are optimistic and confident. There is also a sense of excitement. Positive feelings reign. They have time for each other and for fun.

o After living together for a while, partners gain a more realistic view of each other. At this point people realize that they are being asked to make a stronger commitment to the relationship.  They learn to resolve conflicts and differences. Thus, a deeper intimacy may be achieved.

o As time goes on, the marriage may be dominated by the demands of personal careers. It may also be dominated by the shared demands of building a home and raising a family. If there are children, a couple may have less time for each other and for themselves. This may make them feel less satisfied with their marriage. On the other hand, when both are committed to having children, these years can improve their relationship and strengthen the bond between them.

o The couple's middle years may present different challenges. If the partners have raised children, these children may have left home. This is a return to a situation in which the partners have more time for themselves and for each other. Physical changes may also bring a new awareness of aging and death. It is particularly important at this time that couples openly discuss their feelings with each other. This will bring them closer together and allow them to become true companions.

o As the partners mature, they may also ask themselves, "What have I done (outside my family) to show that I have lived?" A satisfactory answer to this question allows a person to go forward with new energy and a sense of fulfillment. Couples need to talk about this concern, when it arises. They may feel a need to find meaningful work or provide a service to others. Each will need to understand and support the other's chosen activities. Shared differences at this time of life can be enriching rather than threatening and isolating.

o Retirement offers partners a chance to spend time together and to enjoy each other. There can be a good deal of adjustment at this time as one accepts new roles (e.g., becoming grandparents), poor health, failing abilities, the possibility of losing the other partner, or the nearness of death. A positive outlook, however, contributes a great deal to the happiness of each partner's senior years.

In the end, the strongest marriage will be one that proves adaptable— a relationship that continuously evolves to meet your needs and those of your partner throughout a lifetime of growth and change.

Sharing Decisions
Perhaps the thing that makes married life different from single life is the need for marriage partners to share in making decisions about matters that affect them both. Living together requires you to make decisions together about a variety of things. These things include: housing (e.g., type and location), food (e.g., what to eat and when), work (e.g., career commitments and ambitions), health care (e.g., choosing a medical doctor), Leisure activities, religious observances,  money management, friendships and time spent with others.

Building on the Romance

Banishing the Myths
For many couples, one of the hardest things to deal with is the popular view that wonderful marriages happen naturally and without effort. Then, in working out the problems and difficulties that do occur, couples may come up against another popular view. This view states that marriages are personal and private, and that discussing marriage difficulties with someone outside the marriage is taboo or will lead to embarrassment.

In fact, neither of these views is justified or helpful. Intimate relationships never outgrow the need for both partners to give of themselves. The most successful relationships are usually those that are consciously worked on. Knowing this can help you to keep things in perspective when faced with the day-to-day challenges of married life. At the same time, being able to open up and share your thoughts and experience with others can provide a needed reminder that you are not alone. 

 2. REPRODUCTIVE SYSTEMS

Describe reproductive health,  the reproductive systems and related disease prevention

The Visible Human Project

2.1. What are the parts of the female reproductive system?

2.2 What are the parts of the male reproductive system?

2.3 How can you prevent disease?

Planned Parenthood: Your Uncensored Source

Some facts: If a women misses her period, it may mean she is pregnant, under stress or exercising much. The erectable organ and most sensitive spot in the female genital area is the clitoris. The placenta supplies the growing baby in the mother with nutrients.

Sexually transmitted diseases

STDs once called venereal diseases, are among the most common infectious diseases in the United States today. More than 20 STDs have now been identified, and they affect more than 13 million men and women in this country each year. The annual comprehensive cost of STDs in the United States is estimated to be well in excess of $10 billion.

Understanding the basic facts about STDs – the ways in which they are spread, their common symptoms, and how they can be treated – is the first step toward prevention. It is important to understand at least five key points about all STDs in this country today:

1. STDs affect men and women of all backgrounds and economic levels. They are most prevalent among teenagers and young adults. Nearly two-thirds of all STDs occur in people younger than 25 years of age.
2. The incidence of STDs is rising, in part because in the last few decades, young people have become sexually active earlier yet are marrying later. In addition, divorce is more common. The net result is that sexually active people today are more likely to have multiple sex partners during their lives and are potentially at risk for developing STDs.
3. Most of the time, STDs cause no symptoms, particularly in women. When and if symptoms develop, they may be confused with those of other diseases not transmitted through sexual contact. Even when an STD causes no symptoms, however, a person who is infected may be able to pass the disease on to a sex partner. That is why many doctors recommend periodic testing or screening for people who have more than one sex partner.
4. Health problems caused by STDs tend to be more severe and more frequent for women than for men, in part because the frequency of asymptomatic infection means that many women do not seek care until serious problems have developed.

• Some STDs can spread into the uterus (womb) and fallopian tubes to cause pelvic inflammatory disease (PID), which in turn is a major cause of both infertility and ectopic (tubal) pregnancy. The latter can be fatal.
• STDs in women also may be associated with cervical cancer. One STD, human papillomavirus infection (HPV), causes genital warts and cervical and other genital cancers.
• STDs can be passed from a mother to her baby before, during, or immediately after birth; some of these infections of the newborn can be cured easily, but others may cause a baby to be permanently disabled or even die.

5. When diagnosed and treated early, many STDs can be treated effectively. Some infections have become resistant to the drugs used to treat them and now require newer types of antibiotics. Experts believe that having STDs other than AIDS increases one's risk for becoming infected with the AIDS virus.

HIV Infection and AIDS   AIDS (acquired immunodeficiency syndrome) was first reported in the United States in 1981. It is caused by the human immunodeficiency virus (HIV), a virus that destroys the body's ability to fight off infection. An estimated 900,000 people in the United States are currently infected with HIV. 

Chlamydial Infection  This infection is now the most common of all bacterial STDs, with an estimated 4 to 8 million new cases occurring each year. In both men and women, chlamydial infection may cause an abnormal genital discharge and burning with urination. In women, untreated chlamydial infection may lead to pelvic inflammatory disease, one of the most common causes of ectopic pregnancy and infertility in women. Many people with chlamydial infection, however, have few or no symptoms of infection. Once diagnosed with chlamydial infection, a person can be treated with an antibiotic.

Genital Herpes  Genital herpes affects an estimated 60 million Americans. Approximately 500,000 new cases of this incurable viral infection develop annually. Herpes infections are caused by herpes simplex virus (HSV). The major symptoms of herpes infection are painful blisters or open sores in the genital area. These may be preceded by a tingling or burning sensation in the legs, buttocks, or genital region. The herpes sores usually disappear within two to three weeks, but the virus remains in the body for life and the lesions may recur from time to time. Severe or frequently recurrent genital herpes is treated with one of several antiviral drugs that are available by prescription. These drugs help control the symptoms but do not eliminate the herpes virus from the body. Suppressive antiviral therapy can be used to prevent occurrences and perhaps transmission. Women who acquire genital herpes during pregnancy can transmit the virus to their babies. Untreated HSV infection in newborns can result in mental retardation and death.

Genital Warts  Genital warts (also called venereal warts or condylomata acuminata) are caused by human papillomavirus, a virus related to the virus that causes common skin warts. Genital warts usually first appear as small, hard painless bumps in the vaginal area, on the penis, or around the anus. If untreated, they may grow and develop a fleshy, cauliflower-like appearance. Genital warts infect an estimated 1 million Americans each year. In addition to genital warts, certain high-risk types of HPV cause cervical cancer and other genital cancers. Genital warts are treated with a topical drug (applied to the skin), by freezing, or if they recur, with injections of a type of interferon. If the warts are very large, they can be removed by surgery.

Gonorrhea  Approximately 400,000 cases of gonorrhea are reported to the U.S. Centers for Disease Control and Prevention (CDC) each year in this country. The most common symptoms of gonorrhea are a discharge from the vagina or penis and painful or difficult urination. The most common and serious complications occur in women and, as with chlamydial infection, these complications include PID, ectopic pregnancy, and infertility. Historically, penicillin has been used to treat gonorrhea, but in the last decade, four types of antibiotic resistance have emerged. New antibiotics or combinations of drugs must be used to treat these resistant strains.

Syphilis  The incidence of syphilis has increased and decreased dramatically in recent years, with more than 11,000 cases reported in 1996. The first symptoms of syphilis may go undetected because they are very mild and disappear spontaneously. The initial symptom is a chancre; it is usually a painless open sore that usually appears on the penis or around or in the vagina. It can also occur near the mouth, anus, or on the hands. If untreated, syphilis may go on to more advanced stages, including a transient rash and, eventually, serious involvement of the heart and central nervous system. The full course of the disease can take years. Penicillin remains the most effective drug to treat people with syphilis.

Other diseases that may be sexually transmitted include trichomoniasis, bacterial vaginosis, cytomegalovirus infections, scabies, and pubic lice. STDs in pregnant women are associated with a number of adverse outcomes, including spontaneous abortion and infection in the newborn. Low birth weight and prematurity appear to be associated with STDs, including chlamydial infection and trichomoniasis. Congenital or perinatal infection (infection that occurs around the time of birth) occurs in 30 to 70 percent of infants born to infected mothers, and complications may include pneumonia, eye infections, and permanent neurologic damage.

What Can You Do to Prevent STDs?  The best way to prevent STDs is to avoid sexual contact with others. If you decide to be sexually active, there are things that you can do to reduce your risk of developing an STD. 

• Have a mutually monogamous sexual relationship with an uninfected partner.
• Correctly and consistently use a male condom.
• Use clean needles if injecting intravenous drugs.
• Prevent and control other STDs to decrease susceptibility to HIV infection and to reduce your infectiousness if you are HIV-infected.
• Delay having sexual relations as long as possible. The younger people are when having sex for the first time, the more susceptible they become to developing an STD. The risk of acquiring an STD also increases with the number of partners over a lifetime.

Anyone who is sexually active should:

• Have regular checkups for STDs even in the absence of symptoms, and especially if having sex with a new partner. These tests can be done during a routine visit to the doctor's office.
• Learn the common symptoms of STDs. Seek medical help immediately if any suspicious symptoms develop, even if they are mild.
• Avoid having sex during menstruation. HIV-infected women are probably more infectious, and HIV-uninfected women are probably more susceptible to becoming infected during that time.
• Avoid anal intercourse, but if practiced, use a male condom.
• Avoid douching because it removes some of the normal protective bacteria in the vagina and increases the risk of getting some STDs.

Anyone diagnosed as having an STD should:

• Be treated to reduce the risk of transmitting an STD to an infant.
• Discuss with a doctor the possible risk of transmission in breast milk and whether commercial formula should be substituted.
• Notify all recent sex partners and urge them to get a checkup.
• Follow the doctor's orders and complete the full course of medication prescribed. A follow-up test to ensure that the infection has been cured is often an important step in treatment.
• Avoid all sexual activity while being treated for an STD.

Sometimes people are too embarrassed or frightened to ask for help or information. Most STDs are readily treated, and the earlier a person seeks treatment and warns sex partners about the disease, the less likely the disease will do irreparable physical damage, be spread to others or, in the case of a woman, be passed on to a newborn baby. Sexually transmitted diseases  

Selected Notes: Symptom of testicular cancer are testicular lumps, enlarged testicles, and enlargement of nipple. The majority of women will not get pregnant after age of 45. A healthy male has about 30-80 million sperms in one ejaculation. Of all males over 40, 50% have had impotence problems. 

 3. SEX & REPRODUCTIVE CHOICES

"As defined by lawyers in the Paula Jones case, sexual relations occur 'when the person knowingly engages in or cause contact with the genitalia, anus, groin, breast, inner thigh, or buttocks of any person with an intent to arouse or gratify the sexual desire of any person." Newsweek, September 21, 1998, page 38.

Describe sex, conception, contraception, abortion and pregnancy.
3.1 How does conception work?

3.2 How do the methods of contraception work? http://www.sexuality.org/l/safersex/bcroundu.html

Contraception Methods: Reproductive Rights - Contraception Links

3.3. What are the pros and cons on abortion?

3.4 What are the stages and conditions in pregnancy?

3.5 What is the updated information on reproductive choices?

News - Sexually related disorders  CNN-Health  

Good Reproductive Health: Birth Control Methods 

What are birth control methods? Birth control methods are devices, medicines, and approaches that people use to prevent pregnancy.

Cervical Cap The cervical cap is a small, soft rubber cup with a round rim that fits closely around the cervix. The doctor or nurse fits you for a cervical cap. You can only get the cap with a prescription.

Condom  A condom is a sheath (covering) that is put over an erect penis. Most condoms are made of latex rubber and some have spermicide (cream that kills sperm) on them. You do not need to see a doctor or have a prescription to get condoms. You can get them from the drug store.

Female Condom  The female condom looks a little like the male condom. It is a sheath (covering) that goes into a woman's vagina. You do not need to see a doctor or have a prescription to get a female condom.

Diaphragm  The diaphragm is somewhat larger than the cervical cap, but works in the same way. It is a soft rubber cup with a round rim that fits inside the vagina and covers the cervix. The doctor or nurse fits you for a diaphragm. You can only get the diaphragm with a prescription.

Vaginal Spermicides  Spermicides kill sperm. Vaginal spermicides come in foam, cream, jelly, film, suppository, and tablet forms.

The Pill  The birth control pill is made up of estrogen and progestin (female hormones). A woman must take her birth control pill every day to keep from getting pregnant. She needs to have a check-up and talk to her doctor before taking birth control pills. You can only get birth control pills with a prescription.

The Minipill  The minipill is another kind of birth control pill. It has only one hormone in it, progestin. It must be taken every day. A woman needs to have a check-up and talk to her doctor before taking the minipill. You can only get the minipill with a prescription.

The Morning After Pill (Emergency Contraceptive)  Morning after pills are made up of female hormones and taken after a woman has unprotected sex (having sex without using a birth control method). A woman must see her doctor to get a prescription for the morning after pill.

What is the RU486 Pill?  RU486 (also called "mifepristone") is different than emergency contraception. It is actually a series of pills that cause an abortion very early in pregnancy. RU 486 is widely used in Europe, and was approved for use in the United States in September 2000. A woman must see her doctor to get a prescription for RU486. It is sometimes called an "abortion pill."

Depo-Provera  Depo-Provera is a birth control method that is injected (given as a shot) by a doctor into a woman's bottom or arm muscle every three months.

Norplant Norplant is a birth control method that is put into a woman's arm. A doctor does an operation to put small, matchstick-sized rods under the skin of the upper arm.

Intrauterine Device (IUD)  An IUD is a T-shaped device that a doctor puts into a woman's uterus. Some IUDs must be replaced every year, while other IUDs can stay in a woman's uterus for up to 10 years. The IUD is a birth control method that is best for people who have one sex partner over the long term and are not at risk for STDs and HIV/AIDS.

Tubal Ligation  Tubal ligation ("getting your tubes tied") is a surgical method of birth control for women. This is a permanent method of birth control and is for women who do not want any or anymore children. Talk to your doctor about tubal ligation. It is a serious decision.

Vasectomy  Vasectomy is a surgical method of birth control for men. This is a permanent method of birth control and is for men who do not want any or anymore children. Talk to your doctor about a vasectomy. It is a serious decision.

Natural Family Planning/Fertility Awareness  Natural family planning/fertility awareness are methods of birth control that use a woman's menstrual cycle to predict when she is likely to get pregnant and when she is not likely to get pregnant. Many people use natural family planning as their method of birth control for health and/or religious reasons.

Withdrawal  Withdrawal is a birth control method that requires the man to pull his penis out of the woman's vagina before he has an orgasm. Birth Control Methods 

General notes: The most popular contraceptive among married US couples is sterilization.  The surest way of avoiding pregnancy is abstinence. The fatal hepatitis B is transmitted via sex and may be prevented via vaccine.  The greatest risk for sexually transmitted diseases is among ages 15-29.  Antibiotics do not destroy viruses.

Library of Reproductive Health: Repro Studies 8  Repro Studies 9  Repro Studies 10  Repro Studies 11 Introduction Fertility Quiz |   International Planned Parenthood Federation   Population Council  Population Research Institute

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