Chapters 26,27,28 female reproductive, male reproductive, and STD(2) (1)

FEMALE REPRODUCTIVE SYSTEM

Overview

• Primary gonads (sex organs): Ovaries, responsible for the production of oocytes (egg cells) and sex hormones important for reproductive functions and secondary sexual characteristics.

• Accessory sex organs: Uterus, fallopian tubes, vagina, and breasts that play critical roles in reproduction, childbirth, and milk production.

• Accessory glands: Vestibular glands, providing lubrication that enhances sexual intercourse and maintaining overall reproductive health.

OVARIES & FALLOPIAN TUBES

Key Structures

• Fallopian tube (uterine tube): A pair of tubes that transport the oocyte from the ovaries to the uterus and is the site where fertilization typically occurs.

• Ovarian ligament: Connects the ovary to the lateral pelvic wall, providing support.

• Secondary oocyte: An immature egg released during ovulation, which can be fertilized by sperm.

• Infundibulum: Funnel-shaped end of each fallopian tube that catches the released oocyte.

• Fimbriae: Finger-like projections that assist in directing the oocyte into the fallopian tube through peristaltic movements.

Function

• Production of oocytes: The ovaries produce oocytes through oogenesis, a complex process that begins before birth but continues to mature throughout the female reproductive years. By puberty, a female will have around 300,000 to 400,000 oocytes.

• Production of sex hormones: Ovaries secrete hormones like estrogen and progesterone, which are crucial for regulating the menstrual cycle, promoting secondary sexual characteristics, and maintaining pregnancy.

ACCESSORY ORGANS

Fallopian Tubes

• Site of fertilization: Fertilization usually occurs in the ampulla section of the fallopian tube, where the sperm meets the oocyte.

• Egg transport: The oocyte is moved toward the uterus via peristalsis (muscle contractions) and cilia that line the fallopian tubes, ensuring the timely delivery of the egg.

Uterus

Functions

• Implantation: Once the ovum is fertilized, it implants into the thickened lining of the uterus, known as the endometrium.

• Development of fetus: The uterus provides a protected and nourishing environment for the developing fetus during pregnancy, accommodating growth and development.

Anatomy

• Layers:

  • Perimetrium: The outermost layer made of visceral peritoneum, providing a protective covering.

  • Myometrium: The middle muscular layer, crucial for uterine contractions during labor and menstruation.

  • Endometrium: The innermost mucosal layer that undergoes cyclic changes during the menstrual cycle, thickening in preparation for potential implantation.

Vagina

Roles

• Birth canal: The vagina serves as the passageway during childbirth through which the baby is delivered.

• Menstrual fluid passage: The vagina enables the expulsion of menstrual blood during menstruation.

• Intercourse: Provides a suitable acidic environment that helps protect against infections while facilitating sexual intercourse.

Vulva (External Organs)

• Components:

  • Labia Majora: The outer folds of skin that protect the external reproductive structures, covered with pubic hair.

  • Labia Minora: The inner folds that enclose the vaginal and urethral openings, rich in blood vessels and sensitive to stimulation.

  • Clitoris: A small, sensitive organ that plays a key role in sexual arousal and pleasure, packed with nerve endings.

  • Vestibular glands: Secrete mucus to lubricate the vagina during sexual arousal, enhancing comfort during intercourse.

MENSTRUAL CYCLE

Overview

• Hypothalamic-pituitary-ovarian axis: A complex interplay between the hypothalamus, pituitary gland, and ovaries that regulates the menstrual cycle and orchestrates hormone production.

Phases

• Follicular phase (Days 1–14): Follicle-stimulating hormone (FSH) stimulates the growth of ovarian follicles and production of estrogen, leading to the development of a dominant follicle.

• Ovulation (Day 14): A surge of luteinizing hormone (LH) triggered by rising estrogen levels results in the release of the ovum from the mature follicle.

• Luteal phase (Days 14–28): Post-ovulation, the corpus luteum forms and produces progesterone, preparing the endometrium for potential implantation of a fertilized egg.

Hormonal Functions

• Estrogen: Stimulates the growth and thickening of the endometrium, promotes secondary sexual characteristics, and regulates the menstrual cycle.

• Progesterone: Stabilizes the endometrium after ovulation, ensuring a suitable environment for implantation and assisting in maintaining early pregnancy.

• If no fertilization occurs: The corpus luteum degenerates, leading to decreased levels of progesterone and estrogen, resulting in menstruation.

OVARIAN CYCLE

Phases Covered

• Follicular phase: Period of ovarian follicle maturation in response to hormonal stimulation.

• Ovulation: Release of the ovum from the ovary, marking the peak of fertility.

• Luteal phase: The phase characterized by the functioning of the corpus luteum and preparation for potential implantation.

UTERINE CYCLE

Phases

• Menstruation: Shedding of the uterine lining, marking the end of one cycle and the beginning of another.

• Proliferative phase: The endometrial lining rebuilds in response to estrogen, preparing for potential implantation.

• Secretory phase: Following ovulation, the endometrium thickens further under the influence of progesterone, creating optimal conditions for a fertilized ovum.

• Premenstrual phase: When hormone levels decline if fertilization does not occur, resulting in the onset of menstruation.

Progression of Menstrual Cycle

• Menarche: The first episode of menstrual bleeding, typically occurring between ages 9 to 16, signalling the beginning of reproductive capability.

• Menopause: Permanent cessation of menstrual cycles, generally occurring in the late 40s to early 50s, marking the end of a woman's reproductive years.

• Perimenopause: The transitional phase leading to menopause characterized by irregular cycles, hormonal fluctuations, and symptoms such as hot flashes and mood swings.

Symptoms

• Symptoms associated with perimenopause may include atrophic vaginitis, vasomotor instability, low estrogen levels, and elevated follicle-stimulating hormone (FSH) concentrations.

FEMALE BREAST

Development

• Breast development begins around the onset of the first menstrual period, influenced by hormonal changes in the body during puberty and pregnancy.

• The breast is composed of 15-25 lobes made of lobules which are the functional units responsible for milk production during lactation.

• Lobules drain into lactiferous ducts that converge and form the nipple, allowing for the exit of milk during breastfeeding.

Anatomical Features

• Nipple: Contains pores from lactiferous ducts that release milk, surrounded by a sensitive area called the areola.

• Areola: Contains sebaceous gland pores that keep the area lubricated and may darken during pregnancy.

HORMONES EFFECT ON BREAST TISSUE

Hormonal Actions

• Estrogen: Promotes the growth of ductal tissue in the breast, contributing to enlargement during puberty and pregnancy.

• Progesterone: Stimulates the growth of lobular structures, which can cause breast tenderness and swelling, particularly during the menstrual cycle.

• Prolactin: Responsible for initiating and maintaining milk production in the lobules following childbirth.

• Oxytocin: Facilitates milk ejection from the lobes in response to suckling, allowing breastfeeding to continue smoothly.

FEMALE REPRODUCTIVE DYSFUNCTION

• Assessment of systemic disorders and symptomatology is crucial for diagnosing reproductive dysfunction, including menstrual irregularities and difficulties conceiving.

• Essential history considerations include details of the last menstrual period (LMP) and a comprehensive sexual history, encompassing the “5 P’s” — partners, practices, protection, past STIs, and pregnancy history.

• Physical exams and relevant tests, such as Pap smear and HPV testing, are fundamental screening methods to identify cervical abnormalities and potential sources of dysfunction.

FEMALE INFERTILITY

Definition

• Defined as the inability to conceive after unprotected intercourse for over one year. Infertility can be primary (never conceived) or secondary (after previous conception).

Factors affecting infertility

• Ovulation dysfunction: Conditions like polycystic ovarian syndrome (PCOS) or anatomical abnormalities impair the regular ovulation process.

• Hormonal deviations: Abnormal levels of LH, FSH, TSH, and other hormones may hinder fertility by impacting egg development or uterine receptivity.

• Physical obstructions: Pelvic inflammatory disease (PID), fibroids, or scarring from surgeries can block or damage reproductive pathways.

• Uterine defects: Congenital anomalies or the presence of fibroids may lead to an environment unsuitable for implantation.

• Infections: Sexually transmitted infections (STIs) that result in inflammation or scarring can contribute to infertility.

Potential Causes

• Lifestyle factors: Including obesity, smoking, excessive alcohol use, and stress negatively impact hormonal balance and reproductive functionality.

DISORDERS OF THE FEMALE REPRODUCTIVE SYSTEM

Types

• Menstrual disorders: A spectrum of conditions impacting the regularity and symptoms of menstrual cycles, including amenorrhea, dysmenorrhea, and polymenorrhagia.

• Uterine disorders: Such as fibroids, endometriosis, and abnormal bleeding patterns affecting quality of life and fertility.

• Vaginal disorders: Infections, irritations, and structural abnormalities like vaginal agenesis can disrupt normal function.

• Ovarian disorders: Conditions like ovarian cysts, hormone imbalances, and PCOS can interfere with reproductive health.

• Breast disorders: Including benign conditions such as fibrocystic changes and malignant conditions, requiring specific management.

MENSTRUAL DISORDERS

Definitions

• Amenorrhea: The absence of a menstrual period; can be primary or secondary and may indicate underlying health issues.

• Dysmenorrhea: Painful menstruation which can disrupt daily activities, classified as primary (without underlying conditions) or secondary (due to identifiable problems).

• Polymenorrhagia: Abnormally frequent menstrual cycles, occurring more often than every 21 days.

• Oligomenorrhea: Infrequent menstrual periods occurring more spaced apart than 35 days, potentially indicating hormonal imbalances.

• Metrorrhagia: Intermenstrual bleeding occurring between cycles, which may signal underlying conditions.

• Menorrhagia: Excessive blood loss during menstruation, often necessitating medical intervention to manage.

• PMS (Premenstrual Syndrome): A common disorder characterized by a range of symptoms — including mood swings, bloating, and irritability — in the luteal phase before menstruation.

UTERUS DISORDERS

Examples

• Uterine prolapse: When the uterus descends into the vaginal canal due to weakened pelvic support tissues, may require surgical intervention.

• Endometriosis: A painful condition where tissue similar to the lining of the uterus grows outside of it, potentially leading to infertility and chronic pain.

• Leiomyoma (fibroids): Noncancerous growths in the uterus that may cause substantial pain and heavy menstrual bleeding, often treated with medication or surgery.

• Dysfunctional uterine bleeding (DUB): Abnormal bleeding patterns without an obvious physical cause, often requiring hormonal therapy or surgical options.

VAGINAL DISORDERS

• Candidiasis: A common yeast infection leading to itching, discharge, and discomfort; often treated with antifungal medications.

• Atrophic vaginitis: Thin, dry, and inflamed vaginal tissue due to decreased estrogen levels, particularly common during menopause, often managed with estrogen therapy.

OVARIAN DISORDERS

• Ovarian cysts: Benign fluid-filled sacs that can develop on the ovaries, sometimes causing discomfort and disruption in the menstrual cycle; treatment depends on size and symptoms.

• Polycystic ovarian syndrome (PCOS): A hormonal disorder characterized by enlarged ovaries with multiple cysts, causing irregular periods and potential infertility.

• Ectopic pregnancy: Occurs when a fertilized ovum implants outside of the uterus, often in a fallopian tube, requiring urgent medical intervention due to risk of tubal rupture.

BREAST DISORDERS

• Fibrocystic breast disease: Characterized by the presence of benign lumps or cysts in breast tissue that may fluctuate in size and tenderness with menstrual cycles.

• Mastitis: Inflammation of breast tissue, often due to infection or during breastfeeding, requiring antibiotics for treatment.

CANCERS

Types

• Vaginal cancer: A rare malignancy associated with risk factors such as HPV infection; often diagnosed in advanced stages due to subtle early symptoms.

• Vulvar cancer: Also linked to HPV; symptoms may include itching, changes in vulvar appearance, and pain.

• Cervical cancer: Strongly associated with HPV; routine Pap smears and HPV vaccinations are vital for early detection and prevention.

• Uterine cancer (endometrial): The most common cancer of the female reproductive tract; symptoms typically include abnormal vaginal bleeding post-menopause.

• Ovarian cancer: Often referred to as the silent killer due to vague early symptoms that can lead to late diagnosis, necessitating awareness of risk factors and symptoms.

• Breast cancer: The most common malignancy among women; regular screenings such as mammograms along with self-examinations are crucial for early detection.

MALE REPRODUCTIVE SYSTEM

Overview

• Primary gonads: Testes, primarily responsible for sperm production and secretion of androgens which influence secondary sexual characteristics.

• External sex organs: Scrotum and penis play essential roles in reproduction and urine excretion, with the scrotum also regulating testicular temperature.

• Accessory ducts: Epididymis, vas deferens, ejaculatory ducts, and urethra, essential for storing, maturing, and transporting sperm during ejaculation.

• Accessory glands: Seminal vesicles, prostate gland, and bulbourethral glands produce seminal fluid which nourishes and transports sperm.

SPERM PRODUCTION

Process

• Sperm is produced in the seminiferous tubules of the testes through spermatogenesis, a continuous process that begins at puberty. Maturation occurs within the epididymis, where sperm gain motility and begin to develop the ability to fertilize an egg.

Accessory Ducts

• Vas deferens: A muscular tube that transports sperm from the epididymis; it can be cut during a vasectomy for permanent contraception.

HORMONE REGULATION

Process

• The hypothalamus releases gonadotropin-releasing hormone (GnRH), stimulating the pituitary gland to produce FSH and LH, which regulate sperm production and androgen levels.

• Negative feedback mechanisms: Involving inhibin, released by Sertoli cells to inhibit FSH secretion, and testosterone from Leydig cells regulate hormone levels in a feedback loop to maintain homeostasis in reproductive functions.

MALE INFERTILITY

Definition

• Male infertility is defined as the inability to conceive after unprotected intercourse for over a year, commonly linked to issues with sperm production, quality, or delivery mechanisms.

Factors contributing

• Decreased sperm number and motility: Caused by lifestyle factors (such as obesity, smoking), hormonal imbalances, or medical conditions (like diabetes).

• Hormonal deviations: Imbalances in testosterone or other hormones can negatively impact sperm production.

• Physical abnormalities: Issues affecting the testes or ducts, such as varicoceles or congenital disabilities.

• Infections: Sexually transmitted infections (STIs) can damage reproductive organs or impair sperm function, complicating fertility efforts.

DISORDERS OF THE MALE REPRODUCTIVE SYSTEM

Types

• Benign prostatic hyperplasia (BPH): Age-related enlargement of the prostate that leads to urinary issues such as frequent urination or difficulty in starting urine flow.

• Erectile dysfunction (ED): Difficulty in achieving or maintaining an erection, which can be caused by psychological issues (stress, anxiety) or medical conditions (such as cardiovascular disease).

• Disorders of testes and scrotum: Conditions such as varicoceles or testicular torsion can have significant impacts on fertility and sexual function.

Assessment

• Comprehensive assessment involves subjective reporting of symptoms, a thorough physical examination, and digital rectal examination (DRE) to evaluate prostate health and diagnose potential issues.

BPH (BENIGN PROSTATIC HYPERPLASIA)

• Characterized by excessive cell growth of the prostate gland, commonly affecting older men, leading to potential complications such as urinary tract infections.

• Symptoms: Include frequent urination, weak urine stream, feeling of incomplete bladder emptying, and nighttime urination (nocturia).

ERECTILE DYSFUNCTION (ED)

• Can affect men of any age, though more prevalent in older individuals. Treatment can include lifestyle modifications, medications, therapy, or surgical interventions depending on the underlying cause.

CANCERS

Types

• Penile cancer: Rare and often associated with HPV infection; early detection and prevention are achievable through vaccination.

• Testicular cancer: The most common malignancy in males aged 15-35; self-examination and awareness of symptoms are essential for early detection.

• Prostate cancer: The leading cancer type in men; regular screening can aid in early diagnosis and improve survival rates.

• Male breast cancer: Rare but can occur, primarily located around the nipple area, often identified late due to lack of awareness.

SEXUALLY TRANSMITTED DISEASES (STDs)

Basics

• STDs are transmitted through various sexual behaviors, with education and prevention strategies crucial to reduce incidence.

• Prenatal care: Essential for expecting mothers to prevent fetal complications stemming from STIs, emphasizing the importance of testing and treatment.

MOST COMMON STIs

• Include HPV, Chlamydia, Gonorrhea, Syphilis, Bacterial vaginosis, Genital herpes, Hepatitis B, and HIV; untreated STIs can increase vulnerability to other infections and severe health complications.

CLINICAL PRESENTATION OF STIs

• Asymptomatic infections may occur; hence routine screening is vital.

• Women: May present with abnormal discharge, pelvic pain, and irregular menstrual cycles.

• Men: Typically experience urethritis, characterized by burning sensations during urination.

MODES OF STI TRANSMISSION

• Primarily through unprotected sexual contact, but also through blood transfusions, sharing needles, and mother-to-child transmission during childbirth or breastfeeding.

BACTERIAL INFECTIONS

• Chlamydia: Often asymptomatic; effectively treated with antibiotics, commonly azithromycin or doxycycline.

• Gonorrhea: Can lead to serious complications like infertility; treatment usually consists of dual antibiotic therapy.

• Syphilis: Increasing incidence requires awareness; effective treatment is available with Benzathine Penicillin.

VIRAL INFECTIONS

• HPV: The most prevalent STI; vaccination (Gardasil) can prevent several carcinogenic strains, emphasizing the importance of public health strategies.

• Herpes Simplex Virus: Transmitted through skin contact, manageable with antiviral medications but with no current cure.

• Hepatitis B Virus & HIV: Can cause systemic health issues, requiring lifelong management with ongoing medical care and monitoring.

PELVIC INFLAMMATORY DISEASE (PID)

• A significant complication arising from untreated STIs, where infections spread into the reproductive organs, leading to potential infertility, chronic pelvic pain, and complications in pregnancy if left untreated. Treatment involves the use