Reproductive System Disorders

1. Reproductive System Disorders HLTAP501A Analyse Health Information

2. Common signs and symptoms of female reproductive system diseases and disorders include: • Abdominal and pelvic pain • Fever and malaise • Abnormal vaginal drainage • Burning and or itching of the genitals • Pain during sexual intercourse • Any change in breast tissue • Abnormal discharge from the nipple • Abnormal menses.

3. Common signs and symptoms of male reproductive system disease or disorders include: • Urinary disorders including frequency, dysuria, nocturia, and incontinence • Pain in the pelvis, groin, or reproductive organs • Lesions on external genitalia • Swelling or abnormal enlargement of the reproductive organs • Abnormal penile drainage • Burning and or itching of the genitals

4. ENDOMETRIOSIS • -is the abnormal growth of endometrial tissue outside the uterus. • Common sites of endometrial implantation: • Ovaries • Fallopian tubes • Abdominal wall • Intestine • Urinary bladder • Diaphragm • Nerves and ligaments of the back • Vulva

5. Symptoms: • Bleeding endometrial tissue in the abdominopelvic cavity and other ectopic (out of normal place) areas causes dysmenorrhoea beginning a few days before menses and extending several days into the menstrual cycle. • Constant cramping pain in the lower back, pelvis, vagina. • Menorrhagia • Dyspareunia (painful sexual intercourse)

6. Endometriosis http://endometriosis.morefocus.com/articles/endometriosis-symptoms/

7. Complications: • Primary complication is infertility • Ectopic pregnancy • Spontaneous abortion

8. Management • Hormonal medication may help • Pregnancy, nursing, and menopause will not cure the condition but do cause a remission in symptoms as the abnormal tissue shrinks when menstrual hormones are reduced. • In severe cases a total hysterectomy may be required (removal of ovaries, fallopian tubes, and uterus).

9. Pelvic inflammatory disease • Pelvic inflammatory disease is an inflammation of some or all of the pelvic reproductive organs. • It may be mild to severe, May involve: • Cervix (cervicitis) • Inner lining of the uterus (endometritis) • Fallopian tubes (salpingitis) • Ovaries (oophoritis)

10. Commonly due to infection by bacteria that ascends from the vagina and travels upward to the pelvic cavity • Bacteria can be introduced into the female reproductive system: • During childbirth • Miscarriage • Abortion • Gynaecologic procedures • Most common cause is sexually transmitted disease including gonorrhoea and chlamydial infection. • Young sexually active females and those using IUD’s are most at risk of developing PID.

11. Proposed pathways of dissemination of microbes: A – direct spread of bacterial infection through lymphatics. B – Direct spread (gonorrhoea). C – Haematogenous spread. [Smeltzer & Bare, 1992, p. 1270

12. Symptoms: • Fever • Chills • Pain in pelvic region • Leukorrhoea, a white, usually foul-smelling vaginal discharge. • Diagnosis: • Pelvic examination including positive swab culture or vaginal discharge (positive for specific bacteria) • Treatment: • Antibiotic therapy • Analgesics • Bed rest

13. Tucker et al, 1992, p. 513

14. Complications • Without treatment infection may become blood borne, septicaemia • This may lead to life threatening situation • Inflammation of reproductive organs can lead to scar tissue and adhesions • Adhesions may in turn lead to infertility and ectopic pregnancy

15. Uterine Prolapse • Uterine prolapse is the condition of the uterus dropping or protruding downward into the vagina. • There are varying degrees of prolapse. • Cause: • Commonly due to ageing and childbirth and associated weakening of the pelvic floor muscles

16. Smeltzer & Bare, 1992, p. 1274

17. Symptoms • Feeling of heaviness in the pelvic area • Urinary stress incontinence • Dysuria • Low back pain • With complete prolapse the uterus can be seen bulging out of the vaginal orifice • Although very uncomfortable this condition is not an emergency or even a health risk unless there is bleeding or an inability to urinate. • Treatment: • A hysterectomy is the surgical treatment of choice depending on the woman’s age and desire to bear children

18. Cystocele • Cystocele is the herniation or protrusion of the urinary bladder through the vaginal wall. • This condition is often due to weakening or trauma to the pelvic muscles related to ageing and childbirth. • Symptoms: • Pelvic pressure • Urinary urgency • Frequency • Incontinence

19. Treatment depends on the degree of herniation: • Strengthening the pelvic floor muscles with exercise • Contracting the pelvic floor muscles (the group of muscles tightened to stop urine flow) and releasing performs specific exercise. This should be done several times a day • If the cystocele is large and exercise ineffective, surgery (anterior colporrhaphy) may be necessary

20. Rectocele • Rectocele is the herniation or protrusion of the rectum through the posterior vaginal wall. • Like the cystocele, this condition is due to trauma to these muscles during childbirth • Symptoms: • Discomfort • Constipation • Faecal incontinence

21. Management • Commonly surgical repair (posterior colpoplasty) • Often the affected individual needs both a cystocele repair and a retrocele repair; this surgery is called an anterior-posterior repair. • Surgical repairs are frequently performed laproscopically with good outcomes. • A laparoscope is inserted through small abdominal incisions, the pelvis is visualised, and surgical repair performed.

22. Most common sites of pelvic floor relaxation. [Smeltzer & Bare, 1992, p. 1273]

23. Common sites for fistulas: [Smeltzer & Bare, 1992, p. 1272]

24. Cervical cancer • Cervical cancer is the fifth leading cause of cancer-related deaths in women. • Human papillomavirus (HPV) has been determined to be the cause of essentially all cervical cancer • HPV is generally obtained through sexual contact • Condoms cannot prevent the spread of HPV as it is found on all genital tissue of the infected individual

25. http://www.preventcervicalcancer.ie/what_causes_it.asp

26. Treatment: • Surgical removal of the tumour • If metastasis has occurred surgery is often followed by radiation therapy • If the tumour has spread into adjacent tissues a complete hysterectomy may be performed • Untreated the tumour becomes inoperable and fatal

27. Uterine cancer • Uterine cancer develops in the inner lining of the uterus, the endometrium, and spreads into the uterine wall • This type of cancer usually occurs in postmenopausal females who never had children • Symptoms: • Abnormal bleeding (quite noticeable in post menopausal women) • Increased risk factors include: • Infertility • Obesity • Prolonged oestrogen stimulation as occurs with hormone replacement therapy

28. http://www.humanillnesses.com/original/U-Z/Uterine-and-Cervical-Cancer.htmlhttp://www.humanillnesses.com/original/U-Z/Uterine-and-Cervical-Cancer.html

29. Treatment: • Very successful if the cancer is discovered in its early stages • Surgical removal of ovaries and uterus • Radiation therapy http://www.hypatiamaze.org/cancer/risk.html

30. Ovarian cancer • Ovarian cancer is common and often fatal • The ovaries position deep in the pelvis make discovery of this tumour difficult • Often extensive metastasis will occur before there are noticeable symptoms • Symptoms: • Feeling of pressure on the bladder • Low abdominal pain or pelvic pain • General feeling of ill health

31. http://www.medhelp.org/Medical-Dictionary/Terms/2/9627.htm

32. Diagnosis: • Basis of physical examination • Visualisation of the mass during exploratory laparoscopy • Treatment depends on the stage of the cancer: • Complete hysterectomy • Radiation • Chemotherapy • Prognosis: • Good with early detection • If metastasis has occurred this cancer may be fatal in one to two years • The only preventative measure is early detection through annual gynaecological examinations

33. Prostatitis • Prostatitis is inflammation of the prostate gland • Most common in males over fifty years of age • Most common cause: urinary tract infection or infection by gonorrhoea • Symptoms: • Dysuria (painful urination) • Pyuria (pus in urine) • Fever • Low back pain

34. http://www.prostate.org.au/what-is-the-prostate.php

35. Diagnosis: • Based on urinalysis, urine culture • Digital rectal examination • Treatment is dependent on the cause: • Antibiotic therapy with penicillin • Warm sitz baths • Increased fluid intake • Analgesics • Usually responds well to treatment

36. Prostate Cancer • Prostatic cancer is a neoplasm of the prostate that commonly affects men after the age of fifty. • It is the second most common cancer related cause of death in men (lung cancer is first) • The cause of the cancer is unknown although it is thought to be related to testosterone levels. • There is also some evidence of a strong family or genetic predisposition

37. Prostate Cancer http://www.meb.uni-bonn.de/cancer.gov/Media/CDR0000442273.jpg

38. Symptoms when present are similar to benign prostatic hyperplasia as the urethra becomes obstructed • Diagnosis: • Digital rectal examination will reveal a hard abnormal mass • Blood test measuring prostatic- specific antigen (also called PSA) will be elevated • Biopsy is a definitive test • Treatment: • Depends on the age and physical condition of the affected individual and the degree of metastasis • If the tumour has not metastasised, complete removal and cure may be accomplished with prostatectomy • If metastasis has occurred, treatment may involve hormone therapy to slow the growth of the neoplasm • Chemotherapy and radiation

39. Prostatectomy procedures: A: TURP B: Suprapubic C: Perineal D: Retropubic [Smeltzer & Bare, 1992, p. 1328]

40. Epididymitis • Epididymitis is inflammation of the epididymis • Common causes: • Prostatitis • Mumps • Urinary tract infection • Sexually transmitted disease eg. chlamydia, syphilis, and gonorrhoea • Usually affects only one epididymis (unilateral) • Symptoms: • Swollen, hard and painful epididymis • Severe scrotal pain and swelling • Scrotal discomfort makes walking difficult and the affected individual may walk straddle legged in order to protect the scrotum

41. Epididymitis http://www.ecureme.com/atlas/data/epididymitis550_ab.htm

42. Diagnosis: • On the basis of clinical presentation • Urinalysis • Urine culture • Treatment: • Prompt appropriate antibiotic therapy • Delay in treatment may lead to complications of scarring and sterility associated with inability to impregnate a female due to sperm quality or quantity • Bed rest • Analgesics • Use of a scrotal support • Avoidance of alcohol • Avoidance of spicy food • Avoidance of sexual stimulation • Prevention: • Prompt treatment of causative infections • Sexual abstinence • Use of condoms during sexual intercourse to decrease the risk of infection with sexually transmitted diseases

43. Orchitis • Orchitis is inflammation of one or both testes usually due to bacterial or viral infection or trauma. • Viral mumps is the most common cause of orchitis in the adult male. • Commonly orchitis occurs in conjunction with or as a complication of Epididymitis • Symptoms: • Swelling, pain, tenderness of one or both testes • Fever • Malaise

44. Drawing illustrates epididymo-orchitis and an associated pyocele. http://radiographics.rsnajnls.org/cgi/content-nw/full/23/1/214/F1

45. Diagnosis • Made on the basis of symptoms • Blood testing • Urinalysis • Treatment: • Dependant on cause • Bacterial infection is treated with antibiotics • If the cause is a viral infection such as mumps it is treated symptomatically. • Eg bed rest, antipyretics, analgesics • Use of a scrotal support • Prognosis is good although atrophy of the involved testis does occur in 50% of cases. • If both testes are involved, sterility may occur

46. Cryptorchidism • Condition commonly called undescended testicle. • As the unborn male foetus develops, the testes appear first in the abdominal cavity. • As the foetus grows and develops, the testes move downward through the inguinal canal and into the scrotum. • If this process does not occur properly the testes may become lodged in any position in the abdominal cavity. • Babies born prematurely often present with Cryptorchidism, which is, usually time limited

47. Porth, 1998, p. 1162

48. The failure of both testes to descend is uncommon • If a testis remains undescended into childhood, surgical intervention is necessary to move and secure the testis in the scrotum • The surgery is usually performed during infancy or prior to the age of five. • If the testis is left in the abdominal cavity it will not function properly due to the higher temperature • If only one testis is involved the male will still have one functional testis and will remain fertile. • If both testes are affected and are not repaired in early childhood the male will be sterile

49. Testicular cancer • Testicular cancer is a disease in which cancer cells grow in one or both testicles. • The causes of testicular cancer are unknown. However, research shows that certain risk factors are associated with the disease.

50. Risk factors include • Personal or family history of testicular cancer • Race: White • Age: 25 to 35 • Abnormal testicular development, such as that seen in Klinefelter syndrome (a sex chromosome disorder involving low levels of male hormones, sterility, breast enlargement, and small testes) • Undescended testicle that did not move down into the scrotum before birth