Male + Female Reproduction Biomed Capstone

Major hormones in hypothalamus-pituitary axis in males and females

Hypothalamus-pituitary axis releases GnRH -> targets anterior pituitary to release LH + FSH -> targets gonads to release sex hormones -> negative feedback to HPG axis + anterior pituitary

Cryptorchidism

Failure of one or both testicles to descend to scrotum by birth.

By 1 year undescended tests have less germ cells

Caused by congenital defects, gonadotropin insensitivity and physical barriers

Consequences are malignancy and infertility

Purpose of prostate gland

Produce prostatic fluid that contributes to semen fluid. Acts like a valve, contracts to close off opening between bladder + urethra during ejaculation and controls flow. Contains DHT which contributes to growth + development of prostate + penis

What is BPH

Benign prostatic hyperplasia / non cancerous enlargement of prostate gland -> enlarges and compresses urethra which obstructs urinary flow, causes retention of urine, increases frequency, overflow incontinence

Pathology of BPH

Caused by formation of large discrete nodules in periurethral glands of prostate due to estrogen sensitisation of prostate to DHT

BPH linked to cancer

When BPH occur PSA (prostate specific antigen) levels are raised. Bound/complexed PSA is indicator of cancer risk, untreated BPH can cause PSA levels to raise further

Endometriosis pathology

growth of functional endometrial tissue located outside uterus

responds to hormonal fluctuations of menstrual cycle

implantation sites = ovaries, uterine ligaments, outer uterus, peritoneum, bladder, intestine

endometriosis risk factors

family history, starting menstruation young, higher levels of estrogen, never giving birth

endometriosis symptoms

painful periods, pelvic, back and lower abdominal pain, repeated bleeding, pelvic adhesions, peritonitis, infertility

Fibroids pathology

benign tumours that develop from smooth muscle cells in myometrium, submucosal, subserous and intramural layers

Fibroids risk factors

age 30 - 50 years old, family history, obesity

Fibroids symptoms

Abnormal uterine bleeding, pain, pressure on nearby structures, urinary frequency

Adenomyosis pathology

Endometrial tissue in lining of uterus grows into muscular myometrium wall of uterus

common over 40

at least 1 pregnancy and endometriosis increases risk

Adenomyosis symptoms

dysmenorrhea, heavy periods, abnormal menstruation, pelvic pain, infertility

1st Degree Amenorrhea

Failure of menarche, caused by dysfunctional hypothalamic-pituitary-ovarian axis

2nd Degree Amenorrhea

Failure to menstruate for more than 6 months after period of normal function. Caused by stress, excessive exercise, hypothalamic-pituitary disorder

Primary Dysmenorrhea

painful menstrual cramps

PGF-2. = potent vasoconstrictor + myometrial stimulator.

Toxic Shock syndrome

caused by toxins produced by s.aureus in vagina that move into blood, peripheral vasodilation and septic shock occur. Symptoms are very low BP, high fever, headache etc.

PCOS

Hyperinsulinemia -> excessive androgens (from ovaries) -> increased estrogen -> increased LH -> Decreased FSH -> stimulates androgen production from the stoma of the ovary and producing anovulation

Male Regulation of sex hormone secretion

1. hypothalamus releases GnRH causing LH secretion from anterior pituitary causing testosterone secretion from leydig cells

2. FSH secretion from anterior pituitary causing spermatogenesis

3. Inhibin inhibits FSH secretion from anterior pituitary (negative regulation)

Role of testosterone

enlargement of genitals and reproductive system

promotes sperm cell formation and maturation

secondary sex characteristics

anabolic effects

stimulates red blood cell production

Hydrocele

excess fluid accumulation between serous layers of tunica vaginalis

caused by patent (infection) process vaginalis (kids) or imbalance between secretion + absorption of fluid, injury, or infection (adults)

complications = compression of blood supply = atrophy

Variocele

Like varicose veins but in scrotum

Abnormal dilation of veins within spermatic cord

caused by impotent valves causing retrograde blood flow causing pooling and decreased blood flow causing decreased sperm count and motility

left side affected 95% cases

Spermatocele

sperm containing cyst which forms at end of epididymis, seperate to testis, freely movable usually painless

Testicular torsion

twisting of spermatic cord that suspends the testis and the spermatic vessels that supply the testis with blood, detorsion after 6 hours decreases viability of testicle

Orchitis

Infection of the testes caused by UTI or infection via bloodstream or lymphatics or epididymitis (associated with mumps)

Symptoms are fever, painful enlargement of testes causing inflammation of seminiferous tubules and atrophy of testes (~50%) decreasing spermatogenesis

Epididymitis

Inflammation of epididymis due to bacterial pathogens, caused by retrograde urine with pathogens via spermatic cord lymphatics

Female Puberty

Menarche occurs 11-13 years. Hormones are lower previously, at puberty GnRH, FSH and LH peak and are secreted in pulsatile fashion

GnRH levels increase = increase FSH and LH = increase in estrogen and progesterone

Leptin

Leptin signals brain when full. If obese leptin receptor is buried therefore leptin cannot bind and signal is not released (never satiated).

Theory; increase leptin = increase GnRH = early puberty

endometriosis causes

Retrograde menstruation - endometrial lining goes back up into fallopian tube and doesn’t shed.

Metaplasia of epithelium into endometrial cells

Spread of endometrial cells through lymphatic and vascular systems

Depressed immune system

endometriosis clinical manifestations

secondary dysmenorrhea with pelvic back pain and low abdominal pain

repeated bleeding (pelvic adhesions, pain, scarring)

peritonitis inflammation of the peritoneum

pain defecating; infertility (30-40%)

Uterine Fibroids - Leiomyomas

benign tumours that develop from smooth muscle cells in myometrium

increase with age (30-50 years); decrease with menopause

Clinical Manifestations of Uterine Fibroids - Leiomyomas

pressure due to abnormal uterine bleeding and pain associated with growth of fibroids

Cause of Uterine Fibrioids - Leiomyomas

unknown (theory due to hormonal fluctuations with menarche)

Pelvic Inflammatory Disease (PID)

acute ascending infection of upper genital tract (uterus, fallopian tube, ovaries, peritoneal cavity)

Causes - STI’s (chance developing much lower)

Clinical Manifestations of PID

severe lower abdominal pain

fever, chills, dysuria

pain walking/ intercourse

purulent vaginal discharge; irregualr bleeding (repeated infection)

infertility; ectopic pregnancy

chronic pelvic pain

septic shock

Menopause

Cessation of menstrual cycle - 1 year from last period

Fewer follicles that are less sensitive to FSH and LH, the body doesn’t recognise that corpus luteum isn’t working

Corpus Luteum drives estrogen and progesterone production

Symptoms of Menopause

hot flushes, irritability, fatigue, anxiety and emotional disturbances

estrogen administration helps with symptoms and possible osteoporosis

Post Menopause Health Risksm- Metabolic Disorders

Metabolic disorders = obesity, diabetes and MetS

Brain health = cerebrovascular disorders (clotting, poor blood circulation or bleeding in the brain), dementia, alzeihmer’s disease

Cancer = uterine cancer, breast cancer, colorectal cancer

Other body organs = prolapsed uterus or vagina, loss of vision, cataract, loss of teeth

Bone health = osteoporosis, fracture, back pain

Cardiovascular health = high cholesterol, risk of heart attack, hypertension