1. Reproductive System Diseases and Disorders
Chapter 17
Reproductive System Diseases and Disorders 1

2. Anatomy and Physiology
Female external structures:
Vulva
Labia majora and minora
Clitoris
Vestibule and vestibular glands
Hymen
Vaginal orifice 2

3. Anatomy and Physiology
Female internal structures:
Ovaries
Fallopian tubes
Uterus
Cervix
Vagina
Female hormones:
Estrogen
Progesterone 3

4. Anatomy and Physiology
Male external structures:
Scrotum
Penis
Male internal structures:
Testes
Epididymis
Vas deferens
Urethra
Seminal vesicles
Bulbourethral and prostate glands 4

5. Common Signs and Symptoms for Female Reproductive Disorders
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 5

6. Common Signs and Symptoms for Male Reproductive Disorders
Urinary disorders
E.g., frequency, dysuria, nocturia, incontinence
Pain in pelvis, groin, or reproductive organs
Lesions on external genitals
Swelling of reproductive organs
Abnormal penile drainage
Burning, itching of the genitals 6

7. Diagnostic Tests for Females
Bimanual examination
Hysterosalpingogram
Pap smear of cervix
Cervical biopsy
Cone biopsy 7

8. Diagnostic Tests for Females
Dilatation and curettage
Laparoscopy
Mammography
Blood tests 8

9. Laparoscopy 9

10. Diagnostic Tests for Males
Digital rectal examination
Cystoscopy
Biopsy
Laboratory tests
Including prostate-specific antigen (PSA) 10

11. 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 11

12. Female Reproductive System Diseases
PMS
Symptoms begin mid-cycle:
Breast tenderness
Sleep disturbances
Irritability
Mood swings
Depression
Individualized treatment:
Dietary changes
Avoid caffeine, chocolate, nicotine, salt, sugar, and alcohol 12

13. Female Reproductive System Diseases
Menstrual abnormalities:
Amenorrhea
Dysmenorrhea
Menorrhagia
Metrorrhagia 13

14. Female Reproductive System Diseases
Menopause
Natural halting of menstruation
NOT a disease, is normal physical change related to aging
Usually takes place between age 40 and 50
Can be surgically induced at any age by removal of both ovaries 14

15. Female Reproductive System Diseases
Menopause
Symptoms:
Hot flashes, night sweats, and vaginal dryness
For some women – psychological symptoms of depression, sleep disorders, and decreased libido
Diagnosis:
Blood tests for presence of FSH
Treatment:
MHT (menopausal hormone therapy) on an individual basis by the individual and their physician 15

16. Female Reproductive System Diseases
Vaginitis
Inflammation of the vagina
Causes:
Bacteria
Yeast
Symptoms:
Vaginal burning, itching, swelling of the vagina and external genitalia
A white cottage cheese–appearing discharge with Candida
Diagnosis:
Testing vaginal fluid pH
Culture; antigen detection 16

17. Female Reproductive System Diseases
Vaginitis:
Treatment:
Identify and treat cause
Abstain from sexual intercourse until condition has healed
Common types of vaginitis include
Candida
Fungus or yeast
Trichomonas
Parasite
Atrophic
Postmenopausal 17

18. Female Reproductive System Diseases
Endometriosis
Abnormal growth of endometrial tissue outside of uterus
Common implantation sites:
Ovaries
Fallopian tubes
Abdominal wall
Intestines
Implanted endometrial tissue continues to act under the influence of hormones producing chocolate cysts, scar tissue, and adhesions 18

19. Female Reproductive System Diseases
Endometriosis
Symptoms:
Dysmenorrhea
Low back, vaginal, and pelvic cramping
Heavy menses
Dyspareunia
Primary complication is infertility
Treatment:
Hormones
Remission with pregnancy, nursing, and menopause
Panhysterectomy 19

20. Female Reproductive System Diseases
Pelvic inflammatory disease (PID)
Inflammation of some or all pelvic reproductive organs
May include cervicitis, endometritis, salpingitis, and oophoritis
Causes:
Most commonly STDs
Symptoms:
Fever
Chills
Pelvic pain
Leukorrhea 20

21. Female Reproductive System Diseases
PID
Treatment:
Antibiotics
Analgesics
Rest
Prevention:
Practicing safe sex with proper use of condoms 21

22. Female Reproductive System Diseases
Ovarian cyst
Commonly benign fluid-filled sac(s) on or near ovary
Two types:
Physiologic
Neoplastic
Symptoms:
Low back pain
Pelvic pain
Dyspareunia
Nausea and vomiting
Treatment depends on type and size
May resolve by itself or require laparoscopy 22

23. Female Reproductive System Diseases
Fibroid tumor
Also known as leiomyomas
Benign tumors of smooth uterine muscle
Most common tumor of female reproductive system
Symptoms:
Abnormal uterine bleeding
Excessive menstrual bleeding and pain
Treatment depends on woman’s age and desire for children:
Surgical removal
Hysterectomy 23

24. Female Reproductive System Diseases
Toxic shock syndrome
A severe, life-threatening illness
Found almost exclusively in menstruating females using tampons
Cause:
Organism called Staphylococcus aureus
Symptoms:
Sudden onset of high fever
Vomiting

25. Female Reproductive System Diseases
Toxic shock syndrome
Symptoms: (continued)
Diarrhea
Decreasing blood pressure
Treatment:
IV fluids
Antibiotics

26. Female Reproductive System Diseases
Uterine prolapse
Uterus protrudes into vagina
Symptoms:
Heaviness in pelvis
Urinary stress
Dysuria
Low back pain
Treatment:
Hysterectomy 26

27. 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
Kegel exercise
Surgery 27

28. Female Reproductive System Diseases
Rectocele
Herniation of rectum through posterior vaginal wall
Symptoms:
Discomfort
Constipation
Fecal incontinence
Treatment:
Surgical repair 28

29. 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 29

30. Female Reproductive System Diseases
Cervical cancer
Risk factors:
Beginning sex at an early age
Multiple sex partners
Smoking
Sex with males who smoke
Sex with males who have a spouse diagnosed with cervical cancer
Obesity
Excessive alcohol consumption
Prevention: Reduce risk factors AND
Have yearly pap smear tests – follow up on results
Get HPV vaccine

31. Female Reproductive System Diseases
Uterine cancer
Develops in endometrium and spreads to uterine wall
Symptoms:
Abnormal bleeding in postmenopausal females
Treatment:
Surgical removal of uterus and ovaries
Radiation therapy 31

32. Female Reproductive System Diseases
Ovarian cancer
Quite common and often fatal
Symptoms:
Pressure on bladder
Abdominal or pelvic pain
General feeling of ill health
Treatment:
Complete hysterectomy
Radiation
Chemotherapy 32

33. Diseases of the Breast Fibrocystic disease
Most common breast disorder of premenopausal females between age 30 and 55
Cause: Cysts linked to estrogen levels
Treatment: To decrease breast pain:
Reduce caffeine and salt
Use mild diuretics
Use mild analgesics week before menstruation 33

34. Diseases of the Breast Mastitis Inflammation of breast tissue
Symptoms:
Redness, heat, swelling
Pain
Bloody nipple discharge
Treatment:
Antibiotics
Application of heat
Analgesics
Firm, supporting bra to decrease discomfort 34

35. Diseases of the Breast Breast cancer Adenocarcinoma of breast ducts
Most common breast neoplasm
Affects one in eight females
Risk factors:
Age 40 and over
Family member affected with breast cancer
Onset of menses before age 13 35

36. Diseases of the Breast Breast cancer Risk factors: (continued)
Menses continuing after age 50
Nullipara
First child after age 30
Obesity
Chronic breast disease
Brassiere wear time 36

37. Diseases of the Breast Breast cancer Symptoms: Treatment:
Nontender lump of varying size
Occurs most often in upper-outer quadrant of breast
Often with dimpling
Treatment:
Lumpectomy
Mastectomy
Chemotherapy
Radiation 37

38. 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
Treatment:
Prompt surgery to terminate pregnancy
Every effort taken to preserve ovary and tube if future pregnancy desired 38

39. Ectopic Pregnancy 39

40. Disorders of Pregnancy
Spontaneous abortion
Natural termination of pregnancy before fetus is viable
Also known as miscarriage
Symptoms:
Vaginal bleeding
Cramping and pelvic pain
Treatment:
Bed rest
Once spontaneous abortion begins, it is difficult to stop
D&C 40

41. Disorders of Pregnancy
Morning sickness
Associated with first trimester of pregnancy
Symptoms:
Nausea and vomiting
Treatment:
Not necessary unless excessive vomiting
Light meals several times per day
Dry food before drinking
Avoidance of fatty foods
Rest after meals 41

42. Disorders of Pregnancy
Hyperemesis gravidarum
Excessive vomiting during pregnancy
Symptoms:
Excessive vomiting
Leading to dehydration, weight loss, and possible electrolyte imbalance
Treatment:
IV fluids
Withholding all foods and oral fluids
Usually subsides by second pregnancy 42

43. Disorders of Pregnancy
Toxemia
Usually appears during third trimester
Symptoms:
Hypertension
Sudden weight gain
Proteinuria
Edema in face, hands, and feet
Treatment:
Frequent monitoring of blood pressure, weight, and urine protein 43

44. Disorders of Pregnancy
Abruptio placentae
Separation of placenta from uterus
Symptoms: Determined by degree of separation
Partial separation may be asymptomatic
Complete separation may cause severe abdominal pain and vaginal bleeding
Hemorrhage, shock, and decrease in fetal heart tones
Treatment:
Prompt delivery either vaginally or by cesarean section (C-section)
Blood replacement may also be necessary 44

45. Disorders of Pregnancy
Placenta previa
Abnormal positioning of placenta in lower uterus often near or over cervical os
Symptoms:
Painless, bright red vaginal bleeding during third trimester
Treatment:
Vaginal delivery if asymptomatic or bleeding not severe
Emergency C-section if maternal bleeding or fetal anoxia 45

46. Male Reproductive System Diseases
Prostatitis
Inflammation of prostate gland
Symptoms:
Dysuria Pyuria
Fever Low back pain
Treatment:
Antibiotics
Warm sitz baths
Increased fluid intake
Analgesics 46

47. 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
Symptoms:
Nocturia
Inability to start urination
Weak urinary stream
Inability to empty bladder 47

48. Male Reproductive System Diseases
BPH
Treatment:
Prostatic massage
Sitz bath
Catheterizations
Regular sexual intercourse
Surgery 48

49. Transurethral Resection of Prostate (TURP)49

50. 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
Symptoms:
Similar to BPH
Treatment:
Depends on age, physical condition of individual, and degree of metastasis 50

51. Male Reproductive System Diseases
Epididymitis
Inflammation of epididymis
Symptoms:
Swollen, hard, and painful epididymis
Severe scrotal pain and swelling
Treatment:
Rest
Analgesics
Use of scrotal support
Avoidance of alcohol, spicy foods, and sexual stimulation 51

52. 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
Antibiotic if bacterial
Bed rest, analgesic, antipyretic, scrotal support 52

53. 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
Treatment:
Orchiectomy
Chemotherapy
Radiation 53

54. Male Reproductive System Diseases
Cryptorchidism
Undescended testicle
Common cause:
Premature birth
Treatment:
Surgery 54

55. Cryptorchidism 55

56. Sexually Transmitted Diseases (STDs)
Formerly called venereal diseases
A group of many diseases that are spread by intimate or sexual contact
Treatment commonly consist of identifying sex partners and treating the infected individuals concurrently
Prevention of STDs is best achieved by avoiding intimate contact with infected individuals 56

57. 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 57

58. STDs Acquired immunodeficiency syndrome Hepatitis AIDS
Blood-borne viral infection
Discussed in detail in Chapter 5
Hepatitis
Viral infection of the liver
Hepatitis B and C can be spread by sexual intercourse
Discussed in detail in Chapter 12 58

59. STDs Genital herpes Viral infection of the mucous membranes Cause:
Herpes simplex virus
Symptoms:
Blisters
Extreme pain
Severe itching
Painful urination 59

60. STDs Genital herpes Symptomatic treatment: No cure
Antiviral medications
Sitz baths
Ice therapy
Analgesics
No cure 60

61. STDs Gonorrhea One of the most common STDs in the United States
Causes inflammation in mucous membranes of genital and urinary system
Cause:
Neisseria gonorrhoeae bacterium
Symptoms:
Purulent discharge from penis and vagina
Dysuria 61

62. STDs Gonorrhea Symptoms: (continued) Treatment:
Urinary frequency in males and females
Cervicitis in females
Genital itching and burning pain
Treatment:
Antibiotics
Penicillin
Tetracycline
Ceftriaxone 62

63. STDs Syphilis Chronic, life-threatening STD Cause:
Treponema pallidum bacterium
Symptoms: Three stages
Primary
Painless chancre appears
Secondary
Chancre heals
Rash appears 63

64. STDs Syphilis Three stages: Treatment: Tertiary Penicillin
Period of rest lasting 6 weeks to 1 year
Bacteria invade organs throughout body leading to gumma
Curable with antibiotics during this stage
But effects of lesions irreversible
Treatment:
Penicillin
Tetracycline 64

65. STDs Chlamydia Very common, one of the most damaging STDs
Also known as silent STD
Cause:
Bacterial
Symptoms:
Drainage from penis and vagina
Burning and itching of genital area or with urination
Abdominal pain and dyspareunia in the infected
Treatment:
Antibiotics 65

66. STDs
Trichomoniasis
Common STD affecting approximately 10% of all sexually active individuals
Cause:
Protozoan – Trichomonas vaginalis
Symptoms:
Usually asymptomatic
When symptoms occur they include:
Male
Urethritis 66

67. STDs Trichomoniasis Symptoms: Treatment Male (continued) Female
Epididymitis
Prostatitis
Female
Itching and burning of genital area
Green, frothy vaginal discharge
Treatment
Antiparasitic medications 67

68. STDs Genital warts One of the most common STDs
Warts that affect the warm, moist tissue of the genital area
Cause:
HPV (virus)
Symptoms:
Tenderness, discomfort related to size, location, and number of warts
Treatment:
Chemical or surgical removal
*Cervical cancer more common in females with genital warts 68

69. Sexual Dysfunction Dyspareunia
Pain or discomfort with sexual intercourse
May affect males and females
Cause: physical or psychological conditions
Treatment:
Dependent on cause 69

70. Sexual Dysfunction Female arousal–orgasmic dysfunction
Also known as frigidity
Lack of sexual desire or responsiveness
Cause: Often due to neurologic and psychological conditions
Symptom: Inability to reach orgasm
Treatment:
Education on healthy sex attitudes and sexual stimulation techniques 70

71. Sexual Dysfunction Impotence/erectile dysfunction (ED)
Now most commonly known as ED
Symptoms:
Inability of male to achieve or maintain erection sufficient to complete sexual intercourse
Does not affect fertility
Cause:
Vascular insufficiency and psychological factors 71

72. Sexual Dysfunction Impotence/ED Treatment varies: Prevention:
Change in medications
Psychological counseling
Surgery
Internal and external devices
Prevention:
May not be preventable
Activities related to healthy lifestyle may aid in prevention 72

73. 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
Cause:
Usually psychological rather than physical
Treatment
Based on cause
Can include sex therapy and education 73

74. Sexual Dysfunction Infertility
Inability of couple to achieve pregnancy
Female causes:
Presence of STD
Hormonal disorders
Abnormality of reproductive organs
Endometriosis
Scarring or blockage of fallopian tubes
Vaginal antibodies that kill sperm 74

75. Sexual Dysfunction Infertility Male causes: Treatment:
Presence of STD or other infection in tract
Structural abnormalities
Hormonal disorders
Treatment:
Surgery
Medications to correct hormone imbalance
Fertility drugs
Inseminations 75

76. Trauma
Rape
Sexual intercourse (vaginal or anal) without consent or against will of individual
May be any age and against either sex
High incidence
Date rape drugs
Difficult recovery 76

77. Rare Diseases Vaginal cancer
Rare form of cancer that occurs in daughters of mothers who used diethylstilbestrol (DES) hormone
Treatment:
Surgery
Chemotherapy
Radiation 77

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

79. 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 79

80. 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
Breast atrophy 80

81. Effects of Aging on Males
Decreases in testosterone and sperm
Decrease in size of testes
Decreased elasticity of penis and scrotum
Thinning and graying of pubic hair
Greater stimulation required for erection
Diminished ejaculation amount
Enlarged prostate–problem with urination 81