SRHS Project

Relationship and Emotions (4th Session)

2009-11-21T06:24:00.000-08:00

A. What is relationship?

Early age relationship Actor and Influences : Parent,Family,Friends
Role-model : Parent

Teenage relationship
Actor : Parent, Family, Friends, Bestfriend, Boy/Girl friend
Influences : Media, Culture, Beliefs/Religion

Adult relationship
Actor : Parent, Family, Friends, Bestfriend, Boy/Girl friend, Partner

Influences : Media, Culture, Beliefs/Religion

Types of relationship :

Monogamous (Married/Unmarried)
Polygamous (Married/Openrelationship/Casual)

How role-model relationship contribute to your relationship?

Somehow we adopt the pattern in the family ( good/bad or both ways ) and brings to our relationship,especially with partner.

Most of us expect partner to fulfill the unmet needs when we were young

We create ideal-image of relationship by analyze the unmet needs in former relationship and avoiding the same situation that leads to trauma.

Some trauma are burried and some others are healed by the capability of the person to deal with it, ussualy by time people learn to forgiving, wisdom is needed for such situation.

Why we need relationship?
Basic needs : love, joy, peaceful,sex,etc..
Practical reason : sex,money,wealth,etc..

How relationship effects your life?
The more you have connected with people the more you learn about your self and understanding others.
If you have good relationship, it increase your :
§   Confidence
§   Self-esteem
§   Comfort
§   Happiness
§   Health
§   Safety
§   Joy

Some relationships caused trauma,it depend with whom you interact, situation and how you deal with it. Trauma can lead someone to feel uncomfort,inconfidence,insecure and fear of commitment in the next relationship,mostly with partner.

Ideal or healthy relationship?

How you define ideal relationship?
How you define healthy relationship?

Healthy relationship based in mutually supportive and encouraging to each other.

Things to remember,
§   Every relationship is unique
§   Everyone is different
§   People’s change
§   There are two (or more) person in the relationship, so it’s not all about YOU!
§   The goals is’nt just YOUR goals!

How to strengthen relationship?
§   Staying involved with each other. Spend quality time together to make sure that both of you staying involved. Quality time doesn’t refer to    something big or important, it can be having a cup of tea in the afternoon, going to movies or walk together around the neighbourhood.

§ Getting through conflict. Some might think that conflict are bad. Conflict can be a good way to know more the deeper level of your partner. Not to be fearful of conflict, just make sure that both of you feel safe to express things that bother both of you. and be able to resolve conflict without humiliation,degradation or insisting on being right.

§ Keeping outside relationship and interest alive. Having sometime with friends, doing activities that you like are good for your relationship with partner. When we spend most of the time with partner,it possible that we become boring or loosing interest to each other. In the other hand, it possible that we expect more from our partner. No one person can meet all of our needs, and expecting too much from someone can put a lot of unhealthy pressure to the relationship.

§ Communication. Some people seems never had conflict in their relationship. Even it seems stable on the surface doesn’t mean that they have good communication skills. Some people choose to be quiet, some others expected their partner understanding their needs,feelings or desires without them to talk. Lack of communication increases distance. Make sure that both of you feel comfortable to express the needs, feelings, fears and desires.

B. Relationship,Emotions,Sex`and Health
Emotion defined as Perceptions, Expression of Feelings and Bodily Changes, or Feeling that is private and subjective. Basic emotions : Love, Joy, Anger, Surprise, Sadness, Fear
Interaction in relationship creates emotions in many ways. There’s always good times and bad times in every relationship. Good times leads to positive emotions and bad times leads to negative emotions.

Positive emotions
Confident, curious, cheerful, feeling healthy, passion, excitement, grateful, love, comfort, happy, etc..

Negative emotions
Fear, uncomfortable, hurt, anger, frustration, disappointment, guilt, lonely, etc..

Functions of Emotions :

Arousal, emotions arouse us to move and take action. This is done through activation of the autonomic nervous system, which causes an increased heart rate, etc…

Adaptive functions - emotional responses provide us with adaptive responses that assist us in coping with particular situations.

Regulating social interactions - identifying the emotions that others are feeling through their facial expressions and body language and tone of voice enables us to work out the way to respond. In some instances we may be attracted to an individual, in others, we may be warned to move away.

Etc…

How can my emotions affect my health?
When we feel positive emotions, our body release oxcytoxin that makes us relaxed and increase our body immune. Oxytocin may be linked to the formation of romantic bonds as well as bonds of mothers to infants in some species.

Women cry 4 times more than men, possibly because of higher levels of prolactin in women. Prolactin is present in tears and contributes to the amount of crying a person does.The difference in levels of crying between men and women could also be the result of cultural expectations.

Your body responds to the way you think, feel and act. This is often called the “mind/body connection.” When you are stressed, anxious or upset, your body tries to tell you that something isn’t right. Poor emotional health can weaken your body's immune system, making you more likely to get colds and other infections during emotionally difficult times. Also, when you are feeling stressed, anxious or upset, you may not take care of your health as well as you should

Can we transform negative emotions to positive?
As we know that emotions defined as perception, expression of feelings and bodily changes. Its gonna be difficult to control your bodily changes, but possible to change your perception and expression of feelings, or manage your emotions by practice..

Example :
Fear is not always bad. Behind the fear there are some new experience. Fear leads us to an adventure of excitement.

Sex and emotions
Sex is not just a physical act to relive sexual tension. Having sex can cause very strong emotions.Sex can lead a person to feel that they are in love, or it can make the feelings of love stronger.
Some people difficult to enjoy sex while they have problem with partner. In some serious case, some women can be frigid when they psychologically stressed.

FERTILITY AWARENESS (3rd Session)

2009-11-02T06:26:00.000-08:00

Fertility awareness atau “Kesadaran akan Masa Subur” adalah kombinasi berbagai metode untuk mengetahui kapan masa subur seorang perempuan. Praktik ini memberi control pada perempuan atay pasangan untuk menentukan kapan dan jika ia ingin hamil.
Syarat :

Komitmen
Mengamati tubuh dan perubahan tubuh anda
Untuk menghindari kehamilan, harus disiplin untuk absen melakukan hubungan seks melalui vagina (vaginal intercourse) atau menggunakan metode perintang seperti kondom atau diafragma.

Hal yang perlu diketahui mengenai masa subur :

Sel telur yang sudah dibuahi dapat hidup di dalam tubuh perempuan hingga 48 jam
Sperma dapat bertahan dalam tubuh perempuan hingga 5 hari, biasanya hanya 2 hari.
Kehamilan dapat terjadi 3 hari sebelum ovulasi dan 2-3 hari setelahnya.

1)SISTEM KALENDER
Hal pertama yang harus dilakukan dalam sistem kalender adalah mengetahui siklus menstruasi anda. Hari pertama anda haid adalah hari pertama siklus menstruasi, berakhir pada hari pertama anda haid periode berikutnya.

Siklus menstruasi regular.

Masa subur biasanya terjadi pada hari 12 – 16 dari siklus menstruasi.
Misalkan siklus mentruasi anda adalah 28 hari, hari pertama anda haid adalah tanggal 1, maka masa subur anda adalah tanggal 12-16 bulan tersebut.

Siklus menstruasi tidak regular.

Jika siklus menstruasi anda berubah-rubah, maka anda harus mengamati dan mencatat siklus menstruasi anda minimal selama 6 bulan. Catat siklus terpanjang dan terpendek dalam 6 bulan. Untuk mengetahui jarak ovulasi, gunakan rumus berikut ini :
Hari pertama masa subur = siklus terpendek – 18
Hari terakhir masa subur = siklus terpanjang – 11
Jika siklus terpendek anda adalah 26 hari maka hari pertama masa subur adalah 26-18 yaitu hari ke-8 siklus menstruasi anda.
Jika siklus terpanjang adalah 34 hari maka hari terakhir masa subur anda yaitu hari ke-23 siklus menstruasi.
Jadi masa subur anda adalah antara hari 8-23 dari siklus menstruasi anda.

2)MEMONITOR MUKUS CERVIX
Kekentalan dan warna mukus berubah selama siklus menstruasi dan memainkan peranan yang sangat penting dalam menyuburkan sel telur selama masa subur. Catat perubahan warna dan kekentalan. Perubahan tersebut dapat dilihat sebagai berikut :
a)Darah menstruasi 3-5 hari
b)Kering sekitar 3-4 hari
c)Sekresi mucus yang lengket, putih/kuning (biasanya tand persiapan masa subur)
d)Sekresi mucus yang lebih licin, elastic dan jernih (tanda masa subur)

Ovulasi biasanya terjadi 2 hari sebelum atau sesudah terjadinya peningkatan jumlah mucus yang banyak.

Cara mengecek mucus cervix

Masukan jari, usapkan disekitar cervix
Melihat cervix dengan speculum plastic
Sebaiknya dilakukan pada saat/waktu yang sama setiap harinya
Usap dari arah depan ke belakang, kumpulkan sekresi dari bukaan vagina. Tidak selalu akurat, sebagian perempuan tidak memperhatikan ada sesuatu. Membutuhkan waktu cukup lama terjadinya sekresi melalui bukaan vagina.

Hal yang harus diingat mengenai monitoring mucus :

Sekresi akibat hubungan seks dapat mengacaukan tanda-tanda kesuburan/ketidaksuburan mucus.Lakukan hubungan seks di hari lain dari 1/3 siklus atau gunakan metode perintang akan sangat membantu melihat perubahan mucus.
Douching dapat menghilangkan atau merubah tampilan mucus. Misalnya oleh krim, busa, sabun sirih, spermicides, dll.

Ketika seorang perempua mengalami infeksi vagina ( missal jamur, bakteri,BV atau PMS) maka sekresi vagina berubah. Bau yang kuat dan tekstur yang tidak biasa dapat menutupi sekresi vagina yang normal.

MENGOBSERVASI PERUBAHAN POSISI DAN TEKSTUR CERVIX SELAMA SIKLUS .

Menstruasi.

Letak cervix rendah dan keras seperti ujung hidung dan os kecil

Menjelang masa subur, cervix sedikit naik dan menjadi lembut (seperti bibir), basah dan terbuka. Pada posisi tertinggi ketika masa ovulasi dan lebih terbuka.

Catatan : cek di waktu yang sama dengan posisi yang sama.

3)BASAL BODY TEMPERATURE (bbt)
Catat perubahan temperature basal tubuh anda dengan digital thermometer segera saat anda bangun tidur di pagi hari.

Sebelum ovulasi temperature biasanya segera turun dengan cepat
Setelah ovulasi temperature kembali naik dan bertahan hingga periode berikutnya ( atau terus meningkat dalam kehamilan)

Catatan :anda butuh tidur yang teratur (sekitar 6 jam). Bangun di waktu yang sama.obat-obatan,alkohol dan penyakit dapat mempengaruhi temperatur anda.

TANDA-TANDA LAINNYA

Kram di satu sisi salah satu ovarium pada saat ovulasi
Bercak
Payudara menjadi lebih empuk/lembut
Emosi
Dll

Catat setiap perubahan selama siklus anda, anda bisa menemukan pola tertentu yang dapat membantu anda untuknmengetahui anda berada dalam tahapan mana di dalam siklus anda.

EFEKTIFITAS
Efektifitas sangat tergantung pada keteraturan siklus menstruasi, disiplin dan kecermatan dalam mengamati perubahan tubuh, komitmen dan dukungan dari pasangan untuk absen dari hubungan seks atau menggunakan metode perintang selama masa subur.

KEUNTUNGAN :

Tidak beresiko terhadap kesehatan dan tanpa efek samping
Dapat diterima oleh pasangan dengan pertimbangan agama
Dapat digunakan untuk merencanakan atau mencegah kehamilan.
Meningkatkan kesadaran dan pemahaman menegnai tubuh.
Biayanya sangat sedikit.
Efektif ketika digunakan secara benar dan konsisten.
Menciptakan komunikasi yang lebih baik dengan pasangan.

KELEMAHAN;

Membutuhkan waktu dan usaha.
Membutuhkan komitmen dan control diri (lelaki dan perempuan)
Tidak melindungi dari penyakit menular seksual (PMS)
Lebih menantang untuk mereka yang siklus menstruasinya tidak regular.

MENSTRUASI (2nd Session)

2009-10-30T02:22:00.001-07:00

1) Menstruasi
Adalah proses peluruhan bagian endometrium di uterus, sebagai akibat tidak terjadinya pembuahan setelah proses ovulasi. Peluruhan ini mengakibatkan pendarahan yang keluar melalui cervix dan vagina. Masa menstruasi terjadi antara 3-5 hari, namun bisa bervariasi bagi setiap orang. Pada saat menstruasi, hormon estrogen dan progesterone menurun hingga titik terendah.

2) Siklus Menstruasi
Siklus menstruasi adalah siklus dimana tubuh perempuan memproduksi telur yang siap di fertilisasi. Satu siklus menstruasi dihitung dari hari pertama menstruasi hingga hari pertama periode menstruasi berikutnya. Menstruasi melibatkan hipotalamus, pituitary dan ovarium. Pada manusia siklus ini biasanya terjadi selama 28 hari, dan dapat bervariasi bagi setiap orang antara 21-35 hari pada orang deasa dan 21-45 hari pada remaja.

Fase yang terjadi pada siklus menstruasi:
Menses
Biasanya, siklus menstruasi dimulai pada saat terjadinya mens, perdarahan dan hilangnya lapisan endometrium yang biasa terjadi selama 3-5hari ( bervariasi bagi setiap wanita). Tingkat estrogen dan progesterone di dalam darah dari siklus sebelumnya mulai menurun hingga level terendah.
Fase Folikuler:
Hipotalamus melepaskan follicle stimulating hormone (FFSH) yang menstimulasi ovarium untuk perkembangan sel telur. Ovarium memproduksi estrogen yang menstimulasi uterus untuk memasuki fase proliferasi.
Fase Proliferative
Peningkatan estrogen menstimulasi perkembangan pada lapisan dan pembuluh darah yang`ada di uterus. Di bagian cervix terjadi produksi mucus yang memunginkan sperma untuk hidup di dalam uterus sebelum terjadi pembuahan. Lapisan uterus menebal sebagai persiapan untuk menerima telur yang sudah dibuahi.
Fase Ovulasi
Level estrogen yang tinggi memberi sinyal pada otak bahwa sudah saatnya untuk ovulasi. Hypothalamus mensekresi GnRH dalam jumlah yang sangat banyak, memstimulasi pituitary anterior untuk mensekresi LH dan FSH dalam jumlah yang sangat banyak, biasanya hanya terjadi dalam 24 jam. LH dan FSH menstimulasi enzim-enzim di folikel. Enzim-enzim tersebut bereaksi, bersamaan dengan tekanan dari antrum untuk melepaskan telur dari folikel. Telur melewati tuba falopi dimana terjadinya fertilisasi. Telur bisa bertahan hingga 24 jam setelah ovulasi. Sisa-sia folikel yaitu corpus luteum tetap berada di ovarium dan mensekresi estrogen dan progesterone.
Fase Luteal
corpus luteum berdegenerasi dan menghasilkan estrogen dan progesterone. Level progesterone lebih tinggi dari estrogen pada fase ini. Level progesterone ini tetap bertahan dalam jumlah yang sama selama kurang lebih 2 minggu.
Corpus luteum menyusut dan mulai mati. Biasanya akan mati dalam 14 hari, kecuali menerima stimulasi dari hCG, hormone yang disekresi dari embrio yang berkembang. Jika fertilisasi terjadi, dan embrio di implant di lapisan dinding uterus,hCG menyelamatkan corpus luteum sehingga tetap dapat mensekresi estrogen dan progesterom selama kehamilan. Jika fertilisasi tidak terjadi, corpus luteum mati pada fase akhir luteal, terjadi penurunan level progesterone yang memicu terjadinya menstruasi. Jika terjadi kehamilan maka level progesterone ini akan tetap tinggi. Telur yang tidak dibuahi juga mati dan keluar melalui uterus ketika mens dimulai. Siklus menstruasi berikutnya dimulai.
3) MASALAH SEPUTAR MENSTRUASI

Amenorrhea – periode menstruasi yang jarang terjadi. Istilah ini digunakan untuk menjelaskan absennya periode pada :
• perempuan muda yang belum menstruasi hingga umur 15 tahun
• perempuan yang biasanya memiliki periode yang berkala, namun kemudian tak mengalami periode hingga 90 hari.
• perempuan muda yang belum menstruasi hingga 90 hari meskipun mereka belum mengalami menstruasi dalam waktu yang lama.

Penyebabnya bisa karena kehamilan, menyusui dan kehilangan berat badan yang ekstrem karena penyakit yang serius, gangguan makan, olahraga berlebihan atau stress. Permasalahan hormonal yang diakibatkan oleh polycystic ovarian syndrome (PCOS)a atau permasalahan dengan organ reproduksi juga bisa terlibat.
Dysmenorrhea – periode yang menyakitkan selama memstruasi, termasuk kram yang parah. Biasanya kram terjadi pada remaja karena adanya prostaglandin yang berlebihan. Kebanyakan remaja dengan dismenorhea tidak memiliki penyakit yang serius meskipun kram parah. Pada perempuan yang lebih tua, penyakit atau kondisi tertentu seperti uterus fibroid dan endometriosis kadang-kadang menyebabkan rasa`sakit.
Pendarahan uterus abnormal – perdarahan vagina yang berbeda dari periode menstruasi normal. Biasanya mengeluarkan darah sangat banyak atau periodenya sangat lama, jarak periode terlalu dekat atau perdarahan dianatar dua periode. Pada saat menjelang menopause, perubahan hormone dapat mengakibatkan terjadinya periode yang panjang dengan siklus yang irregular.

4) PRE MENSTRUAL SYNDROME (PMS)
Sekumpulan gejala atau sensai yang dialami perempuan sebagai hasil tingginya level hormon, biasanya terjadi menjelang atau selama periode menstruasi.
Perubahan emosi yang biasa terjadi diantaranya adalah :
• Kegelisahan – dipercaya berhubungan erat dengan tingginya level estrogen disbanding progesterone
• Depresi – berhubungan dengan tingginya level progesteron dibanding estrogen
• Makan banyak – berhubungan dengan peningkatan respon berlebih pada insulin. Makan makanan yang mengandung karbohidrat kompleks akan menyediakan energy yang cukup untuk mentasi perubahan turun naiknya gula darah.

5) MENSTRUASI PADA MASA KEHAMILAN
Beberapa perempuan mengalami menstruasi selama awal kehamilan. Sebagian lainnya mengalami bercak darah selama kehamilan dan menghubungkan hal ini dengan siklus menstruasi yang irregular. Ada beberapa penyebab terjadinya bercak dan perdarahan selama kehamilan, ada yang serius ada juga yang tidak.
1. Siklus Menstruasi Regular
Biasanya menstruasi pada kehamilan terjadi ketika jarak kehamilan terlalu dekat dengan awal periode mestruasi berikutnya.
2. Kehamilan Tubal atau Ectopic Preganancy
Kehamilan tubal adalah kondisi serius yang dapat mengakibatkan perdarahan yang mirip dengan menstruasi. Hal ini terjadi karena sel telur yang sudah dibuahi terimolan di temopat selain uterus, biasanya pada tuba fallopi. Karena tidak ada cukup ruang untuk tumbuhnya embrio, organ tuba falopi daoat rusak dan mengakibatkan kematian. Jika anda merasakan kram dengan perdarahan di masa awal kehamilan, sebaiknya anda segera menghubungi dokter.
3. Keguguran.
Hanya 25 % dari kehamilan yang bertahan hingga melahirkan. Kebanyakan kehamilan berakhir bahkan sebelum para perempuan menyadari diri mereka hamil. Jika hasil tes kehamilan menunjukkan positif dan mulai merasakan kram dan perdarahan, anda mungkin tengah mengalami keguguran. Segera hubungi dokter.
4. Perdarahan karena implantasi
Banyak perempuan yang mengalami bercak selama awal kehamilan. Para ahli percaya bahwa munculnya bercak ini karena pada`saat implan telur yang dibuahi mencoba masuk ke dalam lapisan endometrium.
5. Masalah Placenta
masalah placenta seperti placenta previa dan placenta abruption dapat menjadi komplikasi yang serius. Placenta previa terjadi ketika sebagian atau seluruh placenta menutupi cervix, atau tempat dimana bayi seharusnya keluar. Placenta abruption terjadi ketika placenta secara premature terlepas dari dinding uterus.

6) SEKS PADA SAAT MENSTRUASI
Larangan berhubungan seks pada saat menstruasi lebih dikaitkan pada masalah agama yang menganggap bahwa perempuan sedang dalam keadaan kotor. Mengkaitkan darah menstruasi sebagai darah kotor tentu saja tidak benar. Darah menstruasi bukanlah darah yang kotor, darah mentruasi adalah suatu peristiwa normal dan fisiologis. Justru ini menunjukkan bahwa si perempuan sehat.

Larangan berhubungan pada saat seks lebih tepat jika dikaitkan dengan alasan biologis. Pada saat menstruasi, lapisan endometrium dalam keadaan yang sangat sensitif. Melakukan hubungan seks pada saat ini dapat mengakibatkan rasa ngilu pada si perempuan.

Selain itu, jika penis membawa kuman atau penyakit, atau si perempuan memiliki penyakit seperti herpes atau gonorrhea, maka darah menstruasi dapat menjadi medi yang sangat baik untuk menularkan penyakit.

7) KAPAN HARUS MENEMUI DOKTER?
• Jika belum menstruasi pada umur 15 atau 3 tahun setelah payudara tumbuh atau jika payudara belum tumbuh hingga usia 13
• Tiba-tiba berhenti menstruasi lebih dari 90 hari
• Siklus menstruasi anda berubah-rubah
• Anda berdarah lebih dari 7 hari
• Darah menstruasi anda`sangat banyak sehingga anda harus sering mengganti pembalut atau tampon setiap satu atau dua jam.
• Periode menstruasi anda terjadi
• Mengalami rasa sakit yang parah pada saat menstruasi
• Anda merasa demam atau sakit setelah menggunakan tampon
• Anda mengalami perdarahan di antara dua periode anda.
• Anda mengalami perdarahan pada masa awal kehamilan.

SRHS Project

2009-10-30T02:09:00.000-07:00

BACKGROUND :

- NOT ENOUGH INFORMATION AND SKILLS ON SEXUALITY AND REPRODUCTIVE HEALTH
- NOT ENOUGH GROUP ACTIVITY ON SEXUALITY AND REPRODUCTIVE HEALTH
- THE COMMON GROUND THAT MOST PEOPLE DON’T FEEL COMFORT TO GO TO DOCTOR RELATED TO THEIR SEXUAL PREFERENCES AND/OR DISEASE
OBJECTIVES :
- GIVING ACCESS TO INFORMATION AND SKILL ON SEXUALITY AND REPRODUCTIVE HEALTH
- EMPOWERING PEOPLE TO FEEL OPEN AND SAFE WITH THEIR SEXUALITY
- EDUCATE PEOPLE ABOUT THEIR BODY AND FEELINGS
- PROVIDE THEIR OWN NEEDS THRU SELF-HELP SKILLS
- REMINDING PEOPLE THAT THEY HAVE AUTHORITY AND CONTROL OF THEIR OWN BODY
- HAVING/SHARING ACCESS AND SOURCES FOR WHAT IS NOT AVAILBALE WIDELY IN PUBLIC

FASILITATOR :
- TALCON
- INNA
- EVERYONE IN THE GROUP

SUBJECT :
- Anatomy and Physiology : An Intruduction to Reproductive Health
- Relationship
- Emotions
- Breast Health
- Herbal Medicine
- STD’S/STI’S
- Abortion
- Birth Control & Birth Option
- Menstruation : Menstrual Cycles/Period, Normal/Abnormal Menstruation, PMS/PSDD
- Pregnancy : Ovulation, Menstruation, Early Pregnancy Symptoms, Pregnancy Care, Birth Options
- Sexuality : Safe/Unsafe Sex, Body Feeling, Masturbation
- Physical Exams : Bi-manual exams, cervical exams, visual exam of genitals and breast exams

TIME & PLACE :
EVERY SATURDAY 14.00 WIB AT ROEMAH SCHAKTY, JL GATAK 77B TAMANTIRTA KASIHAN BANTUL
FURTHER INFORMATION : 08562969500/0274-6686120

GROUP RULES :
- CONFIDENTIALITY
- OPEN TO ALL ( EXCEPT FOR THE PHYSICAL EXAMS, NO MEN INCLUDED)
- DISCRIMINATION CAN NOT BE TOLERATED
- IDENTITY AND EMOTIONS STAYS IN THE CIRCLE, KNOWLEDGE CAN BE SHARED
- GROUP FOCCUSS NOT PERSONAL FOCUSS
- EVERYONE IN THE GROUP IS WILLING AND ABLE TO WORK IN A TEAM

Anatomy & Physiology of Female Reproductive Organs (1st Session )

2009-10-30T01:56:00.000-07:00

I. Introduction

A. Group Goal : To expand knowledgeof Reproductive Health in the Jogja community

1) Reproductve Health is the system,functions & process of our reproductive organs.
Includes mental and social-cultural health.

B. Open group to all, in order to this we all must be :
1) Non-judgemental/non-discriminative
2) Confidential. Share knowledge not personal information to others outside the group
3) Mature

II. What does the group know about Reproductive Health ?
• Make list on the wipeboard
• Handout diagrams
• Give remember that this workshop is to learn what is normal for you

III. Breast

A. Location : Around Chest wall and armpit
B. Functions :
a. Produces and secretes milk
b. Organs of sexual arousal
C. Composition :
 Inner Anatomy
1) Connective Tissue – a web of ligaments that binds the breast together and give shape
2) Fat – makes up the mass of the breast, give soft consistency, also effects shape and size
3) Mammary Gland, includes :
o Lobes ( 15-25 lobes each breast ) - Milk producing glands that are imbedded into the fat tissue of the breast
o Ducts – small tube like structure that transport milk from lobes to nipple.
The Mammary gland is develop as a response to the ovarian hormones. That’s why it is not develop in men.

 Outer anatomy
1) Nipple – raised, center of the breast, darker in color ; where milk is released during lactation.
Formed by nerves that sensitive to stimulation, and smooth muscle fibers that respond to stimulation to make the nipple erect.
Nipple stimulation causes contractions in uterus ; which aids in the birth of the placenta ( after birth) and for some women is sexually stimulating.
2) Aerola – same color as nipple, surrounds nipple in a circle.
Contains gland that lubricate the aerola and become darker during pregnancy so that it is more easily seen by the newborn.

D. Breats size & shape
 Varies from men to women dpending on
a. Volume of breast tissue
b. Family genetics
c. Age
d. Weight loss/gain
e. Pregnancy and breast feeding history
f. Thickness and elasticity of breast skin
 Variations in womens breast are normal For example :
a. one larger than the other
b. one higher than the other
c. one more sensitive
d. nipples a bit different shape

III. Female Reproductive Organs

A. Internal Anatomy & Physiology

1) OVARIES
 Location : 2 on either side of the uterus, held in place by broad ligaments. Size and shapes of almonds.
 Structure :
a. mesovarium: ligament of the ovary
b. germinal epithelium: surface covering
c. tunica albuginea: fibrous capsule; immediately below epithelium
d. divided into an outer cortex and an inner medulla.
e. cortex: consists of a very cellular connective tissue stroma in which the ovarian follicles are embedded.
f. medulla: composed of loose connective tissue, which contains blood vessels and nerves.
 Function :
a. Storing eggs and ovulation.
A woman is born with approximately 400,000 immature eggs called follicles ( our mama’s had her eggs when her mother was pregnant with her) when we run-out menopause.
During a lifetime a woman release @ 400 to 500 fully matured eggs for fertilization
b. The follicles in the ovaries produce the female sex hormones, progesterone and estrogen. These hormones prepare the uterus for implantation of the fertilized egg.

2) FIMBRIA
 Don’t touch the ovaries but lightly surround each one partially; like many little fingers. Thefinger-like parts are called cilia.
 When an ovum is ready the fimbria creates a fluid current that acts to carry the ovum into the fallopian tubes.

3) FALLOPIAN TUBES
 Location : At the upper corners of the uterus. 2 tubes approximately 10-16 cm and about as wide as a piece of spaghetti extend from fimbria into the uterus. They are positioned between the ligaments that support the uterus.
 Function : o
a. Tansport ovum from ovaries to the uterus ( 3-5 days )
b. Most ideal & most likely spot for conception

4) UTERUS
 Location : lies in the pelvic cavity between the urinary bladder and the rectum.
 Structure : a hollow muscular pear-shaped organ. It is about 7.5 cm long, 5 cm wide and its walls are about 2.5 cm thick. It weighs from 30 to 40 grams. The parts of uterus :
 Fundus
 Body, madeup of 3 layersof muscle
 Endometrium – inner layer where a fertilized egg would burrow or this lining shed if there is no fertile egg.
 Epithelium with thick connective tissue
 Myometrium – smooth muscle
 Cervix
i. Located at bottom portion of uterus and protrude into yoni
ii. Releases fertile mucus to enable sperm into uterus at fertile time
iii. Stretches during pregnancy to home fetus and will open to approximately 10 cm during child birth
iv. During menstruation, the cervix stretches open slightly to allow the endometrium to be shed. This stretching is believed to be part of the cramping pain that many women experience
 Functions :
 Home of pregnancy
 Menstruation

5) VAGINA

 Location : between the bladder and rectum
 Structure :
 Thin fibromuscular tube approximately 6 inch long extending from uterus to external genitalia between bladder and rectum
 Wall consisting of three layers:
i. inner mucosal layer, is made of vaginal rugae that stretch and allow penetration to occur. These also help with stimulation of the penis. has glands that secrete an acidic mucus (pH of around 4.0.) that keeps bacterial growth down.
ii. a middle muscularis layer,
iii. an outer fibrous layer. important with delivery of a fetus and placenta.
 Functions :
 Passage of menstrual flow and childbirth, also receives objects such as toys,fingers and penis during penetrative intercourse.
 Uterine secretions to pass down through the introitus
 May hold forms of birth control, such as a diaphragm, FemCap, Nuva Ring, or female condom.
 The ‘G’ Spot is found within the vagina/yoni. It is located on the anterior side of the vagina/yoni. For some women the “G” Spot is a point of intercourse pleasure when sexually aroused.
 With the help of two Bartholin’s glands becomes lubricated during SI

B. External Anantomy & Physiology

Vulva

The external female genitals are collectively referred to as The Vulva. This consists of the labia majora and labia minora (while these names translate as "large" and "small" lips, often the "minora" can be larger, and protrude outside the "majora"), mons pubis, clitoris, opening of the urethra (meatus), vaginal vestibule, vestibular bulbs, vestibular glands.

The term "vagina" is often improperly used as a generic term to refer to the vulva or female genitals, even though - strictly speaking - the vagina is a specific internal structure and the vulva is the exterior genitalia only. Calling the vulva the vagina is akin to calling the mouth the throat.

Mons Veneris/Mon Pubis

• The rounded prominence caused by a pad of adipose tissue lying over the symphysis pubis in the female.
• It serves as a cushion between the female and her partner during sexual intercourse preventing injury to the underlying bone.
• It is lined by dry epidermis with usually a covering of genital hairs.
• It also contains sebaceous and sweat glands. Some of the latter form a specialized type of gland called the apocrine glands. These glands release a secretion with a characteristic smell that increases sexual attraction.

The mons veneris, Latin for "mound of Venus" (Roman Goddess of love) is the soft mound at the front of the vulva (fatty tissue covering the pubic bone). It is also referred to as the mons pubis. The mons veneris is sexually sensitive in some women and protects the pubic bone and vulva from the impact of sexual intercourse. After puberty it is covered with pubic hair, usually in a triangular shape. Heredity can play a role in the amount of pubic hair an individual grows.

Labia Majora/Outer

• These are the two large folds forming the boundary of the vulva.
• They are composed of skin, fibrous tissue and fat and contain large numbers of sebaceous glands.
• Anteriorly the folds join in front of the symphysis pubis, and posteriorly they merge with the skin of the perineum.
• At puberty, hair grows on the mons pubis and on the lateral surfaces of the labia majora.
• The labia majora (literally "larger lips") are bilateral folds of skin with underlying fat extending backwards from the mons pubis. Posteriorly, they merge into the perineum in front of the anus. Their outer surface becomes covered with hair at puberty. But the inner surface remains smooth, moistened by the secretions from the sebaceous and other glands deep inside.

The labia majora are the outer "lips" of the vulva. They are pads of loose connective and adipose tissue, as well as some smooth muscle. The labia majora wrap around the vulva from the mons pubis to the perineum. The labia majora generally hides, partially or entirely, the other parts of the vulva. There is also a longitudinal separation called the pudendal cleft. These labia are usually covered with pubic hair. The color of the outside skin of the labia majora is usually close to the overall color of the individual, although there may be some variation. The inside skin is usually pink to light brown. They contain numerous sweat and oil glands. It has been suggested that the scent from these oils are sexually arousing.

The labia majora are the lips located in the exterior of the vulva or easily referred to as the "outer lips". It is a pair of thick skin folds where pubic hair normally grows. The labia majora extends on both sides of the vulva from the mons veneris. The function of the labia is to cover partially, if not completely, the rest of the vulva.

Although forming part of the vulva, which is normally hidden from view, the tone of the exterior skin of the labia majora generally follows the person�s normal skin color. This is the general rule, subject to exceptions. The skin inside the labia majora is more often than not, with a tinge of pink or brown color.

Labia Minora/Inner

• These are two smaller folds of skin between the labia majora, containing numerous sebaceous glands.
• The cleft between the labia minora is the vestibule.
• covered with smooth, hairless skin
• The labia minora are delicate flaps of soft skin which lie within the labia majora. They may be of different sizes in different women and if large enough, may protrude from between the labia majora. Their inner surfaces remain in contact with each other. Anteriorly, they unite to enclose the clitoris between them, forming the prepuce and frenulum. The labia minora contains no fat but are so vascular that they become swollen during sexual stimulation.

Medial to the labia majora are the labia minora. The labia minora are the inner lips of the vulva. They are thin stretches of tissue within the labia majora that fold and protect the vagina, urethra, and clitoris. The appearance of labia minora can vary widely, from tiny lips that hide between the labia majora to large lips that protrude. There is no pubic hair on the labia minora, but there are sebaceous glands. The two smaller lips of the labia minora come together longitudinally to form the prepuce, a fold that covers part of the clitoris. The labia minora protect the vaginal and urethral openings. Both the inner and outer labia are quite sensitive to touch and pressure.

Clitoris

The clitoris corresponds to the penis in the male and contains sensory nerve endings and erectile tissue.

The clitoris is present in the upper part of the vestibule at the point where the two labia minor meet. It is a small cylindrical structure homologous to the penis in males. Like the male penis, it also has a glans, a prepuce and two corpora cavernosa which are attached to the pubic bones. The corpora constitute the body of the clitoris and end as the glans clitoridis.

The clitoris, visible as the small white oval between the top of the labia minora and the clitoral hood, is a small body of spongy tissue that functions solely for sexual pleasure. Only the tip or glans of the clitoris shows externally, but the organ itself is elongated and branched into two forks, the crura, which extend downward along the rim of the vaginal opening toward the perineum. Thus the clitoris is much larger than most people think it is, about 4" long on average.

The clitoral glans or external tip of the clitoris is protected by the prepuce, or clitoral hood, a covering of tissue similar to the foreskin of the male penis. However, unlike the penis, the clitoris does not contain any part of the urethra.

During sexual excitement, the clitoris erects and extends, the hood retracts, making the clitoral glans more accessible. The size of the clitoris is variable between women. On some, the clitoral glans is very small; on others, it is large and the hood does not completely cover it.

Urethra

The opening to the urethra is just below the clitoris. Although it is not related to sex or reproduction, it is included in the vulva. The urethra is actually used for the passage of urine. The urethra is connected to the bladder. In females the urethra is 1.5 inches long, compared to males whose urethra is 8 inches long. Because the urethra is so close to the anus, women should always wipe themselves from front to back to avoid infecting the vagina and urethra with bacteria. This location issue is the reason for bladder infections being more common among females.

Hymen

• The hymen is a thin layer of mucous membrane that partially occludes the opening of the vagina.
• It is normally incomplete to allow for passage of menstrual flow.

The hymen is a thin fold of mucous membrane that separates the lumen of the vagina from the urethral sinus. Sometimes it may partially cover the vaginal orifice. The hymen is usually perforated during later fetal development.

Because of the belief that first vaginal penetration would usually tear this membrane and cause bleeding, its "intactness" has been considered a guarantor of virginity. However, the hymen is a poor indicator of whether a woman has actually engaged in sexual intercourse because a normal hymen does not completely block the vaginal opening. The normal hymen is never actually "intact" since there is always an opening in it. Furthermore, there is not always bleeding at first vaginal penetration. The blood that is sometimes, but not always, observed after first penetration can be due to tearing of the hymen, but it can also be from injury to nearby tissues.

A tear to the hymen, medically referred to as a "transection," can be seen in a small percentage of women or girls after first penetration. A transection is caused by penetrating trauma. Masturbation and tampon insertion can, but generally are not forceful enough to cause penetrating trauma to the hymen. Therefore, the appearance of the hymen is not a reliable indicator of virginity or chastity.

Perineum

• The perineum is the area extending from the base of the labia minora to the anal canal.
• It is roughly triangular and consists of connective tissue, muscle and fat.
• An episiotomy is an incision of the perinium used during childbirth for widening the vaginal opening

The perineum is the short stretch of skin starting at the bottom of the vulva and extending to the anus. It is a diamond shaped area between the symphysis pubis and the coccyx. This area forms the floor of the pelvis and contains the external sex organs and the anal opening. It can be further divided into the urogenital triangle in front and the anal triangle in back.

The perineum in some women may tear during the birth of an infant and this is apparently natural. Some physicians however, may cut the perineum preemptively on the grounds that the "tearing" may be more harmful than a precise cut by a scalpel. If a physician decides the cut is necessary, they will perform it. The cut is called an episiotomy.