Lecture 13: Male and Female Reproductive System (Exam 3)

Question 1

WHat diseases are covered in this lecture?

Answer 1

Sexually-transmitted disease
-Gonorrhea
-Syphilis
-Chlamydia
-Herpes

Male
-Infertility
-Cryptorchidism
-Torsion
-Benign Prostatic Hypertrophy
-Prostatitis

Female
-infertility
-Amenorrhea
-endometriosis
-eclampsia/Pre-eclampsia
-ectopic Pregnancy
-Mastitis

Question 2

Where does spermatogenesis begin?

Answer 2

testes

Question 3

What is infertility?

Answer 3

inability to conceive within one year
-monthly probability 20%-25%
-infertility has not increased
-screening and treatment options have

Question 3

What is infertility?

Answer 3

inability to conceive within one year
-monthly probability 20%-25%
-infertility has not increased
-screening and treatment options have

Question 4

What are the causes of infertility?

Answer 4

appx 11% of US reproductive age population
most case are treated with medication or therapy
-less than 3% of cases are treated with Assisted Reproductive Technologies (ART)

Question 5

Describe ways of Female Infertility

Answer 5

Ovulatory
-anything that impacts ova production will reduce fertility

Tubal
-structural damage to oviducts will prevent the movement of ova or fertilization

Uterine
-Damage can prevent implantation or maintenance of pregnancy

Question 6

What are the ovulatory causes?

Answer 6

Endocrine
-Hypothalamus/pituitary disease
-insufficient production of gonadotropins

Ovarian Disease
- polycystic ovarian syndrome (eg. Gonadotropin insufficiency; direct ovarian damage)

Other causes
Chemotherapy/pelvic irradiation
-destroys developing oocytes

Question 7

What are Tubal/Uterine causes?

Answer 7

infections
-resulting in inflammation, scars, adhesions
-block transport/implantation
-ectopic pregnancy

Pelvic/Abdominal surgeries
- can also cause scarring/adhesions

Exposure to toxins
- Damage to the endometrium

Question 8

Other causes of infertility

Answer 8

Thyroid disease
-excessive thyrotropin-releasing hormone induces PRL secretion (at high levels, will suppress GnRH release)
-response to low thyroid hormone levels

Androgen excess
-affects oocyte development
-anovulation and amenorrhea
-Genetic, and environmental causes

Hyperprolactinemia
-drugs that alter PRL secretion
-damage to pituitary

-Both prevent dopamine from inhibiting PRL secretion
-Effect on fertility may be related to excessive dopamine
-Altered gonadotropin release
-Direct effect on follicles

Question 9

Whare the three types of male infertility?

Answer 9

Pretesticular
-endocrine disorders
-drugs

Testicular
-trauma, infections
-environmental, developmental

Post-testicular
-Tubal obstruction
-Autoimmune
-Developmental

Question 10

What are the factors spermatogenesis?

Answer 10

Pretesticular Causes
hormones and medications
systemic diseases
environmental/lifestyle factors
dieary deficiencies
Toxins

Testicular causes
testicular temperature (elevated)
ionizing radiation alkylating agents
developmental disorders
local infections

Question 11

What are pretesticular causes

Answer 11

-focuses on hormones that promote spermatogenesis

-Hypothalamus0pituitary deficiencies
-affect hormone production
-reduced testosterone slows spermatogenesis

Or drugs that inhibit their effects
-anabolic steroids initiate a negative feedback loop that reduces LH/FSH levels

Question 12

What are testicular causes?

Answer 12

direct effect on testicular function
-most common cause of reduced male fertility is varicocele

Varicocele: abnormally dilated scrotal veins
-the scrotal temperature is increased

Question 13

What can cause testicular damage?

Answer 13

Trauma (reversible with early intervention)
-Damage can result in atrophy
-Antisperm antibodies form when compartmentalization breaks down

Torsion of the spermatic cord
-Disrupted blood flow-ischemic damage

Infections
-swelling causes necrosis, atrophy

Question 14

What is testicular torsion?

Answer 14

This occurs primarily in 2 circumstances
-neonatal- in utero or shortly after birth; no anatomic defect
-Adult-usually in adolescence

Adult Torsion
-Sudden onset of testicular pain
-no apparent injury/cause
-linked to a bilateral anatomic defect that increases mobility

-Considered a vascular disorder as twisting of the spermatic cord will reduce/ eliminate venous drainage
-The veins are unusually thick-walled (pampiniform plexus )
-Will remain patent

-Leads to infarction (emergency)
-If torsion is revered within 6 hours, generally have a full recovery

Question 15

What are other testicular causes?

Answer 15

-Genetic diseases that impact sperm
-Klinefelter syndromee
-Microdeletions on the Y chromosome
Cryptorchidism (failure of descent)
-Developmental disorder

Toxins
-Different cells have different sensitivities
-cigarette smoke

Question 16

What is Cryptorchidism?

Answer 16

-Complete or partial failure of testes to descend during fetal development
-Higher temperature impairs function
-Structural changes (microscopic) are apparent by 2 years of age
-Lack of germ cell development (no spermatogonia, spermatocytes, spermatids)
-Hyalinization and thickening of basement membrane

Question 17

What are post-testicular causes?

Answer 17

Ductal obstructions (vas derens, epididymis)
-surgical (trauma, vasectomy)
-congenital (cystic fibrosis)

Ejaculatory issues
-Duct obstruction (congenital or acquired)
-Anejaculation (spinal cord injuries)

Infections (STDs, E. coli)
-can be due to urinary tract abnormalities

Question 18

What are specific sexually transmitted infections?

Answer 18

Bacterial (gram negative)
-GOnorrhea (Neisseria gonorrhoeae)
-Chancroid (Haemophilus ducreyi)
-Granuloma inguinale (Klebsiella granulomatis)
-Syphilis (spirochete: Treponema pallidum)

Bacterial (obligate intracellular)
-Chlamydia (chlamydia trachomatis)

Viral
-Genital Herpes (HSV2 infection; viral)

Question 19

What is Gonorrhea?

Answer 19

Infection with Neisseria Gonorrhoeae
-Males; causes urethritis
Females: often asymptomatic; may lead to pelvic inflammatory disease and infertility

in newborns, can causes blindness

Question 20

What is Syphilis?

Answer 20

-infection with treponema pallidum (spirochete)
-can cross the placenta (congenital)

Question 21

What is Lymphopathia Venerea?

Answer 21

Type of chlamydia
-aka lymphogranuloma venereum
infection with specific serotypes (L type)

Chronic infection
-initial lesion is small
-growth leads to swelling of lymph nodes
-can lead to lymph node rupture
-if untreated, causes fibrosis and structure in structures of the lower urogenital tract

Other genital chlamydia infections appear clinically like gonorrhea

Question 22

What is Herpes simplex virus infection?

Answer 22

Both HSV-1 and HSV-2 infect mucosa
-HSV-2 more likely to cause genital herpes

Can infect nearby nerves and remain latent
-activated by stress, trauma, U irradiation, hormonal changes

-Causes lesions on the skin

-Can also cause:
-Corneal lesions (blindness)
-Encephalitis
-Bronchopneumonia
-Esophagitis
-Hepatitis

Cells are multinucleated

Question 23

What are disorders of female reproduction involving disruption of menstruation?

Answer 23

Hormonal Control
-Pituitary hormones act on the ovaries
-FSH (follicle development, estrogen). Follicle-stimulating hormone
-LH (follicle maturation, progesterone) luteinizing hormone

Ovarian hormones act on the uterus
-estrogen (produced by follicle prior to ovulation; stimulates proliferative phase)
-progesterone (produced by corpus luteum; stimulates secretory phase)

Question 24

Explain the hormonal cycle.

Answer 24

-Complex interaction of hormones
-pregnancy halts the cycle in the secretory phase
-other structures are involved

Question 25

What are some menstrual disorders?

Answer 25

Amenorrhea
-lack of menstrual bleeding

Dysmenorrhea
-irregular menstrual symptoms
-excessive pain

Menorrhagia
-excessive bleeding

Metrorrhagia
-irregular/protracted bleeding

Question 26

What is Amenorrhea?

Answer 26

-normal (pregnancy, menopause)
-uterine disorder
-scarring after infection

Ovarian disorder
-gonadal failure (multiple causes)
-Resistance to gonadotropic hormones

Endocrine disorder
-insufficient gonadotropin secretion

Question 27

How does stress affect amenorrhea?

Answer 27

stress –> increase cortisol–> change GnRH–>change in LH and FSH levels–> Amenorrhea

Question 28

What is endometriosis?

Answer 28

Presence of endometrium outside the uterus
-causes infertility if it affects other parts of the reproductive tract
- causes intestinal disorders when it affects the intestines
-pathogenesis is not well understood
-Symptoms include: Dysmenorrhea, pelvic pain

Question 29

What is an ectopic pregnancy?

Answer 29

-implantation of embryo anywhere but the uterus
-appx 90% in the uterine tissue
-Predisposing condition: a pelvic inflammatory disease that results in chronic salpingitis
-most common cause of tubal hematoma
-Fertilized ovum develops as usual:
-forms a placenta
-Amniotic sac suggests surrounds the developing fetus
–Growth of fetus will cause rupture of the uterine tube
-may undergo regression and resorption or spontaneous ejection into the abdominal cavity (tubal abortion)

Question 30

What is eclampsia/pre-eclampsia?

Answer 30

-systemic syndrome of pregnant women:
-WIdespread maternal endothelial dysfunction
-Symptoms: HTN, edema, proteinuria (pre); Convulsions (eclampsia)
Also, can develop hypercoagulability, acute renal failure, and pulmonary edema
-Remember HELLP syndrome (last week)

Pathogenesis is not well understood, but linked to three specific changes:
-abnormal placental vasculature
-endothelial dysfunction (imbalance of anti/angiogenic factors)
-Defective vascular development in the placenta secondary to hypoxia
-Coagulation abnormalities
-reduced endothelial production of antithrombotic factors

**proteinuria separates eclampsia from other diseases

Question 31

Describe some changes in placental Vasculature

Answer 31

-during implantation and placental development, the spiral arteries of the secretory phase endometrium will be modified to provide blood to the placenta
-Fetal cells invade the decidual plate and destroy the excess smooth muscle
-Vessels change from the small lumen, high resistance to the large lumen, low resistance

Remodeling does not occur in pre-eclampsia, resulting in placental ischemia and maternal HTN

Question 32

Describe placental vessel damage

Answer 32

-may develop atherosis
-lipid deposits in decidual vessel intima

Hemorrhages may be visible in the liver, brain, heart, anterior pituitary

-Kidney will have excess fibrin in glomeruli and thrombi in the cortex that may be associated with cortical necrosis

Question 33

What is Mastitis?

Answer 33

-acute bacterial infection
-Typically ocurrs during during first month of breast feeding
-During breastfeeding, cracks and fissures may develop in the nipples
-Allows access to bacteria like S. aureus or Streptococci

Symptoms: fever, painful swelling, and edema

Tissue changes : erythema,abscesses (S.aureus or strep)

Starts in ducts but may spread to entire breast

Usually treated with antibiotics and milk expression

Question 34

What is the function of the prostate?

Answer 34

-releases product into the urethra
-slightly alkaline fluid
-contains an enzyme that maintains seminal fluid as liquid

Prostate disease
-surrounds the urethra, so inflammation or hypertrophy impacts urethral function
-symptoms of difficulty urinating (starting, volume, incomplete voiding, pain)

Question 35

What is prostatis?

Answer 35

bacterial (acute or chronic), abacterial (chronic) or granulomatous

Acute bacterial
-causative agents that cause cystitis
-access to the prostate is through urinary reflux, surgery, or lymphatics/blood from a distant site
Symptoms: fever, chills, dysuria
Exam: prostate will be enlarged and tender
Dx: urine culture and Sx/Exam

Chronic Bacterial
-causative agents as above
-maybe asymptomatic; not necessarily preceded by acute infection
-Sx: low back pain, dysuria, perineal/suprapubic discomfort
-Hx: recurrent urinary tract infections (antibiotics do not penetrate prostate well)
Dx: leukocytes in prostatic secretions: positive bacterial cultures

Chronic Abacterial
-a most common form of prostatitis
-as chronic bacterial but bacterial cultures are negative
-prostatic secretion will still have leukocytes
-no history of recurrent urinary tract infections

Granulomatous
-Specific (agent ID’d) or nonspecific
-most common is due to cancer treatment
-fungal seen is due in immunocompromised hosts
-nonspecific is due to ruptured ducts and acini

-These clinical syndromes, when found incidentally on biopsy-acute/chronic inflammation

Histologically: acute may have small abscesses, areas of necrosis that may be quite large, or diffuse edema, congestion, and suppuration

Question 36

What is Benign prostatic hypertrophy ?

Answer 36

Transition Zone (TZ)
-mucosal glands empty directly into the urethra common location for hypertrophy

Peripheral Zone (PZ)
-main glands with long ducts
-primary location for inflammation and cancer

Question 37

What causes BPH?

Answer 37

-circulating testosterone is converted to DHT by 5-alpha reductase in the prostatic stroma
-Excessive cell growth due to DHT
-Treatment with reductase inhibitors slows the growth and relieves symptoms
–Other treatments require the destruction of tissue
-minimally invasive (lasers)
-Surgical

Histologically
Hyperplastic glands on either side of the urethra
Two layers of cells in glands:
1. Inner columnar
2. Outer basal, flattened

Question 38

Describe BPH clinically

Answer 38

only clinically apparent in 10%
Common Sx: hesitancy
Urgency
Nocturia
Poor urinary stream

-Chronic obstruction: increased risk of UTI
-Acute Obstruction: may damage bladder or kidneys