alteration of the reproductive system

• can range from structural abnormalities to functional abnormalities

  • ex. delayed puberty, precocious puberty, hormonal and menstrual alterations, infection, and inflammation

• many rs disorders such as impotence and infertility can have serious physiological and psychological consequences

alterations of sexual maturation

• variety of congenital and endocrine disorders can disrupt timing of puberty

  • delayed or precocious (early) puberty

• both types of disorder involves inappropriate onset of sex hormone production by gonads

• delayed puberty

  • secondary sex characteristics have not appeared in girls by age 13

    • first sign of puberty is breast development

  • secondary sex characteristics have not appeared in boys by age 14

  • 95% of cases are simply a constitutional delay

    • hormonal levels are normal but maturation is happening slowly

  • 5% are caused by some type of disruption of the hypothalamic-pituitary-gonadal axis

• precocious puberty

  • sexual maturation before age 6 in black girls and age 7 in white (and other) girls

  • sexual maturation before age 9 in boys

  • precocious puberty occurs in many forms such as

    • isosexual precocious puberty- premature development of secondary sexual characteristics most commonly due to premature onset of hormones

    • heterosexual precocious puberty- child develops some secondary sexual characteristics of opposite sex (still before typical onset)

    • incomplete precocious puberty- partial development of secondary sexual characteristics (some develop early, some develop at normal time)

disorders of the female reproductive system

• hormonal and menstrual alterations

  • primary dysmenorrhea

    • painful menstruation associated with prostaglandin release in the ovulatory cycles

    • related to the duration and amount of menstrual flow

  • secondary dysmenorrhea

    • painful menstruation related to pelvic pathology

    • can occur any time in the menstrual cycle

  • dysmenorrhea is the result of excessive endometrial prostaglandin production

  • manifestations: pelvic pain with onset of menses

  • diagnosis: pelvic examination

hormonal and menstrual alterations

• primary amenorrhea

  • failure of menarche (first period) and absence of menstruation of age 14 without the development of secondary sex characteristics and by age 16 with secondary sex characteristics

  • diagnosis is based on history, physical examination, and clinical symptoms

  • treatment involves hormone therapy and correction of underlying disorders (hypothalamus, pituitary, ovarian)

• secondary amenorrhea

  • absence of menstruation for three or more cycles or 6 months in women who have previously menstruated

  • could be caused by structural abnormalities or abnormal ovarian steroid hormones

  • causes: pregnancy (itself but thats a normal cause, also postpartum but then its not normal), dramatic weight loss due to malnutrition or excessive exercise

    • normal time to resume menstruation postpartum

      • if breastfeeding: its common to not have a period while breastfeeding

      • if not breastfeeding: typically returns 6-8 weeks postpartum, if hasnt returned 3-6 months (or more), might be secondary amenorrhea

  • symptoms: anovulation, hyperprolactinemia, hirsutism (abnormal hairiness)

hormonal and menstrual alterations

• polycystic ovarian syndrome

  • oligoovaluation (infrequent or irregular ovulation) or anovulation (complete lack of ovulation)

  • elevated levels of androgens or clinical signs of hyperandrogenism and polycystic ovaries

  • leading cause of infertility in the us

  • multifactorial

    • hyperinsulinism (insulin stimulates androgen secretion and reduces serum sex hormone binding globulin- excessive androgen affect follicular growth)

  • dysfunction of follicle development

  • diagnosis: excess androgen level, clinical symptoms

  • treatment: reversing signs of excess androgen

• premenstrual syndrome (pms)

  • cyclic physical, psychological, or behavioral changes that impair interpersonal relationships or interfere with usual activities

  • symptoms can be inconsistent from month to month

  • occurs in the luteal (postovulatory) phase

  • abnormal nervous, immunologic, vascular, emotional, and gi tissue response to the normal menstrual cycle (>200 symptoms)

  • common and normal

infection and inflammation

• infections of the genital tract can be caused by exogenous (often sexually transmitted) or endogenous (floral bacteria or vagina, or bowel) microorganisms

• pelvic inflammatory disease (pid)

  • acute inflammatory disease caused by infection

  • may involve any organ or combination of organs of the reproductive tract

  • caused when sexually transmitted bacteria migrate from the vagina to the upper genital tract

  

• vaginitis

  • infection of the vagina

  • major cause is sexually transmitted pathogens

  • develops due to loss of local defense mechanism ex. change of vaginal ph due to disruption of normal flora

  • alkaline ph occurs before puberty, after menopause, and during pregnancy

• cervicitis

  • inflammation or infection of the cervix

• vulvitis

  • inflammation of the female external genitalia

  • causes

    • contact with soaps, detergents, lotions, hygienic sprays, shaving, menstrual pads, perfumed toilet paper, or nonabsorbing or tight fitting clothing

    • vulvitis may increase susceptibility to vaginal infections that spread to the labia

pelvic relaxation disorders

• the bladder, urethra, and rectum are supported by the endopelvic fascia and perineal muscles

• the muscular and fascial tissue loses tone and strength with aging

  • cannot maintain the pelvic organs in proper position

  • can lead to displacement of uterine, bladder, urethra, or rectum

• uterine prolapse- decent of the cervix or entire uterus into vaginal canal

• vaginal prolapse

benign growths and proliferative conditions

• benign ovarian cysts

  • may occur at anytime of life but most common during reproductive years

    • occurs when hormonal imbalance is common (puberty)

  • functional cysts such as follicular cysts and corpus luteum cysts are caused by variation of normal physiologic events

  • benign cysts are produced when a follicle or number of follicles are stimulated but no dominant follicle develops and reaches maturity

  • corpus luteum cyst may develop due to hormonal imbalances

female reproductive cancer

• malignant tumors of rs are common

• cervical cancer

  • most common cancer in women

  • it is a progressive disease (pre malignant lesion usually occur 10-12 years before the development of invasive carcinoma

  • caused by human papilomavirus (hpv)

  • diagnosis: since asymptomatic- regular cytological screening is necessary. clinical symptoms in late stages include, vaginal bleeding, abnormal discharge

• vaginal cancer- the rarest

• vulvar cancer

• endometrial cancer- cancer of glandular epithelium of uterine lining

• uterine sarcoma

• ovarian cancer

sexual dysfunction

• organic (ex. chronic illness) and psychological disorders can be implicated in sexual dysfunction

• disorders of desire (inhibited sexual desire, decreased libido)can be a biological sign of depression or substance abuse

• vaginismus- involuntary muscle spasm in response to penetration due to prior sexual trauma or fear of sex

• anorgasmia (orgasmic dysfunction)- inability to achieve orgasm due to chronic illness (ex. diabetes, alcoholism, hormonal deficiencies)

• rapid orgasm- after orgasm- little interest in sex (chain of events that could occur)

• dyspareunia (painful intercourse)- women may have pain during arousal, orgasm, or initiation of intercourse due to ex. lack of lubrication

impaired fertility

• infertility

  • inability to conceive after 1 year of unprotected sex with the same partner

  • fertility can be impaired by factors in the man, woman, or both

  • fertility tests

    • structural

    • hormonal

disorders of the male reproductive system

• disorders of the urethra

  • urethritis

    • inflammation of the urethra usually, but not always, caused by a sexually transmitted disease

    • nonsexual origins can be due to urologic procedures, insertion of foreign objects, anatomical abnormalities, or trauma

  • urethral strictures

    • fibrotic narrowing of the urethra caused by scarring

    • commonly due to trauma or untreated or severe urethral infections

• disorders of the penis

  • phimosis and paraphimosis in which penile prepuce (foreskin) is ‘too tight’

    • phimosis

      • the foreskin has a narrow opening

        • the inability to retract foreskin from the glans of the penis (distal to proximal)

    • paraphimosis

      • inability to replace or cover the glans with the foreskin (proximal to distal) leads to formation of constricting band around penis

    • frequently caused by poor hygiene or chronic infections

  • penile cancer

    • carcinoma of the penis is rare

    • mostly squamous cell carcinomas

disorders of the scrotum, testis, and epididymis

• disorders of the scrotum

  • varicocele, hydrocele, and spermatocele are common disorders

    • varicocele

      • inflammation/dilation of veins in the spermatic cord

      • caused by inadequate or absent valves in the spermatic cord

      • varicocele reduces blood flow to the testicles and interferes with spermatogenesis

        • the blood flow/blood drainage is inefficient (it pools) which can interfere with temperature and the microenvironment

    • hydrocele

      • scrotal swelling due to collection of fluid within the tunica vaginalis

      • imbalance between fluid secretion and reabsorption

      

  • disorders of the testis

    • cryptorchidism

      • failure of one or more of the testes to descend from the abdominal cavity into the scrotum

    • ectopic testis

      • testis that has strayed from the normal pathway of descent

        • diagnosis in both cases is based on physical examination

        • treatment: hormone (gnrh, hcg) may initiate descent, if not, surgery

    • torsion of the testis

      • rotation of the testis

      • the rotation causes the twisting of the blood vessels in the spermatic cord

      • painful and swollen testis

      • condition may be spontaneous or follow physical exertion or trauma

      • if cannot be corrected manually, surgery must be performed

  • disorders of the epididymis

    • epididymitis

      • inflammation of the epididymis

      • common in sexually active young men

      • the pathogenic microorganism reaches the epididymis by ascending the vas deferens from an already infected bladder or urethra

      • pain is the main symptom

      • treatment include

        • antibiotics

        • symptom relief medication

disorders of the prostate gland

• benign prostatic hyperplasia

  • enlargement of the prostate gland

  • symptoms associated with urethral compression

  • relationship to aging (80% of men before ag 80 will experience it)

  • evaluation

    • digital rectal exams

    • prostate specific antigen (psa) monitoring

• prostitis

  • inflammation of the prostate

  • normal protective barriers

  • similar symptoms to bph

  • prostitis can be

    • acute bacterial

    • chronic bacterial

    • nonbacterial

• cancer of the prostate

  • 95% of prostate neoplasms are adenocarcinomas and demonstrate peripheral zone growth

  • prostatic cancer is asymptomatic until its advanced stages

  • symptoms are similar to bph

  • causes: dietary factors, hormones (ex. androgen), vasectomy, familial factors

male sexual dysfunction

• in males, normal sexual response includes: erection, emission, and ejaculation

• the causes of sexual dysfunction due to organic factors are

  • vascular

    • vascular disorders can prevent erection

  • endocrine

    • can reduce testosterone production

  • neurologic disorders

    • can interfere with sympathetic and parasympathetic innervations needed for erection

  • chronic diseases

    • renal failure and diabetes mellitus

  • penile diseases and penile trauma

  • iatrogenic factors

    • surgery and pharmaceuticals

impairment of sperm production and quality

• spermatogenesis require hormone and growth factors

  • fsh, lh, and testosterone

  • androgen binding protein, inhibin b, and other peptides

• adequate spermatogonia

• sperm count >= million/mL

• spem motility

• antisperm antibodies

• drugs and toxins in the semen

disorders of the breast

• galactorrhea

  • persistent and sometimes excessive secretion of milky fluid from the breasts of a woman who is not pregnant or nursing

  • galactorrhea can also occur in men

  • women with galactorrhea also experience menstrual abnormalities

breast cancer

• most common cancer in american women

• leading cause of death from ages 40-44

• second most common killer after lung cancer

• reproductive factors

• hormonal factors

• environmental factors and lifestyle

  • radiation

  • diet

  • chemicals

• physical activity

• familial factors and tumor related genes