Male and Female Reproductive Pathophysiology

Female/Male Reproductive Anatomy and Physiology, Menstrual Pathology, Female/Male Reproductive Cancers, Diseases, and Disorders

1. Reproductive pathophysiology

2. MALE REPRODUCTIVE physiology

3. ANATOMY OF THE MALE REPRODUCTIVE SYSTEM Testicles – male gonad; produces sperm and testosterone Epididymis – stores sperm Vas Deferens – conducts sperm from testes to urethra Urethra – conducts semen from vas deferens; conducts urine from urinary bladder to tip of penis Penis – deposits sperm in the female reproductive tract Seminal Vesicles – secretes fluid into the semen Prostate Gland – secretes fluid into the semen Bulbourethral Glands – secretes fluid into the semen

4. The male gonad: testes Functions Produces sperm Small, motile No food reserves because there’s no cytoplasm Location Scrotum, a pouch hanging outside the main body cavity

5. sperm Microscopic male germ cell Unlike other cells of the body Cytoplasm disappears, and the haploid nucleus nearly fills the sperm

6. Semen: composition Sperm 5% Secretions from: Seminal Vesicle ~60% Prostate Gland Bulbourethral Glands

7. IMPORTANT Male reproductive hormones Follicle-Stimulating Hormone Produced in the anterior pituitary gland Target organ: sperm Stimulates development of sperm Luteinizing Hormone Produced in the anterior pituitary gland Acts on interstitial cells to secrete testosterone Testosterone Produced in the interstitial cells b/w seminiferous tububles Promotes sperm development and secondary sex characteristics

8. Male reproductive pathophysiology

9. Bacterial prostatitis Inflammation of the prostate Cause : E. Coli Incidence : young men with UTI’s, old men with prostatic hypertrophy, men with STD’s, or those undergoing catheterization Signs : low back pain, decreased urinary stream, muscle aches, fever, anorexia Acute Bacterial Prostatitis – gland is swollen and tender; bacteria is found in urine Chronic Bacterial Prostatitis – gland is slightly enlarged; dysuria; increased frequency w/urgency

10. Non-bacterial prostatitis Inflammation of the prostate Leukocytes are found in the urine

11. Benign prostatic hypertrophy Signs/Symptoms : obstructed urinary flow, dribbling, and increased urination at night time

12. Prostate cancer Cause : Often androgen dependent Presents as : Hard nodule forms on periphery of gland Signs/Symptoms : hesitancy in urinating, recurrent UTI’s Diagnosis : serum marker PSA, prostate specific antigen

13. Testicular cancer Most common solid tumor in young men Self-exam is a preventative measure Biopsy is not performed Tumor markers: hCG , AFP Diagnosis: ultrasound

14. Female reproductive physiology

15. Anatomy of the female reproductive system Ovary – female gonad; produces eggs, estrogen, and progesterone Fimbriae – at the opening of uterine tubes; cilia that sweep egg into the oviduct Uterine tube - conducts the egg to the uterus; houses ovaries; site of fertilization Uterus – muscular chamber where the embryo develops Cervix – nearly closes off the outer end of the uterus Vagina – receptacle for semen; birth canal

16. Uterine Walls Endometrium , inner layer Most active wall layer Essential to menstrual and reproductive function Myometrium , middle layer Makes up most of the uterine volume Muscular layer; primarily composed of smooth muscle cells Perimetrium , outer layer Thin layer of tissue made of epithelial cell Envelops the uterus

17. IMPORTANT Female reproductive hormones Follicle-Stimulating Hormone Produced in the anterior pituitary gland Target organ is the ovaries Stimulates the follicle in the ovary Luteinizing Hormone Produced in the anterior pituitary gland Acts on the ovary to cause ovulation

18. IMPORTANT Female reproductive hormones Estrogen Produced by follicle cells for the egg Acts on the endometrial lining of the uterus Lining grows thicker to enable it to nourish a fetus Affects development of secondary sex characteristics Progesterone Produced in the ovary Targets the uterine lining Maintains the thickness for the monthly cycle Affects development of secondary sex characteristics

19. The ovarian cycle The normal sex cycle that includes development of an ovarian follicle, rupture of the follicle, discharge of the ovum, and formation and regression of a corpus luteum

20. Hormonal changes during the ovarian cycle Day 1 Estrogen and progesterone levels are low Signals the pituitary gland to produce follicle-stimulating hormone Follicles produce estrogen while maturing a follicle and preparing the uterus for pregnancy

21. Hormonal changes during the ovarian cycle Day 12-14  ovulation Increased estrogen triggers a sharp increase in Luteinizing Hormone (LH), releasing the egg from the follicle Ruptured follicle (corpus luteum) secretes progesterone and estrogen to continue to prepare the uterus for pregnancy

22. Hormonal changes during the ovarian cycle Day 28 Menses begin if the egg is not fertilized Estrogen and progesterone levels drop

23. FEMALE REPRODUCTIVE PATHOPHYSIOLOGY

24. MENSTRUAL ABNORMALITIES Amenorrhea No menstruation Dysmenorrhea Painful menstruation Due to excess release of prostaglandins

25. Abnormal menstrual bleeding Menorrhagia Increased menstrual flow Metorrhagia Menstrual bleeding b/w cycles Polymenorrhea Short menstrual cycles, <3 weeks Oligomenorrhea Long menstrual cycles, >6 weeks

26. endometriosis Endometrial tissue grows outside of the uterus Causes internal bleeding, severe pain, cysts, and adhesions

27. adenomyosis Endometrial tissue exists and grows within the uterus Causes severe pain and irregular menstruation

28. Polycystic ovarian disease Fibrous capsule thickens around the follicles of the ovaries Cause : hereditary Signs/Symptoms : absence of ovulation, infertility, hormonal imbalance, amenorrhea, and hirsutism

29. candidiasis NOT a sexually transmitted infection – caused by a fungus Opportunistic infection by normal flora of the vagina Signs/Symptoms : white, curd-like discharge Treatment : anti-fungal medications

30. Pelvic inflammatory disease Infection of the uterus, fallopian tubes, or ovaries originating from the lower reproductive tract Cause : STD, non-sterile abortion, postpartum Signs : pain with guarding, fever, nausea, leukocytosis, and purulent discharge Treatment : antibiotic therapy in the hospital Complications : peritonitis, pelvic abscess, and septic shock

31. leiomyoma Benign tumor of the myometrium Well-defined, encapsulated masses Treatment : hormonal therapy, surgery

32. Ovarian cysts Last around 8 to 12 weeks Multiple small fluid-filled sacs Require surgical removal if bleeding is present Diagnosis made w/ ultrasound

33. Ovarian cancer Diagnostic Tests : no reliable screenings – detected by pelvic exams Risk Factors : BRACA gene, early menarche, obesity, late first pregnancy, and fertility drugs Decreasing Risk : oral contraceptives

34. Fibrocystic breast disease Cyclic occurrence of nodules or masses in the breast tissue

35. Carcinoma of the breast Characteristics – unilateral, metastasize via the lymph nodes Risk Factors – increased risk after age 20, family history, BRACA gene, late first pregnancy, sedentary lifestyle, smoking, and high-fat diet

36. Cervical cancer Usually due to HPV Often asymptomatic Pap Smear can catch it early

37. Carcinoma of the uterus Early Signs – abnormal vaginal bleeding Diagnosis – pap smear cannot detect Characteristics – slow growing, but invasive Risk Factors – over 50 y/o, obesity, diabetes, and high-doses of estrogen w/o progesterone

38. Ectopic pregnancy Implantation outside of the uterus

39. Summary of all Reproductive hormones

40. GONADOTROPIN RELEASING HORMONE Secreted by the hypothalamus Targets the anterior pituitary gland Secretion of GnRH results in the release of FSH and LH from the anterior pituitary gland

41. LUTEINIZING HORMONE Secreted by the anterior pituitary gland Targets the testes and the ovaries Stimulates interstitial cells to secrete testosterone, ovulation, and development of corpus luteum

42. FOLLICLE STIMULATIONG HORMONE Secreted by the anterior pituitary gland Targets the testes and the ovaries Stimulates the development of sperm, follicles, and seminiferous tubules; secretes estrogen; role in ovulation

43. OXYTOCIN Secreted by the posterior pituitary gland Targets the uterus and mammary glands Stimulates contraction of the uterus and prostaglandin release

44. ESTROGEN Secreted by granulosa cells, corpus luteum, and the placenta Targets general reproductive structures Stimulates growth of sex organs at puberty, development of secondary sex characteristics, monthly preparation of endometrium, pregnancy maintenance, and uterine wall development

45. PROGESTERONE Secreted by the corpus luteum and the placenta Targets the uterus Stimulates the completion of endometrium preparation for pregnancy, pregnancy maintenance, and prevention of uterine contractions

46. PROLACTIN Secreted by the anterior pituitary gland Targets the breast Stimulates milk production after the breast has been prepared by estrogen and progesterone

47. TESTOSTERONE Secreted by interstitial cells Targets general male reproductive structures Stimulates development of primary sex organs, descent of testes, growth, development of reproductive structures and secondary sex characteristics

48. inhibin Secreted by the testes, granulosa cells, and corpus luteum Targets the anterior pituitary gland Inhibits secretion of follicle-stimulating hormone (FSH)

49. SEXUALLY TRANSMITTED DISEASES

50. chlamydia Most common STD Male Symptoms – itchy, white discharge, painful/swollen scrotum Female Symptoms – asymptomatic until PID or infertility; can infect newborn

51. gonorrhea Male Symptoms – inflammation of urethra Female Symptoms – asymptomatic until PID; may cause blindness in newborns

52. syphilis Presents with : chancre at site of infection; painless, firm, ulcerated nodule appearing 3 weeks after exposure Treatment : antimicrobials If left untreated : develop flu-like illness w/ rash Tertiary Stage – dementia blindness.

53. herpes Blisters on the genitals; itchy and painful Treated with antivirals

54. hpv Genital warts Incubation for up to 6 months, but asymptomatic May predispose to cervical cancer