Lecture 15: Male and Female Reproductive Systems Flashcards
(31 cards)
Male Genital/Reproductive System
- system consists of the testes, epididymis, vas deferens, seminal vesicles, prostate gland, and the penis
- structures are susceptible to inflammatory disorders, neoplasms, and structural defects
- do not typically treat these diseases, but need an understanding of their clinical presentation
Aging and Male Reproductive System
- testes become smaller: with thickening of seminiferous tubules impeding sperm production
- prostate gland enlarges: affecting urine outflow
- sclerotic changes in blood vessels: resulting in sexual dysfunction
- ↓ in male sex hormone levels (testosterone)
- decline in bioavailable testosterone correlated with: age-related memory changes, ↓ing sexual interest, physical changes (↓’d strength, body mass, and bone density)
Prostatitis
- refers to multiple disorders that can cause pelvic pain and discomfort
- typically preceded by lower urinary tract infections
- half of all men have at least one episode during their lifetime
- poorly controlled diabetes mellitus ↑’s the risk of UTI and prostatitis
- dx: DRE; prostatitis is differentiated from BPH and prostate cancer by the presence of pain (rarely present in BPH or cancer) and by age
- tx: antibiotics
SIFTT for Prostatitis
- may be cause of back pain
- bicycle seats can aggravate prostatitis so recumbent bicycle is recommeded which puts less pressure on groin
Benign Prostatic Hyperplasia (BPH)
- age-related nonmalignant enlargement of the prostate gland
- of men > 50 y/o, 75% experience symptoms of prostate enlargement
- drinking moderate amounts (1-2 drinks per day) is associated with a ↓’d risk of BPH and cigarette smoking ↑’s the risk for BPH-like symptoms
- patho: pathologic changes are marked by hyperplasia not hypertrophy; compresses urethra and causes urinary obstruction; DHT thought to be the primary mediator of hyperplasia-as men age, the prostate slowly grows larger, restricting urine flow and causing narrowing of the urethra, obstructing urinary outflow
- estrogens sensitize tissue to growth producing effect of DHT
- prostate enlarges, obstructs urethra, inhibiting normal urine flow
- CM: ↓’d caliber and force of the urine stream, urinary hesitancy, difficulty initiating or continuing urine stream, sense of urgency, incontinence, nocturia; residual urine in the bladder results in urine retention and urinary frequency
- tx: alpha-1 blocker (blocks α-1 receptors, which cause smooth muscle constriction)
- renal failure and death may occur if treatment is not initiated
- might have urine backup leading to enlarged pelvices
SIFTT for BPH
- therapists conducting PMH with men over the age of 50 can easily include a series of 4 questions to help identify the presence of urologic involvement:
1. Do you urinate often, especially during the night?
2. Do you have trouble starting or continuing your urine?
3. Do you have weak flow of urine or interrupted urine stream?
4. Does it feel like your bladder is not emptying completely? - yes answer to any of these questions warrants further medical evaluation
- painful urination, blood in urine, or unexplained lower back, pelvis, hip or upper thigh pain in the presence of any of these symptoms requires medical referral
- if the person notes sexual dysfunction and has a history of the above symptoms, ask him periodically about changes in sexual function: if it appears to worsen, communicate with the physician
- drug side effects: general muscle weakness, ED, loss of libido, gynecomastia, drowsiness, dizziness, tachycardia, postural orthostatic hypotension
- take steps to institute a falls prevention program when appropriate
Prostate Cancer
-adenocarcinoma accounts for 98% of primary prostatic tumors
-usually starts in the outer portion of the prostate and spreads inwardly
-most common visceral malignancy in American men
-2nd most common cause of male death from cancer
-rarely produces S & S until well advanced
-RF: age > 50, african american, geography (US and scandinavian countries), family hx (inherited gene mutation), environmental exposure to cadmium, high-fat diet, alcohol consumption
-patho: precise cause is unknown, a strong endocrine system link is theorized; males castrated before puberty do not develop prostate cancer or BPH; 15% higher serum testosterone level in blacks
-tumors more likely to develop initially in the periphery of the prostate, unlike BPH, where the pathologic changes typically originate close to the urethra
-CM: slow urinary stream, urinary hesitancy, incomplete bladder emptying and, dysuria (painful urination); Gleason score-used to grade prostate cancer; higher the score, the more abnormal and poorly differentiated
the cells are as seen under the microscope
-A: low grade, back to back uniformly sized malignant glands
-B: variable size more widely dispersed, moderately differentiated adenocarcinoma
-C: poorly differentiated adenocarcinoma composed of sheets of malignant cells
-prevention and screening: early detection, DRE, PSA (prostate specific antigen) screening; strong link between physical activity and exercise and ↓’d prostate cancer risk
-Whitmore-Jewett staging system: spread of prostate cancer has been divided into 4 stages
-tumor not spread beyond gland capsules in stages A and B
-stage C tumor spread to adjacent tissues
-D spread to lymphatic system and beyond
-tx: observation, radical prostatectomy, radiation, hormonal therapy
-prognosis: 93% men diagnosed with prostate cancer survive at least 10 years, 77% survive at least 15
SIFTT for Prostate Cancer
- screening for medical disease: if no mechanical back pain or the person notes urologic dysfunction, refer to a physician; age over 50, past history of cancer, and unknown cause of musculoskeletal pain or symptoms are three red flags that warrant further medical investigation
- complications of medical tx: complications associated with radical prostatectomy procedures include, infection, incontinence, and impotence; average time to achieve continence is 3 weeks with virtually all individuals being continent within 6 months; postop impotence occurs in 70% of men who undergo retropubic prostatectomy
Orchitis
- inflammation of testis often associated with epididymitis
- primary infections of genitourinary tract or in other body regions
- sexually active males with multiple partners are at higher risk of developing genitourinary infections
- often secondary to UTIs
- marked by testicular pain and swelling (tender and swollen testicle)
Epididymitis
- inflammation of epididymis
- typically caused by bacterial pathogens
- CM: pain, urinary dysfunction, fever, urethral discharge
Testicular Torsion
-abnormal twisting of spermatic cord as testis rotates within tunica vaginalis
-surgical emergency
-patho: Spermatic cord contains vas deferens and nerve and blood supply for the scrotal contents
-if torsion is severe enough to occlude the arterial supply, infarction can quickly occur
-CM: abrupt onset of scrotal pain and then swelling
-SIFTT: if the scrotal or groin pain is associated with musculoskeletal dysfunction, it can be expected that the therapist could alter the symptoms by mechanically
stressing a component of the musculoskeletal system
Testicular Cancer
- accounts for < 1% of all male cancer deaths
- risk factors include: cryptorchidism (undescended testes), inguinal hernia in childhood, and ethnicity (mainly in white men)
- patho: originate from germinal cells; typically, when it extends beyond the testes, it spreads through the lymphatic system
- metastases affect lungs, liver, viscera, and bone
- CM: swollen testes, gynecomastia, painless lump, SOB, lethargy and fatigue, hemoptysis
- prevention: promoting testicular self-examination at least every 6 months as a technique for early detection is recommended
Erectile Dysfunction (ED)
-also termed impotence: refers to the inability to achieve, keep or sustain an erection sufficient for satisfactory sexual performance
-prevalence: correlation with ↑ing age
-RF: certain meds; chronic diseases, particularly neurological conditions and diabetes mellitus; smoking, age-related testosterone deficiency, CAD, alcohol use
-etiologic factors: may be neurogenic, arteriogenic, venogenic, or psychogenic; 50-80% seeking treatment for sexual dysfunction have an organic lesion; 85% of men > 50 y.o., the cause is organic; 70% of men < 35 cause is psychogenic
-SIFTT: if a sudden change in sexual function is noted, communicate with Dr; prescriptive exercise is often recommended for the individual with
intact nerve innervation and vascular supply
Female Genital/Reproductive System
- ovaries, fallopian tubes, uterus, vagina, and external genitalia
- pelvic floor disorders
- other conditions put women at ↑’d risk of developing other diseases
Aging and Female Reproductive System: Perimenopause
- “change before the change”
- menstrual cycle, sleep disturbances, ↑’d body temperature, anxiety, depression, mood changes, fatigue, and difficulty concentrating
Aging and Female Reproductive System: Menopause
- permanent cessation of ovarian function and the end of a woman’s reproductive potential (average age is early 50’s)
- causes: gradual cessation of ovarian function with reduced estrogen levels
- during reproductive years the primordial ovarian follicles, from which ova are expelled, steadily ↓ in number: by middle age, the ovaries, which each held about 300,000 eggs at puberty, have resorbed or shed nearly all of them
- sx: hot flashes; fatigue; anxiety; sleep disturbances; reduced libido; mood swings; irritability; endometrial, vaginal, and breast atrophy are physiologic changes
- local changes, secondary to ↓’d estrogen levels: strength and tone loss in the pelvic floor musculature
- continued vaginal bleeding: always requires a medical evaluation
- ovaries continue to produce significant amounts of testosterone: natural means of preserving bone and muscle mass and of alleviating menopausal symptoms, particularly the loss of libido
Menopause and Hormone Replacement Therapy
- much remains unknown about the long-term effects of HRT, but studies have been ongoing and new information is available daily and subject to change
- PT’s do not evaluate the need for HRT or prescribe these medications, but clients frequently ask questions and seek additional educational information
- decision to use or not to use based on a thorough understanding of the risks and benefits and individual risk factors
- HRT doesn’t help with heart disease and may even worsen the condition
- PT remains a key health care provider in risk assessment, assessment and prevention of falls, osteoporosis education, and exercise prescription
Exercise and Reproductive System
- too much exercise yields negative effects (reproductive/skeletal systems): 1° and 2° amenorrhea d/t low body weight and improper nutrition; female athlete is at particular risk
- delayed menarche
- disruption or cessation of menstrual cyclicity
- Gn-RH results in hypoestrogenism 10
- obesity: contributes to menstrual disorders, infertility, miscarriage, poor pregnancy outcome, impaired fetal well being, diabetes mellitus
- fertility is improved through exercise and balanced nutrition
- exercise can stop early postmenopausal bone loss
Endometriosis
- functioning endometrial tissue found outside the uterus
- during menstruation, the dislocated tissue is responding just as the uterine lining, but since it cannot shed as the endometrium dies, it remains where it is, eventually forming scar tissue and irritating the affected area
- patho: endometrial cells migrate to other parts of the body and form pockets of tissue referred to as implants, implants swell in response to the cyclic surge of estrogen and progesterone forming cysts on the underlying organs
- CM: dysmenorrhea, abnormal uterine bleeding, pain, and infertility
- dx: dysmenorrhea, dyspareunia, infertility
- tx: no cure; try to preserve fertility; pregnancy does appear to suppress disease
SIFTT for Endometriosis
- women note that back pain is cyclic so PTs need to consider all possibilities
- dyspareunia is a common complaint associated with sacroiliac lumbar or hip dysfunction: if painful intercourse is related to endometriosis, the pain will be present regardless of position; if the pain is related to joint dysfunction, typically certain positions will be comfortable and others painful
- endometriosis may account for false-positive findings during the PT’s physical examination
- for example if there are endometrial implants on the psoas major muscle, local palpation and testing of the psoas may be provocative
Uterine Fibroids
- benign tumors of the uterus (myomas)
- form on outer surface of the uterus or within the walls or lining of the uterus
- become malignant in < .1% (leiomyoma)
- overgrowth of smooth muscle and CT in the uterus
- genetic predisposition exists
- fibroids have both estrogen and progestin receptors (so, ↑’d estrogen levels may cause fibroid enlargement)
- CM: usually asymptomatic; in 10-20%, pain, pelvic pressure, and heavy bleeding
- can grow to the size of a grapefruit or larger-can place pressure on the bladder or spinal nerves
- NSAIDS or hormonal agents, surgical removal
- assess for abnormalities and asymmetries in muscle strength and function throughout abdomen, trunk, pelvis, and hips
Endometrial Carcinoma (Uterine Cancer)
- fourth most common cancer in women
- no apparent genetic component
- environmental, social and lifestyle factors are the most important
- RF: older age, white race, affluent, obese, low parity (births), any condition that increases exposure to unopposed estrogen
- patho: adenocarcinoma that metastasizes late and may spread to lungs and brain
- CM: uterine enlargement, abnormal bleeding, pain and weight loss (advanced)
- tx: usually sx
- SIFTT: physical activity and exercise known to decrease risk of endometrial cancer
Cervical Cancer
-largely a preventable disease with preventative sexual practices, regular screening and intervention at the precancerous stage
-classification: preinvasive-from mild to carcinoma in situ; invasive-cells penetrate basement membrane and can spread
-causes: human papilloma virus (HPV), smoking, high parity, young age at first intercourse (17 or younger), multiple sexual partners, other STDs
-patho: dysplastic changes occur in thin layer of epithelium that covers cervix
-CM: most never know that they have had HPV; abnormal or persistent vaginal bleeding, pelvic pain, anorexia, anemia; when it persists, it can cause lesions; if left untreated, can lead to cancer
-prevention and screening: using barrier contraceptives, monogamous sex, sexual abstinence,
routine cervical screening beginning ~ 3 years after first intercourse
-vaccine: gardasil blocks viruses that cause cervical cancer
-dx: pap test, sentinel lymph node biopsy
-prognosis: slow-growing neoplasm with good response to intervention
-SIFTT: important role of educator and prevention specialist when conducting a
personal/family history that includes questions about the consistency of Pap testing and presence of sexually transmitted diseases
Ectopic Pregnancy
-implantation of a fertilized ovum outside the uterine cavity
-true gynecologic emergency, since accompanying complications are one of two primary causes of maternal death in the US
-patho: caused by delayed ovum transport secondary to ↓’d fallopian tube motility or distorted tubule anatomy; three to four days are typically required for the ovum to travel through the fallopian tube to the uterus; if pregnancy does not terminate, the thin-walled tubule will no longer support the growing fetus, and rupture can occur: life-threatening because rapid intrabdominal hemorrhage can occur
-CM: amenorrhea, or irregular bleeding and spotting, non-specific lower abdominal quadrant or back pain, and a pelvic mass
-SIFTT: if a woman of childbearing age complains of an onset of lower abdominal or back pain, the therapist should ask questions regarding her menstrual cycle
and if any of the symptoms of pregnancy are present
-if PT suspects ectopic pregnancy, immediate call to the physician is warranted
