PHC LECTURE

THEME 6 SECONDARY PREVENTION OF REPRODUCTIVE DISORDERS By, Senimelia Sivo Hataogo

OBJECTIVES
At the end of the lecture you should be able to; Recognize changes during middle and late reproductive years Identify the major reproductive disorders that exist in our country and the region The risk factors and preventative measures of reproductive disorders How to conduct self breast examination and self prostate examination Understand the importance of regular pap smear examination for men and pap smear for women

BRAINSTORM

DISCUSS WITHIN YOU GROUP AND SHARE TO THE CLASS YOUR UNDERSTANDING OF WHAT MAJOR CHANGES OCCUR DURING MIDDLE AND LATE REPRODUCTIVE YEARS

THE CHANGES
CLIMATERIC IS A PERIOD IN MIDDLE AND ADULTHOOD IN WHICH REPRODUCTIVE CAPACITY DECLINES OR IS LOST MALE- AVERAGE AGE- 40YEARS Drop in testosterone level Quantity of sperm decline Testis shrink Volume of seminal fluid decline Loss of muscle Sexual function affected/erectile dysfunction

THE CHANGES
WOMEN MENOPAUSE (average age- 50) Decline in sex hormones (estrogen & progesterone) Genitals and uterus shrink Breasts become less firm Vagina becomes smaller and shorter & the walls become less elastic with less lubricant Depression and negative mood Hot flushes (increases in body temperature)

SEXUAL HEALTH PROBLEMS

INFERTILITY- a couple has not conceived after 12 months of contraceptive free intercourse in the female under age 34 or 6 months in a female over the age of 35 (WHO definition) PRIMARY INFERTILITY has never been able to conceive SECONDARY INFERTILITY difficulty conceiving after already having conceived SUBFERTILITY a couple who has tried unsuccessfully to have a child for a year or more

INFERTILITY CAUSES
1. GENETIC FACTORS 2. GENERAL FACTORS e.g. DM, thyroid or adrenal diseases 3. Hypothalamic pituitary factors 4. Environmental factors e.g. toxins, (glue, smoke) Infertility problems can be referred to gynecologists for investigation & treatment

SEXUAL HEALTH PROBLEMS

PRE MENSTRUAL SYNDROME pain, discomfort, uncertainty, restlessness a woman experience before menses SYMPTOMS Breast tenderness, lumpier, heavier, bloated Fatigue and small weight gain Craving for salt, sugar, chocolate Head ache, back ache and joint pains Pimples acne may appear Moodiness, depressed, trouble sleeping

Management of PMS
Awareness of the existence of the problem Able to identify the problem Natural remedy as prescribed by the doctor Change of diet and eating habits Moderate exercises and relaxation Medication only if prescribed by the doctor

SEXUAL HEALTH PROBLEMS

CANCER DEFINITION a class of disease in which a cell or a group of cells display; 1. Uncontrolled growth ( division beyond normal limits) 2. Invasion (intrusion and destruction of adjacent tissues) 3. Metastasis (spread to other locations in the body).

Cancer cont.
Cause 13% of all human deaths globally Environmental disease 90-95% due to environmental factors 5-10% due to genetics Common environmental problems are; Tobacco, diet and obesity, infections, radiation, stress, physical activity and environmental pollutants.

SEXUAL HEALTH PROBLEMS

CANCERS Prostate - male Penile male Testicular - male Breast female Ovarian female Uterine female Cervical - female

Discussion
In your groups discuss, which of these cancers can be detected in our country What are the name of the tests How accessible are these tests to the people

Secondary Prevention
Breast cancer 2ND leading cause of death among all women High incidence of breast disease in women 190 women in Fiji had died the last 2 years (2008 2009) 186 new cases were detected (Fiji Cancer Society)

Lymph node areas adjacent to breast ar

A pectoralis major muscle B axillary lymph nodes: levels I C axillary lymph nodes: levels II D axillary lymph nodes: levels III E supraclavicular lymph nodes F internal mammary lymph nodes

Breast cancer
1. 2. 3. 4. Risk factors you cannot change Gender being a woman Age - risk increase as you get older Genetic hereditary ( close blood relative) Race and ethnicity white more than black but in Fiji ( Fijians more than Indians) 5. Dense breast tissues 6. Menstruate early (before 12years & late menopause after 55years).

Breast cancer
SIGNS AND SYMPTOMS breast lump or thickening that persist throughout the menstrual cycle feels like a pea a change in shape or shape A blood stained or clear discharge from nipple Dimpled, puckered, inflamed skin on the breast or nipple Redness of the skin on breast and nipple A marble like hardened area under the skin

Breast self examination (BSL)

STEP 1 VISUAL EXAMINATION Stand in front of mirror with torso exposed Look at the shape, size or any change of color Look for signs of dimpling, swelling, redness in several positions, hands hanging down, hands behind the head and hands resting on the side Step 2 palpation with pads of the fingers to feel for lumps or soreness

Breast self examination (BSL)

PALPATION can be done in three patterns 1. Vertical moving fingers up and down the breast. 2. Pie wedge start at nipple and move outwards. 3. Circular moving fingers in circle around the breast Finally, gently squeeze the nipples for any discharge Palpation should cover the breast to armpit Can be done standing or lying down The best time is at the end of menstrual cycle

Cervical cancer
1st leading cause of death of women in Fiji High prevalence with Fijians 40,000 new cases identified each year globally 80% of new cases occur in developing countries Approximately 200,000 women die each year

Cervical cancer
Mainly caused by human papilloma virus(HPV) Can affect women from 30years and over Risk factors Many sexual partners Early sexual activity before age 18 STD Weak immune system Cigarette smoking

Female reproductive organ

Cervical cancer
Signs and symptoms Vaginal bleeding after intercourse, between periods or after menopause Watery, bloody, vaginal discharge that may have foul odor Pelvic pain or pain after intercourse

Cervical cancer
Can be prevented First line of defense is to empower women to protect themselves against HPV, a sexually transmitted disease Early detection through pap smear screening Papanicolaou smear named after Dr. George Nicholas Papanicolaou (1942) is the sampling and testing of different cell types of the cervix to detect pre - cancerous changes for further investigation and treatment

PAP SMEAR SCREENING

The cervix is covered by stratified squamous epithelium externally and columnar epithelium internally The point where these two coverings meet is the sqaumo columnar junction The junction usually moves around a certain area name the transformation zone Cervical cancer generally originate from this transformation zone

PAP SMEAR SCREENING

The cervix and its epithelium are also affected by hormones given as contraceptives Therefore the junction does not remain static but moves back and forth because of the action of eostrogen The cervix moves out and can be easily seen During pregnancy During 1-15 of menstrual cycle With oestrogen containing Fetus in utero

PAP SMEAR SCREENING

The cervix moves towards the cervical canal and is less seen: In the pueperium Day 15 to end of menstrual cycle After menopause Women taking progesterone-only contraceptives

How to prepare
Do not douche or use any type of vaginal medications within 48hours No intercourse within 24 hours Should empty bladder before the test Regular pap smear can detect cancer early for successful treatment Pap smear can also detect vaginitis, infections and some sexually transmitted disease Pap smear can also reveal cancer of uterus and ovaries

The procedure
Medical and reproductive health history is taken first Provide privacy Prepare pap smear tray and label Woman to lie on her back, knees bent and feet apart Speculum inserted into vagina and secured open Cells from the transformation zone scraped by a special brush/spatula Specimen is sent to laboratory for examination

The procedure
Return dates are given for pap smear results Follow up of cases with abnormal results and treatment as per protocol Regular screening of sexually active women is the best defense Increase awareness for the need of regular screening to prevent mortality Early detection and treatment can save lives.

Prostate cancer
Exact cause- unknown Risk factors are: Genetic Hormones Diet Environment Viruses or infections

Prostate Cancer
Anatomy of the prostate gland

Prostate cancer
Prostate gland is located below the bladder A firm walnut or chestnut size gland Function is to produce semen fluid in which sperm lives Prostate gland enlarges with age Enlargement puts pressure on urethra Causing problem in passing urine

Prostate cancer
Symptoms: Frequency and urgency of urination Nocturia and haematuria Straining to urinate Weak or intermittent stream of urine Feeling of incomplete emptying Back ache

Preventative
Community awareness More programs on motivation of men to undergo prostate examination Organize ways for men in the community to be in access to prostate examination Ensure all men over 49years with lower back pain to seek medical advice or opinion Early detection increases chance of successful treatment

Detection of prostate cancer

The gold standard is digital rectal examination Mostly done by physicians and hated by many Self prostate examination Can be done in the shower Wearing a latex glove Insert a finger into the rectum Feel for a walnut size gland Should feel similar to flesh between thumb and hands If it feels like knuckle to be reported

Detection of prostate cancer

If it is larger than a walnut should be reported Sweeping motions of the finger on both sides of the prostate to cover as much of the surface are as possible All men over 50 should have this examination as part of routine check up Should be done at 6 months interval

Testicular cancer
THE TESTIS
Although testicular cancer is rare in teenage guys, overall it is the most common cancer in males between the ages of 15 and 35. It's important to try to do a TSE every month so you can become familiar with the normal size and shape of your testicles, making it easier to tell if something feels different or abnormal in the future.

TESTICULAR SELF EXAMINATION

THE TEST
It's best to do a TSE during or right after a hot shower or bath. The scrotum (skin that covers the testicles) is most relaxed then, which makes it easier to examine the testicles. Examine one testicle at a time. Use both hands to gently roll each testicle (with slight pressure) between your fingers. Place your thumbs over the top of your testicle, with the index and middle fingers of each hand behind the testicle, and then roll it between your fingers. You should be able to feel the epididymis (the sperm-carrying tube), which feels soft, rope-like, and slightly tender to pressure, and is located at the top of the back part of each testicle. This is a normal lump

(TSE)
Here s how to do the test
Remember that one testicle (usually the right one) is slightly larger than the other for most guys this is also normal. When examining each testicle, feel for any lumps or bumps along the front or sides. Lumps may be as small as a piece of rice or a pea. If you notice any swelling, lumps, or changes in the size or color of a testicle, or if you have any pain or achy areas in your groin, let your doctor know right away. Lumps or swelling may not be cancer, but they should be checked by your doctor as soon as possible. Testicular cancer is almost always curable if it is caught and treated early

THE END

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