Reproductive System Disorders
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Transcript of Reproductive System Disorders
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Reproductive System DisordersReproductive System Disorders
Pathophysiology
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• Anatomy– Gonads = Testes
– Ductile system = epididymis, vas deferens, ejaculatory duct, urethra
– Supportive glands = seminal vesicles, prostate, bulbourethral (Cowper’s)
– External genitals = scrotum, penis
Male Reproductive SystemMale Reproductive System
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• Testes– tunica vaginalis = parietal peritoneum that remains surrounding testis after its descent – tunica albuginea = tough connective tissue membrane that surrounds testis and enters the gland to form septa– seminiferous tubules = where sperm are developed; approx. 100 yards in in testis; contain Sertoli cells; between tubules are inter- -stitial spaces that contain Leydig cells
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• Testes (cont)
– Physiology
• Spermatogenesis
– mature sperm formed by process of Meiosis
» Key = getting mature gamete with ½ number of chromosomes
» mature sperm = head (nucleus & acrosome), neck (mitochondria), and tail
» takes 60 days +/- to make a sperm
– primary spermatocyte, secondary spermatocyte, spermatids, sperm
• Testosterone Production
– 2 key functions
» masculinization
» anabolism
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• Male Ductal System– Epididymis
– storage tank for sperm– sperm get final maturation
– Vas Deferens– becomes Ejaculatory Duct after it joins
seminiferous tubule duct– Urethra
• Accessory Glands– Seminal Vesicles
– contributes 60% of semen» rich in fructose ; provides energy for
the sperm– Prostate
– contributes 30% of semen ; provides nutrients for the sperm; antibiotic secretion
– Bulbourethral Glands (Cowper’s)– contribute 5-10% of semen ; provides
lubrication & sterilization
• External Genitalia– Penis
– 3 columns of erectile tissue» corpora cavernosa (2) & corpora
spongiosum (1)– glans covered by foreskin (prepuce)
– Scrotum– skin-covered (has hair follicles) pouch
suspended from groin
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• Hormones and male reproductive function
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• Anatomy– gonads = ovaries
– ductal system = fallopian tubes, uterus, vagina
– accessory glands = Bartholin's, breasts
– external genitalia = clitoris, labia majora & minora, perineum
Female Reproductive Female Reproductive SystemSystem
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• Ovaries– contain gametes (oocytes) surrounded by
some cells (follicular cells)
– these called Primary Follicles
» each ovary has appox. 1 million at birth
– life cycle of oocyte after puberty: primary oocyte, secondary oocyte, ovum
– functions
• gamete production
• hormone production
– Estrogen = causes feminization ; from granulosa cells
– Progesterone = prepares for pregnancy ; from corpus luteum
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• Female Ductal System– Fallopian Tubes
• distal end = fimbria
• Outer 1/3 = fertilization
– Uterus
• composed of fundus, body, & cervix
• has myometrium & endometrium]
– Vagina
• Accessory Glands– Bartholin’s (greater vestibular)
• exocrine gland
• provides lubrication
– Breasts
• composed of glands & ducts surrounded by fat tissue
• External Genitalia– clitoris, labia majora & minora (no hair follicles), vestibule, perineum
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• The Menstrual Cycle– begins after menarche ; ends
with menopause
– 4 basic parts:– Menses– Proliferative
Phase = first half of cycle
» deals with maturation of follicle & development of more granulosa cells thus producing more estrogen
– Ovulation = usually at midcycle
– Secretory Phase = second half of cycle
» deals with conversion of ruptured follicle to corpus luteum
» corpus luteum produces progesterone
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• hormonal control• hypothalamus--------GnRH (gonadotropin releasing hormone)
• anterior pituitary---- FSH (follicle stimulating hormone)
LH (luteinizing hormone)
• Ovary --------------- Estrogen
Progesterone
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Male reproductive tract disordersoverall outline
• Disorders of testes & scrotum
• Disorders of prostate
• Disorders of the penis
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• Cryptorchidism– undescended testis
– By age one, 80% are in scrotum
– incidence: 3% of term babies; 20% of premies
– increases the incidence of carcinoma (Seminoma)
– treat early-------the longer you wait, the greater the chance of decreased sperm & testosterone production
Disorders of the Testes & ScrotumDisorders of the Testes & Scrotum
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• Remember:– Tunica Albuginea = thick connective tissue that covers testes & divides substance of testes into lobules– Tunica Vaginalis = peritoneum that remains around testes after descent
– 2 layers: visceral (on testis) & parietal (around testis)• Hydrocele
– most common disease of testes– it’s fluid in cavity bound by the 2 layers of tunica vaginalis
– this may communicate with peritoneal cavity via congenital patency of process vaginalis
– this may cause size to vary from time to time
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• Infertility Problems– deals with decreased production and/or quality of sperm
– 2 distinct reasons
– poor production in sperm development
» One correctable cause = varicocele
– blockage of ductile system
– low count = oligospermia
– zero count = azospermia
• Varicocele– varicosities around the testis (usually left testis)
– left spermatic vein into renal vein (10 cm higher
than insertion of right spermatic
vein into inferior vena cava)
– usually begins at puberty
– may be relieved by lying down
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• Torsion of the testis– Etiol:
• Spontaneous
• Post trauma
– Timing • Usually puberty
– Path: necrosis & infarction
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• Testicular Cancer– range from VERY aggressive to least aggressive
• Germ cell tumors
» Seminoma = least aggressive (most common)
» Nonseminomas
* embryonal carcinoma
* teratomas
* choriocarcinoma = most aggressive
• Non- germ cell tumors
» May be hormonally active (secrete androgen or estrogen)
» Exp: leydig cell, Sertoli cell
– tumors of young men ( age 15 - 35)
– diagnosis : tumors are solid masses - no transillumination
– Usually unilateral
– predisposing factors:
– undescended testes
– inguinal hernia during childhood
– prior history of mumps orchitis
» Note: in mumps orchitis, 50% of cases result in testicular atrophy
– Cure rate = 95%
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• Benign Prostatic Hypertrophy (BPH)– enlargement of the prostate common in older men
– Involves central area of gland
– complications include:
• pyelonephritis
• hydronephrosis
• uremia
Prostate DiseasesProstate Diseases
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• Cancer– primarily occurs in men over age 50– third leading cause of cancer death– Involves periphery of gland
– Usually begins as nodule on posterior surface of gland– Many are androgen dependent– If metastases, first usually to bone– diagnosis
» DRE» 2 serum markers
» PSA (prostatic specific antigen)» Prostatic acid phosphatase
» Ultrasound
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• Foreskin (prepuce)– phimosis– paraphimosis– redundant foreskin
• Glans– Balantitis
Pathology of the PenisPathology of the Penis
STD from Yeast (Candida)
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• Carcinoma– Rare– Risk factors: HPV (now have vaccination)– First sign = usually leukoplakia– circumcision in child prevents it
• adult circumcision does not prevent it
• Impotency– approx. 50% of men age 40 - 70 have, at times, some degree or complete
impotency ( failure to get an erection)
– sexual stimulation causes release of nitric acid from nerves in penis
– an enzyme breaks down the product of nitric acid that causes the erection
– this enzyme’s effect is loss of the erection
– this is where Viagra works ; it prevents loss of the erection
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Female reproductive tract disordersoverall outline
• Structural abnormalities
• Menstrual disorders
– Endometriosis
– Menopause
• Infections
• Tumors– Benign
– Malignant
• Breast
• Pregnancy
• STD’s
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Structural abnormalities
• Pelvic relaxation disorders– Normal variations of uterine position
• Uterine mobility is key to normalcy – Uterine prolapse
– First, second, & third degrees– Cystocele– Rectocele
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Normal variations of uterine position
– Uterine mobility is key to normalcy
– midline
– Anteverted & anteflexed
– Retroverted & retroflexed
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Uterine Prolapse• def = downward
displacement of uterus
• etiol = fascial tissue defect
• First degree
• Get vaginal shortening
• Second degree
• Cervix at introitus
• Third degree
• Vagina completely everted
• Uterus hanging outside vagina
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• Cystocele• downward displacement of bladder
into vagina• Can get retention & frequent
cystitis• urethra may or may not accompany
it» called cysto-urethrocele» frequently get symptom of
urinary stress incontinence
• Rectocele• displacement of rectum into vagina
• Usually asymptomatic
• If very large may get constipation & inability to completely evacuate rectum
• May get ulceration of vaginal wall• See picture
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• Dysmenorrhea– Primary dysmenorrhea = when no obvious pathology found
– ? Hormonal cause » prostaglandins» hormonal changes secondary to teenage ovulatory cycles
– Secondary dysmenorrhea = when obvious pathology found as the cause
• Amenorrhea– Primary Amenorrhea = never having a menstrual flow– Secondary Amenorrhea = having menstrual cycles & then they stop– causes = many !!!
» Treatment directed at the underlying cause
Menstrual DisordersMenstrual Disorders
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• Dysfunctional Uterine Bleeding (DUB)– abnormal menstrual flow when no obvious cause is known
– frequently thought to be secondary to some type of hormonal imbalance, but specific diagnosis not necessary to have DUB
– Types:» oligomenorrhea » polymenorrhea» menorrhagia» metrorrhagia» meno-metrorrhagia
• Premenstrual Syndrome (PMS)– group of symptoms that occur in the woman’s secretory phase of cycle– Currently called : PMDD (premenstrual dysphoric disorder)
• Def of dysphoria = excessive pain, anguish, & agitation
– usually secondary to inappropriate ovulation– Key = too much estrogen & not enough progesterone in the second half of the cycle
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• Endometriosis– A condition when you get
endometrial tissue located outside its normal position, which is the inside lining of the uterus
– symptoms depend on where the ectopic tissue is located
– the tissue has function, i.e.
bleeds with menstruation
– Sx : pain
– Complications
• Fibrosis
• Scarring
• Adhesions
• Infertility
• Dyspareunia
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• menopause– Get cessation of menses & drop in estrogens which can cause:
– general symptoms
» irritability
» short term memory loss
» Insomnia
» Vasomotor instability = hot flashes & night sweats
– gynecological symptoms
» vaginal dryness & dyspareunia
» urinary stress incontinence
– Cardiovascular problems
» ASHD
» coronary artery disease
» strokes
– Osteoporosis
– Dx:
– High FSH; low estrogens
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• Vaginitis– 3 types:
• Yeast Vaginitis– caused by fungus from genus Candida or Monilia
• Trichomonas
– caused by a protozoa
– may be sexually transmitted
• Bacterial Vaginosis
– caused by different bacterial overgrowth
– used to be called non-specific vaginitis or Gardnella
• Generally most cases of vaginitis are NOT sexually transmitted, but at times they ALL may be sexually transmitted !!
Infections of the Female Reproductive TractInfections of the Female Reproductive Tract
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• Pelvic Inflammatory Disease (PID)– usually acute, but may be chronic
– may involve some or all of the pelvic organs
– get tissue inflammatory reaction with resultant symptoms
– Key symptom = pelvic pain
– Pain worsens with movement & sex
– frequently secondary to untreated or inadequately treated STD
– Complications
– Infertility (pyosalpinx)
– Adhesions
– Dysuria
– Irregular vaginal bleeding
See next slide
• Note PID spread:– Vaginitis
– Cervicitis
– Endometritis
– Oophoritis
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• Toxic Shock Syndrome (TSS)– vaginal infection with systemic symptoms
– caused by staphlococci toxin which comes from nidus of infected tampon
– prevention by proper tampon toilet
– Symptoms begin immediately post menses
Bartholin cyst (Bartholinitis) Etiol = pathogens that cause inflammation Duct become obstructed
Get “large pimple”
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TumorsTumors of the Female Reproductive Tract of the Female Reproductive Tract
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• Cervix– Benign
• Cervical polyps
– malignant• key ages: 20 - 40• pap smear• Etiol: HPV
– Vaccine available
• Uterus– benign
• fibroids = commonest tumor of female repo. System
– leiomyomas– only in premenopause– See next slide
– malignant• ? Estrogen related• Age: 50 – 70• Dx: pmb
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• Estimated that half the women get them during the reproductive years
• Clinically symptoms depend on size & location
• Submucous = bleeding problems, infertility
• Intramural = sx only if large
• Subserous = pressure sx from surrounding structures
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• Ovary– Benign
• Functional (commonest)– Follicular cyst– Corpus luteum cyst
• Non-functional (benign germ cell)
(e.g. Teratoma)
– Malignant• Factors that suppress ovulation
decrease the risk• Avg age = 40• 2 basic types
– Epithelial (line ovary or
follicles)– Germ cell – aggressive
» Mainly in children & adolescents
• See next slide re:– Late diagnoses – seeding
Solid teratoma
Functional (follicular) cyst
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Breast disorders• Fibrocystic breasts
• Was called fibrocystic “disease”
• “lumpy” breasts
• Fibroadenoma• Benign
• In young girls (age 15-25)
• nontender
• Intraductile papilloma• Get nipple discharge
• Mammary duct ectasia– Get lumpiness beneath areola
– Seen in
– Postmenopausal
– Pregnancy
– Lactation
– Get thick nipple discharge
– Pathophysiology: ducts dilate & fill with cellular debris; get inflammation
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• Breast cancer– 1 out of 8 women in USA
– Most are intraductile carcinomas
– 50% in upper outer quadrant
– Ca in situ = mammary dysplasia
– Risk factors:
– Family history
– Menstrual history
– Reproductive history
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• Morning Sickness– severe form = Hyperemesis Gravidarum
• Spontaneous Abortion– 3 Types : Complete, Incomplete, Missed
• Ectopic Pregnancy• Toxemia of Pregnancy = syndrome of hypertension, proteinuria,
& edema• called Preeclampsia• If severe & accompanied by convulsions, called Eclampsia
• Placental Problems– Placenta Praevia– Abruptio Placenta
• Hydatidiform Mole = development abnormality of conception• may progress to Choriocarcinoma
Pathology in PregnancyPathology in Pregnancy
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• Preterm Birth – 8% of all births in US
– Preterm labor
– Preterm PROM (premature rupture of membranes)
» Responsible for half of all premie deliveries in US
• Trauma during pregnancy– Complicates 1 out of 12 pregnancies in US
– Watch for:» Uterine contractions» Uterine tenderness &/or irritability» Ruptured BOW» Nonreassuring FHR pattern» Vaginal bleeding
• Maternal hemorrhage– Is the leading cause of maternal mortality
– Hemorrhagic shock
– Postpartum hemorrhage
• Endometritis– Occurs in 1-3% of vaginal births
– Occurs in 10-50% of cesarean sections
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STD’sSTD’s• AIDS (Acquired Immunodeficiency Syndrome)
• Def: progressive impairment of the immune system caused by the immunodeficiency virus (HIV)
– Attacks helper T lymphocytes
• Initial infection similar to URI• Then latency• Then AIDS
– Begins with generalized adenopathy, weight loss, fatigue, nt. Sweats, and diarrhea
– Get opportunistic infections:» PCP (pneumocystis carinii pneumonia) = caused by small
protozoa (? fungus) that can normally be found in lung tissue of certain animals (dogs) and in humans
» Toxoplasmosis = small protozoan that can infect many mammals including cats and dogs
» Herpes simplex» Herpes zoster (shingles)» TB
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• AIDS (continued)– Get opportunistic cancers
» Non-Hodgkins lymphoma
» Kaposi’s sarcoma
• HIV also has predilection to attack G-I cells & CNS cells– Get malabsorption, colitis, and proctitis
– Dementia
• Diagnosis– ELISA (enzyme-linked immunosorbent assay)
– Western blot test
• Treatment– AZT = reverse transcriptase inhibitors
– Protease inhibitors
– Fusion inhibitors
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• Chlamydia– Most frequent bacterial STD– Known as the “silent STD”– Transmitted via oral, anal, or genital intercourse
» Oral route can lead to conjunctivitis– If symptomatic, get urethritis – Incubation = 1-3 weeks
• Gonorrhea– Bacterial– Incubation = 1-3 weeks (usually less than 1 week)– Very similar in signs & symptoms to chlamydia– Antibiotic resistance
• Syphilis– Bacterial – Can get primary, secondary, and tertiary forms– New cases at an all time low– Primary = hard, painless chancre in 2-3 weeks ------------ see pictures– Secondary syphilis may appear 1-3 months later– Then latency for years & then possible tertiary syphilis
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• Chancroid– Soft chancre (painful) with
bubo(necrotizing ulceration & lymphadenopathy) in 1 week
• See pictures
– Bacterial
– Frequent in developing tropical countries
– Increasing in urban USA
• Genital Herpes– Type I & type II
– Short incubation of 2-7 days
– See pictures
• Hepatitis B & C– Transmitted in body fluids
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• Genital warts– Very contagious
– First exposure incidence:– 40% ---to--- 90%
– Viral; HPV– 120 different serotypes– A few cause dysplasia &
neoplasia– Condylomata accuminatum
– Benign growths– See picture
– Prolonged incubation of 1-6 months
– Most frequent STD– Estimated that 60% of
sexually active young women in USA have it
– New vaccine available
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Differences in clinical appearance among genital ulcers