Sexual and Reproductive Health (eBook)

Cover Page 1
Sexual and Reproductive Health: A Public Health Perspective 4
Copyright Page 5
Contents 6
Contributors 8
Preface 10
Section 1: Physiology, General Epidemiology and Demography 12
Female Reproductive Function 13
Introduction 13
Menstruation and the Menstrual Cycle 13
The Ovarian Cycle 14
The Endometrial Cycle 18
The Conceptional Cycle 18
Gamete Encounter and Fertilization 18
Development and Transport of the Zygote to the Site of Implantation 20
Implantation 20
Regulation of the Hypothalamic-Pituitary- Ovarian Axis 21
Conclusion 22
Citations 22
Further Reading 22
Relevant Websites 22
Male Reproductive Function 23
Introduction 23
The Testis 23
Hormonal Regulation of Testicular Function 23
Gonadotropin-releasing hormone (GnRH) 23
Gonadotropins 25
Endocrine Function: Testosterone Production 26
Hypogonadism 26
Exocrine Function: Spermatogenesis 28
Seminal Ducts 28
Epididymis 28
Deferent Duct and Seminal Vesicle 28
Prostate 29
Penis 29
Infertility 29
Conclusion 30
Citations 30
Further Reading 31
Relevant Websites 31
Puberty 31
Definition 31
Physiological Changes 32
Secular Trends 33
Variation Within the Normal Range 34
Abnormal Pubertal Development 34
Disorders of Sexual Development 35
Conclusions 36
Citations 36
Further Reading 36
Menopause 37
Introduction 37
Types of Menopause 37
Premature 37
Surgical 37
Natural 37
Effects of Menopause 38
Symptoms 38
The Hot Flush 38
Other Symptoms 39
Libido 40
Physical Effects 40
Urogenital Tract 40
Bone 41
Cardiovascular Disease 42
Dementia 43
Skin and Hair 43
Treatments 43
Hormone Replacement Therapy 43
Alternative Treatments 44
Conclusion 44
Citations 44
Further Reading 44
Relevant Websites 44
Sexual and Reproductive Health: Overview 45
Introduction 45
Sexual and Reproductive Health: Concepts and Dimensions 45
Reproductive Health 45
Definition of reproductive health 45
Sexual Health 46
The Human Rights Dimension 46
The Development Dimension 46
The Burden of Sexual and Reproductive Ill-Health 46
Global Situation of Sexual and Reproductive Health 46
Pregnancy, Childbirth, and Health of Newborns 47
Family Planning 47
Unsafe Abortion 47
Sexually Transmitted Infections, including HIV and Reproductive Tract Infections 47
The Unfair Burden on Women 48
Sexual and Reproductive Health Indicators 48
Inequity in Sexual and Reproductive Health 49
Determinants of Sexual and Reproductive Health 49
Behavioral Determinants 49
Economic and Social Determinants 50
Health System Determinants 50
The Sexual and Reproductive Health Package 51
The Five Core Aspects of Sexual and Reproductive Health 51
Sexual and Reproductive Health: An Integrated Package 51
Family Planning 51
Integration of Sexual and Reproductive Health Services 51
Implementation of the Sexual and Reproductive Health Package 52
Special Considerations of Sexual and Reproductive Health Care 52
Dealing with Healthy People 52
Dealing with More than One Client 53
Dealing Mostly with Women 53
Dealing with Society 53
International Commitment to Sexual and Reproductive Health 53
Sexual and Reproductive Health and the Millennium Development Goals (MDGs) 53
WHO Reproductive Health Strategy to Accelerate Progress Toward the Attainment of MDGs 53
Conclusion 54
Citations 54
Further Reading 54
Relevant Websites 54
Sexual Health 55
Introduction 55
Defining the Area of Sexual Health 55
Barriers to the Achievement of Sexual Health 55
The Public Health Burden 55
Risk Behaviors 56
Trends and Patterns 56
Risk Factors and Risk Groups 56
Social and Environmental Factors 57
Effective Public Health Strategies 57
Interventions Aimed at Individual Behavior Change 57
Intervention at the Level of the Social Context 59
Conclusion 61
Citations 61
Further Reading 62
Relevant Websites 62
Population Growth 62
Dynamics of Population Growth 62
Population Projections 63
The Demographic Transition 63
Fertility Rates 63
Population Aging 65
Factors That Influence Population Growth 65
Contraceptive Prevalence 65
Mortality from HIV/AIDS and Other Infectious Diseases 66
Gender Equity 67
Migration 67
Government Policies 68
Impacts of Population Growth 68
Health 68
Poverty 68
Natural Resources 69
Conflict and Security 70
Conclusion 70
Citations 70
Further Reading 71
Relevant Websites 71
Trends in Human Fertility 71
Introduction 71
Trends in Industrialized Countries 73
Trends in Developing Regions 74
Conclusions 76
Citations 78
Further Reading 78
Relevant Websites 78
Perinatal Epidemiology 78
Introduction 78
Definitions and Definitional Pitfalls 79
Perinatal Mortality 79
Causes of Perinatal Death 80
Perinatal Morbidity 81
Perinatal Audit 82
Perinatal Risk Factors 82
Analytical Studies 83
Recurrence Risk 84
Generational Studies 85
Record Linkage to Registries Outside Medical Birth Registries 85
Maternal and Child Cohorts 86
Citations 86
Section 2: Core Elements 88
Family Planning/Contraception 89
Introduction 89
Combined Hormonal Contraception 90
Mode of Action 90
Combined Oral Contraceptives 90
Contraindications 91
Side effects and risks 91
Noncontraceptive benefits 92
Combined Hormonal Patches, Injectables, and Rings 92
Progestogen-Only Contraception 92
Mode of Action 93
Progestogen-only pills 93
Injectables 93
Implants 93
Intrauterine Devices and Systems 94
Mode of Action 94
Side Effects and Risks 94
Intrauterine System 94
Barrier Methods 94
Male Condom 94
Female Condom 95
Diaphragms 95
Cervical Caps 95
Spermicides 95
Fertility Awareness Methods 96
Lactational Amenorrhea Method 96
Withdrawal 96
Sterilization Procedures 96
Female Sterilization 96
Timing of the procedure 97
Techniques 97
Clinical management 97
Male Sterilization 97
Technique 97
Clinical management 97
Emergency Contraception 98
Hormonal Emergency Contraception 98
Postcoital Intrauterine Device 98
Conclusion 98
Citations 98
Further Reading 99
Relevant Websites 99
Gynecological Morbidity 99
Introduction 99
Amenorrhea 99
Polycystic Ovarian Syndrome (PCOS) 101
Heavy Menstrual Bleeding (Menorrhagia)/Dysfunctional Uterine Bleeding 101
Medical Treatments 102
Surgical Treatments 102
Benign Gynecological Tumors 103
Endometrial Polyps 103
Cervical Polyps 103
Fibroids (Uterine Leiomyomata) 103
Adenomyosis 104
Endometriosis 104
Adnexal Pathologies 105
Adnexal Masses 105
Adnexal Torsion 105
Bartholin Gland Cyst/Abscess 106
Chronic Pelvic Pain (CPP) 106
Premenstrual Syndrome 107
Diethylstilbestrol (DES) Exposure 107
Pelvic Organ Prolapse 107
Urinary and Fecal Incontinence 108
Urinary Incontinence 108
Fecal Incontinence 109
Female Genital Tract Fistulae 109
Female Genital Mutilation (FGM) 110
Citations 111
Further Reading 111
Relevant Websites 112
Sexually Transmitted Infections: Overview 112
Introduction 112
History and Epidemiology of STIs 113
Transmission Dynamics of STIs 113
Classification of STI Pathogens 114
Syphilis 114
Gonorrhea 116
Chlamydia 116
Chancroid 117
Genital Herpes 117
Human Papillomavirus (HPV) Infection 118
Trichomoniasis 119
Consequences of STIs 119
STI Control and Prevention 120
Partner Notification and Referral 120
The Future of STIs 121
Conclusion 121
Citations 122
Further Reading 122
Relevant Websites 122
AIDS: Epidemiology and Surveillance 122
Introduction 122
Overall Prevalence of HIV 123
Distinctions between HIV Types 1 and 2 123
HIV-1 Groups and Subtypes 124
Modes of HIV Transmission: Rates and Risk Factors 126
Sexual Transmission 126
Transmission via Injection Drug Use (IDU) 128
Mother-to-Child Transmission 129
Transmission via Exposure to Blood Products 130
Occupational Exposure and HIV Transmission Risk 130
Regional HIV Surveillance Data 130
Sub-Saharan Africa: Overview 131
Southern Africa 131
East Africa 131
West and Central Africa 131
Asia: Overview 131
South-East Asia 131
People's Republic of China 132
India 132
Eastern Europe and Central Asia 132
Latin America and the Caribbean 132
North America, Western, and Central Europe 133
Middle and North Africa 133
Oceania 133
Citations 133
Relevant Websites 136
Mother-to-Child Transmission of HIV 136
Introduction 136
Prevention of Transmission of HIV from HIV-Positive Mothers to Their Infants 137
Prevention of Mother-to-Child Transmission (pMTCT) 137
ART in Pregnant Women 137
Recommended ART regimens for pMTCT 138
ART toxicity during pregnancy 138
Mode of Delivery 138
Breastfeeding and MTCT Risk 140
The Care of HIV-Exposed Infants 141
Diagnosing HIV Infection in Infants 141
HIV Prevention and the Adolescent 143
Pediatric HIV Infection 143
Care of the Child with HIV 143
Starting ART in Infants and Children 143
Conclusions 146
Citations 146
Further Reading 147
Infertility 149
Introduction 150
Definitions 150
Prevalence of Infertility 151
Consequences of Infertility for Individuals and the Family 152
Etiology 153
Overview of Infertility Evaluation and Treatment Alternatives 153
Infertility Evaluation of the Female Partner 154
Evaluation of ovarian reserve 154
Assessment and characterization of the ovulatory cycle 154
Assessment of uterine cavity and evaluation of tubal indemnity and pelvic integrity 155
Endometriosis 155
Infertility Evaluation of the Male Partner 156
Unexplained Infertility 156
Overview of Assisted Reproductive Technology 156
Inequality in Access to Fertility Treatments/ART 157
Citations 159
Further Reading 159
Abortion 160
Introduction 160
Defining Abortion 160
The Magnitude of Induced Abortion 160
Regional Differences in Induced Abortion 160
Regional Differences in Occurrence of Unsafe Abortion 161
Methods of Pregnancy Termination 161
Surgical Abortion 161
Pharmacological Abortion 162
Methods of Unsafe Abortion 163
Complications and Consequences of Unsafe Abortion 163
Acute Complications 163
Long-Term Sequelae 163
Maternal Mortality 163
Psychological Consequences 163
Economic Consequences 164
Association Between Legal Status and the Consequences of Abortion 164
Legal Status of Abortion in the World 164
Legal Status and Abortion Rate 165
Abortion Law and Maternal Mortality 165
Determinants of Induced Abortion 165
Knowledge of Contraception 165
Access to Contraception 166
Effectiveness of Contraceptive Methods 166
Gender Power Imbalance 166
Interventions to Reduce Induced Abortions 167
Family Planning 167
Sex Education 168
Other Interventions 168
Interventions to Reduce Unsafe Abortions and Their Consequences 168
Decriminalizing or Extending Legal Grounds for Abortion 168
Improving Access to Legal Abortion 169
Access to Postabortion Care 169
Conclusions 169
Citations 170
Further Reading 170
Maternal Mortality and Morbidity 171
Introduction 171
Concepts and Definitions 171
Maternal Death 171
Maternal Morbidity 172
Maternal Death 173
Measurement 173
Measures of maternal mortality 173
Data sources and collection methods 173
Global Levels and Determinants 174
Causes of Maternal Deaths 174
Maternal (Obstetric) Morbidity 177
Severe Acute Maternal Morbidity (Near Miss) 177
Major Morbidities 179
Obstetric hemorrhage 179
Hypertensive disorders of pregnancy (preeclampsia/eclampsia) 180
Sepsis 181
Obstructed labor 181
Venous thromboembolism 182
Other major morbidities 182
The effect of AIDS 182
The effect of malaria 182
Minor Morbidities 183
Obstetric trauma 183
Psychological/psychiatric problems 184
Conclusion 184
Disclaimer 184
Citations 184
Further Reading 185
Sexual Violence 185
Introduction 185
Sexual Violence: Definition 185
Prevalence of Sexual Violence 186
Sexual Assault 186
Sexual Trafficking 188
Harmful Traditional Practices 188
Sexual Violence Against Men 188
Understanding Perpetration of Sexual Assault 188
Health Consequences of Sexual Assault 190
Ethics of Research on Sexual Violence 190
Responding to Sexual Assault in the Health Sector 191
Preventing Sexual Violence 191
Citations 192
Further Reading 192
Relevant Websites 192
Violence Against Women 193
Introduction 193
How Widespread Is Violence Against Women? 193
Intimate Partner Violence 193
Intimate Partner Violence during Pregnancy 197
Sexual Violence, Including during Conflict and Displacement 197
Child Sexual Abuse and Forced First Sex 197
Trafficking of Women 197
Female Genital Mutilation 197
The Sexual and Reproductive Health Consequences of Violence 198
Responding to Violence Against Women 199
Conclusion 200
Disclaimer 201
Citations 201
Further Reading 201
Relevant Websites 202
Fetal Growth Retardation: Causes and Outcomes 202
Introduction 202
Concepts about the Relationship between Birthweight and Gestational Age 203
Terminology and Definitions 203
Birth Weight for Gestational Age Reference Standards 204
Causes of Fetal Growth Retardation 205
Consequences of Fetal Growth Retardation 207
Prevention of Fetal Growth Retardation 208
Management of Fetal Growth Retardation 209
Educational Programs 210
Citations 210
Further Reading 210
Infant Mortality/Neonatal Disease 211
Introduction 211
History 211
Measurement of Infant Mortality 211
Definitions 211
Sources of Data 212
Global Patterns of Infant Mortality 212
Components of Infant Mortality 213
Neonatal Mortality 213
Low birthweight 213
Prematurity 213
Intrauterine growth retardation 214
Asphyxia 214
Pneumonia and sepsis 214
Tetanus 214
The importance of birthweight and causal interactions 214
Birthweight distribution effects 215
Birthweight-specific mortality effects 215
Neonatal mortality and women's health 216
Postneonatal Mortality 216
Pneumonia 216
Diarrhea 216
Birth defects 216
Malaria 216
Acquired Immune Deficiency Syndrome (AIDS) 217
Conclusion 217
Further Reading 217
Section 3: Reproductive Cancers 218
Cancer Screening 219
Introduction 219
Cancers Suitable for Screening 219
Benefits and Harms of Screening 220
Validity of Screening 220
Predictive Values of a Screening Test 221
Evaluating the Effect of Screening 222
Organizing a Screening Program 223
Cancer Screening by Primary Site 224
Cervical Cancer Screening 224
Natural history 224
Screening with cervical smears 224
Effectiveness of screening 224
Screening programs 225
Adverse effects of screening 225
Other screening tests 225
Breast Cancer Screening 226
Natural history 226
Mammography screening 226
Effectiveness of screening 226
Service screening 227
Adverse effects 228
Other screening tests 228
Colorectal Cancer Screening 228
Natural history 228
Screening tests 228
Effectiveness of FOBT 229
Service screening 229
Adverse effects of screening 229
Other screening tests 229
Screening for Oral and Liver Cancer 230
Lung Cancer Screening 230
Natural history, diagnosis, and treatment 230
Screening with chest X-rays, with or without sputum cytology 230
Effectiveness of screening 230
Adverse effects of screening 230
Other screening methods 230
Neuroblastoma Screening 231
Prostate Cancer Screening 231
Natural history 231
Prostate cancer screening based on PSA 231
Effectiveness of PSA screening 231
Adverse effects of screening 232
Other screening tests 232
Screening for other cancers 232
Cancer Screening Guidelines 232
Conclusion 233
Citations 234
Worldwide Burden of Gynecologic Cancer: The Size of the Problem 235
Introduction 235
Indices of Cancer Burden 235
Sources and Methods of Estimation of Data 235
2002 Estimates of Gynecological Cancer Burden 236
Cancer of the Uterine Cervix 238
Cancer of the Uterine Body 239
Ovarian cancer 240
Other Gynecological Cancers 242
Discussion 242
Conclusion 244
Practice Points 244
Research Points 244
Citations 245
Cervical Cancer 246
Introduction 246
HPV 246
Cofactors of Risk for Cervical Cancer 246
Screening Tests and Their Efficacy 247
Conventional and Liquid-based Cytology 247
HPV Testing 248
VIA, VIAM and VILI 249
Concurrent Screening Test Assessment 250
Organization of Cervical Cancer Screening Programs 250
Age and Screening Interval 251
When to Stop Screening 251
Follow-up and Treatment of Detected Abnormalities 252
Recruiting the Women 252
Prospects for Controlling Cervical Cancer 252
Conclusion 253
Practice Points 253
Research Agenda 253
Acknowledgments 253
Citations 253
Endometrial Cancer 255
Introduction 255
Epidemiology 256
Risk Factors 256
Estrogen-Alone and Estrogen-With-Progestin Replacement 256
Tamoxifen 257
Obesity 257
Diabetes and Hypertension 257
Parity 258
Menstrual Factors 258
Diet 259
Genetic Predisposition 259
Prevention 259
Oral Contraceptives 259
Smoking 260
Physical Activity 260
Screening for Endometrial Cancer 260
Outpatient Endometrial Biopsy 261
Ultrasound 261
Mass Screening 262
Conclusion 262
Practice Points 262
Research Agenda 262
Citations 262
Breast Cancer 264
Introduction 264
Causes 265
Family History 265
Pregnancy-Related and Hormone-Related Factors 266
Anthropometric Indices and Physical Activity 266
Dietary Factors 267
Environmental Exposures 267
Possibilities of Chemoprevention 267
Pathogenesis 267
Progression from Healthy Tissue to Invasive Carcinoma 267
Diagnosis and Staging 269
Diagnostic Procedures 269
Staging 269
Surgery 270
Radiotherapy 270
Radiotherapy in Breast Conservation 270
Partial breast irradiation 271
Intraoperative radiotherapy 271
Radiotherapy for ductal carcinoma in situ 271
Development in radiation techniques 271
Radiotherapy in Locally Advanced Carcinoma 271
Radiotherapy of Metastases 271
Systemic Treatment 271
Treatment of Locally Advanced Disease 271
Adjuvant Treatments 272
Neoadjuvant (Primary) Systemic Treatments 272
Conclusion 273
Citations 273
Ovarian Cancer 273
Epidemiology 273
Biology and Etiology 274
Diagnosis and Treatment Pathway 274
Symptomatic Presentation 274
Screening 275
Primary Management 275
Surgery 275
Chemotherapy 276
Management of Relapse 277
Palliation 277
Prevention 277
Conclusion 278
Citations 278
Relevant Websites 278
Prostate Cancer 279
Introduction 279
Anatomy, Physiology, and Pathology 279
Diagnosis, Screening, and Treatment 281
Variation in Incidence and Mortality 281
Risk Factors for Prostate Cancer 282
Family History and Genetic Factors 283
Hormones 283
Sexual Activity 284
Infection and Inflammation 284
Dietary and Nutritional Factors 284
Other Factors 285
Alcohol 285
Tobacco 285
Radiation 286
Occupation 286
Vasectomy 286
Conclusion 286
Citations 286
Further Reading 286
Testicular Cancer 287
Introduction 287
Histology 287
Seminoma 287
Nonseminomatous Germ Cell Tumors 287
Incidence 288
Trends in Incidence 288
Birth Cohort Effect 289
Age 289
Racial Factors 290
Occupation and Sociodemographic Characteristics 290
Laterality 290
Risk Factors 290
Cryptorchidism 290
Hormones 290
Genetic Factors 291
Diet 291
Etiology and Pathogenesis 291
Diagnostic Delay 291
Signs and Symptoms 292
Physical Examination 292
Natural History 292
Staging 292
Treatment 292
Prognosis 292
Seminoma 292
Nonseminomatous Germ Cell Tumor 292
Trends in Mortality 293
Citations 293
Further Reading 295
Section 4: Selected Ethical Andother General Aspects 296
Reproductive Ethics: New Reproductive Technologies 297
Introduction 297
General Ethical Issues Associated with ARTs 297
Artificial Insemination 298
In Vitro Fertilization and Embryo Transfer 298
Other ARTs 299
Conclusion 300
Citations 300
Further Reading 300
Reproductive Ethics: Ethical Issues and Menopause 301
Introduction 301
Menopause 301
Culture and Menopause 301
Is Menopause a Disease? 302
Making Informed Decisions about Treatment for Menopause 302
Hormone Replacement Therapy and Disease Prevention 303
Research Ethics and Menopause 304
Conclusion 304
Citations 304
Further Reading 305
Relevant Websites 305
Reproductive Ethics: Perspectives on Contraception and Abortion 305
Introduction 305
The Autonomy of Women 306
Minimizing Harm 306
Is Self-Determination Harmful to Women? 306
Is Contraception or Abortion Harmful to Women? 307
Competing Interests 307
Justice 308
Conclusion 309
Citations 309
Further Reading 309
New Technologies: Ethics of Stem Cell Research 310
Introduction 310
Ethical Debates About the Moral Status of the Embryo 310
Cloning 311
Ethical Debates on Cloning 312
Other Issues Related to hESC Research 312
Conclusion 312
Citations 313
Further Reading 313
Gender Aspects of Sexual and Reproductive Health 313
Definitions 313
Dimensions of Gender Considerations 314
The Burden of Sexual and Reproductive Ill- Health, by Sex 314
Norms and Values 315
Access to Resources 316
Gender Biases in Health Services 317
Laws and Policies 318
Conclusion 318
Disclaimer 319
Citations 319
Further Reading 319
Relevant Websites 319
Reproductive Rights 320
Introduction 320
The Evolution of an International Consensus 320
Rights in the Service of Health, Welfare, and Development 320
Rights in Respect of the Inherent Dignity of the Individual 320
An International Consensus on Reproductive Rights 321
The Protection of Reproductive Rights as Human Rights 322
Rights to Reproductive Self-Determination 322
Rights to Sexual and Reproductive Health Services, Information and Education 323
Rights to Equality and Nondiscrimination 323
Conclusion 324
Citations 324
Further Reading 325
Relevant Websites 325
Cultural Context of Reproductive Health 325
Introduction 325
History of Anthropological Research on Human Reproduction 326
Biological Anthropology and the Study of Human Reproduction 326
Structural-Materialist Anthropology and the Study of Human Reproduction 327
Sociocultural Anthropology and the Study of Human Reproduction 327
Public Health and the Anthropology of Reproduction 328
Conclusion 329
Citations 329
Further Reading 329
Women's Mental Health Including in Relation to Sexuality and Reproduction 330
Introduction 330
Sex Differences and Mental Disorders 330
Which Mental Disorders Are More Common in Women? 330
Clinical Profile of Various Mental Disorders in Women 330
Depression 330
Anxiety disorders 331
Schizophrenia 331
Dementias: Alzheimer's Disease 331
Suicide 331
Substance Use 331
What Are the Factors That Contribute to Increased Vulnerability in Women to Mental Health Problems? 331
Life Stress and Mental Health Problems in Women 331
Sexual Abuse and Sexual Coercion 332
Intimate Partner Violence 332
Poverty 332
Migration 333
War 333
Natural Disasters 333
Clinical Interface of Women's Mental Health with Reproductive Health and Medical Disorders 333
Psychiatric Disorders in Relation to Pregnancy and the Postpartum Period 333
Major consequences of untreated maternal depression 334
In the mother 334
In the child 334
Postpartum psychiatric disorders 334
Epidemiology 334
Severe mental illness in the postpartum period 335
Depression 335
Treatment and prevention of maternal mental disorders 335
Menstrual Cycle and Menopause 336
Reproductive Health Problems and Women's Mental Health 336
Malignancies and Impact on Mental Health 337
HIV/AIDS 337
Medical Disorders and Impact on Mental Health 337
Interventions 337
Primary Prevention 337
Secondary Prevention 337
Tertiary Prevention 338
Conclusion 338
Citations 338
Further Reading 338
Relevant Websites 339
Subject Index 340