Reproductive System Diseases and Disorders Chapter 17 Reproductive System Diseases and Disorders

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

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

Anatomy and Physiology Female hormones: Estrogen Progesterone

Animation Click Here to Play Female Reproductive System Animation

Anatomy and Physiology Male external structures: Scrotum Penis

Anatomy and Physiology Male internal structures: Testes Epididymis Vas deferens Urethra Seminal vesicles Bulbourethral and prostate glands

Common Signs and Symptoms for Females Abdominal and pelvic pain Fever and malaise Abnormal vaginal discharge Burning and/or itching of genitals Pain during sexual intercourse Any change in breast tissue Abnormal discharge from nipple

Common Signs and Symptoms for Males Urinary disorders E.g., frequency, dysuria, nocturia, incontinence Pain in pelvis, groin, or reproductive organs Lesions on external genitals

Animation Click Here to Play Male Reproductive Animation

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

Diagnostic Tests for Females Bimanual examination Hysterosalpingogram Pap smear of cervix Cervical biopsy Cone biopsy

Diagnostic Tests for Females Dilatation and curettage Laparoscopy Mammography Blood tests

Laparoscopy

Diagnostic Tests for Males Digital rectal examination Cystoscopy Biopsy Laboratory tests Including prostate-specific antigen (PSA)

Female Reproductive System Diseases Premenstrual syndrome (PMS) Symptoms prior to menses Symptoms begin mid-cycle: Headache Nausea Back and joint pain Edema and bloating Weight gain

Female Reproductive System Diseases PMS Symptoms begin mid-cycle: Breast tenderness Sleep disturbances Irritability Mood swings Depression

Female Reproductive System Diseases PMS Individualized treatment: Dietary changes Avoid caffeine, chocolate, nicotine, salt, sugar, and alcohol

Female Reproductive System Diseases Menstrual abnormalities: Amenorrhea Dysmenorrhea Menorrhagia Metrorrhagia

Female Reproductive System Diseases Endometriosis Abnormal growth of endometrial tissue outside of uterus Common implantation sites: Ovaries Fallopian tubes Abdominal wall Intestines

Female Reproductive System Diseases Endometriosis Symptoms: Dysmenorrhea Low back, vaginal, and pelvic cramping Heavy menses Dyspareunia

Female Reproductive System Diseases Endometriosis Treatment: Hormones Remission with pregnancy, nursing, and menopause Panhysterectomy

Female Reproductive System Diseases Pelvic inflammatory disease (PID) Inflammation of some or all pelvic reproductive organs May include cervicitis, salpingitis, endometritis, and oophoritis Causes: Most commonly STDs

Female Reproductive System Diseases PID Symptoms: Fever Chills Pelvic pain Leukorrhea

Female Reproductive System Diseases PID Treatment: Antibiotics Analgesics Rest

Female Reproductive System Diseases Ovarian cyst Commonly benign fluid-filled sac(s) on or near ovary Two types: Physiologic Neoplastic

Female Reproductive System Diseases Ovarian cyst Symptoms: Low back pain Pelvic pain Dyspareunia Nausea and vomiting Treatment depends on type and size May resolve by itself or require laparoscopy

Female Reproductive System Diseases Fibroid tumor Also known as leiomyomas Benign tumors of smooth uterine muscle Symptoms: Abnormal uterine bleeding Excessive menstrual bleeding and pain

Female Reproductive System Diseases Fibroid tumor Treatment depends on woman’s age and desire for children: Surgical removal of fibroids or hysterectomy Uterine embolization Hormone therapy

Female Reproductive System Diseases Vaginitis Inflammation of vagina Symptoms: Burning Itching Swelling of vagina and external genitalia

Female Reproductive System Diseases Vaginitis Common types: Candida Fungus or yeast Trichomonas Parasite Atrophic Post-menopausal

Female Reproductive System Diseases Toxic shock syndrome Found almost exclusively in menstruating females using tampons Cause: Organism called staphylococcus aureus Symptoms: High fever Vomiting

Female Reproductive System Diseases Toxic shock syndrome Symptoms: Diarrhea Decreasing blood pressure Treatment: IV fluids Antibiotics

Female Reproductive System Diseases Menopause Natural halting of menstruation Occurs between ages 45 and 55 Symptoms: Hot flashes Night sweats Vaginal dryness Depression

Female Reproductive System Diseases Menopause Symptoms: Sleep disorders Decreased libido Treatment: Hormone therapy Exercise

Female Reproductive System Diseases Uterine prolapse Uterus protrudes into vagina Symptoms: Heaviness in pelvis Urinary stress Dysuria Low back pain

Female Reproductive System Diseases Uterine prolapse Treatment: Hysterectomy

Female Reproductive System Diseases Cystocele Herniation of urinary bladder through anterior vaginal wall Symptoms: Pelvic pressure Urinary urgency, frequency, and incontinence Treatment depends on degree of herniation

Female Reproductive System Diseases Rectocele Herniation of rectum through posterior vaginal wall Symptoms: Discomfort Constipation Fecal incontinence Treatment: Surgical repair

Female Reproductive System Diseases Cervical cancer Fifth leading cause of cancer-related death in females Most common cause: Human papillomavirus (HPV) Symptoms: Abnormal cervical bleeding Treatment: Surgical removal of tumor

Female Reproductive System Diseases Cervical cancer Reducing risk: Smoking cessation Limiting number of sexual partners Using condoms Having yearly pap smear tests and following up on results Getting HPV vaccine

Female Reproductive System Diseases Uterine cancer Develops in endometrium and spreads to uterine wall Symptoms: Abnormal bleeding in menopausal females Treatment: Surgical removal of uterus and ovaries with radiation

Female Reproductive System Diseases Ovarian cancer Quite common and often fatal Symptoms: Pressure on bladder Abdominal or pelvic pain General feeling of ill health

Female Reproductive System Diseases Ovarian cancer Treatment: Complete hysterectomy Radiation Chemotherapy

Diseases of the Breast Fibrocystic disease Most common breast disorder of premenopausal females between age 30 and 55 Cysts linked to estrogen levels To decrease breast pain: Reduce caffeine and salt Use mild diuretics Use mild analgesics week before menstruation

Diseases of the Breast Mastitis Inflammation of breast tissue Symptoms: Redness Heat Swelling Pain Bloody nipple discharge

Diseases of the Breast Mastitis Treatment: Antibiotics Application of heat Analgesics Firm, supporting bra to decrease discomfort

Diseases of the Breast Breast cancer Adenocarcinoma of breast ducts Most common breast neoplasm Affects one of eight females Risk factors: Age 40 and over Family member affected with breast cancer Onset of menses before age 13

Diseases of the Breast Breast cancer Risk factors: Menses continuing after age 50 Nullipara First child after age 30 Obesity Chronic breast disease Brassiere wear time

Diseases of the Breast Breast cancer Symptoms: Non-tender lump of varying size Occurs most often in upper-outer quadrant of breast Often with dimpling

Diseases of the Breast Breast cancer Treatment: Lumpectomy Mastectomy Chemotherapy Radiation

Disorders of Pregnancy Ectopic pregnancy Fertilized ovum attaches to tissue outside uterus Usually in fallopian tubes Symptoms: Acute pelvic pain Vaginal bleeding Positive pregnancy test

Ectopic Pregnancy

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

Disorders of Pregnancy Spontaneous abortion Also known as miscarriage Natural termination of pregnancy before fetus is viable Symptoms: Vaginal bleeding Cramping and pelvic pain

Disorders of Pregnancy Spontaneous abortion Once started, progression difficult to stop Dilation and curettage (D & C) may be necessary to remove any tissue remaining in uterus

Disorders of Pregnancy Morning sickness Associated with first trimester of pregnancy Symptoms: Nausea and vomiting

Disorders of Pregnancy Morning sickness Treatment: Not necessary unless vomiting Light meals several times per day Dry food before drinking Avoidance of fatty foods Rest after meals

Disorders of Pregnancy Hyperemesis gravidarum Excessive vomiting during pregnancy Treatment: IV fluids Withholding all foods and oral fluids Usually subsides by second pregnancy

Disorders of Pregnancy Toxemia Usually appears during third trimester Symptoms: Hypertension Sudden weight gain Proteinuria Edema in face, hands, and feet

Disorders of Pregnancy Toxemia Treatment: Frequent monitoring of blood pressure, weight, and urine protein

Disorders of Pregnancy 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

Disorders of Pregnancy Abruptio placentae Treatment: Prompt delivery either vaginally or by caesarean section (c-section) Blood replacement may also be necessary

Disorders of Pregnancy Placenta previa Abnormal positioning of placenta in lower uterus near or over cervical os Symptoms: Painless, bright red vaginal bleeding during third trimester

Disorders of Pregnancy Placenta previa Treatment: Vaginal delivery if asymptomatic or bleeding not severe Emergency c-section if maternal bleeding or fetal anoxia

Male Reproductive System Diseases Prostatitis Inflammation of prostate gland Symptoms: Dysuria Pyuria Fever Low back pain

Male Reproductive System Diseases Prostatitis Treatment: Antibiotics Warm sitz baths Increased fluid intake Analgesics

Male Reproductive System Diseases Benign prostatic hyperplasia (BPH) Enlargement of prostate gland due to normal cells overgrowing and enlarging Common in males over age 60

Male Reproductive System Diseases BPH Symptoms: Nocturia Inability to start urination Weak urinary stream Inability to empty bladder

Male Reproductive System Diseases BPH Treatment: Prostatic massage Sitz bath Catheterizations Regular sexual intercourse Surgery

Transurethral Resection of Prostate (TURP)

Male Reproductive System Diseases Prostatic carcinoma Neoplasm of prostate gland affecting males over age 50 Second most common cause of cancer-related deaths in males

Male Reproductive System Diseases Prostatic carcinoma Symptoms similar to BPH Treatment: Depends on age, physical condition of individual, and degree of metastasis

Male Reproductive System Diseases Epididymitis Inflammation of epididymis Symptoms: Swollen, hard, and painful epididymis Severe scrotal pain and swelling

Male Reproductive System Diseases Epididymitis Treatment: Rest Analgesics Use of scrotal support Avoidance of alcohol, spicy foods, and sexual stimulation

Male Reproductive System Diseases Orchitis Inflammation of one or both testes due to viral or bacterial infection Symptoms: Swelling, pain, and tenderness of one or both testes Fever Malaise Treatment depends on cause

Male Reproductive System Diseases Testicular tumor Commonly affects young males between age 20 and 35 Most common type of cancer in this age group Symptoms: Painless mass felt in testicle

Male Reproductive System Diseases Testicular tumor Treatment: Orchiectomy Chemotherapy Radiation

Male Reproductive System Diseases Cryptorchidism Undescended testicle Common cause: Premature birth Treatment: Surgery

Cryptorchidism

Sexually Transmitted Diseases (STDs) Genital herpes Viral infection One in six individuals in United States infected Periods of remission and exacerbation Symptoms: Blister-like lesions causing dysuria Severe itching

STDs Genital herpes Symptomatic treatment: No cure Antiviral medications Sitz baths Ice therapy Analgesics No cure

STDs Gonorrhea Causes inflammation in mucous membranes of genital and urinary system

STDs Gonorrhea Symptoms: Purulent discharge from penis and vagina Dysuria Urinary frequency in males and females Cervicitis in females Genital itching and burning pain

STDs Gonorrhea Treatment: Antibiotics Tetracycline Ceftriaxone Including penicillin Tetracycline Ceftriaxone

STDs Syphilis Three stages: Primary Secondary Painless chancre appears Chancre heals Rash appears

STDs Syphilis Three stages: Tertiary Period of rest lasting six weeks to one year Bacteria invade organs throughout body leading to gumma Curable with antibiotics during this stage But effects of lesions irreversible

STDs Syphilis Treatment: Penicillin Tetracycline

Syphilis Chancre Photo courtesy Mark L. Kuss

STDs Chlamydia Also known as silent STD Cause: Symptoms: Bacterial Drainage with burning and itching Urination due to urethritis and epididymitis

STDs Chlamydia Treatment: Antibiotics

STDs Trichomoniasis Cause: Symptoms: Protozoan Male Urethritis Epididymitis Prostatitis

STDs Trichomoniasis Symptoms: Treatment Female Green, frothy vaginal discharge Itching and burning of genital area Treatment Antiparasitic medications E.g., Flagyl

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

Genital Warts Photo courtesy Mark L. Kuss

Sexual Dysfunction Dyspareunia Pain or discomfort with sexual intercourse May affect males and females Treatment dependent on cause

Sexual Dysfunction Female arousal-orgasmic dysfunction Also known as frigidity Lack of sexual desire or responsiveness Inability to reach orgasm

Sexual Dysfunction Female arousal-orgasmic dysfunction Causes: Neurological Psychological Treatment: Education on healthy sex attitudes and sexual stimulation techniques

Sexual Dysfunction Premature ejaculation Expulsion of seminal fluid during foreplay, prior to complete erection, or immediately after beginning sexual intercourse Most common sexual problem in males Especially young males Treatment based on cause Typically psychological Rather than physical

Sexual Dysfunction Impotence/erectile dysfunction (ED) Now most commonly known as ED Inability of male to achieve or maintain erection sufficient to complete sexual intercourse Does not affect fertility

Sexual Dysfunction Impotence/ED Caused by vascular insufficiency and psychological factors Treatment varies: Change in medications Psychological counseling Surgery External devices

Sexual Dysfunction Impotence/ED Prevention: Activities related to healthy lifestyle May not be preventable

Sexual Dysfunction Infertility Inability of couple to achieve pregnancy Female causes: Presence of STD Hormonal disorders Abnormality of reproductive organs Endometriosis

Sexual Dysfunction Infertility Female causes: Male causes: Scarring or blockage of fallopian tubes Vaginal antibodies that kill sperm Male causes: Presence of STD or other infection in tract Structural abnormalities Hormonal disorders

Sexual Dysfunction Infertility Treatment: Surgery Medication therapy Hormone imbalance

Trauma Rape Sexual intercourse (vaginal or anal) without consent or against will of individual May be against either sex High incidence Date rape drugs Difficult recovery

Rare Diseases Vaginal cancer Occurs in daughters of mothers who used diethylstilbestrol (DES) hormone Treatment: Surgery Chemotherapy Radiation

Rare Diseases Puerperal sepsis Infection of endometrium following childbirth Treatment: Antibiotics Prevention: Asepsis during and after childbirth

Rare Diseases Hydatidiform mole Grape-like cysts in uterus that mimic pregnancy Treatment: D & C At higher risk to develop choriocarcinoma Requiring frequent follow-up examinations

Effects of Aging on Females Thinning and graying of pubic hair Decreased elasticity and atrophy Shrinking of internal organs Decreased vaginal lubrication Greater stimulation and lubricants required for sexual pleasure

Effects of Aging on Males Thinning and graying of pubic hair Decreased elasticity and atrophy Decreased testosterone Decreased sperm production Diminished ejaculation amount Enlarged prostate Greater stimulation required for erection