Chapter 17 Reproductive System Diseases and Disorders

Anatomy and Physiology Female external structures Vulva Labia majora and labia minora Clitoris Vestibule and vestibular glands Hymen Vaginal orifice

Anatomy and Physiology Female internal structures Ovaries Fallopian tubes Uterus Cervix Vagina Hormones: estrogen and progesterone

Anatomy and Physiology Male external organs Scrotum and penis

Anatomy and Physiology Male internal organs Testes Epididymis Vas deferens Urethra Seminal vesicles Bulbouretheral and prostate glands

Common Signs and Symptoms Female Abdominal and pelvic pain Fever and malaise Abnormal vaginal discharge Burning and/or itching of the genitals

Common Signs and Symptoms Female Pain during sexual intercourse Any change in breast tissue Abnormal discharge from the nipple

Common Signs and Symptoms Male Urinary disorders including frequency, dysuria, nocturia, and incontinence Pain in the pelvis, groin, or reproductive organs Lesions on external genitals

Common Signs and Symptoms Male Swelling or abnormal enlargement of the reproductive organs Abnormal penile discharge Burning and/or itching of the genitals

Diagnostic Tests Female Bimanual examination Hysterosalpingogram Papanicolaou smear of cervix Cervical biopsy Cone biopsy

Diagnostic Tests Female Dilatation and Curettage Laparoscopy Mammography Blood tests

Diagnostic Tests Male Digital rectal examination Cystoscopy Biopsy Laboratory tests including PSA

Premenstrual Syndrome Symotoms prior to menses Symptoms begin mid-cycle Headache and nausea Back and joint pain Edema and bloating Weight gain

Premenstrual Syndrome Symptoms begin mid-cycle Breast tenderness Sleep disturbances Irritability Mood swings Depression

Premenstrual Syndrome Treatment Individualized Dietary changes Avoid caffeine, chocolate, nicotine, salt, sugar, and alcohol

Menstrual Abnormalities Amenorrhea Dysmenorrhea Menorrhagia Metrorrhagia

Endometriosis Abnormal growth of endometrial tissue outside of the uterus Common sites of implantation include ovaries, fallopian tubes, abdominal wall, and intestines

Endometriosis Symptoms Dysmenorrhea Low back, vaginal, and pelvic cramping Heavy menses and dyspareunia

Endometriosis Treatment Hormones Remission with pregnancy, nursing, and menopause Panhysterectomy

Pelvic Inflammatory Disease Inflammation of some or all of the pelvic reproductive organs May include cervicitis, salpingitis, endometritis, oophoritis Most commonly caused by STDs

Pelvic Inflammatory Disease Symptoms Fever Chills Pain in pelvic area Leukorrhea Treatment: antibiotics, analgesics, and rest

Ovarian Cyst Commonly benign fluid-filled sacs on or near the ovary Two types Physiologic Neoplastic

Ovarian Cyst Symptoms Treatment depends on type and size Low back pain Pelvic pain Dyspareunia Nausea and vomiting Treatment depends on type and size May resolve by itself or require laparoscopy

Fibroid Tumor Also known as leiomyomas Benign tumors of smooth uterine muscle Symptoms Abnormal uterine bleeding Excessive menstrual bleeding and pain

Fibroid Tumor Treatment depends on woman’s age and desire for children Surgical removal of fibroids or hysterectomy Uterine embolization Hormone therapy

Vaginitis Inflammation of vagina Symptoms Burning and itching Swelling of vagina and external genitalia

Vaginitis Common type of vaginitis Candida: fungus or yeast Trichomonas: parasite Atrophic: post-menopausal

Toxic Shock Syndrome Found almost exclusively in menstruating women using tampons Organism: staphylococcus aureus Symptoms: high fever, vomiting, diarrhea, and dropping blood pressure Treatment: IV fluids, antibiotics

Toxic Shock Syndrome Symptoms Treatment: IV fluids, antibiotics High fever Vomiting Diarrhea Decreasing blood pressure Treatment: IV fluids, antibiotics

Menopause Natural halting of menstruation Occurs between ages 45 and 55

Menopause Common symptoms Treatment: hormone therapy, exercise Hot flashes and night sweats Vaginal dryness Depression Sleep disorders Decreased libido Treatment: hormone therapy, exercise

Uterine Prolapse Uterus protrudes into vagina Symptoms Heaviness in pelvis Urinary stress Dysuria Low back pain Treatment: hysterectomy

Cystocele Herniation of urinary bladder through anterior vaginal wall Symptoms: pelvic pressure, urinary urgency, frequency, and incontinence Treatment: depends on degree of herniation

Rectocele Herniation of rectum through posterior vaginal wall Symptoms: discomfort, constipation, fecal incontinence Treatment: surgical repair

Cervical Cancer Fifth leading cause of cancer-related death in females Symptoms: abnormal cervical bleeding Treatment: surgical removal of tumor

Uterine Cancer Develops in endometrium and spreads to uterine wall Symptoms: abnormal bleeding in menopausal women Treatment: surgical removal of uterus and ovaries with radiation

Ovarian Cancer Quite common and often fatal Symptoms: pressure on the bladder, abdominal or pelvic pain, general feeling of ill health Treatment: complete hysterectomy, radiation, and chemotherapy

Fibrocystic Disease Most common breast disorder of premenopausal females between the ages of 30 and 55 Cysts are linked to estrogen levels

Fibrocystic Disease To decrease breast pain: Reduce caffeine and salt Use of mild diuretics Use of mild analgesics the week prior to menstruation is recommended

Mastitis Inflammation of breast tissue Symptoms Redness Heat Swelling Pain and often bloody nipple discharge

Mastitis Treatment Antibiotics Application of heat Analgesics Firm supporting bra to decrease discomfort

Breast Cancer Adenocarcinoma of the breast ducts Most common breast neoplasm (affects one out of nine females) Risk factors Age 40 and over Family member affected with breast cancer

Breast Cancer Risk factors Onset of menses before age 13 Menses continuing after age 50 Nullipara First child after age 30 Obesity Chronic breast disease

Breast Cancer Symptoms Treatment Non-tender lump of varying size Occurs most often in upper outer quadrant of breast often with dimpling Treatment Mastectomy, chemotherapy, and/or radiation

Ectopic Pregnancy Fertilized ovum attaches to tissue outside the uterus, usually in fallopian tubes Symptoms Acute pelvic pain Vaginal bleeding Positive pregnancy test

Ectopic Pregnancy Treatment Prompt surgery to terminate pregnancy Every effort is taken to preserve ovary and tube if future pregnancy is desired

Spontaneous Abortion “Miscarriage” Natural termination of pregnancy before fetus is viable Symptoms Vaginal bleeding Cramping and pelvic pain

Spontaneous Abortion Once it starts, progression is difficult to stop D & C may be necessary to remove any tissue remaining in the uterus

Morning Sickness Associated with first trimester of pregnancy Symptoms: nausea and vomiting Treatment Not necessary unless vomiting Light meals several times a day

Morning Sickness Treatment Dry food before drinking Avoid fatty foods Rest after meals

Hyperemesis Gravidarum Excessive vomiting during pregnancy Treatment includes IV fluids and withholding all foods and oral fluids Usually subsides by second pregnancy

Toxemia Usually appears during 3rd trimester Symptoms Hypertension Sudden weight gain Proteinuria Edema in face, hands, and feet

Toxemia Treatment Frequent monitoring of blood pressure Weight and urine protein

Abruptio Placentae Separation of placenta from uterus Degrees of symptoms Partial separation may be asymptomatic Complete separation may cause severe abdominal pain and vaginal bleeding Shock and decrease in fetal heart tones

Abruptio Placentae Treatment Prompt delivery either vaginally or by c-section Blood replacement may also be necessary

Placenta Previa Abnormal positioning of placenta in lower uterus near or over cervical os Symptoms: painless, bright red vaginal bleeding during third trimester

Placenta Previa Treatment-vaginal delivery is asymptomatic or if bleeding is not severe; emergency c-section if maternal bleeding or fetal anoxia

Placenta Previa Treatment Vaginal delivery is asymptomatic if bleeding is not severe Emergency c-section if maternal bleeding or fetal anoxia

Prostatitis Inflammation of prostate gland Symptoms Dysuria Pyuria Fever and low back pain Treatment: antibiotics, warm sitz baths, increased fluid intake, analgesics

Benign Prostatic Hyperplasia Enlargement of prostate gland due to normal cells overgrowing and enlarging Common in men over age 60

Benign Prostatic Hyperplasia Symptoms Nocturia Inability to start urination Weak urinary stream Inability to empty stream

Benign Prostatic Hyperplasia Treatment Prostatic massage Sitz bath Catheterizations Regular sexual intercourse Surgery

Prostatic Carcinoma Neoplasm of prostate gland affecting men over 50 Second most common cause of cancer-related deaths in men

Prostatic Carcinoma Symptoms are similar to BPH Treatment Depends on age and physical condition of individual Degree of metastasis

Epididymitis Inflammation of epididymis Symptoms Swollen, hard, and painful epididymis Often accompanied by severe scrotal pain and swelling

Epididymitis Treatment Rest Analgesics Use of a scrotal support Avoidance of alcohol, spicy foods, and sexual stimulation

Orchitis Inflammation of one or both testes due to viral or bacterial infection Symptoms: swelling, pain, tenderness of one or both testes, fever, malaise Treatment: dependent on cause

Testicular Tumor Commonly affect young men age 20-35 Most common type of cancer in this group Symptoms: painless mass felt in testicle Treatment: orchiectomy, chemotherapy, and radiation

Cryptorchidism Undescended testicle Premature birth is common cause Treatment: surgery

Genital Herpes Viral infection 1 in 6 individuals in United States is infected Not curable Periods of remission and exacerbation

Genital Herpes Symptoms Treatment is symptomatic Blister-like lesions causing dysuria Severe itching Treatment is symptomatic Antiviral medications Sitz baths Ice therapy and analgesics

Gonorrhea “Clap” Symptoms Purulent discharge from penis and vagina Dysuria Urinary frequency in males and females Female - cervicitis Genital itching and burning pain

Gonorrhea Treatment Antibiotics including Penicillin Tetracycline Ceftiaxone

Syphilis Treatment: Penicillin or Tetracycline is very effective Three stages Primary - appearance of painless chancre Secondary - chancre heals Period of rest lasting 6 weeks to 1 year

Syphilis Secondary - rash appears Tertiary Bacteria invade organs throughout body causing gumma Curable with antibiotics during this stage but effects of lesions are irreversible

Chlamydia Known as “silent” STD - Bacterial Symptoms Drainage with burning and itching Urination due to urethritis and epididymitis Treatment: antibiotics

Trichomoniasis Caused by protozoan Symptoms Male - urethritis, epididymitis, and prostatitis Female - green frothy vaginal discharge, itching and burning of genital area

Trichomoniasis Treatment Antiparasitic medications such as Flagyl

Genital Warts Viral infection Symptoms Treatment Possible tenderness in affected area Treatment Chemical or surgical removal Cervical cancer related to genital warts

Dyspareunia Pain or discomfort with sexual intercourse May affect men and women Treatment is dependent on cause

Premature Ejaculation Expulsion of seminal fluid during foreplay, prior to complete erection, or immediately after sexual intercourse Common in young males Treatment is based on cause

Infertility Inability of couple to achieve pregnancy after one year of unprotected sex

Infertility Causes Presence of STD Hormonal disorders Abnormality of reproductive organs Endometriosis Scarring or blockage of fallopian tubes Vaginal antibodies that kill sperm

Infertility Treatment Based on cause Surgery Medication therapy Hormone imbalance

Hydiatidiform Mole Grape-like cysts in uterus that mimic pregnancy Treatment: D & C At higher risk to develop choriocarcinoma requiring frequent follow-up examinations