Gender-Based Pathology

1. Gender-Based Pathology

2. Female Athlete Triad • 1. Disordered Eating: Wide spectrum of abnormal eating patterns

3. Female Athlete Triad • Disordered Eating Cycle • Monitoring food Intake ↓ • Restricting foods ↓ • Limiting acceptable foods ↓ • Voluntary starvation

4. Female Athlete Triad • Sports related Triggers – Disordered Eating • 1. • 2. • 3. • 4. • 5. • 6. • 7. • 8. • General Risk Factors of Disordered Eating • 1. • 2. • 3. • 4. • 5. • 6. • 7.

5. Female Athlete Triad • Disordered Eating-Diagnostic criteria • Anorexia Nervosa: • Bulimia Nervosa:

6. Female Athlete Triad • Amenorrhea • Primary- • Secondary- • Starvation of the endocrine reproductive system • Exercise →amenorrhea? OR • Eating Disorder →amenorrhea?

7. Female Athlete Triad • Bone loss/Osteoporosis • Prevention • Screening

8. Female Athlete Triad • Osteoporosis: • Treatment

9. The Menstrual Cycle

10. The Menstrual Cycle • Hormone Cycle • Hypothalamus ↓ GnRH • Anterior Pituitary ↓ FSH & LH • Ovaries Estrogen & Progesterone ↓ Endometrial Maturation

11. Exercise-Induced Menstrual Disorders • Delayed Menarche • Shortening of Luteal Phase • Oligomenorrhea/Amenorrhea

12. Exercise-induced Amenorrhea • Definition: Absence of 3-12 consecutive menstrual periods • Predisposing Factors: • Etiology? 1. 2.

13. Exercise-Induced Amenorrhea • Consequences: • 1. • 2. • 3. • 4. • Treatment:

14. Dysmenorrhea • Definition: • Leading cause of Absenteeism in HS • Primary Onset VS Secondary Onset • TX:

15. Male Conditions • 1. Varicocele • 2. Hydrocele • 3. Undescended Testicle • 4. Testicular Cancer • 5. Genital Injury • 6. Gynecomastia

16. Varicocele • “Bag of Worms” • Rare before Puberty • Infertility • DX: • TX:

17. Hydrocele • Fluid collection (cyst) surrounding testicle d/t over production or diminished resorption • DX: • TX:

18. Undescended Testicle • “cryptorchidism” – hidden testis • Not testicular retraction • Common at birth • Tx:

19. Testicular Cancer • Most common malignancy in 16-35 yr old men • 400-500 deaths per year • 85% cure rate with treatment • HX: • DX:

20. Testicular Contusion • Direct trauma • S/S: • TX: • Need to inform Patient to monitor testis…if expanding mass, consider fracture of testicle or epididymis. If goes untreated, can lead to infertility/loss of testis.

21. Spermatic Cord Torsion • TRUE SURGICAL EMERGENCY! • You will not be able to calm them down on the field • S/S: • Tx: surgery

22. Penile Injuries • Straddle or direct blow injury could cause urethral rupture, vascular injury, hematoma formation. • Runner: Frostbite • Cyclists: Pudendal Nerve damage. • Priapism • Ischemic Neuropathy

23. Gynecomastia • Palpable breast tissue in males • Must be distinguished from lipomastia • Cause: 1. Increase estrogen secretion 2. Testosterone Deficiency

24. Female Conditions • 1. Common Breast Problems • 2. Breast Cancer • 3. Menstrual Cycle Irregularities • Endometriosis • Pregnancy

25. Breast Issues • Most abnormalities are NOT breast cancer. ~ 1in 8 will be diagnosed. • Cysts are very common in young women • Self Breast Exams: • Start at age 18 • Tumors are hard, irregular and not very mobile • Examine monthly • One week after menstrual cycle • Pain in not a good diagnostic indicator

26. Age Race Menarche ≤ 11yrs old Menopause ≥ 55 yrs old Nulliparity First pregnancy ≥ 30 yrs No lactation Family Hx Previous Brest CA Use of fertility drugs Previous exposure to Radiation Prolonged use of postmenopausal estrogen replacement drugs Family hx of ovarian CA Risk Factors for Breast CA

27. Menstrual Irregularities • Amenorrhea • Oligomenorrhea • Intermenstrual Bleeding • Exercise causes increase in many hormones • VERY COMLPEX! • Changes in diet, body fat, exercise, hormones

28. Endometriosis • Definition: Presence of tissue that is biologically similar to normal endometrium in locations outside the endometrial cavity. • Cause: Theory: Retrograde flow of menstrual fluid through fallopian tubes into free pelvis • Typical Patient: • S/S:

29. Endometriosis • Found in 30-40% of Patients who present for an infertility evaluation • Requires direct visualization via surgery • Brown Spots, “chocolate cysts” • Treatment:

30. Pregnancy • Normal gestation is 40 weeks ~9 mo • ALL women of childbearing age should take a multivitamin with 400 micrograms of FOLATE (folic acid) – prevention of neural tube defects – 800 micrograms during pregnancy • Physiological Changes of Pregnancy: • GI tract • Respiratory system • Cardiovascular system • Hemodynamic response • Urinary Tract • Skin • Breasts • Musculoskeletal changes

31. Physiological Changes during pregnancy • GI Tract • Respiratory Changes • Cardiovascular Changes • Hemodynamic Response

32. Physiological Changes During Pregnancy • Urinary Tract • Skin • Breasts • Musculoskeletal Response

33. Exercise during Pregnancy • Not time to begin new strenuous exercise, can maintain regular routine for most of time. • Absolute Obstetric Contraindications: • 1. • 2. • 3. • 4. • 5. • 6.

34. Exercise during Pregnancy • Relative Obstetric Contraindications: • 1. • 2. • 3. • 4. Special Considerations: 1. 2. 3. 4. 5. 6.

35. Pregnancy Restrictions • No abdominal trauma sports: • Basketball • XC – extreme exertion • Hockey Need to restrict after 1st trimester only.