Let’s talk about our REPRODUCTIVE HEALTH!
This third day and our second session of “Let’s talk: Let’s get embarrassed”, we learned about one of the most crucial concerns of our body; our reproductive health. Our motive? – That we unburden ourselves from our curiosities and problems of reproductive health and share them without being awkward and uncomfortable.
Our organizer Deepika Paswan set the session in motion by welcoming our resource person for the day, Doctor Alok Kumar Jha.
Dr. Alok Kumar Jha is received Bs.MD from Philippines. He is Senior Medical Officer at MMCH, Thamel. He has been working as a medical officer for almost 3 years. He has had experiences working at Scheer Memorial hospital Banepa, Bir hospital, Paropakar Prasuti Griha, Kantibal hospital. He is interested in Medicine, Surgery.Before starting his presentations on the topic, Dr. Jha took an important question.
Question: Why is it that when it comes to our reproductive health, we are unable to voice our questions or share them with our parents or friends?
Dr. Jha: A genuine question! We live in a very religious conservative society where talking anything about reproductive health is considered a taboo, so it remains hidden for the most part. Our sisters are still locked up in cowsheds during their menstruation period labelling then “untouchable”. We do not talk about it because of the sort of stigma attached to it. But then if we are unable to voice our problems to our parents to look for solutions, the problems start turning bigger. This is one of the biggest obstacles in our society.
For example, one of the burgeoning issues in our society is rape. Due to the lack of knowledge and awareness in females, some do not even know what they experience is abuse whereas it is their curiosities (of both young and old alike) that drive the offenders to commit the abuse.
Girls may still find it easier to talk about their problems with their mothers, but boys find it easier to hide their issues than to share it. This might in turn be more problematic later on leading them on the wrong path dur to the unsatiated curiosities.
Programs such as this can bring awareness to the society, hopefully ridding off the stigma attached to reproductive health.
This session was focused on medical and anatomical side of Reproductive health.
Reproductive Health
What is reproductive health?
According to World Health Organization,
“Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes.”
With enough knowledge about their own reproductive sexual health people can have a satisfying and safe sex life, by deciding feely on how and when they can reproduce.
Anatomy:
Fig: Anatomy of Male (Left) and Female (Right) Reproductive Organs
👦 Male:
The visible reproductive anatomy in males are penis and scrotum. Scrotum consists of one pair of testicles which connects with a pipe like structure called vas differentia to the prostate and on to the urethra.
So, How do both the urine and sperm release out of the same place?
Urine comes through the urinary bladder that is connected to the kidneys and passes through the urethra.
Sperms are released through the seminal vesicles to the urethra during the ejaculation process when the penis turns erect.
👧 Female:
The visible reproductive anatomy in females is the vaginal wall, labia majora and minora, and clitoris. Vagina is connected through vaginal canal until cervix to the uterus. Foetus grows for 9-10 months in the uterus. Two fallopian tubes connect ovaries to the uterus.
Are these reproductive organs differentiated from the beginning?
In the initial stages of embryonic development, there is no such differences between a male and female sex organ initially. But slowly, due to the chromosomes, these changes occur in bodies of babies inside the womb. If they have two X chromosomes, they develop female reproductive organs and if they have X and Y chromosomes, they develop male reproductive organs.
How does it develop differently?
In Males: the sex organ progenitors descend out of the pelvic cavity.
In Females: the sex organ progenitors remain within the pelvic cavity.
Sexual Intercourse
Fig: Sexual Intercourse
Sexual intercourse is a vital process of life formation. In a heterosexual intercourse, a male penetrates vagina with penis and after some movement ejaculates sperm which enters to uterus through cervix. If the sperm fertilizes with the ovum in the uterus, the female become pregnant. The foetus stays in the uterus for 9 months and a baby is born!
Menstruation Cycle
Fig: The phases of menstrual cycle.
Menarche (the first of menstrual cycle or its beginning) in a female occurs as early as the age of 8 years to 16 years whereas menopause (the last menstrual cycle) occurs at the age of 45 years to 50 years.
*Important: A female should always know their age of menarche because it is on of the first question a doctor asks during the check-up.
The first day of bleeding starts a menstruation cycle. Bleeding lasts for 3 to 5 days. The ovulation phase where the follicle is transferred from the ovary to the uterus lasts up to the fourteen day from the start of the menses or bleeding. Ovulation occurs when the egg sheds out of the follicle into the uterus and this is when the females are most fertile have high chances of conception This is around 12th to 14th day. After the ovulation, the body stats preparation for the next cycle. This is an infertile period for the females.
Question: Is a gap after the first mensuration normal?
Dr. Jha: Yes, about one to two years gap might occur sometimes in between the first and second mensuration, which is quite normal. This happens when the body is unable or not ready for hormonal changes after the first mensuration. But a doctor should be consulted if such gaps lengthens for three or more years.
Question: Is the fluctuations in the amount of bleeding (sometimes heavy sometimes scanty) normal?
Dr. Jha: The bleedings happen due to change in hormonal level. Fluctuations might happen when the hormones do not get enough supplements such as vitamins or minerals due to food habits or maybe even due to other health issues. If this is a recurring problem, one should do an ultra-sound and hormonal analysis.
Question: Is taking medicines during periods harmful?
Dr. Jha: Opting diet modifications, drinking hot water etc. in low grade pains is advised. You can take medicines such as Meftal (Mefenamic acid) if the pain is unbearable.
Question: Is excess hair in female body a hormonal problem?
Dr. Jha: When the body starts developing our reproductive organs, there are different hormones that play dominant roles. In males, androgen plays the major role whereas oestrogen plays major part in females. As such sometimes there might be excess androgen in females which might cause excess growth of hair and melanin pigmentation. To some extent, it is not a problem. It might also be a racial difference; for example, Asian females have low androgen affect than Aryan females. It might be a problem if it causes frequent irregular periods, too much hair etc. We do chromosomal analysis and hormonal therapy in such cases.
Question: Do mensuration happen to bisexuals?
Dr. Jha: There are two kinds of bisexuals, mentally and anatomically. If they are anatomically bisexual, then mensuration happens to them and it does not happen if they are mentally bisexual. Mensuration basically occurs due to hormones. So, without necessary hormones in the body, mensuration does not occur.
Female Fertility
Fertility is the natural capability to produce an offspring.
Fig: Chance of conception and Age
The menarche indicates that a female is fertile.
18-39 years of age is the best age to conceive from a biological point of view because that is the time when all the sexual organs are in the best condition and when females have the highest number of eggs.
From the age of 30-35 the number of eggs start to decrease.
If a female conceives at the age of 36-40, the offspring might be born with abnormalities such as downs syndrome. There are fewer eggs so there is less chance of conception.
Around the age of 40 or more years, the female body start to prepare for menopause, so she is either infertile or with very low fertility.
Male Fertility
Men’s fertility is concerned with their sperm. it is associated with the ability to impregnate a fertile woman. The sperm production starts after they hit their puberty at around the age of 9-15 and decrease around the age of 40. After the age of 50 the motility, count and shape of the sperm decrease by 50%.
There are around 15 million to 300 million sperm in a milliliter of semen where at least 40% are moving sperms. A sperm as at least 4% long tail and an oval head. Only the healthiest, strongest, and fastest sperm wins the race to fertilize the egg.
If the sperm count is less than 15 million per milliliter or less than 39 million per ejaculation than the male might be infertile. (Source: Mayo Clinic: Male Infertility, www.mayoclinic.org)
Therefore, the chance of conception depends on both male and female.
Pregnancy
Pregnancy is the state of carrying a developing embryo or foetus within the female body.
When the sperm enter to female body after ejaculation, it travels to the uterus through cervix, where the ovum that is produced from the ovary and transported through the fallopian tube fertilized with it.
It can be indicated by the positive result on an over-the-counter urine test. A blood test and an ultra-sound (to detect the heartbeat of the foetus) can confirm it.
Pregnancy lasts for about nine months, conveniently divided into three trimesters, each roughly three moths long. It is measured from the woman’s last menstrual period (her period before the pregnancy).
Question: How is pregnancy determined by the urine and blood tests?
Dr. Jha: In urine test, a hormone- Human Chronic Gonadotropin (HCG) is detected by the instrument by doing a PH test. The presence of the same hormone is also the indication of pregnancy in blood test. This hormone is made and released in a woman’s placenta after the fertilized egg implants itself in the uterus.
High HCG hormone might also be indicator for cancer and other health maladies. An ultrasound confirms whether the high hormone indication is pregnancy or other health concern.
Question: Does blood group plays an important role in conception and pregnancy?
Dr. Jha: No, there is no role of blood group in pregnancy. But the RH factor in blood plays an important role in carrying out safe pregnancy. Conflicting RH factor in the mother and the baby (+in mother and – in baby or the opposite) might be harmful for both the child and the mother. But there are measures we can take to prevent it nowadays.
Contraception
Contraception is the deliberate use of artificial methods or other technics to prevent pregnancy as a consequence of sexual intercourse. It is method of family planning.
It can be done through following methods:
Barrier method: It is a common method done by covering the genitals with condom or a sheath.
Fig: How to use a condom.
Contraceptive pills: These pills contain synthetic hormones which prevents ovulation in females.
Fig: Contraceptive pills
How it works:
It stops the body from releasing an egg by decreasing hormone production.
It thickens the cervical mucus stopping the sperm from getting into the uterus.
Advantages:
It causes regular and lighter periods.
Fewer cramps and PMS symptoms can be experienced.
Disadvantages:
One must remember to take it every day.
It can cause spotting between periods, mild nausea, or breast tenderness.
It provides no protection against STDs like the barrel methods.
Reliability:
It is about 99.7 percent effective if taken every day.
3. Intrauterine devices: Devices such as coil or Copper IUD prevents the ovum from being released to the uterus.
Fig: IUD
Advantage:
It remains in place once inserted. (May have small change of falling out.)
It remains effective while in place.
It prevents pregnancy for a long period.
It does not interfere with sexual intercourse.
Disadvantage:
It may cause bleeding and cramping.
It increases the risk of ectopic pregnancy.
Is also does not prevent STDs.
4. Contraceptive Implant: It is inserted beneath the skin of the upper arms which releases hormones to stop the sperm before reaching the egg or stop the release of the egg. It might cause heavy bleeding. It is about 99% effective.
5. Male and Female sterilization:
Hysterectomy is an operation to remove uterus.
Fig: Hyserectomy
(Source: https://teachmeobgyn.com/wp-content/uploads/2017/06/Classification-of-Hysterectomy.png)
Fig: Tubal litigation in female (Right) and Vasectomy in male (left)
Tubal Litigation: It is the process of permanently removing the fallopian tube or blocking it from the uterus.
Vasectomy: It is also a permanent method of sterilization by cutting or blocking the vas differentia.
Sexually Transmitted Diseases or Infections
How are STDs/STIs contracted?
They are generally transmitted by sexual contact. It is transmitted through blood, semen, vaginal or other bodily fluids due to the presence of any bacteria, viruses, or parasites through them. They can also be transmitted non-sexually such as from mother to infant during pregnancy of childbirth, through blood transfusions or shared needles.
What are the symptoms that indicate STDs/STDs?
Sores or bumps on the genitals or in the oral or rectal area.
Painful or burning urination.
Whitish or yellowish discharge from the penis.
Unusual or odd smelling vaginal discharge.
Unusual vaginal bleeding.
Pain during sex.
Sore, swollen lymph nodes particularly in groin but sometimes widespread.
Lower abdominal pain.
Rach over hands or feet.
Some common types of STIs
Chlamydia
Gonorrhoea
Trichomoniasis
Genital Warts
Genital Herpes
Pubic Lice
Scabies
Syphilis
Human Immuno-deficiency Virus (HIV)
Polycystic Ovary Syndrome (PCOS)
It is a hormonal disorder commonly seen in women of reproductive age.
What happens in PCOS?
The ovary may fail to regularly produce eggs which may cause in gaps between menstrual periods.
The is high level of androgen level in the female body which might make it harder for them to get pregnant.
Excessive hair growth (hirsutism) on face, chest, back and buttocks or thinning or loss of hair.
Women have irregular or prolonged menstrual periods due to imbalance in hormone level.
The ovary might develop a collection of fluids or cysts.
Increase in weight due to excess level of glucose in the body because PCOS makes it difficult for the body to use insulin.
Oily skin which results in acne formation.
The exact cause is unknown but early diagnosis and treatment along with weight loss might prevent or reduce the risk of other long-term diseases such as type 2 diabetes and heart diseases.
What are some complications in PCOS?
Infertility
Gestational diabetes or high blood pressure along with pregnancy
Miscarriage or premature birth
Non-alcoholic steatohepatitis- a severe liver inflammation caused by fat accumulation in the liver.
Metabolic Syndrome: high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase the risk of cardiovascular disease.
Sleep apnea
Depression, anxiety and eating disorders
Abnormal uterine bleeding
Cancer of the uterine lining
Obesity
How to treat PCOS?
The treatment focuses on lifestyle changes and medications. A proper diet changes along to maintain healthy weight, being active, exercising, meditation etc. is advised to such patients. Besides this, various medications are prescribed to maintain the hormone level, reduce excessive hair growth, help ovulation, and maintain menstrua cycle.
Abortion
An abortion is a procedure to end or terminate a pregnancy either by taking a medicine or having a surgical procedure done.
In Nepal, until 12 weeks of gestation in any pregnancy and up to 18 months if it is the result of rape or incest, abortion is legal. It was legalized in 2002, under 11th Amendment to the Muluki Civil Code. It is also legal if the foetus poses a serious threat to the mother’s life or if it cannot be conceived due to other abnormalities.
Risks of abortion:
Heavy bleeding
Infection
Incomplete abortion
Damage to cervix
Scarring the uterine lining
Perforation in the uterus
Damage in internal organs
And in some perilous cases - death.
Some Questions:
Questions: If parents have the same blood groups, how are the chances of baby having the same blood group?
Dr. Jha: Most probably they will have the same blood group, but this is determined by the genetic factors. So, sometimes the genetic signatures vary. Sometimes a father having AB positive blood group and the mother having B positive blood group may sire offspring having O positive blood group.
Question: What is the reason behind premature pregnancy?
Dr. Jha: One reason is PCOS. Another reason might be due to UTI which might irritate the womb widening the way for birth prematurely. Diabetic mothers also give birth prematurely due to rapid growth or premature growth of the baby, which sometimes leads to miscarriage. There are various other reasons for premature birth as well.
Question: What is Fallopian Tube called in Nepali?
Dr. Jha: Ha-ha. Nice question. As far as I know, we call it “Tube” in Nepali.
Question: Does Erythroblastosis fetalis harm both foetus and the mother?
Dr. Jha: If any abnormalities is seen in the child it will affect the mother as well. If the foetus stays dead inside the womb, it becomes fatal for the mother. So, in the end it is harmful for both mother and the child.
Question: Why do women bleed after their first sex and is it normal not to bleed?
Answer: There is a tissue called hymen situated on the vaginal walls. The bleeding is mainly due to this tissue. It has been associated with virginity since history. But hymen can slowly break as a woman grows. Cycling, running and other exercises and sports might break the hymen naturally.
Question: Is occasional itching around genital area normal?
Dr. Jha: Of course, occasional itching in any part of the body is normal. But if it accompanies redness, fishy smell and abnormal pigmentation is abnormal.
At last…
Knowing your own body is an empowering feeling. An educative session such as this by Dr. Alok Kumar Jha has surely left our participants reeling with knowledge and awareness. Next time they talk about their own sexual and reproductive health they will not be their previous stuttering mess of shame and instead be a confidant individual in charge of their own bodies and a guide to anyone in the same confusion they were in before.
Cheers!
😄
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