CHAPTER 21 REPRODUCTIVE SYSTEM Conception Erectile Fertility Genital Gestation Intercourse Lactation Mammography Menses Menstrual Ovulation Ectopic Fibroid Sterility Journal question: What tests are used to detect abnormalities of the fetus during pregnancy?

Chapter 21 Learning Objectives Define at least 10 terms relating to the reproductive system. Describe the function of the reproductive system. Identify at least 10 reproductive system structures and the function of each.

Chapter 21 Learning Objectives Identify at least three methods of assessment of the reproductive system.

Structure and Function Male and female reproductive organs produce sex cells called gametes. Combination of the female gamete (ova) and male gamete (sperm) is called fertilization. Puberty is the age at which the reproductive organs mature sufficiently to allow reproduction.

Fertilization After a sperm has penetrated an egg, the outer shell of the ovum makes it impossible for any other sperm to penetrate it. FIGURE 21-1 Fertilization.

Male Organs of Reproduction Testes Produce sperm Secrete testosterone, causing the appearance of secondary sexual characteristics such as facial and body hair, deepened voice, increased muscle mass, and thickening of the bones Epididymis Tube on the surface of each testis that stores the sperm while they mature Penis Excretes semen and urine The average lifespan of the sperm is 2 to 3 days.

Male Reproductive System FIGURE 21-2 Male reproductive system.

Female Organs of Reproduction Ovaries Glands that produce eggs and the hormones, estrogen, and progesterone Fallopian tubes Transport the mature ovum from the ovary to the uterus After release from the ovary, the average lifespan of an egg is 12 to 24 hours, after which it disintegrates or is flushed out of the body with the menstrual flow. 

Female Organs of Reproduction Uterus A muscular structure in which the zygote is implanted after conception Cervix Neck of the uterus Opens for delivery of a fetus Vagina Muscular tube that extends from the cervix to the exterior of the body Inner layer of the uterus is called the endometrium, which is shed during each menstrual cycle.

Internal Structure of the Female Reproductive System FIGURE 21-4 The internal structures of the female reproductive system.

Female Organs of Reproduction Vulva External structures of the female reproductive system Labia majora Mons pubis Labia minora Clitoris Bartholin’s glands Mammary glands

Menstrual Cycle Lasts approximately 28 days Complex process of hormone secretion and tissue changes in the uterus A mature ovum is released from an ovary on about the 14th day of each cycle. If the released ovum is not fertilized, the endometrium is released from the body along with the ovum. Sloughing of this bloody tissue, or menses, lasts 3 to 7 days. The menstrual cycle continues until 45 to 50 years of age.

Menstrual Cycle Discuss the phases of the menstrual cycle. FIGURE 21-6 The menstrual cycle.

Menstrual Cycle Menopause Cessation of the menstrual cycle Hot flashes are symptoms of reduction in hormone production. Levels of estrogen and pituitary gonadotropins are reduced. A woman’s ability to conceive or reproduce ceases without these hormones. Another term for menopause is climacteric-–cessation of the cycle.

Pregnancy Pregnancy results from the union of the ovum and sperm, usually in the fallopian tube. Growth of an offspring in the uterus lasts about 280 days (9 months).

Pregnancy The fertilized egg is known as a zygote from the time of conception to 2 weeks. It is then considered to be the morula, and it enters the uterus. The largest cell in the female human body is the ovum or egg in the ovaries.

Pregnancy As a blastocyst, it implants in the uterine wall and is considered to be an embryo through the eighth week. From 8 weeks to birth, the unborn baby is called a fetus. During the first 30 days of life, the baby is considered to be a neonate.

Pregnancy Changes in the female reproductive system during pregnancy Increase in muscle mass of the uterus Elongation of the vagina Uterus increased to 16 times normal size Increase in secretions, vascularity, and elasticity of the cervix and vagina

Pregnancy Amniotic sac Membrane surrounding the fetus in the uterus Filled with fluid to cushion and protect the fetus Placenta formed by a portion of the uterus Placenta filters the blood of the mother and provides oxygen and nutrients to the fetus.

Pregnancy Premature baby Born before the 37th week of pregnancy or weighing less than 5 pounds No single cause but influences include Social factors Environmental factors Economic status Nutritional deficits Cost of care for a premature neonate ranges from $12,000 to $150,000.

Labor and Delivery Three stages of labor First stage: Muscle contractions of the uterus cause the amniotic sac to rupture and the cervix to open (dilate) to about 10 cm in diameter, allowing passage of the fetus. Labor is muscle contractions signalling the onset of delivery of the fetus.

Labor and Delivery Second stage: Delivery of the baby is called parturition. Third stage: Delivery of the afterbirth, or placenta, takes place about 15 minutes later. Uterus shrinks back to normal size, and the hormonal balance of the body is re-established during the first 6 to 8 weeks after delivery of the baby.

Growth and Development Growth refers to the changes that can be measured by changes in height and weight and the changes in body proportions. Development describes the stages of change in psychological and social functioning. Changes in growth and development occur in spurts throughout the lifespan.

Growth and Development Neonate (first 4 weeks of life) At birth the neonate Is 19 to 21 inches long Weighs about 7 to 8 pounds Has a head that is about one fourth of length of the body

Assessment Techniques Many disorders of the reproductive system can be assessed by palpation. Other disorders are assessed with blood tests, with tissue culture, or by visual examination. Cystoscopy Method is used to view some of the reproductive structures. Most disorders of the male reproductive system are treated by a urologist. Disorders of the female reproductive system are treated by a gynecologist.

Assessment Techniques Prostate-specific antigen (PSA) test Blood test that measures PSA to detect prostate cancer in men Pap smear Cells of the cervix are removed and studied.

Assessment Techniques Mammography X-ray technique used to visualize breast tissue Amniocentesis Procedure in which amniotic fluid is removed and tested to detect abnormalities of the fetus

Examination for Breast Cancer FIGURE 21-7 Examination for breast cancer. (From Damjanov I: Pathology for the health professions, ed 3, St. Louis, 2006, Saunders.)

Assessment Techniques Ultrasonography Uses high-frequency sound waves to visualize structures deep in the body Chorionic villus sampling (CVS) Laparoscopy procedure to allow prenatal evaluation of the fetus

Disorders of the Reproductive System Benign prostatic hypertrophy Age-associated condition in men in which the prostate grows and may stiffen, causing blockage of the urethra Cancer of the female reproductive system Breast cancer Endometrial cancer Cervical cancer

Disorders of the Reproductive System Cancers of male reproductive system Prostate cancer Testicular cancer Chancroid Contagious bacterial infection characterized by painful ulcers on the genital area

Disorders of the Reproductive System Chlamydia Caused by the bacteria Chlamydia trachomatis Most common sexually transmitted disease Cryptorchidism Failure of the testes to descend into the scrotal sac before birth

Cryptorchidism FIGURE 21-11 Cryptorchidism. (From Damjanov I: Pathology for the health professions, ed 3, St. Louis, 2006, Saunders.)

Disorders of the Reproductive System Ectopic pregnancy One that occurs in an abnormal location in the body Endometriosis Growth of endometrial tissue in an area other than the uterus The embryo or fetus does not usually survive in ectopic pregnancies, and the situation can be life threatening to the woman if rupture results in internal bleeding.

Disorders of the Reproductive System Erythroblastosis fetalis Condition that may develop in an Rh-positive fetus of an Rh-negative mother who has developed antibodies against the Rh blood protein in a prior pregnancy Fetal alcohol syndrome Physical and mental birth defects that result from damage to the fetus by alcohol consumed by the mother About 5,000 to 12,000 babies are born with fetal alcohol syndrome each year.

Disorders of the Reproductive System Fibroid tumors Benign growths found in the uterus Genital warts Caused by one type of human papillomavirus called condyloma acuminata Fibroids are found in 50% of women older than 50 years. Genital warts can often reappear after treatment removes the wart.

Disorders of the Reproductive System Gonorrhea Bacterial infection and one of the most prevalent sexually transmitted diseases Herpes simplex virus One of the most common sexually transmitted diseases resulting in blisters, which open into painful sores. Gonorrhea can lead to sterility and arthritis if untreated. Gonorrhea may result in blindness in babies born to infected mothers. Herpes simplex virus is the most commonly sexually transmitted disease, affecting about 30 million people. It is also called genital herpes.

Disorders of the Reproductive System Human papillomavirus (HPV) Infection often does not cause visible symptoms but may appear as genital warts. Klinefelter's syndrome Defect appearing in males who carry an extra chromosome, resulting in a karyotype of XXY More than 40 types of HPV has been identified. HPV infection is the most important risk factor for the development of cervical cancer.

Disorders of the Reproductive System Leukorrhea Whitish vaginal discharge Menstrual disorders Dysmenorrhea: painful menstrual cramping Menorrhagia: excessive bleeding Amenorrhea: no bleeding Orchitis Inflammation of the testes Orchitis usually results from sexually transmitted infections or mumps.

Disorders of the Reproductive System Pelvic inflammatory disease (PID) Associated with infection by gonorrhea or Chlamydia Phimosis Narrowing of the foreskin of the glans penis Usually caused by infections

Disorders of the Reproductive System Premenstrual syndrome (PMS) Women experience irritability, depression, impaired concentration, headache, and edema. Pubic lice Yellow-gray parasites found in the pubic hair Evidence indicates that serotonin (a brain chemical) may affect a severe and disabling form of PMS called premenstrual dysphoric disorder (PMDD).

Disorders of the Reproductive System Syphilis Caused by a spirochete bacteria Three stages First stage: painless sores, or chancres Second stage: infection spreads and causes fever, swollen glands, and rash Third stage: symptoms appear years later and affect nervous system tissue Syphilis can be successfully treated with antibiotics.

Disorders of the Reproductive System Trichomonas vaginalis Parasitic protozoon causing a foul-smelling, yellowish green discharge, and redness of the vulva, urinary frequency, or painful urination Vaginitis Infection that may cause a scant, gray, foul-smelling discharge

Disorders of the Reproductive System Yeast infection Overgrowth of yeast in the vagina appearing as a cottage cheese–like discharge

Issues and Innovations Alternatives in conception Birth control Assisted reproductive technology (ART) In vitro fertilization (IVF) Intracytoplasmic sperm injection (ICSI) Gamete intrafallopian transfer (GIFT) Surrogacy

Issues and Innovations Factors increasing risk of infertility Age Smoking Stress Alcohol use Athletic training Weight Sexually transmitted infections (STIs) One of every 10 women is infertile.

Issues and Innovations Redefining the sexes Changes in family structure and sexual orientation Gender roles

Summary The function of the reproductive system is to produce offspring. Reproductive structures of the man include the testes, prostate gland, penis, ejaculatory duct, and seminal vesicle.

Summary Reproductive structures of the woman include the ovaries, fallopian tubes, vagina, uterus, and cervix. Methods to assess the reproductive system include self-examination, mammography, cystoscopy, and chorionic villus sampling.

Summary Growth and development of the neonate change rapidly after birth and occur in spurts throughout the lifespan. Disorders of the reproductive system include sexually transmitted diseases, cancers, ectopic pregnancies, erythroblastosis fetalis, and fetal alcohol syndrome.

Review Endometriosis, a disorder of the reproductive system, is: a. A condition that may develop in an Rh+ fetus of an Rh– mother who has developed antibodies against the Rh blood protein b. A growth of endometrial tissue in an area other than the uterus c. A bacterial infection that is one of the most prevalent sexually transmitted diseases d. Caused by one type of human papillomavirus e. Caused by a virus and results in blisters that open into painful sores

Review Endometriosis, a disorder of the reproductive system, is: a. A condition that may develop in an Rh+ fetus of an Rh– mother who has developed antibodies against the Rh blood protein b. A growth of endometrial tissue in an area other than the uterus c. A bacterial infection that is one of the most prevalent sexually transmitted diseases d. Caused by one type of human papillomavirus e. Caused by a virus and results in blisters that open into painful sores

Review What virus is the most important risk factor for the development of cervical cancer? a. Herpes simplex I b. Herpes zoster c. Enterovirus d. Human papillomavirus (HPV) e. All of the above

Review What virus is the most important risk factor for the development of cervical cancer? a. Herpes simplex I b. Herpes zoster c. Enterovirus d. Human papillomavirus (HPV) e. All of the above

Review Chlamydia, caused by the bacterium Chlamydia trachomatis, is: a. A painless swelling of the scrotum b. A contagious bacterial infection characterized by painful sores in the genital area c. The most common sexually transmitted disease d. Failure of the testes to descend into the scrotal sac before birth e. An age-associated condition in men in which the prostate grows and may stiffen

Review Chlamydia, caused by the bacterium Chlamydia trachomatis, is: a. A painless swelling of the scrotum b. A contagious bacterial infection characterized by painful sores in the genital area c. The most common sexually transmitted disease d. Failure of the testes to descend into the scrotal sac before birth e. An age-associated condition in men in which the prostate grows and may stiffen

Review Orchitis, a disorder of the reproductive system, is: a. An inflammation of the testes usually resulting from sexually transmitted infection or mumps b. A whitish vaginal discharge c. A narrowing of the foreskin of the glans penis d. Caused by spirochete bacteria e. Caused by one type of human papillomavirus

Review Orchitis, a disorder of the reproductive system, is: a. An inflammation of the testes usually resulting from sexually transmitted infection or mumps b. A whitish vaginal discharge c. A narrowing of the foreskin of the glans penis d. Caused by spirochete bacteria e. Caused by one type of human papillomavirus