Sexual Reproductive Health of Young People (10-24 Years) A Parthasarathy, MKC Nair
INDEX
A
Abnormal sexual behaviors 98
Abortions, methods of 126, 127
Abstinence education 45
Adequacy of lactation 185
Adolescence 3
early 3
growth failure 5
growth patterns 4
late 4
middle 3
Adolescent body image concerns 23
Adolescent friendly services 41
Adolescent health card 56
Adolescent health services 41
Adolescent reproductive and sexual health 42
Adolescent reproductive sexual health services 46
Adolescent sexuality 27
Amenorrhea 20
Anorgasmia 153
Antenatal exercises 179
Art of breastfeeding 184
Assisted reproductive technology 66
B
Behavioral signs 35
Benefits of exercise 175
Body temperature, maintenance of 186
Breastfeeding 183
Breasts 16
care 16
functions 16
Burping 184
C
Castration 14
Child abuse 34
Child abuse, Indian penal code-reference to 38
Child sexual abuse 35
Colostrum 184
Commitment 89
Committed relationship 141
Common feeding problems 185
Communication in marriage 86
Communication, ways to improve 87
Compatibility vs incompatibility 80
Concept of virginity 142
Conflict in marriage, common sources of 92
Conflicts, types of 92
Contraception, myths on 163
Contraception, risk-benefit of 163
Contraceptive services 46
Contraceptives for males 161
natural contraception 162
permanent method 162
temporary method 161
Corporal punishment 36
Counseling 45
D
Development of sexuality 27
Disease conditions, considered in marriage 96
alcoholism 96
cardiac problems 96
infertility and STIs 97
mental health issues in 97
neurological problems 96
other illness 97
problems, reproductive system 96
Diseases of infections 108
bacterial vaginosis 110
candidiasis 110
chancroid 111
chlamydia 109
genital herpes 110
genital warts 111
gonorrhea 109
trichomoniasis 108
Dispareunia 156
Divorce, major reasons for 92
Dowry system 77
E
Early child development 188
Early marriage and pregnancy 42
Education in human sexuality, primary goals for 29
Ejaculatory duct 12
Emergency IUD insertion 164
Emotional abuse 35
Endogenous infection 105
Epididymis 12
Erectile dysfunction 153
Escalation 36
Expected date of delivery, calculation of 166
External female genital structures 14
F
Factors impacting body image 23
Fallopian tubes 14
Fantasy vs reality 79
Female orgasmic disorder 156
Female reproductive role 16
Female reproductive system 14
Female sexual arousal disorder 156
Female sexual dysfunctions 154
Frequency of sexual act 145
G
Groin infection 129
Growth spurt 6
H
Happy marriage 202
Health education 44
Healthy marriage 96
Healthy relationships 85
High-risk pregnancies 169
HIV/AIDS 44, 130
Home management 191-196
certain tips 191
financial management 192
financial responsibilities 192
food management 192
personnel grooming 196
work simplification 191
Homosexuality 53, 56, 132, 133
Honeymoon cystitis 143
Husband and wife, role and responsibilities 80
Hymen 15, 51
Hymenal membranes, types of 16
I
Iatrogenic infections 106
Immunization 188
Importance of fitness 176
Infertility 65
Intimacy 88
Intrauterine contraceptive devices 159
J
Joyful pregnancy 171
K
Kegel's exercises 182
L
Legal responsibilities, marriage 72
Lesbianism 53, 132
Love in marriage, SVR stage 78
M
Male and female orgasm 147
Male reproductive role 13
Male reproductive system 11
Marginalized adolescents 42
Marital adjustments 83
adjusting with the partner 83
adjustment with in-laws 84
Marital conflicts 92
Marital disharmony 90
Marriage 67, 76
essentials of 68
spirituality in 70
types of 68
Marriage laws 72-75
christian marriage act, 1872 75
divorce, divorce act of 1869 75
dowry prohibition act, 1961 74
Hindu marriage act 1955 72
Hindu succession act, 1956 74
muslim marriage act 74
residence and maintenance act 1946 74
special marriage act 1954 73, 75
Masturbation 52, 56, 132
Masturbation myths 136 Maturation of ova 15 Mature sperm 12
Menarche 9
Menstrual blood 55
Menstrual disorders 20
Menstrual hygiene 20
Menstruation cycle, physiology of 17, 18
Mirror of good attachment 89
Misconceptions 151
N
National immunization schedule 188
Newborn care 183
Newly weds, tips for 204
Nocturnal emission 48, 51
Normal labor 173
Normal periods 19
Normal vaginal environment 102
O
Oral contraception 159
Orchidometer 11
Orgasm 145
Ova production and release 18 Ovaries 14
Ovulation 17
P
Penis 13
Permanent methods, contraception 161
bilateral tubectomy 161
Personality disorder 97
Physical abuse 34
Polycystic ovarian syndrome 20, 55
Polycystic ovary 21
Positive sexuality 139
Post-abortion care 127
Postnatal care 174
Post-natal exercises 180
Post-traumatic stress disorder 39
Precocious puberty 55
Pregnancy and child labor 165
Pregnancy, effect of RTI on 106
Premarital counseling 59, 101
fertility and conception 62
fertility problems 64
goals and content 59
need and importance 59
tips for self help 64
Pre-marital sex 120
Premarital sexual activity 43
Premature ejaculation 152
Pre-menstrual syndrome 19
Prevention of infection 187
Prostate gland 13
Puberty 6-8
R
Reproductive tract infections, future implications 102, 114
Reproductive tract infections, sites of 104
RTI and family planning methods, relationship 106
S
School interventions 45
Scrotum 12
Secondary amenorrhea 20
Semen 13
Seminal vesicles 12
Sensual sex 148
Sequence of changes 7, 9
Sex characteristics 6
Sex education to adolescents 28, 30, 31
Sex wait until marriage, reasons 120
Sexual abuse 44
Sexual act, positions for 147
Sexual activity of adolescents, factors affecting 28, 130
Sexual acts, categories of 140
Sexual aversion disorder 156
Sexual behavior and value system 31
Sexual fantasies 79
Sexual health 33
Sexual problems, men 151, 152
Sexual problems, causes of 158
Sexual relationships 32
Sexual response, phases of 146
Sexual rights 140
Sexuality concepts 140
Sexually transmitted diseases 4
Size chart for bras; imperial system 25 Skin care during pregnancy 170
Skin presentation 129 Stages of labor 173
STD, factors associated with 111 STI, approach to diagnose 112 Structure of sperm 13
Structure of uterus 15
T
Tampon 54
Teenage pregnancy, problems of 121, 123
Teenage pregnancy, strategy for prevention of 124
Teenagers, social responsibilities of 126
Temporary methods, contraception 159
combined oral contraceptives 159
diaphragm 160
female condoms 160
injections 160
intrauterine device 160
norplant system 160
spermicides 160
Testes, functions of 11, 12
Three trimesters of pregnancy, tips for 168
Timing of intercourse 65
U
Unmarried adolescents 122
Unsafe abortion in adolescents, factors 128
Urethra 13
Uterus 15
V
Vagina 15
Vaginal discharge, differential diagnosis of 102, 103
Vaginismus 157
Vas deferens 12
Vertical transmission 107
Virginity 49
W
World Medical Association on child abuse, recommendations 36
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Chapter Notes

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1Adolescent Sexual and Reproductive Health (10-19 Years)
  • ❑ Introducing Reproductive and Sexual Health
  • ❑ Reproductive and Sexual Growth
  • ❑ Male and Female Reproductive System
  • ❑ Menstruation
  • ❑ Body Image Concerns
  • ❑ Adolescent Sexuality Development
  • ❑ Child Abuse—A Threat to Society
  • ❑ Adolescent Sexual and Reproductive Health Needs
  • ❑ Introducing Reproductive and Sexual Health Education in High Schools2

Introducing Reproductive and Sexual Health1

 
INTRODUCTION
The term ‘adolescence’ was popularized 100 years ago when G Stanley Hall used it to describe the second decade of life. Since then adolescence has been considered a very turbulent period. They run after excitement, thrills, stirring action and great exploits. Extremism seems to be on the air. Even the mannerisms and gestures of film stars and cricket players enthuse them.
 
CHARACTERISTICS
It is well recognized that childhood and adolescence are periods of intense psychological growth and development and often involve many crises, much instability, inner turbulence and behavioral deviance. These can adversely affect the development of an individual into a healthy adult (Table 1.1).
 
Change in Physical Stature
  1. Emotional changes
  2. Changes in thinking and behavior
  3. Secondary sexual changes.
 
Early Adolescence
  • Self concern and consciousness increase and morally they may think, right and wrong, as absolute and unquestionable.
  • Self-awareness centers around external characteristics, and may feel that others are staring at them.
  • Self-esteem increase in boys but may decrease in girls due to assigned gender roles in society involving inequalities in power and prestige.
  • Separation from family and increasing involvement with peers occur during this period.
    Table 1.1   Characteristics of adolescence
    • A transitional stage
    • Peek intelligence and stamina
    • Confused about identity
    • Never accepts without interrogation
    • Loves liberty
    • Tries to seek attention by any means
    • Emotional instability
    • Lack of self control
  • Changes occur in the cognitive development, from the concrete operational thinking (believing only what he/she can see, hear or touch) to formal logical operations (can understand concepts better)
  • Secondary sex characters appear along with rapid physical growth.
  • Ejaculation usually occurs at this time first during self-stimulation and later in sleep.
  • They tend to socialize among the same sex group and role models usually are from out side home.
 
Middle Adolescence
  • Growth spurt in girls is by 11.5 years and in boys’ 13.5 years and growth stops at 16 years for girls and 18 years for boys.
  • With menarche, sexual maturation is dramatic (age of menarche is decreasing due to good nutrition and less physical activity).
  • Before menarche clear vaginal discharge can occur.
  • In boys spermarche occurs.
  • Biologic maturation and social pressures combine to determine sexual activity in this stage.
  • They gain knowledge about various aspects of sexuality like risk of pregnancy; STD's, AIDS from, peers and from newspapers, television and radio, parents and teachers.
  • 4In the cognitive aspect may question and analyze extensively.
  • The peer group exerts less influence over dress activities and behavior.
  • They become distant from parents, redirecting emotional and sexual concept energies towards peer relationships and the need to belong to same sex group decreases.
 
Late Adolescence
  • In late adolescence somatic changes are modest, even though changes in breast, penis and pubic hair can occur.
  • Sexual experimentation tends to decrease.
  • Cognition tends to be less self-centered with increasing thoughts about concepts of justice and history.
  • They are often idealistic but may be absolutists and intolerant of opposing views.
  • Intimate relationships are also an important component of identity for many older adolescents. They involve love and commitment than superficial relations (Table 1.2).
Ego, Fads, Anxiety Mob Mentality, Mood Changes Hostility to parents, Idealistic/Moralistic Can't accept rejection, Interest in opposite sex Dependence on friends
 
ADOLESCENT GROWTH PATTERNS
Velocity of growth is different in different periods of life. It is high during the first years of life, then slows down and again reaches its peak during the adolescent years. With the onset of puberty there is adolescent growth spurt. Increase in general growth rate with growth of skeleton, muscles and viscera.
This is the most rapid period of growth with gains of 19 gm/day in boys and 16 gm/day in girls. The gain in height is about 27-29 cm in boys and 18-23 in girls and stops with epiphyseal closure. Weight gain is 25 to 30 kg in both sexes. The skeletal growth is completed in adolescence—50 percent of adult bone mass and 20 percent of the body stature is acquired during this period.
Table 1.2   Stages of adolescence
Change
Early
Middle
Late
Growth
Secondary sexual characteristics appear, growth accelerates and reaches a peak
Secondary sexual characteristics advanced, growth slows down, approximately 95% of adult stature attained
Physically mature
Each one cm gain in height needs 20 gm of calcium. The bone growth is mainly cortical growth.
At the cessation of growth boys are taller than girls, although in the early adolescents the girls are taller.
Body segments grow at different rates at different stages of puberty.
  • Legs begin to grow earlier than the trunk
  • Hands and feet grow at a faster rate
  • The shoulders widen in boys
  • The hips widen in girls.
 
Weight and Height
It is the growth hormone, which play a major role in growth spurt.
Pubertal height spurt begins at an average age of 12 years for girls and 14 years for boys
About 25 percent of adult weight is gained during this period.
Usually the more distal parts of the limbs (feet and hands) grow faster first. This accounts for the awkward appearance of adolescents;
E.g: Foot accelerates first followed by calf and thigh
E.g: Hands, forearms, followed by upper arms.
 
Target Height Gain of Adolescents
Mid parental height (MPH) is approximately the average final height expected in a child. It is calculated as follows. The target height of the child can be calculated roughly from the mid parental height.
5
zoom view
There are two important processes that contribute to the physical manifestations during this period; adrenarche and gonadarche. Adrenarche normally occurs between 8-10 years of age with increased androgen secretion from the hypothalamus and pituitary glands. Gonadarche is initiated by the hypothalamus that secretes gonadotrophine releasing hormone. The exact age of adrenarche and gonodarche depends on factors such as heredity and nutrition and whether the baby is a boy or girl.
 
ADOLESCENT GROWTH FAILURE
Never noted in time because after early childhood nobody bothers to monitor growth.
 
Causes for Growth Failure
Normal variation—need only reassurance Pathologic—due to genetic, chronic illness, nutritional problems and endocrine problems need to be detected early and given proper management. Growth failure resulting from reduced nutritional intake is also a major community health problem.
The adolescence is the second and perhaps the last chance for nutritional rehabilitation and prevention of future risks like growth failure, psychological problems, birth of low birth weight babies and so on.