Reproductive Pathophysiology

1. Female Reproductive System Overview

Anatomy and Structure

The female reproductive system includes internal organs (ovaries, fallopian tubes, uterus, cervix, vagina) and external genitalia (vulva). The system is divided into:

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• Upper tract: Ovaries, fallopian tubes, uterus

• Lower tract: Cervix, vagina, vulva

![Female Reproductive Anatomy]

Diagram of the internal female reproductive organs including fallopian tubes, ovaries, uterus, cervix, vagina, and hymen 

Menstrual Cycle and Hormonal Control

The menstrual cycle is controlled by hormonal feedback between the hypothalamus, pituitary, and ovaries.

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Diagram of the menstrual cycle phases showing hormone levels, follicular development, ovulation, and endometrial changes over 28 days 

2. Sexually Transmitted Infections (STIs)

Bacterial STIs

Viral STIs

3. Pelvic Inflammatory Disease (PID)

Definition: Infection of upper female reproductive tract (uterus, fallopian tubes, ovaries)

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Common Causes: Chlamydia trachomatis (most common), Neisseria gonorrhoeae, polymicrobial

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Pathophysiology: Ascending infection from lower tract → inflammation → scarring of fallopian tubes

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PID Diagnostic Criteria

• Pelvic/lower abdominal pain PLUS:

  • Fever >101°F

  • Purulent vaginal/cervical discharge

  • Elevated WBC, ESR, or CRP

  • Cervical motion tenderness

Complications

• Infertility (tubal scarring)

• Ectopic pregnancy (scarred tubes)

• Chronic pelvic pain

• Tubo-ovarian abscess

Treatment

• Antibiotics: Ceftriaxone + doxycycline ± metronidazole

• Treat sexual partners

PID Pathophysiology Flowchart

Pelvic Inflammatory Disease (PID) Pathophysiology and Complications

4. Female Sexual Dysfunction and Infertility

5. Endometriosis vs Adenomyosis

6. Polycystic Ovary Syndrome (PCOS)

Definition: Hormonal disorder characterized by hyperandrogenism and ovulatory dysfunction

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Pathophysiology:

• ↑ GnRH pulse frequency

• ↑ LH:FSH ratio

• ↑ LH → Theca cells produce excess androgens

• ↓ FSH → Follicular arrest → polycystic ovaries (multiple small follicles)

• Insulin resistance → ↑ insulin → ↑ androgens (vicious cycle)

Symptoms:

• Irregular/absent periods (oligomenorrhea, amenorrhea)

• Hirsutism (male-pattern hair growth - 60%)

• Acne (severe, persistent)

• Obesity (but can occur in lean women)

• Infertility (leading cause)

• Acanthosis nigricans (dark, thick skin patches from insulin resistance)

Treatment:

• Lifestyle modifications (weight loss, exercise)

• Metformin (insulin sensitizer)

• Oral contraceptives (regulate cycles, reduce androgens)

• Ovulation induction (for fertility)

PCOS Pathophysiology Diagram

PCOS Pathophysiology and Clinical Manifestations

7. Female Reproductive Cancers

Triple-Negative Breast Cancer (TNBC):

• Lacks estrogen receptors, progesterone receptors, and HER2 protein

• Cannot use hormone therapy or HER2-targeted therapy

• Chemotherapy is main treatment (anthracyclines, taxanes, alkylating agents)

• Immunotherapy (pembrolizumab) approved for TNBC

• Often treated with neoadjuvant chemotherapy (before surgery)

• Tends to respond well to chemo but higher recurrence rate

8. Male Reproductive System Overview

Anatomy and Function

The male reproductive system includes testes, epididymis, vas deferens, seminal vesicles, prostate, and penis.

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![Male Reproductive Anatomy]

Anatomical labeled diagram of the male reproductive system showing internal and external structures relevant to reproductive pathophysiology 

Testosterone and Spermatogenesis

• Leydig cells: Produce testosterone (stimulated by LH)

• Sertoli cells: Support sperm development, provide nutrients

• Testosterone: Stimulates spermatogenesis, secondary sex characteristics

9. Male Sexual Dysfunction and Infertility

Male Infertility Causes Diagram

Causes of Male Infertility - Four Main Categories

10. Benign Prostatic Hyperplasia (BPH) vs Prostate Cancer

BPH Comorbidities: Metabolic syndrome, diabetes, obesity, cardiovascular disease

11. Male Reproductive Cancers

Prostate Cancer

Screening: PSA blood test + digital rectal exam (DRE)

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Treatment Options:

• Localized: Active surveillance, radical prostatectomy, radiation

• Advanced/Metastatic: Hormone therapy (Androgen Deprivation Therapy - ADT)

Hormone Therapy for Prostate Cancer:

• Goal: Lower testosterone levels or block testosterone action

• Types:

• LHRH agonists/antagonists: Block testosterone production

• Anti-androgens: Block testosterone from reaching cancer cells

• Androgen synthesis inhibitors (abiraterone): Drop testosterone lower than other treatments

• Orchiectomy: Surgical removal of testicles (less common)

• Use: Shrink prostate before radiation, treat metastatic disease, relieve pain

• Castration-resistant prostate cancer: Cancer becomes resistant to hormone therapy after months/years; requires additional treatments

Testicular Cancer

Most Common in Ages 15-35

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Cell Types:

• Seminoma (40%): Pure seminomatous germ cell tumor

• Non-seminoma (60%): Embryonal, teratoma, choriocarcinoma, yolk sac tumor

Diagnosis:

• Physical exam, scrotal ultrasound

• Tumor markers: AFP, β-hCG, LDH

• Radical inguinal orchiectomy: Removes affected testicle (diagnostic + therapeutic)

Treatment:

• Stage I Seminoma:

• Surveillance (preferred)

• OR Single-agent carboplatin

• OR Radiotherapy

• Stage II-III Seminoma:

• Chemotherapy: BEP (bleomycin, etoposide, cisplatin) or EP (etoposide, cisplatin)

• Radiotherapy (select cases)

• Non-seminoma: Chemotherapy (BEP) ± surgery

Prognosis: Excellent; 5-year survival ~97% overall; >95% for stage I seminoma

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Cancer Treatment Pathways Comparison

Treatment Pathways: Prostate Cancer vs Testicular Cancer

12. Case Study Applications

Jennifer's PID Evaluation and Treatment

Evaluation for PID:

• Pelvic exam (cervical motion tenderness)

• Laboratory: WBC count, ESR, CRP

• NAAT testing for chlamydia/gonorrhea

• Pregnancy test (rule out ectopic)

• Pelvic ultrasound (if abscess suspected)

Treatment if PID confirmed:

• Antibiotics: Ceftriaxone IM + doxycycline PO ± metronidazole

• Treat sexual partners

• Hospitalization if severe, pregnant, or tubo-ovarian abscess suspected

Lily's PCOS Effects

Menstrual Cycles:

• Irregular or absent periods (oligomenorrhea/amenorrhea)

• Anovulation (no ovulation) or infrequent ovulation

Androgen Levels:

• Elevated testosterone (1.5x higher than normal)

• Causes hirsutism, acne, male-pattern baldness

Fertility:

• Leading cause of female infertility

• Lack of ovulation prevents conception

• Can be treated with ovulation-inducing medications

Daniel's BPH vs Prostate Cancer

If BPH Instead of Prostate Cancer:

Symptom Differences:

• BPH: Urinary symptoms (frequency, urgency, weak stream, nocturia, incomplete emptying)

• Prostate cancer (early): Often asymptomatic; detected via elevated PSA or abnormal DRE

• No bone pain, weight loss, or metastatic symptoms with BPH

Treatment Options for BPH:

• Watchful waiting (mild symptoms)

• Medications:

• Alpha-blockers (e.g., tamsulosin, doxazosin): Help relax the muscles in the prostate and bladder neck.

• 5-alpha-reductase inhibitors (e.g., finasteride, dutasteride): Reduce prostate size and lower levels of dihydrotestosterone (DHT).

• Combination therapy

• Minimally invasive procedures: Prostate artery embolization (PAE), prostatic urethral lift

• Surgery: TURP (transurethral resection of prostate), laser procedures

13. Key Takeaways for ADHD Learners

✓ STIs: Know the Big 3 bacterial (chlamydia, gonorrhea, syphilis) and viral (HSV, HPV, HIV)

✓ PID: Ascending infection → scarring → infertility/ectopic pregnancy

✓ Endometriosis vs Adenomyosis: OUTSIDE uterus vs INSIDE uterine muscle

✓ PCOS: High LH:FSH ratio → excess androgens → no ovulation → infertility + hirsutism

✓ Female cancers: HPV causes cervical cancer (95%+); screening saves lives

✓ Male infertility: 4 categories - sperm production, delivery, lifestyle, medical conditions

✓ BPH vs Prostate Cancer: BPH = benign, urinary symptoms; Cancer = malignant, often asymptomatic early

✓ Prostate cancer treatment: Hormone therapy (ADT) blocks testosterone to slow growth

✓ Testicular cancer: Orchiectomy first, then chemo (BEP/EP for seminoma); excellent prognosis