Patho of Reproductive System Module 5

Question 1

Male system

Answer 1

Includes:
penis, scrotum, testes, duct system, and accessory glands

Functions:
Spermatogenesis (makes sperm) and transports sperm
Produces sex hormones
Aids in urination

Question 2

Normal Male Reproductive System: Penis

Answer 2

External genitalia containing erectile tissue
Deposits sperm in the female reproductive system through ejaculation
Consists of three cylinders: the corpus spongiosum and two corpora cavernosa
Average length is 2–5 inches when flaccid and 4–7 inches when erect

Foreskin: sheath of loose skin covering the penis

Smegma: oily secretion produced by the glans combined with dead skin

Meatus: an opening in the glans that allows for ejaculation and urination

Ejaculation: propulsion of sperm-containing fluid

Question 3

scrotum

Answer 3

Sac of skin that contains the testes, epididymis, and lower spermatic cords
Maintains testicular temperature for spermatogenesis
The scrotum contracts to draw the testes closer to the body to warm them
The scrotum relaxes to drop the testes further from the body to cool them

Question 4

Penis

Answer 4

External genitalia containing erectile tissue
Deposits sperm in the female reproductive system through ejaculation
Consists of three cylinders: the corpus spongiosum and two corpora cavernosa
Average length is 2–5 inches when flaccid and 4–7 inches when erect
Foreskin: sheath of loose skin covering the penis

Smegma: oily secretion produced by the glans combined with dead skin

Meatus: an opening in the glans that allows for ejaculation and urination
Ejaculation: propulsion of sperm-containing fluid

Question 5

Testes

Answer 5

Produce sperm and the sex hormones

Spermatogenesis develops in most males by age 16

Seminiferous tubules produce sperm
Epididymis stores sperm for maturation until ejaculation

Epididymis: stores sperm until ejaculation

Testosterone
Gives males their secondary sex characteristics and sex drive
Regulates metabolism and protein anabolism
Inhibits pituitary secretion of the gonadotropins
Promotes potassium excretion and renal sodium reabsorption
Contributes to male pattern baldness and acne

Question 6

Duct System

Answer 6

Delivers sperm from the testes to the female reproductive system

Includes epididymis, vas deferens, spermatic cord, ejaculatory duct, and the urethra

Ejaculatory duct: made up of ampulla and seminal vesicles
Ampulla: a pouch where vas deferens meets prostate and seminal vesicles
Seminal vesicles: pair of pouches that secrete alkaline ejaculatory fluid containing sugar, protein, and prostaglandins to nurture sperm

Semen: sperm and ejaculatory fluid from the seminal vesicles

Question 7

Accessory Glands

Answer 7

Prostate gland
Secretes a fluid that mixes the semen to decrease its acidity, increases sperm motility, and prolongs sperm life

Cowper’s glands
Secrete another alkaline fluid into the urethra to neutralize acidity caused by urine transportation

Orgasm: climax of pleasurable sensations that usually accompanies ejaculation

Question 8

Normal Female Reproductive System

Answer 8

Functions: 
Oogenesis: generation of eggs
Ovulation: transportation of eggs
Impregnation: fertilization of eggs
Gestation: fetal development
Parturition: delivery of the fetus
Lactation: milk production
Includes the ovaries, fallopian tubes, uterus, vagina, external genitalia, and mammary glands

Question 9

ovaries

Answer 9

Produce hormones that regulate reproductive function and secondary sex characteristics
By puberty, contain about 400,000 follicles (units containing one oocyte)
Pituitary hormones cause the follicles to mature during the reproductive years

Question 10

Fallopian Tubes

Answer 10

Extend from the fundus of the uterus to near the ovaries
Capture ovum after ovulation
Move sperm and ova toward each other
Move the zygote toward the uterus for implantation
Ectopic pregnancy: pregnancy occurring outside the uterus

Question 11

Uterus

Answer 11

Site of fetal growth
Placenta: vascular organ that supports fetal growth

Anteflexed: position of the uterus in which it is tilted over the bladder (usually)
Retroflexed: when the uterus is tilted backward

Layers;
Endometrium: mucosal inner lining
Myometrium: muscular middle lining
Perimetrium: outer sac

Cervix: opening between the uterus and vagina

The menstrual cycle:
Average age of onset is approximately 13 years (menarche)
Menstruation: shedding of the endometrium
28-day cycle (average)
Three phases: menstrual, proliferative, and secretory
Each phase is marked by changes in hormone levels
Repeats until pregnancy or menopause (surgical or natural) occurs

Menopause:
Complete cessation of the menstrual cycle (1 year)

Manifestations: breast and internal reproductive organs atrophy, decreased vaginal secretion, painful sexual intercourse, behavioral changes, headaches, insomnia, hot flashes, night sweats, and decreased bone density
Treatment: may not be required or hormone replacement may be given

Question 12

Vagina

Answer 12

Serves as a passageway for sperm to travel to the fallopian tubes, discharging menstrual fluid, and birthing the fetus

Skene’s gland secretes a protective, lubricating fluid during sexual intercourse
May play a role in the female orgasm

Hymen: thin connective tissue that covers the external vaginal opening

Question 13

External Genitalia

Answer 13

Vulva: refers to all external structures collectively

Include mons pubis, labia majora, labia minora, clitoris, and vestibule

Bartholin’s glands provide lubrication during sexual intercourse

Both males and females have mammary glands, but they are functional only in females

Produce milk

Prolactin: a hormone from the anterior pituitary gland that prompts milk production
Include nipple, areola, and areolar gland

Question 14

Mammary Glands (breast)

Answer 14

Both males and females have mammary glands, but they are functional only in females

Produce milk

Prolactin: a hormone from the anterior pituitary gland that prompts milk production
Include nipple, areola, and ducts

Question 15

Epispadias

Answer 15

Urethral meatus occurs on the dorsal surface of the penis and may extend the entire length of the penis; can also affect females, placing the meatus in the clitoris
More likely to cause urination problems in men and sexual dissatisfaction in women; both genders are at increased risk for urinary tract infections
Usually develops during the first month of gestation; urinary defects often also present

Men are not necessarily infertile, but may not propel semen well during ejaculation

Diagnosis: exam, intravenous pyelogram, and other imaging strategies

Treatment: surgical procedures using the foreskin to protect external structures

Question 16

Hypospadias

Answer 16

Urethral meatus located on the ventral surface of the penis and extending the length of the penis

Chordee: downward curvature of the penis

Cause: unknown, but a combination of environmental exposure and genetic vulnerability plays a role

Risk increases with maternal factors like age >35 years, obesity, use of fertility treatments, and hormone therapy

Does not usually affect females, but it can be the cause of gender ambiguity

Diagnosis: physical exam and imaging tests

Treatment: surgical repair (often in stages, usually before 18 months of age)

Question 17

Cryptorchidism

Answer 17

One or both testes do not descend from abdomen to scrotum; undescended testes remain along the path of descent but can deviate from that path (ectopic testes)

Risk factors: prematurity, low birth weight, small size for gestational age, family history of problems of genital development, multiple fetuses, maternal estrogen exposure during first trimester, maternal alcohol use during pregnancy, maternal cigarette smoking or secondhand smoke exposure during pregnancy, maternal diabetes, and parental exposure to pesticides

Retractile testicle: moves back and forth between the scrotum and the lower abdomen

Ascending testicle: testicle returns to lower abdomen; cannot easily be returned to scrotum

Diagnosis: history, examination, self-testicular examinations, abdominal ultrasound, MRI, hormone levels, and genetic studies

Treatment: may not be required, manual manipulation, hormonal therapy, surgical repair, orchiectomy, testicle implants, and hormone replacement

Question 18

Disorders of the Testes and Scrotum

Answer 18

Usually structural in origin

Can be acquired or congenital

Most can be resolved with minimal residual effects

Examples: hydrocele, spermatocele, varicocele, testicular torsion

Question 19

Hydrocele

Answer 19

Fluid accumulation between the layers of the tunica vaginalis or along the spermatic cord

Can affect one or both testes

Causes: congenital defect, inflammation, infection, trauma, and tumors

Diagnosis: painless scrotal enlargement that transilluminates and scrotal heaviness, scrotal ultrasound

Treatment: may not be required, scrotal elevation, sitz baths, heat/cold application, aspiration, surgical removal

Question 20

Spermatocele

Answer 20

Sperm-containing cyst that develops between the testes and the epididymis

Manifestations: painless, small, moveable cyst that may transilluminate

Cause: unknown, but may be a blockage of the duct system, infection, inflammation, or trauma

Diagnosis: similar to hydrocele

Treatment: usually not required but may require surgical removal if large

Question 21

Varicocele

Answer 21

Dilated vein in the spermatic cord
Results from valve issues that allow blood to pool in the veins

Causes: congenital defects and obstructions

Most common cause for low sperm counts and decreased sperm quality because of testicular ischemia

More common in left testicle because of anatomic factors

Manifestations: “bag of worms” feeling to the scrotum and scrotal heaviness
Men with varicocele may experience fertility issues

Diagnosis: similar to hydrocele

Treatment: often unnecessary, surgical repair, embolectomy, and sclerotherapy

Question 22

Testicular Torsion

Answer 22

Testes rotated around the spermatic cord, blocking blood flow. Can lead to Necrosis
Symptoms: severe pain in the scrotum and lower abdomen, swelling and redness
Can also occur spontaneously

Diagnosis: history, physical examination, and scrotal ultrasound

Treatment: manual manipulation and surgery

Question 23

Phimosis

Answer 23

Foreskin cannot be retracted from the glans penis

Problematic after 3 years of age

Causes: poor hygiene, infections, and inflammation

Elderly men are at increased risk because of loss of skin elasticity and infrequent erections

Complications: urinary obstruction and pain

Paraphimosis: foreskin is retracted and cannot be returned over the glans penis
Penis becomes constricted and edematous
Medical emergency
Complications: gangrene

Treatment: circumcision, topical steroid cream, and foreskin stretching

Question 24

Erectile Dysfunction

Answer 24

Inability to attain or maintain a penile erection sufficient to complete sexual intercourse

Psychological causes: anxiety, depression, guilt, stress, feelings of inadequacy, and relationship issues
Physiologic causes: circulatory impairment, diabetes mellitus, multiple sclerosis, prostate disease, hypertension, neurologic dysfunction, certain medications, low testosterone levels, alcohol and tobacco use, and liver cirrhosis

Diagnosis: history, physical exam, hormone analysis, ultrasound, dynamic infusion cavernosometry and cavernosography, nocturnal tumescence test, and specific tests for chronic diseases

Treatment: identify and manage underlying cause, psychological counseling, testosterone replacement, phosphodiesterase inhibitors, herbal remedies, prostaglandin E injections directly into the corpus cavernosum, penis pumps, surgical penile implants, and vascular surgery

Question 25

Abnormal Uterine Bleeding

Answer 25

Abnormal uterine bleeding (AUB): Previous terms like menorrhagia, metrorrhagia, etc. are not used as often Widely experienced, especially at menarche and perimenopause Acute or chronic Abnormal frequency, regularity, duration and/or volume for most of past 6 months Heavy menstrual bleeding (HMB): increased daily/monthly volume Intermenstrual bleeding (IMB): bleeding between regular menses Treatment depends on the underlying cause

Question 26

Dysfunction Uterine Bleeding

Answer 26

Abnormal unterine bleeding resulting from alterations in the normal cyclic changes of the endometrium in the absence of structural or organic pathologic processes and is usually a hormonal disturbance Specific pathologic processes such as polyps, inflammation, hyperplasia, carcinoma, exogenous hormones, complications of pregnancy and postmenopausal bleeding are excluded

Question 27

Amenorrhea

Answer 27

Primary amenorrhea occurs when a woman has not had her first menstrual period (menarche) by age 15-16. It is most often due to late puberty (idiopathic). Gonadal dysgenesis, including Turner syndrome Mullerian agenesis imperforate hymen or transverse vaginal septum Hormonal imbalances Secondary amenorrhea occurs when a woman has experienced menstrual periods, but stops menstruating for three or more consecutive cycles. ``` Secondary amenorrhea can be caused by: Pregnancy (the most common cause) Breast feeding Menopause Emotional or physical stress Rapid weight loss Frequent strenuous exercise Hormonal birth control methods, including birth control pills, the patch and long acting progesterone. Polycystic ovary syndrome. Hysterectomy Hypothyroidism Tumors of the pituitary gland (adenoma) Chemotherapy ```

Question 28

Dysmenorrhea

Answer 28

Painful menstruation Cramping pain impairs usual daily activities; begins at end of ovulation and continues through menstruation May be primary or secondary Causes: unknown, reproductive conditions (e.g., endometriosis or reproductive cancers), and after childbirth Diagnosis: history, physical examination, pelvic ultrasound, laparoscopy, and hysteroscopy Treatment: analgesics, oral contraceptives, and heat application

Question 29

Premenstrual Syndrome

Answer 29

Premenstrual syndrome Group of physical and emotional symptoms that affect many women for reasons not fully understood Manifestations: irritability, depression, fatigue, headache, abdominal bloating, joint pain, breast tenderness, weight gain, and sleep disturbances that usually begin 5 to 11 days before menstruation Premenstrual dysphoric syndrome: severe form of PMS characterized by severe depression, tension, and irritability Diagnosis: history (focusing on gynecologic complaints) and physical examination Treatment: hormone therapy; diuretics; antidepressants; analgesics; comfort measures; and decreasing intake of caffeine, soda, chocolate, fat, processed sugars, and alcohol

Question 30

Pelvic Organ Prolapse

Answer 30

Muscles, ligaments, and fascia normally support the bladder, uterus, and rectum in female pelvis These can weaken with age, childbirth, trauma, and hormonal changes during menopause This causes organs to shift out of normal position Examples: cystocele, rectocele, uterine prolapse

Question 31

Uterine Prolapse

Answer 31

Descent of the uterus or cervix into the vagina Causes: conditions that stretch or weaken the pelvic support Classification system First degree: cervix has dropped into the vagina Second degree: cervix is apparent at the vaginal opening Third degree: cervix and uterus bulge through the vaginal opening Manifestations: asymptomatic, visualization of the cervix or uterus from the vaginal opening, feeling of fullness in the pelvis or vagina, difficult or painful sexual intercourse, vaginal bleeding, and difficulty with urination and defecation Diagnostic and treatment strategies are similar to those used for cystoceles and rectoceles

Question 32

Vaginal Wall Prolapse

Answer 32

Cystocele (urethrocele): bladder protrudes into anterior wall of vagina Causes: weakened pelvic support resulting from excessive straining (e.g., childbirth, chronic constipation, heavy lifting) Complications: recurrent cystitis Manifestations: may be asymptomatic, visualization of the bladder from the vaginal opening, feeling of fullness in the pelvis or vagina, stress incontinence, retention, frequency, urgency, and pain or urine leakage during sexual intercourse Diagnosis: history, physical examination, and voiding cystourethrogram Treatment: pessary devices, surgical repair, estrogen therapy (if postmenopausal), incontinence interventions, Kegel exercises, and avoidance of straining

Question 33

Vaginal Wall Prolapse

Answer 33

Rectocele: rectum protrudes through the posterior wall of the vagina Causes: condition that strains the fascia and menopause Manifestations: asymptomatic, painless, visualization of the rectum from the vaginal opening, feelings of fullness in the pelvis or vagina, difficulty defecating, rectal pressure, and bowel incontinence Diagnosis: similar to cystoceles Treatment: surgical repair, estrogen therapy (if postmenopausal), bowel training, and avoidance of straining

Question 34

Endometriosis

Answer 34

Endometrium grows in areas outside the uterus: Most commonly grows in the fallopian tubes, ovaries, and peritoneum, but the tissue can grow anywhere in the body The abnormal endometrial tissue continues to act as it normally would during menstruation Blood becomes trapped and irritates the surrounding tissue Theories on etiology: Menstrual blood containing endometrial cells flows back through the fallopian tubes, takes root, and grows, or bloodstream carries endometrial cells to other sites A predisposition may be carried in certain families’ genes Inappropriate immune response Certain cells (responsible for embryonic reproductive development) retain their ability to become endometrial cells with genetic or environmental influences later in life Complications: pain, cysts, scarring, adhesions, and infertility Manifestations: dysmenorrhea, menorrhagia, pelvic pain, infertility, and pain during or after intercourse Diagnosis: history, physical examination, laparoscopy, and pelvic ultrasound Treatment: analgesics, hormone therapy, and surgical repair

Question 35

Leiomyomas

Answer 35

Firm, rubbery growth of the myometrium, occurring as well-defined, unencapsulated masses Can range from microscopic to weighing several pounds Most common benign tumors in women; more frequent in African Americans Cause: unknown, but most seem to grow during the menstruation years in the presence of estrogen and shrink after menopause May interfere with fertility (increase the risk of spontaneous abortion and preterm labor slightly) Manifestations: asymptomatic; menorrhagia; pain in the pelvis, back, or legs; urinary frequency and retention; urinary tract infections; constipation; abdominal distension; pain during sexual intercourse; and anemia Diagnosis: history, examination, abdominal and transvaginal ultrasound, hysteroscopy, biopsy, laparoscopy, other imaging, and complete blood count Treatment: may not be required, monitoring, hormone therapy, analgesics, surgery, myolysis, endometrial ablation, uterine artery embolization, and anemia treatment

Question 36

Disorders of the Ovaries

Answer 36

Disorders could be benign or malignant They can also be congenital or acquired Affect hormonal balance and fertility