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Reproductive System Disorders
BIO 375
Pathophysiology
Infertility
Infertility or sterility may be caused by
conditions in the male, the female or by
combined male/female factors
Frequency of each is about equal
Male problems include:
Changes in sperm or semen Hormonal abnormalities Physical obstruction of sperm passage
Congenital Abnormalities of
the Penis
Epispadias is a urethral opening on the dorsal surface of the penis If the defect extends to the urethral sphincter, may cause incontinence Exstrophy of the bladder is more severe case of epispadias Infections are also common
Hypospadias is a urethral opening on the ventral surface of the penis In the most severe cases, the opening is at the proximal end of the penis; may also have chordee Cryptorchidism is also associated with this condition Surgical reconstruction may provide normal urinary flow and normal sexual function
Hypospadias
Cryptorchidism
This represents a maldescent of the
testis into the scrotum; testis may:
Remain in the abdominal cavity Remain in the inguinal canal Remain above the scrotum
Causes may be:
Hormonal abnormalities Short spermatic cord Small inguinal ring
Varicocele
This is a dilated vein in the spermatic cord, usually on the left side Frequently develops at puberty and results from lack of valves in the veins allowing back flow of blood May be painful or tender and may lead to infertility because of the impaired blood flow to the testes
Benign Prostatic Hyperplasia
Very common disorder in older men Varies from mild to severe Is actually hyperplasia of prostatic tissue with the formation of nodules surrounding the urethra This generally leads to compression of the urethra and variable degrees of urinary obstruction Appears to be the result of an imbalance between estrogen and testosterone associated with aging No known connection between BPH and prostatic cancer
Cancer of the Prostate
Common in men over age 50 and ranks high as a cause of death from cancer Most common cancer in older men Third leading cause of death from cancer Most prostate cancers are adenocarcinomas arising from tissues near the surface of the gland (rather than deeper tissues as in BPH) Two serum markers, PSA and prostatic acid phosphatase are helpful in early detection
Tumors vary in the degree of cellular differentiation The less differentiated or anaplastic the tumor, the faster it grows and spreads Many are androgen dependent Metastasis to bone occurs relatively early and involves, spine, pelvis, ribs and femur
In most cases, the cancer has spread before diagnosis May spread to: Pelvic lymph nodes Liver Adrenal glands Lungs Cause has not been determined but genetic and environmental factors as well as hormonal levels appear to be involved
Menstrual Abnormalities
Amenorrhea (lack of menstruation)
Primary (menarche never occurred) Genetic, e.g. Turner’s Syndrome Congenital defects affecting the hypothalamus, CNS, pituitary or congenital absence of a uterus Secondary (loss of menstruation) Problems with the hypothalamic-pituitary axis Hypothalamic suppression from tumor, stress, sudden weight loss, eating disorders, participation in competitive sports (leading to reduced body fat); anemia or chemotherapy
Dysmenorrhea (painful menstruation) Primary: has no organic foundation and develops when ovulation commences Secondary: results from pelvic disorders such as endometriosis, uterine polyps, tumors or pelvic inflammatory disease Dysmenorrhea is a condition where pain is sufficient to interrupt normal activities The severe cramping pain is related to excessive release of prostaglandin (PGF (^2) α) during endometrial shedding
Endometriosis
This is the presence of endometrial tissue outside the uterus on structures such as the ovaries, ligaments or colon The ectopic endometrium responds to cyclic hormone variations, forming blood filled “chocolate cysts” The cause of endometriosis is not known
Pelvic Inflammatory Disease
PID is an infection of the reproductive
tract, particularly the oviducts and
ovaries
Condition includes cervix, uterus,
oviducts and ovaries
May be acute or chronic
Complications include peritonitis and
pelvic abcess as well as long term
infertility and a high risk of ectopic
pregnancy
Benign Tumors
Leiomyoma (Fibroids) are benign
tumors of the myometrium (cause
unknown)
Common during reproductive years and
tend to shrink after menopause
Classified by location:
Intramural- developing in the uterine wall Submucosal- beneath the endometrium Subserosal- under the serosa Last two types may develop as polyps
Ovarian Cancer
About 25,000 women are diagnosed with ovarian cancer each year in U.S.
Usually it is diagnosed in advanced stage when it has spread to other organs
About 16,000 women die each year from the disease.
Recent research has found changes in four protein biomarkers in the blood that may prove significant in detecting ovarian cancer in its earliest stages.
Fibrocystic Breast Disease
Also called benign breast disease
Fibrocystic disease refers to the presence
of nodules or masses in the breast tissue
that change during the menstrual cycle
Connective tissue is gradually replaced
by dense fibrous tissue.
Cysts fill with fluid during the
proliferative phase of the cycle and
gradually enlarge over time
Three categories of lesions have been designated according to the risk of developing into breast cancer: Category I: nonproliferative lesions which include microcysts and fibroadenomas; they are single, movable, benign masses Category II: proliferative lesions in which there are NO atypical cells; some risk if there is a family history of breast cancer Category III: proliferative lesions WITH atypical cells; requires monitoring especially where there is a family history of breast cancer
Breast Cancer
Malignant tumors develop in the upper outer quadrant of the breast in about half the cases; central portion of breast is next most common site
Most tumors are unilateral
Are several types of breast cancers
Those arising from the duct epithelium are most common
Malignant cells spread at an early stage, first to nearby lymph nodes
In most cases, several lymph nodes are affected at the time of diagnosis
Widespread dissemination follows quickly, including metastases to the lung, brain, bone and liver
Carcinoma of the breast is a common malignancy in women with the risk increasing after age 20
More women are developing breast cancer and at a younger age
