Reproductive System Diseases and Disorders

Reproductive System Diseases and Disorders LindseaVaudtShelby Engel

Female Anatomy and Physiology

Male Anatomy and Physiology

Common Signs and Symptoms • Female • Abdominal and pelvic pain • Fever and malaise • Abnormal vaginal drainage • Burning, itching, or both of the genitals • Pain during sexual intercourse • Any change in breast tissue • Abnormal discharge from the nipple • Male • Urinary disorders, including frequency, dysuria, nocturia, and incontinence • Pain in the pelvis, groin, or reproductive organs • Lesions on the external genitalia • Swelling or abnormal enlargement of the reproductive organs • Abnormal penile discharge • Burning, itching, or both of the genitals • Diagnosis – Physical examinations, bimanual examinations, pap smears, biopsy, laparoscopy, x-rays, blood testing, mammograms, digital rectal examinations, cystoscopy, and lab testing

Female Reproductive System Diseases • Menstrual abnormalities • Premenstrual syndrome • Amenorrhea • Dysmenorrhea • Menorrhagia • Metrorrhagia • Menopause • Vaginitis

Vaginitis • Inflammation of the vagina and vulva • Symptoms: • Redness and swelling of the vagina and vulva • Unusual vaginal discharge • Vaginal and genital burning • Vaginal and genital itching • Can increase risk for • HIV, AIDS, and other STDs • Infertility • Pelvic inflammatory disease • Premature birth low birth weight, stillbirth, and complications

Causes • Infectious • Bacterial vaginosis • Chlamydia • Genital herpes • Gonorrhea • Poor genital hygiene • Trichomoniasis, a STD caused by a parasite • Yeast Infection • Noninfectious • Irritating substances to genitals • Leaving tampons in too long • Sexual abuse in girls • Antibiotics • Wearing thongs or tight fitting underwear, pants

Prevention • Abstaining from sexual activity • Avoiding exposure of the genitals to irritating substances • Changing tampons frequently • One sexual relationship in which neither partner has an infection • Getting regular, routine medical care, including pelvic exams • Not wearing tight fitting bottoms • Wiping from front to back after bowel movements • Using a new condom for sexual acts

Treatment • Antibiotic medications • Antifungal creams or pills for yeast infection • Antiviral medications for genital herpes • Topical crams may be prescribed to ease the discomfort of itching and burning

Amenorrhea • Absent menstrual periods for more than 3 monthly menstrual cycles • Primary: menstruation never starts • Secondary: menstrual periods become abnormal, irregular or absent • Causes • Natural reasons: Pregnancy, breast feeding, menopause • Ovulation abnormality • Birth defect, anatomical abnormality, or other medical conditions • Eating disorder • Over exercise or strenuous exercise • Thyroid disorder • Obesity

Amenorrhea cont. • Signs and symptoms: • Headache • Milky nipple discharge • Hair loss • Excess facial hair • Vision changes • Weight gain or loss • Can cause infertility or osteoporosis (with low estrogen levels) • Prevention – Maintaining a normal weight • Treatment • Progesterone supplements (hormone treatment) • Oral contraceptives (ovulation inhibitors) • Dietary modifications (to increase caloric and fat intake) • Calcium supplementation to reduce bone loss

Dysmenorrhea • Menstrual condition: severe and frequent cramps and pain during menstruation • Primary: from beginning and usually lifelong • Secondary: due to physical cause or another medical condition • Causes • Primary: • Chemical imbalance in the body: particularly prostaglandin and arachidonic acid • Secondary: • Other medical conditions: endometriosis (tissues becomes implanted outside the uterus), • Resulting in internal bleeding, infection, and pelvic pain.

Treatment • Aspirin and ibuprofen • Oral contraceptives (ovulation inhibitors) • Progesterone (hormone treatment) • Dietary modifications • Vitamin supplements • Regular exercise • Heating pad across the abdomen • Hot bath or shower • Abdominal massage • Endometrial ablation: a procedure to destroy the lining of the uterus • Endometrial resection: a procedure to remove the lining of the uterus • Hysterectomy

Dysmenorrhea cont. • Symptoms: • Cramping in the lower abdomen • Pain in the lower abdomen • Low back pain • Pain radiating down the legs • Nausea • Vomiting • Diarrhea • Fatigue • Weakness • Fainting • Headaches • Prevention and risks: • Don’t smoke • Don’t drink alcohol during menses • Stay a healthy weight • Greater risk are those who started menstruating before 11 years old

Diseases of the Breast • Quite uncommon • 1 in 8 women in the United States ranging from mild to life-threatening • Men can also be affected • Screening • Self-examinations and mammography • Any change from normal in tissue shape or appearance in males or females should be called to the attention of a physician • Disease and Disorders • Fibrocystic Disease • Mastitis • Breast Cancer

Fibrocystic Disease • Most common breast disorder of premenopausal women between ages 30-55 • Thought to be linked to estrogen levels • Causes an increased risk of cancer • Symptoms: • Irregular, lumpy feeling in the breast (usually in the upper outer quadrant area) • Breast discomfort that is persistent or occurs on and off (peaking around the menstrual period and receding after) • Breast often feeling heavy, full, and tender • A tendency to run in families

Fibrocystic Disease cont. • Diagnosis – Made by feeling, or palpation, or lumpy areas in the breast • Multiple cysts make it difficult to detect • Breast ultrasounds • If there is a suspicious area a surgical biopsy can be performed • Treatment – Measures to decrease breast pain include: • Elimination of caffeine in the diet • Reduction of salt intake • The use of a mild diuretic the week prior to menstruation • Use of mild analgesics • Prevention – Often not preventable, but decreasing dietary fat and caffeine intake can help • Research showed that 90% of women who stopped wearing a bra showed improvement in symptoms

Mastitis • Inflammation on the breast tissue • Broad term covering a variety of diseases and disorders • Type commonly thought of is puerperal (childbirth) • Occurs when bacteria from the nursing baby’s mouth or mother’s hands enter the breast tissue through the nipple • Symptoms: • Redness • Heat • Swelling • Pain • Bloody discharges from the nipple • Diagnosis – Made on the basis of symptoms • Treatment – Antibiotics, application or heat, analgesics, and a firm support brassiere to decrease discomfort • Prevention – Emptying breast completely when breast feeding

Breast Cancer • Adenocarcinoma of the breast ducts • Most common neoplasm affecting breast tissue and occurs in 1 out of 8 females • Early detection = monthly self-examinations and routine mammograms • Cause is unknown, but risk factors include: • Age 40 and over • Family member affected with breast cancer • Onset of menses before age 13 • Menses continuing after age 50 • Nullipara (none or no births) • First child after age 30 • Obesity • Chronic breast disease • Brassiere wear time

Breast Cancer cont. • Symptoms: Nontender lump of varying size…often no visual symptoms • Diagnosis – Presence of lump, mammogram, and biopsy(definitive test that can be performed by aspiration or surgery) • Treatment – Usually surgical removal of the mass or the breast followed by chemotherapy, radiation therapy, or both • Lumpectomy – removal of the lump only • Simple or total mastectomy – removal of the breast and nipple • Modified radical mastectomy – removal of the breast, nipple, and lymph nodes • Radical mastectomy – removal of the breast, nipple, lymph nodes, and underlying chest muscles

Disorders of Pregnancy • Ectopic Pregnancy • Spontaneous abortion (miscarriage) • Morning sickness • Hyperemesis Gravidarum • Toxemia • Abruptio placentae • Placenta previa

Ectopic Pregnancy • Ectopic pregnancies occur in 1 in every 40 to 1 in every 100 pregnancies. • Hormones may play a role • Most common site is with in one of the tubes where the egg passes from the ovary to the uterus.

Causes • Birth defect in the fallopian tubes • Complications of a ruptured appendix • Having an ectopic pregnancy before • Scarring from past infections or surgery • Age over 35 • Had surgery to untie tubes (tubal sterilization) to become pregnant • Having had many sexual partners • In vitro fertilization • Having your tubes tied (tubal ligation) - more likely 2 or more years after the procedure

Symptoms • Abnormal vaginal bleeding • Low back pain • Mild cramping on one side of the pelvis • Pain in the lower belly or pelvic area • If ruptures and bleeds symptoms may get worse: • Fainting or feel faint • Intense pressure in the rectum • Low blood pressure • Pain in the shoulder area • Severe, sharp, and sudden pain in the lower abdomen

Prevention • Avoiding risk factors for pelvic inflammatory disease (PID) such as having many sexual partners, having sex without a condom, and getting sexually transmitted diseases (STDs) • Early diagnosis and treatment of STDs • Early diagnosis and treatment of salpingitis and PID • Stopping smoking • Treatment • Ectopic pregnancies is a life-threatening condition • If ruptures--- shock--- Blood transfusion • Surgery is done to stop blood loss, repair tissue damage

Hyperemesis Gravidarum • Severe • Nausea • Vomiting • Weight loss • Electrolyte disturbance • Signs and symptoms: • Severe nausea and vomiting • Food aversions • Weight loss of 5% or more of pre-pregnancy weight • Decrease in urination • Dehydration • Headaches • Confusion • Fainting • Jaundice • Extreme fatigue • Low blood pressure • Rapid heart rate • Loss of skin elasticity • Secondary anxiety/depression

Treatment • Dietary changes • Rest • Antacids • More severe • Stay in the hospital • Mother receives fluid and nutrition through a IV • No known prevention

Abruptio Placentae • Separation of the placenta from its attachment to the uterus wall before the baby is delivered • Direct causes are rare but include • Injury to the belly area • Sudden loss of uterine volume

Risk Factors • Blood clotting disorders • Smoking • Cocaine use • Diabetes • Alcohol • High blood pressure during pregnancy • About half of placental abruptions that lead to the baby's death are linked to high blood pressure • Large number of past deliveries • Older mother • Premature rupture of membranes • The bag of water breaks before 37 weeks into the pregnancy

Symptoms: • Abdominal pain • Back pain • Frequent uterine contractions • Uterine contractions with no relaxation in between • Vaginal bleeding • Prevention: • Don’t drink alcohol • Don’t smoke • Don’t use recreation drugs • Early and regular prenatal care • Manage conditions like diabetes and high blood pressure • Treatment: • Fluids through IV • Blood transfusions • Unborn baby watched for signs of distress • C section may be needed

Male Reproductive System Diseases • Most common diseases affecting the male reproductive system include infection and diseases affecting the prostate • Diseases • Prostatitis • Benign Prostatic Hyperplasia • Prostatic Carcinoma • Epididymitis • Orchitis • Testicular tumors • Cryptorchidism (undescended testicle)

Prostatitis • Inflammation of the prostate gland • More common in men over 50 years old • Cause can be unknown or result of a urinary tract infection or infection by STDs • Symptoms: • Dysuria (painful urination) • Pyuria (pus in urine) • Fever • Lower back pain • Diagnosis – Made on the basis of urinalysis, urine culture, and digital rectal examinations • Treatment – Depends on the cause, but antibiotic therapy with penicillin, warm sitz baths, increased fluid intake, and analgesics • Prevention – Avoid smoking, drinking plenty of fluids, seek early treatment for urinary symptoms, and practice good hygiene by keeping the penis clean

Benign Prostatic Hyperplasia • Enlargement of the prostate due to normal cells overgrowing and enlarging • Common in men over 60 • About 50% of males over 65 have some degree of prostate enlargement • Cause is unknown, but is thought to be due to hormonal changes • Alterations in testosterone, estrogen, and androgen levels (associated with aging) • Symptoms: • Nocturia (frequently getting up in the night to urinate) • Inability to start urination • Weak urinary stream • Inability to empty bladder (can cause frequent urinary tract infections) • Diagnosis – Made on the basis of symptoms and digital rectal examinations

BPH cont. • Treatment – Symptomatic and might include prostatic massage, sitz baths, and catheterizations • Regular sexual intercourse can be helpful in reducing prostatic congestion • Transurethral – Chisel away the excess prostate tissue causing urinary obstruction • Prevention – No known preventative measures • Annual prostate exam after age 40

Prostatic Carcinoma • Neoplasm of the prostate usually affects men over 50 • Cause is unknown…some believe testosterone levels are involved • Caucasian men are affected with prostate cancer 10 times more often than Oriental men • Environmental and lifestyle factors involved and diets high in fat • Grows in the outer layer or the prostate and often shows no symptoms until it has metastasized • Common sites = bones of the spine and pelvis • Symptoms: Similar to BPH as the urethra becomes obstructed

Prostatic Carcinoma • Diagnosis – Digital rectal examination will reveal a hard, abnormal mass and blood testing…biopsy is the definitive test • Treatment – Depends on the age and physical condition of the individual and the degree of metastasis • Administration of estrogen to counteract testosterone • Surgical orchiectomy – removal of the testicles to halt testosterone production (many urologists do not believe this improves the survival rate) • A combination of both treatments • Chemotherapy and radiation therapy might also be beneficial • Over 60 – most likely outlive the cancer and die of some other disease process • Younger individuals and those with extensive metastasis do not have such a positive prognosis • 50%-75% live 5 years or more • Prevention – No preventative measures…annual prostate examination is recommended for early detection

Epididymitis • Inflammation of the epididymis • Common causes include prostatitis, urinary tract infection, mumps, and STDs (chlamydia, syphilis, and gonorrhea) • Most common disease of the male reproductive system and usually only effects one epididymis • Symptoms: • Swollen, hard, and painful epididymis • Scrotal pain and swelling • Makes walking difficult • Diagnosis – Made on the basis of symptoms, urinalysis, and urine culture • Treatment – Prompt, appropriate antibiotic therapy, bed rest, analgesics, use of a scrotum support, and avoidance of alcohol, spicy foods, and sexual stimulation • Delay in treatments can cause sterility (inability to impregnate a female) • Prevention – Sexual absitenence, use on condoms to prevent STDs and prompt treatment of causative infections

Orchitis • Inflammation of one or both testes • Usually due to bacterial or viral infection or trauma • Viral mumps is the most common cause in adult males • Commonly occurs in conjunction with or as a complication of epididymitis • Symptoms: • Swelling, pain, and tenderness in one or both testes • Fever • Malaise • Diagnosis – Made on the basis of symptoms, blood testing, and urinalysis • Treatment – Depends on the cause, but antibiotic therapy is usually effective…when caused by mumps it is treated symptomatically and includes bed rest and analgesics and antipyretic medications • Prevention – Aimed at causative factors and includes mumps vaccinations and prevention of infection from STDs

Sexually Transmitted Diseases • Acquired immunodeficiency syndrome • Hepatitis • Genital herpes • Gonorrhea • Syphilis • Tertiary (late or latent) • Chlamydial infection • Trichomoniasis • Genital warts

Gonorrhea • Bacterium • Grows in warm, moist areas of the reproductive tract • Cervix, uterus, fallopian tubes, urethral • Mouth, throat, eyes, anus • Annually about 820,000 people in the US • 570,000 among 15-24 years of age • Causes: • Having sex with someone who has the disease • Anal, vaginal, or oral sex • Can spread from mother to baby during childbirth

Gonorrhea cont. • Very mild or no symptoms • Men: burning sensation when urinating • White, yellow, or green discharge • Painful or swollen testicles • Women: • Painful or burning sensation when urinating • Increased vaginal discharge • Vaginal bleeding between periods • Treatment – ASAP especially if pregnant…medication • Prevention: • Condom use • Avoid having sexual intercourse • One partner who is not infected

Syphilis • Serious STD • Can become chronic, life threatening disease • Bacterium • Annually 55,400 people in the US • In 2011, 72% occurred among men who have sex with men • 360 reports of children in 2011 • Causes • Person to person by direct contact with syphilis sores • Genitals • Vaginal • Anus • Rectum • Lips • Mouth • During vaginal, anal, or oral sexual contact • Pregnant women can pass it to unborn child

Symptoms • First symptom can appear in 10 to 90 days • PRIMARY stage: • Single sore--- multiple sores • Where syphilis entered the body • Firm, round, painless • Will go away without treatment • Infection can progress to the secondary stage if no treatment • SECONDARY stage: • Skin rashes or sores in the mouth, vagina, anus • Not itchy • Rough, red, or reddish brown spots on palms or bottom of feet • Large, raised, gray or white lesions on mouth, underarm, groin • Fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, fatigue

Latent and Late Stage • Symptoms will go away without treatment BUT… without appropriate treatment, the infection will progress to the latent or late stages • Can last for years • 15% of people not treated • bad muscle movements, paralysis, numbness, gradual blindness, and dementia • Damages internal organs, including brain, nerves, eyes, heart, blood vessels, liver, bones, and joints • Death • Treatment – Easy to treat in early stages, no over the counter drugs, antibiotics • Prevention – Not by washing genitals after sex, condom use, abstain from sex when infected, and one partner without infection

Chlamydial Infection • Most commonly reported STD in the US • Sexually active females 25 years and younger need testing every year • Bacterium • Can cause serious damage to a woman’s reproductive organs • In 2011, 1,412,781 cases where reported in the US • 1 in 15 sexually active females age 14-19 years have Chlamydia • Causes: • Having sex with someone infected • Anal, vaginal, oral • Pregnant woman to her baby during childbirth

Symptoms • “Silent Infection” • Can damage a woman’s reproductive organs • Women: • Infects the cervix and urethra • Abnormal vaginal discharge • Burning sensation when urinating • Untreated---- spread up to uterus and fallopian tubes • Pelvic inflammatory disease • Lead to infertility • Men: • Discharge from penis • Burning sensation when urinating • Pain and swelling in one or both testicles

Treatment • Antibiotics • Prevention: • Condom use • Abstain form vaginal, anal, and oral sex • One partner who is not infected

Sexual Dysfunction • Can limit the ability of the individual to reproduce and to develop a close, nurturing sexual relationship with a significant other • Human sexual cycle – Arousal…sexual intercourse…climax…feelings of pleasure and relaxation • Any disorder that interrupts this cycle can be considered a dysfunction • Disorders • Dyspareunia • Female Arousal-Orgasmic Dysfunction • Impotence (erectile dysfunction) • Premature Ejaculation (rapid ejaculation or rapid climax) • Infertility

Dyspareunia • Condition of experiencing pain or discomfort with sexual intercourse • Can affect both males and females, but more common in women • Not considered a disease but, rather, a symptom of a psychological or physical disorder • Female - Intact hymen, vaginal deformity, insufficient lubrication, sensitivity to spermicide, presence of an STD, bladder infection, pelvic inflammatory disease, and endometriosis • Male – Penile deformity, presence of an STD, abnormally tight foreskin (phimosis), prostatitis, and epididymitis • Psychological conditions – history of past sexual abuse, anxiety, guilt, and fear of pregnancy • Symptoms: Pain can be mild to severe and appear in genitals, pelvis, and low back…females might feel pain specifically in the clitoris, labia, and vagina

Dyspareunia cont. • Diagnosis – General examination, description of pain, and time of occurrence • Treatment – Restrictions of extended foreplay, use of lubricating jelly, and manual stretching of the vaginal opening prior to intercourse • Infections need to be treated appropriately and surgery may be needed to correct deformities, remove tumors, and treat endometriosis • Counseling • Prevention – Not preventable when caused by sexual trauma or abuse…avoid vaginal yeast infections, STDs, bladder infections, and sex on days near menstruation due to increased tenderness

Reproductive System Diseases and Disorders